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Preclinical rheumatoid arthritis (Pre‐RA) is defined as the early stage before the development of clinical RA. While cachexia is a well‐known and potentially modifiable complication of RA, it is not known if such an association exists also in the Pre‐RA stage. To investigate such issue, we aimed to compare the longitudinal alterations in the muscle composition and adiposity of participants with Pre‐RA with the matched controls. In this observational cohort study, the Osteoarthritis Initiative (OAI) participants were categorized into Pre‐RA and propensity score (PS)‐matched control groups. Pre‐RA was retrospectively defined as the absence of RA from baseline to year‐2, with progression to physician‐diagnosed clinical RA between years 3–8 of the follow‐up period. Using a validated deep learning algorithm, we measured MRI biomarkers of thigh muscles and adiposity at baseline and year‐2 follow‐ups of the cohort. The outcomes were the differences between Pre‐RA and control groups in the 2‐year rate of change for thigh muscle composition [cross‐sectional area (CSA) and intramuscular adipose tissue (Intra‐MAT)] and adiposity [intermuscular adipose tissue (Inter‐MAT) and subcutaneous adipose tissue (SAT)]. Linear mixed‐effect regression models were used for comparison. After 1:3 PS‐matching of the groups for confounding variables (demographics, risk factors, co‐morbidities, and knee osteoarthritis status), 408 thighs (102 Pre‐RA and 306 control) of 322 participants were included (age mean ± SD: 61.7 ± 8.9 years; female/male: 1.8). Over a 2‐year period, Pre‐RA was associated with a larger decrease in total thigh muscle CSA [estimate, 95% confidence interval (CI): −180.13 mm2/2‐year, −252.80 to −107.47, P‐value < 0.001]. Further examination of thigh muscle composition showed that the association of the presence of Pre‐RA with a larger decrease in muscle CSA over 2 years was noticeable in the quadriceps, flexors, and sartorius muscle groups (P‐values < 0.05). Comparison of changes in total adipose tissue showed no difference between Pre‐RA and control participants (estimate, 95% CI: 48.48 mm2/2‐year, −213.51 to 310.47, P‐value = 0.691). However, in the detailed analysis of thigh adiposity, Pre‐RA presence was associated with a larger increase in Inter‐MAT (estimate, 95% CI: 150.55 mm2/2‐year, 95.58 to 205.51, P‐value < 0.001). Preclinical rheumatoid arthritis is associated with a decrease in muscle cross‐sectional area and an increase in intermuscular adipose tissue, similar to rheumatoid cachexia in clinical rheumatoid arthritis. These findings suggest the presence of cachexia in the preclinical phase of rheumatoid arthritis. Given that cachexia, which can exacerbate health outcomes, is potentially modifiable, this study emphasizes the importance of early identification of patients in their preclinical phase.

This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)‐related functional limitation. OA Initiative study participants with or at increased risk of knee OA who wore an accelerometer were included. Race was self‐reported. Average time spent in moderate to vigorous physical activity (minutes per day) based on ActiGraph uniaxial accelerometer data was assessed. Functional limitation was based on the following: (1) inability to achieve a community walking speed (1.2 m/s) standard, (2) slow walking speed (<1.0 m/s), and (3) low physical functioning based on a Western Ontario and McMaster Universities OA Index (WOMAC) physical function score greater than 28 of 68. African American (AA) participants (n = 226), compared with White participants (n = 1348), had a higher likelihood of developing functional limitation based on various measures. When adjusted for time in moderate to vigorous physical activity, the association between AA race and inability to walk a community walking speed slightly decreased (from relative risk [RR] 2.15, 95% confidence interval [95% CI] 1.64–2.81, to RR 1.99, 95% CI 1.51–2.61). Association between AA race and other measures of functional limitation mildly decreased (slow walking speed: from RR 2.06, 95% CI 1.40–3.01, to RR 1.82, 95% CI 1.25–2.63; low physical functioning: from RR 3.44, 95% CI 1.96–6.03, to RR 3.10, 95% CI 1.79–5.39). When further adjusted for demographic and other clinical variables, only the association between race and low physical functioning (WOMAC) significantly decreased and no longer met statistical significance. Greater physical activity is unlikely to completely make up for race differences in OA‐related functional limitation, and other barriers to health equity need to be addressed.

To develop evidence‐based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient‐important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate‐to‐severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. This guideline provides evidence‐based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate‐to‐severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient‐important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.

