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Osteoarthritis (OA) is a chronic disease that requires a multimodal therapeutic approach. The aim of this study was to evaluate the effects of undenatured type II collagen (UC-II) as compared to robenacoxib in dogs affected by OA. Our hypothesis was that the two compounds would be similar (non-inferiority) in improving mobility. To test this hypothesis, a complete orthopedic examination, x-ray and the Liverpool Osteoarthritis in Dogs (LOAD) survey were performed in dogs affected by OA before and after the treatments. The study was designed as a clinical, randomized, controlled and prospective study. Sixty client-owned dogs were randomized in the R group (n = 30, robenacoxib 1 mg/kg/day for 30 days) and in the UC-II group (n = 30, UC-II 1 tablet/day for 30 days). Thirty days after the beginning of the treatment (T30), the dogs were reassessed for the LOAD, MOBILITY and CLINICAL scores. Based on the data obtained from the study, a significant reduction in LOAD and MOBILITY scores was recorded between T0 and T30 with a similar magnitude among the two groups (R = 31.5%, p < 0.001; UC-II = 32.7%, p = 0.013). The results of this study showed that UC-II and robenacoxib were able to similarly improve mobility of dogs affected by OA. [ABSTRACT FROM AUTHOR]

Case reports: Five dogs (4 with severe carpal contracture, 1 with a chronically infected carpal joint) underwent antebrachiometacarpal arthrodesis. Excision of all carpal bones, except the accessory carpal bone, was done, either because of persistent infection or to allow the manus to be arthrodesed in a functional position. All five dogs developed varying degrees of soft tissue swelling of the surgical site following surgery. All five arthrodeses achieved complete osseous union within 4–67 weeks. The immediate postoperative distal radiometacarpal frontal plane angulation ranged from 1° to 19° (mean ± SD: 7 ± 8°). The immediate postoperative distal radiometacarpal sagittal plane angulation ranged from 6° to 26° (mean ± SD: 17 ± 9°). Plate coverage of the secured metacarpal bone(s) ranged from 75% to 87% (mean ± SD: 80 ± 4%). Infection necessitated plate removal in four dogs, 3–17 (mean ± SD: 8 ± 6) months following surgery and 0–15 (mean ± SD: 5 ± 7) weeks following radiographic documentation of complete osseous union. Conclusion: Despite one dog having marked elbow incongruency and degenerative joint disease and one dog having an ipsilateral radial nerve deficit, all five dogs improved and had acceptable limb function at the time of the final evaluation, which ranged from 25 to 296 (mean ± SD: 99 ± 111) weeks following surgery. [ABSTRACT FROM AUTHOR]

Osteoarthritis is a common problem in daily veterinary practice with insufficient knowledge about disease mechanism. Because fibrosis is a part of the alteration in the effected joints, we investigated the transforming growth factor beta 1 (TGF-β1) as an important regulation molecule of tissue fibrosis. We chose Osteoarthritis following a cruciate ligament rupture (CLR) because it is a common model of osteoarthritis. A total of 13 healthy dogs and 38 dogs suffering from CLR were included in this prospective study. The concentration of TGF-β1 was measured in synovial fluid using the "Quantikine Human TGF-β1 Immunoassay" (Fa. R & D Systems, Minneapolis, USA). There was a significant difference in the TGF-β1 concentration of the synovial fluid of healthy compared to affected patients (p < 0.001). The synovial TGF-β1 concentration also correlated significantly (p = 0.0147) with the synovial viscosity of the affected patients. No significant correlations could be observed to duration of disease, severity of lameness and degree of joint swelling, but also to joint capsule sickness, osteophyte development and degeneration of joint cartilage. The results of our study show an increased TGF-β1 concentration in knees affected with osteoarthritis as consequence of CLR. So we can conclude that TGF-β1 takes part at the osteoarthritic remodelling process, but different phases of the remodelling process cannot be distinguished by the measurement of TGF-β1. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of interferential current therapy on ground reaction force and orthopedic assessment score of canine patients with hip osteoarthritis. Nine dogs that met the inclusion criteria were enrolled in this study. Each dog received 3 types of treatment: interferential current therapy (IFC), sham current therapy (SHAM), and control treatment (CTR). The order of the treatments for each dog was assigned by block randomization method. A 24-hour interval was applied between each treatment session. Subjective orthopedic assessment and objective force plate gait analysis were used as measurement of clinical improvement in this study. Lameness, articular mobility and articular pain scores as well as peak vertical force (PVF) variables were assessed prior to and post treatments. Statistical analyses revealed significant increase in PVF of the IFC group (p<0.05). There was a significant decrease in PVF in the CTR group (p<0.05). In the SHAM group, there was no significant change in PVF. There were no significant changes detected in the lameness, articular mobility and articular pain scores. Post hoc comparisons using Tukey- Kramer test demonstrated that the IFC treatment was significantly more effective than the SHAM and CTR treatments (p<0.05). The significant improvement in PVF of the dogs with hip osteoarthritis may be associated with pain alleviation effect of the IFC treatment. The results of this study suggest that IFC may be useful for the treatment of canine osteoarthritis [ABSTRACT FROM AUTHOR]

