Identifying Knee Osteoarthritis: Classification, early recognition and imaging

Osteoarthritis (OA) is one of the most frequently occurring health problems in middle aged and older people. Treatment of OA is focused on treating symptoms while it might be more effective to start treatment before symptoms are present. Early predictive signs for evident knee OA need to be identified, so it will be possible to define people that will get OA in the future. This thesis describes the evaluation of different classification criteria and the identification of radiographic and MRI features that are related to different aspects of clinical symptoms and risk factors of (early) knee O

Do self-management supportive interventions reduce healthcare utilization for people with musculoskeletal pain conditions? – A systematic review

Objective: The aim of this systematic review was to investigate the effect of self-management supportive interventions on healthcare utilization in adult cares seekers with musculoskeletal pain conditions. Study design: Systematic review. Methods: We included studies comparing the effect of a self-management supportive intervention against a control intervention and included measures of healthcare utilization. Studies were searched in MEDLINE, Embase, PsycINFO, CINAHL, Pedro, and the Cochrane Library. Results were extracted for the follow-up point closest to 12 months. Risk of bias was assessed using the Cochrane Risk of Bias tool 2, and quality of evidence by The Grading of Recommendations Assessment, Development and Evaluation. Results were synthesized on study level as mean differences or odds ratios with 95 % CI. Results: We included 28 studies. Eighteen studies reported on the use of primary care at follow-up, and ten, four, and 13 on specialty care, diagnostics imaging, and oral pain medication, respectively. Overall, there was very low-quality evidence for no effect of self-management interventions on healthcare utilization in all groups. All studies were classified as either having a “high risk of bias” or “some concerns”. Conclusion: Due to substantial heterogeneity in the types and measurement of healthcare utilization outcomes, it was not feasible to conduct a meta-analysis to estimate an overall effect size. A standardized way of reporting and measuring these outcomes could aid future research in this area. The current evidence suggests that self-management supportive interventions do not affect healthcare utilization in people with musculoskeletal pain conditions, but future high-quality studies may substantially change this conclusion.</p

Towards sex-specific osteoarthritis risk models: evaluation of risk factors for knee osteoarthritis in males and females

Objectives The aim of this study was to identify sex-specific prevalence and strength of risk factors for the incidence of radiographic knee OA (incRKOA). Methods Our study population consisted of 10 958 Rotterdam Study participants free of knee OA in one or both knees at baseline. One thousand and sixty-four participants developed RKOA after a median follow-up time of 9.6 years. We estimated the association between each available risk factor and incRKOA using sex stratified multivariate regression models with generalized estimating equations. Subsequently, we statistically tested sex differences between risk estimates and calculated the population attributable fractions (PAFs) for modifiable risk factors. Results The prevalence of the investigated risk factors was, in general, higher in women compared with men, except that alcohol intake and smoking were higher in men and high BMI showed equal prevalence. We found significantly different risk estimates between men and women: high level of physical activity [relative risk (RR) 1.76 (95% CI: 1.29–2.40)] or a Kellgren and Lawrence score 1 at baseline [RR 5.48 (95% CI: 4.51–6.65)] was higher in men. Among borderline significantly different risk estimates was BMI ≥27, associated with higher risk for incRKOA in women [RR 2.00 (95% CI: 1.74–2.31)]. The PAF for higher BMI was 25.6% in women and 19.3% in men. Conclusion We found sex-specific differences in both presence and relative risk of several risk factors for incRKOA. Especially BMI, a modifiable risk factor, impacts women more strongly than men. These risk factors can be used in the development of personalized prevention strategies and in building sex-specific prediction tools to identify high risk profile patients

Patterns of knee osteoarthritis management in general practice:a retrospective cohort study using electronic health records

Objective: This study determined patterns of knee osteoarthritis (OA) management by general practitioners (GPs) using routine healthcare data from Dutch general practices from 2011 to 2019. Design: A retrospective cohort study was conducted using the Integrated Primary Care Information database between 2011 and 2019. Electronic health records (EHRs) of n = 750 randomly selected knee OA patients (with either codified or narrative diagnosis) were reviewed against eligibility criteria and n = 503 patients were included. Recorded information was extracted on GPs’ management from six months before to three years after diagnosis and patterns of management were analysed.Results: An X-ray referral was the most widely recorded management modality (63.2%). The next most widely recorded management modalities were a referral to secondary care (56.1%) and medication prescription or advice (48.3%). Records of recommendation of/referral to other primary care practitioners (e.g. physiotherapists) were found in only one third of the patients. Advice to lose weight was least common (1.2%). Records of medication prescriptions or recommendation of/referral to other primary care practitioners were found more frequently in patients with an X-ray referral compared to patients without, while records of secondary care referrals were found less frequently. Records of an X-ray referral were often found in narratively diagnosed knee OA patients before GPs recorded a code for knee OA in their EHR. Conclusion: These findings emphasize the importance of better implementing non-surgical management of knee OA in general practice and on initiatives for reducing the overuse of X-rays for diagnosing knee OA in general practice.</p

Patterns of knee osteoarthritis management in general practice:a retrospective cohort study using electronic health records