To investigate which magnetic resonance imaging (MRI)–based articular pathologies are predictive of subsequent medial femorotibial compartment quantitative cartilage thickness loss and therefore suitable for enrichment of clinical trials with participants showing a high likelihood for structural progression. Semiquantitative MRI Osteoarthritis Knee Score (MOAKS) assessments at baseline and quantitative cartilage thickness measurements at baseline and year‐2 follow‐up were performed in 599 participants (age 62 years; body mass index 31 kg/m2; 59% female) from the Osteoarthritis Initiative–based Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium. Knees were classified as medial femorotibial compartment (MFTC) progressors or nonprogressors based on MFTC cartilage thickness change (smallest detectable change threshold −111 μm). Logistic regression was used to investigate the association between baseline presence and severity of MFTC MOAKS pathologies with subsequent MFTC progression. The standardized response mean (SRM) was computed to estimate the sensitivity to change that can be achieved when selecting knees based on MOAKS pathologies. Presence of MFTC MOAKS cartilage damage (odds ratio [OR] 2.77 [95% confidence interval (95% CI) 1.76, 4.36]), MFTC bone marrow lesions (OR 2.69 [95% CI 1.89, 3.83]), medial meniscus extrusion or damage (OR 2.21 [95% CI 1.37, 3.55]), as well as MOAKS severity subscales for cartilage and meniscus damage were associated with subsequent progression. The SRM was greater in knees with than in knees without the presence of these pathologies and was associated with the severity of those pathologies. MRI‐based grading of articular pathologies makes it possible to specifically select progressor knees suitable for inclusion in clinical trials but also to identify knees in which treatment is not indicated (e.g., knees without cartilage damage despite presence of radiographic osteoarthritis).

Functional hand activity induces complex motion of the trapeziometacarpal (TMC) joint. Analyzing the TMC joint motion in vivo can aid in understanding joint behavior and lead to advancements in joint health evaluation. The purpose of this study was to quantify TMC joint motion during pinching using ultrasonography.

Local‐area cartilage segmentation (LACS) software was developed to segment medial femur (MF) cartilage on magnetic resonance imaging (MRI). Our objectives were 1) to extend LACS to the lateral femur (LF), medial tibia (MT), and lateral tibia (LT), 2) to compare LACS to an established manual segmentation method, and 3) to visualize cartilage responsiveness over each cartilage plate. Osteoarthritis Initiative participants with symptomatic knee osteoarthritis (OA) were selected, including knees selected at random (n = 40) and knees identified with loss of cartilage based on manual segmentation (Chondrometrics GmbH), an enriched sample of 126 knees. LACS was used to segment cartilage in the MF, LF, MT, and LT on sagittal 3D double‐echo steady‐state MRI scans at baseline and at 2‐year follow‐up. We compared LACS and Chondrometrics average thickness measures by estimating the correlation in each cartilage plate and estimating the standardized response mean (SRM) for 2‐year cartilage change. We illustrated cartilage loss topographically with SRM heatmaps. The estimated correlation between LACS and Chondrometrics measures was r = 0.91 (95% confidence interval [95% CI] 0.86, 0.94) for LF, r = 0.93 (95% CI 0.89, 0.95) for MF, r = 0.97 (95% CI 0.96, 0.98) for LT, and r = 0.87 (95% CI 0.81, 0.91) for MT. Estimated SRMs for LACS and Chondrometrics measures were similar in the random sample, and SRM heatmaps identified subregions of LACS‐measured cartilage loss. LACS cartilage thickness measurement in the MF and LF and tibia correlated well with established manual segmentation–based measurement, with similar responsiveness to change, among knees with symptomatic knee OA. LACS measurement of cartilage plate topography enables spatiotemporal analysis of cartilage loss in future knee OA studies.

MRI texture features of infrapatellar fat pad were valid to predict the development of incident knee osteoarthritis.

To describe compartmental frequencies of magnetic resonance image (MRI)–defined osteophytes and co‐localized cartilage damage and evaluate the associations of osteophyte size with any ipsicompartmental cartilage damage in knees with incident tibiofemoral radiographic knee osteoarthritis (OA). We evaluated knees from the Osteoarthritis Initiative without radiographic knee OAat baseline that developed radiographic knee OAduring a 4‐year interval. Semiquantitative MRIscoring of osteophytes and cartilage damage was performed at the time point when radiographic knee OAwas diagnosed, defined as Kellgren/Lawrencegrade of ≥2, using the MRIOsteoarthritis Knee Score instrument. The frequencies of maximum osteophyte size and maximum grade of ipsicompartmental (i.e., patellofemoral, medial tibiofemoral, lateral tibiofemoral, posterior femur) cartilage damage were assessed. Generalized estimating equations were used to determine the association of MRI‐defined maximum osteophyte size with presence of any (excluding focal superficial defects) ipsicompartmental cartilage damage. A total of 296 knees that did not have tibiofemoral radiographic knee OAat the baseline visit but developed radiographic knee OAduring the 48‐month observational period were included. In the patellofemoral, medial tibiofemoral, and lateral tibiofemoral compartments, the most frequent osteophyte grade was 1 (67.6%, 59.1%, and 51.7%, respectively) and was 0 (51.7%) in the posterior femur. For all compartments except the posterior femur, a linear trend was found between increasing maximum osteophyte size and the presence of any concomitant cartilage damage. In this sample of knees with incident tibiofemoral radiographic knee OA, the patellofemoral joint showed more severe cartilage damage than other compartments regardless of concomitant osteophyte size. In the posterior femur, cartilage damage was rare despite the presence or size of concomitant osteophytes.

