Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort

_Background:_ We aimed to evaluate the prevalence of hip and knee osteoarthritis (HOA and KOA) according to American College of Rheumatology (ACR) criteria among participants with suspected early symptomatic osteoarthritis (OA) in the CHECK cohort. We also assessed whether participants not fulfilling ACR criteria at baseline develop ACR-defined OA at 2-year and/or 5-year follow up, and which baseline factors are associated with this development. _Methods:_ The CHECK cohort included 1002 subjects with first presentation of knee and/or hip complaints. The primary outcome was onset of HOA and/or KOA according to the ACR criteria, including the clinical classification criteria and the combined clinical and radiographic classification criteria at 2-year and/or 5-year follow up. _Results:_ Of the participants with hip complaints, 63% (n = 370) were classified as having HOA at baseline according to the ACR criteria. Of those not classified with HOA at baseline, 40% developed HOA according to the clinical or combined clinical/radiographic ACR criteria after 2 and/or 5 years. Up to 92% of participants (n = 829) with knee complaints were classified as having KOA at baseline; of those not classified with KOA at baseline, 55% developed KOA according to the clinical ACR criteria or the clinical/radiographic ACR criteria after 2 and/or 5 years. The following factors were associated with development of HOA: morning stiffness (OR 2.39; 95% CI 1.14-4.98), painful internal rotation (OR 2.53; 95% CI 1.23-5.19), hip flexion < 115° (OR 2.33; 95% CI 1.17-4.64) and erythrocyte sedimentation rate (ESR) < 20 mm/h (OR 2.94; 95% CI 1.13-7.61). No variables were associated with development o

Chondroprotective actions of selective COX-2 inhibitors in vivo: A systematic review

Knee osteoarthritis (OA) is a condition mainly characterized by cartilage degradation. Currently, no effective treatment exists to slow down the progression of OA-related cartilage damage. Selective COX-2 inhibitors may, next to their pain killing properties, act chondroprotective in vivo. To determine whether the route of administration is important for the efficacy of the chondroprotective properties of selective COX-2 inhibitors, a systematic review was performed according to the PRISMA guidelines. Studies investigating OA-related cartilage damage of selective COX-2 inhibitors in vivo were included. Nine of the fourteen preclinical studies demonstrated chondroprotective effects of selective COX-2 inhibitors using systemic administration. Five clinical studies were included and, although in general non-randomized, failed to demonstrate chondroprotective actions of oral selective COX-2 inhibitors. All of the four preclinical studies using bolus intra-articular injections demonstrated chondroprotective actions, while one of the three preclinical studies using a slow release system demonstrated chondroprotective actions. Despite the limited evidence in clinical studies that have used the oral administration route, there seems to be a preclinical basis for considering selective COX-2 inhibitors as disease modifying osteoarthritis drugs when used intra-articularly. Intra-articularly injected selective COX-2 inhibitors may hold the potential to provide chondroprotective effects in vivo in clinical studies

KiOmedine® CM-Chitosan is Effective for Treating Advanced Symptomatic Knee Osteoarthritis up to Six Months Following a Single Intra-Articular Injection: A Post Hoc Analysis of Aproove Clinical Study

Background: Symptomatic knee osteoarthritis (OA) is typically treated with hyaluronan-based intra-articular injections. Advanced knee OA patients are often unresponsive to hyaluronan. KiOmedine® Carboxymethyl-Chitosan (CM-Chitosan), a novel fluid implant, was safe and effective for treating symptomatic knee OA. Objective: The objective of this study is to describe the efficacy of a single injection of KiOmedine® CM-Chitosan in advanced knee OA. Methods: Patients with advanced knee OA enrolled in the APROOVE trial and treated with KiOmedine® CM-Chitosan were identified: subgroup-1, BMI >30 kg/m2 and/or Kellgren Lawrence (KL) grade III (n=39), and subgroup-2, BMI >30 kg/m2 and KL-grade III (n=8). Within-group analyses were performed using the WOMAC scores and OMERACT-OARSI responder criteria at 3 and 6 months. Results: In both subgroups, significant improvements in all WOMAC scores were observed at 3 and 6 months (p<0.001 for all comparisons). A high responder rate was observed at 3 and 6 months in subgroup-1 (63.2% and 65.8%) and in subgroup-2 (57.1% and 62.5%). Conclusion: This post hoc analysis of the APROOVE trial showed that a single intra-articular injection with KiOmedine® CM-Chitosan could be an effective therapeutic option for patients with advanced knee OA. Clinical trial registration number: Clinicaltrial.gov identifier: Net30679208.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

