Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis

Background: To investigate (1) the association of specific biomechanical factors with knee osteoarthritis and knee osteoarthritis development, and (2) the impact of other relevant risk factors on this association.Methods: MEDLINE, EMBASE, CINAHL and SPORTDiscus were searched up until April 2017. Studies were included if they fulfilled the following criteria: the study 1) assessed the association of a biomechanical factor with knee osteoarthritis, or knee osteoarthritis development; 2) reported on skeletal malalignment, muscular dysfunction, impaired proprioception, laxity and abnormal loading during gait; 3) was a cohort study with participants developing knee osteoarthritis and participants not developing knee osteoarthritis, or a case-control or cross-sectional study with participants with knee osteoarthritis and without knee osteoarthritis. Risk of bias was assessed with the QUIPS tool and meta-analyses were performed using random effects models.Results: Of 6413 unique studies identified, 59 cross-sectional studies were eligible for meta-analyses (9825 participants, 5328 with knee osteoarthritis). No cohort studies fulfilled the inclusion criteria. Compared with healthy controls, patients with knee osteoarthritis have higher odds of having lower muscle strength, proprioception deficits, more medial varus-valgus laxity and less lateral varus-valgus laxity. Patients with medial knee osteoarthritis have higher odds of having a higher knee adduction moment than healthy controls. Level of evidence was graded as 'very low' to 'moderate' quality. Due to large between study differences moderation of other risk factors on biomechanical risk factors could not be evaluated.Conclusions: Patients with knee osteoarthritis are more likely to display a number of biomechanical characteristics. The causal relationship between specific biomechanical factors and the development of knee osteoarthritis could not be determined as no longitudinal studies were included. There is an urgent need for high quality, longitudinal studies to evaluate the impact of specific biomechanical factors on the development of knee osteoarthritis.Trial Registration: (PROSPERO ID: CRD42015025092)

Association between osteoarthritis and cardiovascular disease: systematic review and meta-analysis

Background: To examine for a possible relationship between osteoarthritis and cardiovascular disease (CVD). Design: A systematic review and meta-analysis Methods: Published and unpublished literature from: MEDLINE, EMBASE, CINAHL, the Cochrane Library, OpenGrey and clinical trial registers. Search to 22nd November 2014. Cohort, case-control, randomised and non-randomised controlled trial papers reporting the prevalence of CVD in osteoarthritis were included. Results: Fifteen studies with 32,278,744 individuals were eligible. Pooled prevalence for overall CVD pathology in people with osteoarthritis was 38.4% (95% Confidence interval (CI): 37.2% to 39.6%). Individuals with osteoarthritis were almost three times as likely to have heart failure (Relative Risk (RR): 2.80; 95% CI: 2.25 to 3.49) or ischaemic heart disease (RR: 1.78; 95% CI: 1.18 to 2.69) compared to matched non-osteoarthritis cohorts. No significant difference was detected between the two groups for the risk of experiencing myocardial infarction or stroke. There was a three-fold decrease in the risk of experiencing a transient ischaemic attack in the osteoarthritis cohort compared to the non-osteoarthritis group. Conclusions: Prevalence of CVD in patients with OA is significant. There was an observed increased risk of incident heart failure and ischaemic heart disease in people with OA compared to matched controls. However the relationship between OA and CVD is not straight-forward and there is a need to better understand the potential common pathways linking pathophysiological mechanisms

A qualitative study : the experience of general practitioners with older adult patients with osteoarthritis

Background: Osteoarthritis is a degenerative condition commonly effecting older adult patients in the community. There is a “demographic transition” leading to an ageing population. -- Objectives: To perform a qualitative study about how general practitioners (GPs) look at osteoarthritis, and its effects on patients’ lives as regards the biopsychosocial model. The aim is to analyse the GPs’ perspectives about the local available sources and any possible improvements. -- Method: Interpretative phenomenological analysis (IPA) was used as it allows the discovery of the details of each individual GP. Two GPs who have been practising for more than 5 years within the community volunteered through the Malta College of Family Doctors. Snowball sampling was used to recruit another two. Semi-structured interviews were then conducted, transcribed and analysed. -- Results: There was a common feeling that dealing with such a widespread disease is challenging within the community and there is a need for a specialised osteoarthritis clinic in the community to cater for all these patients’ needs via an interdisciplinary team. The need for a holistic approach was agreed amongst all the participants. There were four major themes: (i) osteoarthritis as a major health concern, (ii) the GP – a key role in the management of osteoarthritis in the community, (iii) challenges in community care and (iv) the future of primary care in the management of osteoarthritis. -- Conclusion: Osteoarthritis is a common, challenging condition which is treated by GPs; but being multi-faceted, input from other professionals is required.peer-reviewe