The present study was undertaken to assess whether the odds for incident radiographic osteoarthritis (OA) differ between men and women in regard to body mass index (BMI) and inflammatory magnetic resonance imaging (MRI) markers 1 and 2 years prior, and whether the presence of inflammation on MRI differs between normal‐weight and overweight/obese individuals who develop radiographic OA up to 4 years prior. We studied 355 knees from the Osteoarthritis Initiative study that developed incident radiographic OA and 355 matched controls. MRIs were read for effusion‐synovitis and Hoffa‐synovitis for up to 4 consecutive annual time points. Subjects were classified as normal‐weight (BMI <25), overweight (BMI ≥25 and <30), or obese (BMI ≥30). Conditional logistic regression was used to assess odds of incident radiographic OA for effusion‐synovitis and Hoffa‐synovitis at 1 and 2 years prior to radiographic OA incidence (i.e., “P‐1” and “P‐2”) considering BMI category. Bivariate logistic regression was used to assess odds of inflammation for cases only. One hundred seventy‐eight (25.1%) participants were normal weight, 283 (39.9%) overweight, and 249 (35.1%) obese. At P‐2, being overweight with Hoffa‐synovitis, which had an odds ratio [OR] of 3.26 (95% confidence interval [95% CI] 1.39−7.65), or effusion‐synovitis (OR 3.56 [95% CI 1.45–8.75]) was associated with greater odds of incident radiographic OA in women. For those with incident radiographic OA, there were no increased odds of synovitis in the overweight/obese subgroup for most time points, but increased odds for effusion‐synovitis were observed at P‐2 (OR 2.21 [95% CI 1.11–4.43]). Presence of inflammatory markers seems to play a role especially in overweight women, while obese women have increased odds for radiographic OA also in the absence of these markers.

To determine the optimal combination of imaging and biochemical biomarkers for use in the prediction of knee osteoarthritis (OA) progression. The present study was a nested case–control trial from the Foundation of the National Institutes of Health OA Biomarkers Consortium that assessed study participants with a Kellgren/Lawrence grade of 1–3 who had complete biomarker data available (n = 539 to 550). Cases were participants’ knees that had radiographic and pain progression between 24 and 48 months compared to baseline. Radiographic progression only was assessed in secondary analyses. Biomarkers (baseline and 24‐month changes) that had a Pvalue of <0.10 in univariate analysis were selected, including quantitative cartilage thickness and volume on magnetic resonance imaging (MRI), semiquantitative MRI markers, bone shape and area, quantitative meniscal volume, radiographic progression (trabecular bone texture [TBT]), and serum and/or urine biochemical markers. Multivariable logistic regression models were built using 3 different stepwise selection methods (complex models versus parsimonious models). Among baseline biomarkers, the number of locations affected by osteophytes (semiquantitative), quantitative central medial femoral and central lateral femoral cartilage thickness, patellar bone shape, and semiquantitative Hoffa‐synovitis predicted OA progression in most models (C statistic 0.641–0.671). In most models, 24‐month changes in semiquantitative MRI markers (effusion‐synovitis, meniscal morphologic changes, and cartilage damage), quantitative central medial femoral cartilage thickness, quantitative medial tibial cartilage volume, quantitative lateral patellofemoral bone area, horizontal TBT (intercept term), and urine N‐telopeptide of type I collagen predicted OA progression (C statistic 0.680–0.724). A different combination of imaging and biochemical biomarkers (baseline and 24‐month change) predicted radiographic progression only, which had a higher C statistic of 0.716–0.832. The present study highlights the combination of biomarkers with potential prognostic utility in OA disease‐modifying trials. Properly qualified, these biomarkers could be used to enrich future trials with participants likely to experience progression of knee OA.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01314.x Byline: Debra K. Weiner (*[dagger][double dagger]s.), Thomas E. Rudy ([dagger][double dagger]s.[parallel]), Natalia Morone (*), Ronald Glick ([dagger]), C. Kent Kwoh (*#) Keywords: knee osteoarthritis; acupuncture; periosteal stimulation Abstract: OBJECTIVES: To examine the efficacy of periosteal stimulation therapy (PST, osteopuncture) for the treatment of chronic pain associated with advanced knee osteoarthritis. DESIGN: Randomized, controlled clinical trial. SETTING: Outpatient pain clinic. PARTICIPANTS: Eighty-eight community-dwelling older adults with moderate knee pain or greater for 3 months or longer and Kellgren-Lawrence (K-L) grade 2 through 4 radiographic severity (80% had K-L 4). INTERVENTION: Participants were randomized to receive PST or control PST once a week for 6 weeks. MEASUREMENTS: Pain severity and self-reported function (Western Ontario and McMasters University Osteoarthritis Index (WOMAC)) and physical performance (Short Physical Performance Battery (SPPB)) were assessed at baseline, after the last PST session (post), and 3 months later (follow-up). Pain severity was also assessed monthly using the multidimensional pain inventory short form. RESULTS: Pain was reduced significantly more in the PST group than in the control PST group at post (P=.003; mean WOMAC pain subscale baseline 9.4 vs 6.4) and 1 month later (P CONCLUSION: PST affords short-term modest pain reduction for older adults with advanced knee OA. Future research should test the effectiveness of booster treatments in sustaining analgesic benefits and of combining PST with therapeutic exercise in ameliorating disability risk. Author Affiliation: (*)Medicine ([dagger])Psychiatry ([double dagger])Anesthesiology ([parallel])Biostatistics (s.)Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (#)Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Article note: Address correspondence to Debra K. Weiner, Department of Medicine, University of Pittsburgh, 5750 Centre Ave, Suite 400, Pittsburgh, PA 15206. E-mail: dweiner@pitt.edu