First-in-human Study to Evaluate a Single Injection of KiOmedine®CM-Chitosan for Treating Symptomatic Knee Osteoarthritis

Background: Single-injection viscosupplementation is currently performed with cross-linked hyaluronan (e.g. Durolane®) for treating symptomatic knee osteoarthritis. Objective: This first-in-human study evaluated the safety and performance of single-injection treatment with non-crosslinked KiOmedine®CM-Chitosan. Methods: Patients with painful knee osteoarthritis were randomly assigned to the KiOmedine®CM-Chitosan (n=63) or Durolane® (n=32) group. Patients were blinded to treatment and followed up for 26 weeks. Durolane® was used as scientific control to ensure the validity of the study and reliability of results. No direct comparison was performed between the two groups. The primary objective was defined as an intra-group effect size of 0.8 at 13 weeks post-injection compared to baseline on WOMAC-A (pain). Secondary outcomes included self-reported knee stiffness and knee function, responder rate, quality-of-life questionnaires, and safety. Results: The primary objective for both the KiOmedine®CM-Chitosan and the Durolane® groups was met: mean pain reduction of 62.5% (effect size 2.08) for the KiOmedine®CM-Chitosan group and 62.4% (effect size 2.28) for the Durolane® group. Secondary performance outcomes showed all clinically relevant treatment effects over 26 weeks for both groups (p<0.05). Treatment-related adverse events were more often reported in the KiOmedine®CM-Chitosan than Durolane® group and were limited to local reactions. No serious treatment-related adverse events were reported. Conclusion: A single intra-articular injection of non-crosslinked KiOmedine®CM-Chitosan is safe and effective for treating symptomatic knee osteoarthritis with a high responder rate. Pain reduction is maintained for 6 months with a high responder rate. The clinical trial registration number: NCT03679208.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pain trajectories in early symptomatic knee osteoarthritis

We aimed to define distinct knee pain trajectories in individuals with early symptomatic knee osteoarthritis and to determine risk factors for these pain trajectories. Design: Retrospective cohort study. Method: We obtained data for this study from the 'Cohort Hip and Cohort Knee' (CHECK) study. Participants who presented with knee osteoarthritis at baseline were included. We assessed baseline patient parameters such as demographics, anamnesis and physical examination measurements. Pain outcome measure was assessed annually using a numeric rating scale. Different pain trajectories were defined by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios. Results: In total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. We found significant differences in baseline characteristics between the different pain trajectories, including BMI; symptom severity; and pain coping strategies. Higher BMI, lower education, presence of co-morbidities, higher activity limitation scores and joint space tenderness were more often associated with trajectories characterized by more pain at first presentation and pain progression. No association was found for baseline radiographic features. Conclusion: We defined six distinct pain trajectories in individuals with early symptomatic knee osteoarthritis. Our results can help physicians identify those patients that require more frequent monitoring compared patients for whom a watch-and-wait policy seems justifiable. In general practice, radiography does not provide added value to the follow-up of early symptomatic knee osteoarthritis patients.</p

Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK)

Background GPs have high consultation rates for symptoms related to knee osteoarthritis (OA). Many risk factors for symptomatic knee OA progression remain unknown. Aim To define distinct knee pain trajectories in individuals with early symptomatic knee OA and determine the risk factors for these pain trajectories. Design and setting Data were obtained from the multicentre prospective Cohort Hip and Cohort Knee study in the Netherlands. Participants with knee OA, according to the clinical criteria of the American College of Rheumatology, and a completed 5-year follow-up were included. Method Baseline demographic, anamnestic, and physical examination characteristics were assessed. Outcome was annually assessed by the Numeric Rating Scale for pain. Pain trajectories were retrieved by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios. Results In total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. Statistically significant differences were found in baseline characteristics, including body mass index (BMI), symptom severity, and pain coping strategies between the different trajectories. Higher BMI, lower level of education, greater comorbidity, higher activity limitation scores, and joint space tenderness were more often associated with trajectories characterised by more pain at first presentation and pain progression-compared with the reference group with a mild pain trajectory. No association was found for baseline radiographic features. Conclusion These results can help differentiate those patients who require more specific monitoring in the management of early symptomatic knee OA from those for whom a '