Objective: This study determined patterns of knee osteoarthritis (OA) management by general practitioners (GPs) using routine healthcare data from Dutch general practices from 2011 to 2019. Design: A retrospective cohort study was conducted using the Integrated Primary Care Information database between 2011 and 2019. Electronic health records (EHRs) of n = 750 randomly selected knee OA patients (with either codified or narrative diagnosis) were reviewed against eligibility criteria and n = 503 patients were included. Recorded information was extracted on GPs’ management from six months before to three years after diagnosis and patterns of management were analysed.Results: An X-ray referral was the most widely recorded management modality (63.2%). The next most widely recorded management modalities were a referral to secondary care (56.1%) and medication prescription or advice (48.3%). Records of recommendation of/referral to other primary care practitioners (e.g. physiotherapists) were found in only one third of the patients. Advice to lose weight was least common (1.2%). Records of medication prescriptions or recommendation of/referral to other primary care practitioners were found more frequently in patients with an X-ray referral compared to patients without, while records of secondary care referrals were found less frequently. Records of an X-ray referral were often found in narratively diagnosed knee OA patients before GPs recorded a code for knee OA in their EHR. Conclusion: These findings emphasize the importance of better implementing non-surgical management of knee OA in general practice and on initiatives for reducing the overuse of X-rays for diagnosing knee OA in general practice.</p

Exploring Evaluation of eHealth Lifestyle Interventions for Preschool Children:A Scoping Review

EHealth lifestyle interventions can promote positive lifestyle changes in preschool children, but they need to be evaluated to assess their effectiveness and identify areas for improvement. This scoping review aimed to examine evaluation methods, outcome measures, and methodologic strengths and weaknesses, to provide recommendations for the evaluation of eHealth lifestyle interventions for preschool children. A comprehensive literature search was conducted across 6 databases for articles published up to September 29, 2023. We identified 48 articles describing 31 interventions that met our predefined eligibility criteria. These interventions predominantly targeted children's diet. The most frequently evaluated outcomes were effectiveness, acceptability, and usage. Effectiveness outcomes included, among others, dietary intake, anthropometrics, and child and parental behaviors. Acceptability was evaluated primarily as user satisfaction. Evaluation methods for effectiveness and acceptability included questionnaires, interviews, focus groups, and portable devices. Intervention usage was evaluated via logged use and self-reported data. On the basis of our findings, we present recommendations for future evaluation of eHealth interventions for preschool children. These recommendations focus on selecting relevant outcome measures and appropriate evaluation methods and on integrating and applying evaluation results.</p

Metabolic syndrome, radiographic osteoarthritis progression and chronic pain of the knee among men and women from the general population:The Rotterdam study

Objective: Although a relationship between osteoarthritis and components of metabolic syndrome (MetS) has been suggested, most of the results have been cross-sectional. We, therefore, aimed to investigate the sex-specific longitudinal association of (components of) MetS with progression of radiographic osteoarthritis and chronic pain in the knee joints in a large prospective cohort. Method: In the large population-based Rotterdam study of up to 6,138 individuals, median follow-up time 5.7 (IQR 5.5) years, we examined the relation between MetS and its components (abdominal obesity, high triglycerides, low high-density lipoprotein, elevated blood pressure, and type 2 diabetes) with the progression of osteoarthritis using generalized estimating equations, generalized linear models and competing risk analysis. Analyses were stratified for sex. Covariates adjusted for: age, smoking, alcohol use, education, sub-cohort, baseline K/L grade, months between radiographs and BMI. Results: The presence of MetS (37.6 % in men, 39 % in women) and elevated blood pressure was associated with an increased risk of knee osteoarthritis progression in both men and women. MetS was associated with an increased risk of incident chronic knee pain (CKP) in men. In addition, abdominal obesity and high triglycerides showed higher riskfor incidence of CKP in men,but not in women. The associations were attenuated and no longer significant after BMI-adjustment, except for the association of MetS and high triglycerides with incidence of CKP in men that stayed significant (OR 1.04, 95 %CI 1.00–1.07 for MetS and OR 1.04, 95 %CI 1.01–1.07 for high triglycerides). Conclusion: Metabolic syndrome and individual metabolic components, such as abdominal obesity and elevated blood pressure, were associated with radiographic progression of knee OA in both men and women, but not independent of BMI. Metabolic syndrome and high triglycerides were associated with incidence of CKP only in men.</p

Opioid prescriptions in patients with osteoarthritis: a population-based cohort study

OBJECTIVES: To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids wer

Best evidence osteoarthritis care: What are the recommendations and what Is needed to improve practice?

This article provides an overview of osteoarthritis (OA) management recommendations and strategies to improve clinical practice concordance with clinical guidelines. In many countries, the primary point of care for a person with OA is typically general practitioners and physiotherapists. Optimal primary care focuses on core OA treatments, namely education for self-management and lifestyle interventions encompassing increased physical activity, therapeutic exercise, and weight loss (if indicated). Quality indicators are used in clinical practice and research to determine the quality of care and in some settings, are used as knowledge translation tools to address existing evidence-to-practice gaps

Prevalence of small osteophytes on knee MRI in several large clinical and population-based studies of various age groups and OA risk factors

Objective: Osteophytes, also small ones, are an important imaging feature of OA. However, due to their high prevalence on MR, the question has arisen whether these are truly pathophysiologic features of early OA, a result of physiologic aging, or rather a merely transient phenomenon. The aim of this study was to explore the prevalence of osteophytes on MR in various locations of the knee, with special emphasis on small osteophytes, across multiple large studies conducted in our institution comprising a wide range of subjects at different ages. Method: Retrospective explorative study of the prevalence of osteophytes, particularly grade 1 according to MOAKS, among four studies with a wide variety in age and OA risk factors. Results: A large number of grade 1 osteophytes were found in all four studies. The largest number of osteophytes were present in the youngest age group of &lt;30 years (69.6%) compared to 36.8% in the age group of ≥30 ​&lt; ​50 years and 54,3% when aged ≥50 years, of which most were grade 1 osteophytes. Conclusion: Small osteophytes are highly prevalent among populations with varying age and OA risk factors, in particular among young subjects without other OA features. This might suggest that these “osteophytes” do not necessarily represent early OA, but rather indicate a transient physiologic phenomenon.</p