Women with type 1 diabetes have a delayed menarche and a greater prevalence of menstrual disorders than women without diabetes. However, little is known about the menopause transition among type [...]

To assess whether quantitative changes in the meniscus predict progression from early knee osteoarthritis (OA) to knee replacement (KR). A nested case–control study was conducted among Osteoarthritis Initiative participants: all 35 case knees with baseline Kellgren/Lawrence (K/L) grade ≤2 that had KR between 36 and 60 months were matched 1:1 by age, sex, and baseline K/L grade to 35 control knees without subsequent KR. Quantitative 3‐dimensional medial meniscus position and morphologic measures were determined from magnetic resonance imaging at the visit just before KR and 2 years before. Paired t‐tests and case–control odds ratios (ORs, standardized per SD of change in controls) were used to compare changes between groups. Cases (52% women, age 65 ± 7 years, body mass index [BMI] 30 ± 4 kg/m2, K/L grades 0/1/2: 5/8/22 participants, respectively) and controls (52% women, age 64 ± 7 years, BMI 30 ± 5 kg/m2, K/L grades 0/1/2: 9/4/22 participants, respectively) were similar. Compared to control knees, KR case knees displayed longitudinal changes, specifically, a decrease in tibial plateau coverage, an increase in meniscal extrusion, and a decrease in meniscal width. The odds for KR increased with greater reduction in the percentage of tibial plateau coverage (OR 2.28 [95% CI confidence interval (95% CI) 1.43, 3.64]), a greater increase in maximal extrusion (OR 1.40 [95% CI 1.12, 1.75]), and a greater reduction of mean meniscal width (OR 2.01 [95% CI 1.23, 3.26]). The odds for KR increased with medial compartment cartilage thickness loss (OR 2.86 [95% CI 1.51, 5.41]) for comparison. Quantitative measures of meniscal position and morphology are associated with subsequent KR in knees with rapidly progressing knee OA. These findings show that structural changes of the meniscus are related to an important clinical and economic outcome of knee OA.

Despite the numerous health benefits of physical activity, inactivity is endemic among adults with knee osteoarthritis (OA). Because sleep quality may be a target in order to improve physical activity behavior, we investigated the cross‐sectional relationship between restless sleep and physical activity in participants with or at risk for knee OA. We analyzed accelerometer‐measured physical activity and clinical data of participants included in the Osteoarthritis Initiative (OAI). We used multiple regression analysis to evaluate physical activity for participants, who were grouped by the reported frequency of restless sleep, and adjusted for demographic and medical confounders. Of the 1,892 OAIparticipants for whom complete data were available, 300 participants (16%) reported restless sleep ≥3 days in the past week. Participants who reported restless sleep for much of the time (3–4 days/week) and most of the time (5–7 days/week) had 11.9% and 23.7% less weekly minutes of moderately vigorous activity, respectively, compared to participants who reported rarely restless sleep (<1 day/week) (Pfor trend 0.021). These differences persisted after accounting for age, sex, race, body mass index, medical comorbidity, and knee OAseverity and pain (Pfor trend 0.023). Differences related to restless sleep were largely attenuated by the presence of high depressive symptoms and low energy levels. Poor sleep quality is associated with less physical activity in persons with or at risk for knee OA. Future studies are needed to determine the mechanisms of how poor sleep and physical activity are related, how energy and depression mediate these relationships, and whether interventions that improve sleep quality might result in increased physical activity.

