Osteoarthritis and injury in the knee and hip

Context: Osteoarthritis (OA) is one of the most common causes of disability in the United States, but effective interventions for this disease are limited. Difficulty with defining OA, including the lack of sensitive measures of incident OA, hinders the development of successful treatments. Biomarkers of cartilage turnover and inflammation may be important, sensitive indicators of OA, but biomarker levels may be influenced by joint injury. Additionally, previous efforts to examine injury as a risk factor for OA, either with cross-sectional or longitudinal study designs, have resulted in a wide range of estimates. Understanding the association between injury and OA and exploring new, sensitive measures of OA have important clinical implications for patients who have sustained joint injuries, for those seeking treatment for OA, and for identifying participants for clinical trials of OA. Objectives: This research was conducted in a large, community based sample to: 1) determine whether the biomarkers of cartilage oligomeric matrix protein (COMP), hyaluronan (HA), high-sensitivity C-reactive protein (hsCRP), and keratan sulfate (KS) predict incident radiographic OA at the knee and whether their associations vary by lower extremity injury history, 2) examine the hazard of incident OA of the knee and hip by history of injury, and 3) compare prevalence and hazard estimates from cross-sectional and longitudinal designs. Methods: A longitudinal community-based cohort completed baseline (1991-1997) clinical evaluation and identical follow-up assessment (1999-2003; median follow-up time = 5.6 years, range=3.0-13.1 years) for OA. The OA outcomes examined for Objectives 1 were: radiographic OA (Kellgren-Lawrence [K-L] grade of 2 or greater), osteophyte (OST) formation, and joint space narrowing (JSN), and for Objectives 2 and 3 were: radiographic OA (based on K-L grade), chronic joint symptoms, radiographic OA or symptoms, and radiographic OA with symptoms. History of knee injury or hip injury was based on self-report. Baseline serum COMP, HA, hsCRP, and KS were measured for 803 participants. The study groups with injury data comprised 1,570 participants with linked baseline and follow-up knee radiographs and 1,446 participants with linked hip radiographs. Among participants with biomarker data, linked baseline and follow-up radiographs were available for 542 knees at risk for incident OA, 349 knees at risk for incident osteophyte (OST) formation, and 440 knees at risk for incident joint space narrowing (JSN). For biomarker analyses, Cox regression models were used to estimate the hazard ratio (HR) for a 1-unit increase in the natural log of each biomarker, adjusting for age, race, gender, and body mass index and exploring history of lower extremity injury and chronic knee symptoms as potential modifiers. For injury and OA analyses, Cox regression models were used to determine the hazard of incident knee and hip OA outcomes and logistic regression models were use to estimate the prevalence of knee and hip OA outcomes. Results: The hazard of incident knee OA and incident knee OST increased with higher baseline lnCOMP levels, and the hazard of incident knee JSN also increased with higher lnCOMP levels and higher lnHA levels. Higher levels of lnhsCRP and lnKS did not predict the incident knee outcomes. Neither history of lower extremity injury nor chronic knee symptoms was a strong modifier of these associations. The hazard of incident knee radiographic OA and OA or symptoms was higher among participants with knee injury at baseline compared to those without injury. Injury to the knee was associated with incident ipsilateral and contralateral radiographic knee OA. Hip injury also predicted a higher hazard of hip radiographic OA outcomes, although precision was lower for the hip analyses due to small numbers of outcomes. HR and odds ratio (OR) patterns were similar for some knee injury-OA associations, but the OR estimates tended to be higher than the HR estimates. The pattern of HRs and ORs is less clear for the hip due to low numbers for the longitudinal analysis. Conclusions: Higher baseline lnCOMP and lnHA levels predicted incident knee OA, OST, and JSN, but history of lower extremity injury did not modify the association. The hazard of incident radiographic knee and hip OA was higher in those with a history of injury compared to those without injury. Knee injury predicted an increased hazard of incident radiographic knee OA in the ipsilateral joint and the contralateral joint. Estimates calculated from a cross-sectional analysis may provide a fair approximation of the incidence of radiographic knee OA by knee injury status, but further research over a longer follow-up period, particularly for the hip, is needed to help clarify these comparisons