Correction: The role of cumulative physical work load in symptomatic knee osteoarthritis – a case–control study in Germany (Seidler et al. 2008)

ABSTRACT: In the original paper (Seidler et al. 2008), there is a mistake in the results of the occupational group analysis. This mistake occurred when the core data set was merged with the occupational group data. According to the modified occupational group analysis (see modified Table 1), OR for chemical processers and manufacturers of plastics products are no longer significantly elevated. Having worked more than 10 years as metal worker is associated with knee osteoarthritis (OR=2.2; 95% CI 1.1-4.4). The knee osteoarthritis risk of plasterers, insulators, glaziers, terrazzo workers, construction carpenters, roofers, and upholsters approaches statistical significance in the long-duration category (OR=3.7; 95% CI 0.9-15.2). For woodworkers, the knee osteoarthritis risk is no longer significantly elevated. Having worked more than 10 years as painter or varnisher is associated with knee osteoarthritis (OR=9.6; 95% CI 1.2-77.9). Finally, we find a significantly elevated OR of 3.2 (95% CI 1.1-9.1) among subjects having worked as physically exposed service workers (storemen, nurses, refuse collectors) for more than 10 years. When subjects with non-service work as main occupation ("blue-collar workers") are compared with "white-collar workers", the odds ratio for knee osteoarthritis is still significantly elevated (OR=2.0; 95% CI 1.3-2.9)

Aging, osteoarthritis and transforming growth factor-beta signaling in cartilage.

Osteoarthritis is a common malady of the musculoskeletal system affecting the articular cartilage. The increased frequency of osteoarthritis with aging indicates the complex etiology of this disease, which includes pathophysiology and joint stability including biomechanics. The balance between anabolic morphogens and growth factors and catabolic cytokines is at the crux of the problem of osteoarthritis. One such signal is transforming growth factor-beta (TGF-beta). The impaired TGF-beta signaling has been identified as a culprit in old mice in a recent article in this journal. This commentary places this discovery in the context of anabolic and catabolic signals and articular cartilage homeostasis in the joint

Efficacy and safety of the long-term oral administration of carprofen in the treatment of osteoarthritis in dogs

The aim of this study conducted in France was to confirm the efficacy and safety of the oral administration of carprofen (Rimadyl®) at 4 mg/kg once a day during four months in the treatment of clinically chronic osteoarthritis in dogs. One hundred and ten dogs with chronic clinical signs of osteoarthritis were enrolled. The overall severity of the osteoarthritis condition and the clinical signs of osteoarthritis were assessed using visual analogue scales (VAS) on days 0, 5, 30, 60, 90 and 120. During the same visits, owners were asked to perform their own efficacy assessment through the grading of seven parameters using categorical scales. Hematological analyses were performed on days 0 and 120. Clinical blood chemistry evaluations were performed on days 0, 5, 60 and 120. The percentage of dogs showing a positive treatment effect increased from 12% on day 5 to 74% on day 120. The mean VAS scores significantly decreased throughout the study (P ≤0.05). Gastrointestinal undesirable effects likely to be related to carprofen but with no harmful consequences were observed in 5% of treated dogs. No detrimental effects of the treatment on haematological, renal and hepatic parameters were observed. These results show that carprofen at 4 mg/kg once daily can be safely used over a 4 month period in the treatment of osteoarthritis in dogs and provides a steadily increasing improvement of the clinical signs

Assessing knee OA severity with CNN attention-based end-to-end architectures

This work proposes a novel end-to-end convolutional neural network (CNN) architecture to automatically quantify the severity of knee osteoarthritis (OA) using X-Ray images, which incorporates trainable attention modules acting as unsupervised fine-grained detectors of the region of interest (ROI). The proposed attention modules can be applied at different levels and scales across any CNN pipeline helping the network to learn relevant attention patterns over the most informative parts of the image at different resolutions. We test the proposed attention mechanism on existing state-of-the-art CNN architectures as our base models, achieving promising results on the benchmark knee OA datasets from the osteoarthritis initiative (OAI) and multicenter osteoarthritis study (MOST).Postprint (published version

Update on osteoarthritis part 1: current concepts and the relation to exercise

There appears to be an increased risk of lower limb osteoarthritis in participants of repetitive, high impact sports, and this is strongly associated with joint injury. There seems to be little risk associated with recreational running. Assessment of risk for osteoarthritis should take into account the nature of the sport, intensity of training, presence of previous injury, body mass index, and occupation