Aim:To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women. Methods:Postmenopausal women with stage I–III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n= 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n= 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. Results:Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1stextensor compartment (long axis; p= 0.001), 4thextensor compartment (long axis; p= 0.014), 3rdmetacarpophalangeal joint (p= 0.002), the pooled values of the extensor compartments, both long (p= 0.044) and short axes (p= 0.035), and the pooled values for the metacarpophalangeal joints (p= 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. Conclusions:This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor–associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor–associated arthralgias, or a result of aromatase inhibitor treatment.

Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain. We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self‐reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self‐reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel’s test of mediation to examine hypotheses. The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P< 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P< 0.001) as well as pain severity (Z = 2.24, P= 0.025). Perceived discrimination is an important psychosocial stressor that contributes to worsening OA‐related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.

ObjectiveWhile opioids are known to cause unintended adverse effects, they are being utilized by a number of patients with osteoarthritis (OA). The aim of this study was to evaluate the association of patient familiarity and perceptions regarding efficacy and risks with opioid medication use for OA.MethodsA total of 362 adults with knee and/or hip OA were surveyed in this cross-sectional study. Patients’ familiarity with and perceptions of benefits/risks of opioid medications were measured to evaluate potential associations with the utilization of opioid medications for OA within the last 6 months. Logistic regression models were adjusted for sociodemographic and clinical variables.ResultsIn this sample, 28.7% (100/349) reported use of an opioid medication for OA-related symptoms in the last 6 months. Those who were on an opioid medication, compared to those who were not, were younger (mean age 62.5 vs 64.8 yrs), were more likely to have a high school education or lower (48.0% vs 35.3%), and had higher mean depression (Patient Health Questionnaire [PHQ]-8 7.2 vs 4.9) and OA-related pain (Western Ontario and McMaster Universities Arthritis Index [WOMAC] 54.8 vs 46.8) scores. After adjustment for sociodemographic and clinical variables, the following were associated with opioid medication use: higher perception of medication benefit (OR 1.68, 95% CI 1.18–2.41), lower perception of medication risk (OR 0.67, 95% CI 0.51–0.88), and having family or friends who received the medication for OA (OR 3.88, 95% CI 1.88–8.02).ConclusionAmong adults with knee/hip OA, opioid use was associated with being familiar with the treatment, as well as believing that the medication was beneficial and low-risk.

Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.© RSNA, 2020

To develop an evidence‐based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACRrecommendations for the management of hand, hip, and knee OA. We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind‐body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OAwho are overweight or obese, self‐efficacy and self‐management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMCjoint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision‐making that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

To determine the extent of ethnic differences in the use of exercise for therapy and identify relevant modifiable determinants of exercise use among patients with knee/hip osteoarthritis (OA). Knee/hip OA study participants were identified. Surveys were administered to collect patient sociodemographic and clinical information, and beliefs and attitudes about providers and treatments. Final multivariable logistic regression models were created using a fully conditional method. Hispanic participants (n = 130), compared to non‐Hispanic participants (n = 232), were less likely to have private medical insurance (9.2% versus 31.0%) or to report having excellent/very good health (40.7% versus 52.6%). They were also less likely to report using exercise for OA treatment in the last 6 months (56% versus 73%; P= 0.003). When adjusted for age and disease severity, the difference in exercise use among ethnicities remained significant (odds ratio [OR] 0.59 [95% confidence interval (95% CI) 0.36–0.99]). In a multivariable logistic regression model designed to determine the most important determinants of exercise use for OA treatment, in the last 6 months the following were all associated with exercise use: having knee instead of hip OA (OR 2.83 [95% CI 1.51–5.29]), having family/friends who exercise (OR 3.20 [95% CI 1.76–5.84]), having a good understanding of what happens after exercise (OR 2.19 [95 CI 1.15–4.19]), and higher perceived benefit of exercise (OR 2.24 [95% CI 1.64–3.04]). Among patients with knee/hip OA, Hispanics were less likely to exercise for OA treatment. Increased knowledge about the benefits of exercise for treatment and improved familiarity with exercise as treatment for OA may increase exercise use.

Osteoarthritis is the most common form of arthritis and unfortunately lacks disease-modifying treatments. This has led to a growing demand for more effective nonoperative treatment options. Platelet-rich plasma and mesenchymal stem cell therapy offer the potential to modify the natural course of knee osteoarthritis using cell-based technology. Because of the lack of high-quality evidence and the large degree of heterogeneity, in terms of study designs and measured outcomes, the use of platelet-rich plasma or mesenchymal stem cell therapy to treat knee osteoarthritis cannot be recommended at this time.