Physical exercise as non-pharmacological treatment of chronic pain: Why and when

Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety and sleep disturbance and are treated alone or in combination by pharmacologic and nonpharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training and movement therapies). Physical activity improves general health, disease risk and progression of chronic illnesses such as cardiovascular disease, type-2 diabetes and obesity. When applied to chronic pain conditions within appropriate parameters (frequency, duration, intensity), physical activity significantly improves pain and related symptoms. For chronic pain, strict guidelines for physical activity are lacking, but frequent movement is preferable to sedentary behavior. This gives considerable freedom in prescribing physical activity treatments, which are most successful when tailored individually, progressed slowly and account for physical limitations, psychosocial needs and available resources

State of the evidence

This review focuses on recent studies of osteoarthritis epidemiology, including research on prevalence, incidence, and a broad array of potential risk factors at the person level and joint level

Cross-sectional associations between variations in ankle shape by statistical shape modeling, injury history, and race : the Johnston County Osteoarthritis Project

Rheumatology Research Foundation Medical Student Preceptorship Award (Lateef/Nelson), NIAMS K23 AR061406 (Nelson); NIH/NIAMS P60AR064166 and U01DP003206 (Jordan/Renner), NIH/NIAMS R01AR067743 (Golightly). The funders had no role in study design; collection, analysis, or interpretation of data; writing the manuscript or the decision to submit for publication.Peer reviewedPublisher PD

A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis

Exercise is recommended as a first-line conservative intervention approach for osteoarthritis (OA). A wide range of exercise programs are available, and scientific evidence is necessary for advising patients with OA on the optimal treatment strategy. The purpose of this review is to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild to moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, gender and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults

Objectives: Identifying factors associated with opioid use in middle-aged and older adults is a fundamental step in the mitigation of potentially unnecessary opioid consumption and opioid-related harms. Methods: Using longitudinal data on a community-based cohort of adults aged 50-90 years residing in Johnston County, North Carolina, we examined sociodemographic and clinical factors in non-opioid users (n = 786) at baseline (2006-2010) as predictors of opioid use at follow-up (2013-2015). Variables included age, sex, race, obesity, educational attainment, employment status, household poverty rate, marital status, depressive symptoms, social support, pain catastrophizing, pain sensitivity, insurance status, polypharmacy, and smoking status. Results: At follow-up, 13% of participants were using prescription opioids. In the multivariable model, high pain catastrophizing (adjusted odds ratio; 95% confidence interval = 2.14; 1.33-3.46), polypharmacy (2.08; 1.23-3.53), and history of depressive symptoms (2.00; 1.19-3.38) were independent markers of opioid use. Discussion: Findings support the assessment of these modifiable factors during clinical encounters in patients ≥ 50 years old with chronic pain

Leg Muscle Mass and Foot Symptoms, Structure, and Function: The Johnston County Osteoarthritis Project

Loss of muscle mass occurs with aging and in lower limbs it may be accelerated by foot problems. In this cross-sectional analysis, we evaluated the relationship of leg muscle mass to foot symptoms (presence or absence of pain, aching, or stiffness), structure while standing (high arch or low arch), and function while walking (pronated or supinated) in a community-based study of Caucasian and African American men and women who were 50–95 years old

Factors affecting center of pressure in older adults: the Framingham Foot Study

Background: Although aberrant foot movement during gait has been associated with adverse outcomes in the lower extremities in clinical patients, few studies have analyzed population differences in foot function. The purpose of this study was to assess demographic differences in foot function in a large population-based study of community-dwelling adults. Methods: Participants in this study were from the Framingham Foot Study. Walking data were collected from both feet using a Tekscan Matscan pressure mat. Foot function was characterized using the center of pressure excursion index (CPEI). T-tests were used to assess differences between population subsets based on sex, and in men and women separately, age, body mass index (BMI), physical activity and in women, past high heel use. Results: There were 2111 participants included in this analysis. Significant differences in CPEI were noted by sex (p< 0.0001), by age in women (p = 0.04), and by past high heel use in women (p = 0.04). Conclusions: Foot function during gait was affected by sex, as well as by age and shoe-wear in women, but not by BMI or physical activity. Future work will evaluate possible relations between CPEI and outcomes such as falls, sarcopenia, and lower extremity function

“Generalized osteoarthritis”: A systematic review

Given the conflicting definitions of “generalized osteoarthritis” (GOA) in the literature, we performed a systematic review of GOA definitions, risk factors, and outcomes

Racial Differences in Foot Disorders and Foot Type: The Johnston County Osteoarthritis Project

To describe racial differences in the frequency of structural foot disorders and pes planus, and cavus foot types in a large cohort of African American and Caucasian men and women 50+ years old