To examine the impact of physical activity on cartilage thickness loss in knee osteoarthritis (OA). A total of 689 participants with radiographic knee OA at baseline (Kellgren/Lawrence grade ≥2) from the Osteoarthritis Initiative completed the Physical Activity Scale for the Elderly (PASE) questionnaires at annual intervals over 4 years. Magnetic resonance imaging–based cartilage thickness change in the medial femorotibial compartment (MFTC) over 4 years was the main outcome. The impact of PASE tertiles (low, moderate, or high) on changes in MFTC cartilage thickness was estimated using a mixed‐effects model adjusted for baseline characteristics. Furthermore, stratification by sex was performed for secondary analyses. Structural progression of MFTC cartilage loss of −0.20 mm (95% confidence interval [95% CI] −0.22, −0.17) was observed in the entire cohort, with no significant difference between physical activity levels after adjustment for baseline characteristics. An interaction between sex and physical activity was observed in the adjusted analysis (P= 0.02). Stratification by sex showed that women with low physical activity had a statistically greater cartilage loss than women with moderate physical activity (adjusted between‐group difference –0.09 mm [95% CI –0.16, 0.02]), whereas no significant differences were observed in men. While physical activity was not associated with cartilage thickness loss in the whole cohort, this relationship significantly differed between sexes. In women, but not in men, moderate physical activity may slow down structural disease progression compared to low physical activity levels. For both men and women, high physical activity levels do not appear to be more detrimental than lower physical activity levels for cartilage thickness loss.

To determine whether infrapatellar fat pad (IPFP) signal intensity measures are predictive of incident radiographic osteoarthritis (ROA) over 4 years in the Osteoarthritis Initiative study. Case knees (n = 355), as defined by incident ROA, were matched 1:1 with control knees, according to sex, age, and radiographic status. T2‐weighted magnetic resonance images were assessed at P0 (the visit when incident ROAwas observed on a radiograph), P1 (1 year prior to P0), and baseline and used to assess IPFPsignal intensity semiautomatically. Conditional logistic regression analyses were performed to assess the risk of incident ROAassociated with IPFPsignal intensity alteration, after adjustment for covariates. The mean age of the participants was 60.2 years, and most (66.7%) were female and overweight (mean body mass index 28.3 kg/m2). Baseline IPFPmeasures including the mean value and standard deviation of IPFPsignal intensity, the mean value and standard deviation of IPFPhigh signal intensity, median and upper quartile values of IPFPhigh signal intensity, and the clustering effect of high signal intensity were associated with incident knee ROAover 4 years. All P1 IPFPmeasures were associated with incident ROAafter 12 months. All P0 IPFPsignal intensity measures were associated with ROA. The quantitative segmentation of high signal intensity in the IPFPobserved in our study confirms the findings of previous work based on semiquantitative assessment, suggesting the predictive validity of semiquantitative assessment of IPFPhigh signal intensity. The IPFPhigh signal intensity alteration could be an important imaging biomarker to predict the occurrence of ROA.

To assess structural progression in knees with no/mild radiographic osteoarthritis (OA) (i.e., Kellgren/Lawrence [K/L] grades 0–2) that will undergo knee replacement during a 5‐year period; to assess differences in structural damage on magnetic resonance imaging (MRI) in knees with no/mild radiographic OAversus those with severe radiographic OA(i.e., K/L grades 3 and 4) at baseline; and to assess differences in pain levels between those groups. All participants who underwent knee replacement from baseline to 60 months were drawn from the Osteoarthritis Initiative. MRIs were assessed for bone marrow lesions (BMLs), Hoffa synovitis, and effusion synovitis (i.e., hyperintensity signal changes in the fat pad and abnormal amount of capsular distension due to intraarticular joint fluid and/or synovial thickening) at baseline and at the time point before knee replacement (T0). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain were used for pain characterization. WOMACactivities of daily living and KOOSquality of life were applied to characterize functional status of the included participants. Logistic regression was used to assess the association of no/mild radiographic OAwith these MRIfeatures and pain. Based on inclusion criteria, 181 knees were selected. Participants were predominantly female (57.8%) with a mean age of 64.4 years. A total of 51 knees (28.2%) had no/mild radiographic OAat baseline. Of these, 51.0% progressed to severe radiographic OA. No/mild radiographic OAknees showed higher odds of BMLs in the patellofemoral joint at baseline (odds ratio [OR] 7.92 [95% confidence interval (95% CI) 3.45–18.16]) and T0 (OR9.44 [95% CI4.00–22.28]) compared to severe radiographic OAknees. In addition, no/mild radiographic OAknees were associated with change from no pain to pain from baseline to T0 (adjusted OR5.48 [95% CI1.25–24.00]). More than half of the knees with no/mild radiographic OAbefore knee replacement progressed to severe radiographic OAduring 4 years of follow‐up. BMLs in the patellofemoral joint were more often seen among knees that had no/mild radiographic OA. Worsening pain status may contribute to knee replacement in knees with no/mild radiographic OA.

To determine if severity of osteoarthritis‐related knee pain is associated with a willingness to undergo total knee replacement (TKR) and whether this association is confounded or modified by components of socioeconomic status and health care coverage. Cross‐sectional analysis was conducted among 3,530 Osteoarthritis Initiative study participants. Logistic regression models were used to assess the effect of knee pain severity (where 0 = none, 1–3 = mild, 4–7 = moderate, and 8–10 = severe) on willingness to undergo TKR. Stratified analyses were conducted to evaluate whether socioeconomic status and health care coverage modify the effect of knee pain severity on willingness. Participants with severe knee pain, compared to participants without pain, were less willing to undergo TKR (odds ratio [OR] 0.73, 95% confidence interval [95% CI] 0.57–0.93). This association was attenuated when adjusted for age, sex, comorbidity, depression, health insurance coverage, prescription medicine coverage, health care source, education, income, employment, race, and marital status (adjusted OR 0.92, 95% CI 0.68–1.24). The odds of willingness to undergo TKR were significantly lower in those with the highest level of pain, compared to those without pain, among participants without health insurance (adjusted OR 0.08, 95% CI 0.01–0.56), but not among those with health insurance (adjusted OR 1.03, 95% CI 0.73–1.38), when adjusted for demographic, clinical, health care access, and socioeconomic factors (P= 0.015). However, <5% of participants were without health insurance. Among participants without health insurance, severe knee pain was paradoxically associated with less willingness to undergo TKR. Policies that improve access to quality health care may affect patient preferences and increase utilization of TKR surgery among vulnerable populations.

Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.

Older adults with arthritis or joint pain were targeted for a pilot program enhancing the Arthritis Foundation Exercise Program with the 10 Keys™ to Healthy Aging Program. Using a one-group, pre-post design, feasibility was examined and improvements in preventive behaviors, arthritis outcomes, and cardiometabolic outcomes were explored. A 10-week program was developed, instructors were recruited and trained, and four sites and 51 participants were recruited. Measures included attendance, adherence, satisfaction, preventive behaviors, Western Ontario and McMaster Universities Osteoarthritis Index (pain and stiffness), glucose, and cholesterol. Three fourths of participants attended >50% of the sessions. At 6 and 12 months, more than one half performed the exercises 1 to 2 days per week, whereas 28% and 14% exercised 3 to 7 days per week, respectively. Participants (92%) rated the program as excellent/very good. Nonsignificant changes were observed in expected directions. Effect sizes were small for arthritis and cardiometabolic outcomes. This program engaged community partners, demonstrated feasibility, and showed improvements in some preventive behaviors and health risk profiles.[Res Gerontol Nurs. 2016; 9(3):123–132.]

High-resolution US provides superb imaging evaluation of articular erosions; joint, bursal, and tendon sheath effusions; articular and periarticular crystal deposition; and enthesopathy in a spectrum of rheumatologic diseases.

Background: Racial and ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments.Objectives: The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA.Data sources and methods: A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.Results: The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations.Conclusion: This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that is associated with poor health-related quality-of-life outcomes.

The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown.

Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6‐month self‐efficacy‐based, individually delivered, lower‐extremity exercise and fitness walking intervention with 6‐month follow‐up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6‐minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self‐efficacy was assessed by a questionnaire. Results showed significant increases in self‐reported performance of lower‐extremity exercise and participation in fitness walking, distance in the 6‐minute walk, and SPPB scores from baseline to 6‐month follow‐up with a trend for improvement in self‐efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function.

ObjectiveTo determine by magnetic resonance imaging MRI, whether knees with advanced radiographic disease medial joint space narrowing mJSN encounter greater longitudinal cartilage loss than contralateral knees with earlier disease no or less mJSN.MethodsParticipants were selected from 2,678 cases in the Osteoarthritis Initiative, based on exhibition of bilateral pain, body mass index >25 kgm2, mJSN in 1 knee, no or less mJSN in the contralateral knee, and no lateral JSN in both knees. Eighty participants mean ± SD age 60.6 ± 9.1 years fulfilled these criteria. Medial tibial and femoral cartilage morphology was analyzed from the baseline and the 1year followup MRI sagittal double echo at steady state by 3.0T of both knees by experienced readers blinded to the time point and mJSN status.ResultsKnees with more radiographic mJSN displayed greater medial cartilage loss −80 μm assessed by MRI than contralateral knees with less mJSN −57 μm. The difference reached statistical significance in participants with an mJSN grade of 2 or 3 P 0.005–0.08, but not in participants with an mJSN grade of 1 P 0.28–0.98. In knees with more mJSN, cartilage loss increased with higher grades of mJSN P 0.003 in the medial femur. Knees with an mJSN grade of 2 or 3 displayed greater cartilage loss in the weightbearing medial femur than in the posterior femur or in the medial tibia P 0.048.ConclusionKnees with advanced mJSN displayed greater cartilage loss than contralateral knees with less mJSN. These data suggest that radiography can be used to stratify fast structural progressors, and that MRI cartilage thickness loss is more pronounced at advanced radiographic disease stage.

ObjectiveTo describe the location and pattern of knee pain in patients with chronic, frequent knee pain using the Knee Pain Map, and to evaluate the inter and intrarater reliability of the map.MethodsA cohort of 799 participants from the University of Pittsburgh Osteoarthritis Initiative Clinical Center who had knee pain in the last 12 months were studied. Trained interviewers assessed and recorded participantreported knee pain patterns into 8 local areas, 4 regional areas, or as diffuse. Inter and intrarater reliability were assessed using Fleiss kappa.ResultsParticipants most often reported localized 69 followed by regional 14 or diffuse 10 knee pain. In those with localized pain, the most commonly reported locations were the medial 56 and lateral 43 joint lines. In those with regional pain, the most commonly reported regions were the patella 44 and medial region 38. There was excellent interrater reliability for the identification of localized and regional pain patterns κ 0.7–0.9 and 0.7–0.8, respectively. The interrater reliability for specific locations was also excellent κ 0.7–1.0 when the number of participants with pain in a location was >4. For regional pain, the kappa for specific regions varied from 0.7–1.0.ConclusionThe majority of participants could identify the location of their knee pain, and trained interviewers could reliably record those locations. The variation in locations suggests that there are multiple sources of pain in knee OA. Additional studies are needed to determine whether specific knee pain patterns correlate with discrete pathologic findings on radiographs or magnetic resonance images.

OBJECTIVE: Diagnostic codes based on medical records or claims data have been used to identify patient populations with gout for important epidemiologic and clinical studies. We evaluated whether we can document the accuracy of such diagnoses by review of medical records and then on direct interviews with a subset of patients. METHODS: Electronic medical records of 289 patients with 2 visits with ICD-9 codes for gout were extensively reviewed to search for documentation of features that would classify patients as having gout by 3 sets of proposed criteria, the American College of Rheumatology (ACR), New York, or Rome criteria. Records of patients who had been seen by rheumatologists were compared with all others. A subset of patients seen in clinic were directly interviewed for comparison with the results from the records. RESULTS: Based on medical records review there was documentation of gout by the ACR criteria in only 36%, Rome criteria in 30%, and New York criteria in 33%. Records of patients who had seen rheumatologists had better documentation of classification features. Interview in clinic of 37 patients also improved documentation of the 3 sets of criteria features of gout in 65%–81% of those with ICD-9 codes for gout. CONCLUSION: We found it difficult to confirm ICD-9 coded diagnoses of gout using currently available proposed criteria from details recorded in medical records. This may reflect a problem with available criteria and with documentation. Direct interview of patients may be needed to confirm the presence of typical features when high specificity is desired.

Marked racial and ethnic differences exist in the utilization of knee or hip joint replacement in the management of end-stage osteoarthritis. Limited data, however, are available on racial and ethnic differences in hospital length of stay after knee or hip arthroplasty. We sought to examine this issue using the Veterans Administration National database.

ObjectivePrior studies have indicated racial differences in patients expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a wellvalidated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust.MethodsDetailed demographic, clinical, psychological, and social data were collected from 909 male patients 450 African American, 459 white ages 50–79 years with moderate or severe osteoarthritis OA of the hip or knee receiving primary care at 2 veterans affairs medical centers. The previously validated Joint Replacement Expectations Survey was used to assess expectations for pain relief, functional improvement, and psychological wellbeing after joint replacement.ResultsAmong knee OA patients n 627, the unadjusted mean expectation score scale 0–76 for African American patients was 48.7 versus 53.6 for white patients mean difference 4.9, P< 0.001. For hip OA patients n 282, the unadjusted mean expectation score scale 0–72 for African Americans was 45.4 versus 51.5 for whites mean difference 6.1, P< 0.001. Multivariable adjustment for disease severity, socioeconomic factors, education, social support, literacy, and trust reduced these racial differences to 3.8 points 95 confidence interval 95 CI 1.2, 6.3 among knee OA patients and 4.2 points 95 CI 0.4, 8.0 among hip patients.ConclusionAmong potential candidates for joint replacement, African American patients have significantly lower expectations for surgical outcomes than white patients. This difference is not entirely explained by racial differences in demographics, disease severity, education, income, social support, or trust.