The objectives of this study were to assess the prevalence of cartilage erosion in small dogs with patellar luxation (PL), and related osteoarthritis (OA)-related gene expression. In Study 1,71 dogs were examined to determine risk factors associated with PL, including breed, age, weight, sex, and affected joint. In Study 2, a total of 39 dogs were divided into four groups: normal articular cartilage in the stifle joint (G1; n=5); PL without cartilage erosion (G2; n=11); PL with cartilage erosion (G3; n=14); and OA in the stifle (G4; n=9). Articular cartilage and synovial membranes were collected during surgical operations to correct PL. Real-time PCR was used to quantify the expression levels of 11 OA-related genes, including AGG, COL2A1, HAS-1, HAS-2, TIMP-1, MMP-3, IL-1β, TNF-α, IFN-γ, COX-1, and COX-2, with GAPDH used asa reference gene. From Study 1, it was found that the risk factors related with cartilage erosion lesion were age, sex, and PL grade (all variables showed P<0.05). From Study 2, it was demonstrated that PL with or without cartilage erosion expressed pro-inflammatory cytokines and enzymes; some biomolecules were up regulated (IL-1β, MMP-3, AGG, TIMP-1) but some were down regulated (COL2A1, HAS-2, COX-1, COX-2). This expression was the difference between the articular cartilage and the synovial membrane; however, the expression of genes from PL with cartilage erosion was observed to be similar to that of OA. From our results, it can be concluded that PL can develop into secondary OA due to an increase of IL-1β in cartilage and synovial membrane. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a chronic, painful, degenerative and inflammatory disease that affects the synovial joints and leads finally to the loss of mobility. It is highly prevalent in dogs. Nowadays, no cure exists, and the pharmacological treatment is limited to clinical signs alleviation. Some positive beneficial effects have been highlighted with dietary supplements in the course of dog OA. The goals of this narrative review are to summarize the scientific data available in the literature on dietary supplements assessed in dog OA and to discuss some trails about how to improve several aspects of research and issues with dietary supplements, such as bioavailability and dosage regimen. Chondroitin sulphate, glucosamine, undenaturated type II collagen, avocado-soya bean unsaponifiables, curcumin and polyunsaturated fatty acids were studied in dog OA and therefore discussed in the present review. Most of them showed anticatabolic and anti-inflammatory effects. Unfortunately, few data exist concerning their pharmacokinetics. Their bioavailability is low, but new formulations are developed to enhance their gastrointestinal absorption. The clinical relevance of these new formulations compared to native forms should be demonstrated in good clinical trials. Even if further investigations are needed, dietary supplements should be considered in OA management. [ABSTRACT FROM AUTHOR]

Lameness in dogs will be a familiar part of any small animal practitioner's caseload. Osteoarthritis is a common cause for this lameness, although it is often secondary to a primary inciting cause; so treatment and management may need to address the primary inciting cause as well as the pain associated with the arthritis. Management of the condition involves a combination of medical and surgical options, and weight management can often be crucial in reducing pain and improving patient mobility. In this article, Rob Pettitt and Alex German explore the multifactorial elements in both investigating and managing this condition in dogs. [ABSTRACT FROM AUTHOR]

Objective: To assess the use of Global Positioning System receiver (GPS) derived performance measures for differentiating between: 1) different outdoor activities in healthy dogs; 2) healthy dogs and those with osteoarthritis; 3) osteoarthritic dogs before and after treatment with non-steroidal anti-inflammatory analgesia. Design: Prospective study. Animals: Ten healthy dogs and seven dogs with osteoarthritis of the elbow joint (OA dogs). Procedure: Healthy dogs were walked on a standard route on-lead, off-lead and subjected to playing activity (chasing a ball) whilst wearing a GPS collar. Each dog was walked for five consecutive days. Dogs with OA were subjected to a single off-lead walk whilst wearing a GPS collar, and then administered oral Carprofen analgesia daily for two weeks. OA dogs were then subjected to the same walk, again wearing a GPS collar. Results: GPS derived measures of physical performance could differentiate between on-lead activity, off-lead activity and playing activity in healthy dogs, and between healthy dogs and OA dogs. Variation in the performance measures analysed was greater between individual dogs than for individual dogs on different days. Performance measures could differentiate healthy dogs from OA dogs. OA Dogs treated with Carprofen analgesia showed improvements in their physical performance, which returned to values indistinguishable from those of healthy dogs on nearly all the measures assessed. Conclusions and Clinical Relevance: GPS derived measures of physical performance in dogs are objective, easy to quantify, and can be used to gauge the effects of disease and success of clinical treatments. Specific stimuli can be used to modulate physical performance beyond the self-governed boundaries that dogs will naturally express when allowed to exercise freely without stimulation. [ABSTRACT FROM AUTHOR]

Canine osteoarthritis is a common disorder seen in veterinary clinical practice and causes considerable morbidity in dogs as they age. Synovial fluid analysis is an important tool for diagnosis and treatment of canine joint disease and obtaining a total nucleated cell count (TNCC) is particularly important. However, the low sample volumes obtained during arthrocentesis are often insufficient for performing an automated TNCC, thereby limiting diagnostic interpretation. The aim of the present study was to investigate whether estimation of TNCC in canine synovial fluid could be achieved by performing manual cell counts on direct smears of fluid. Fifty-eight synovial fluid samples, taken by arthrocentesis from 48 dogs, were included in the study. Direct smears of synovial fluid were prepared, and hyaluronidase added before cell counts were obtained using a commercial laser-based instrument. A protocol was established to count nucleated cells in a specific region of the smear, using a serpentine counting pattern; the mean number of nucleated cells per 400 x field was then calculated. There was a positive correlation between the automated TNCC and mean manual cell count, with more variability at higher TNCC. Regression analysis was performed to estimate TNCC from manual counts. By this method, 78% of the samples were correctly predicted to fall into one of three categories (within the reference interval, mildly to moderately increased, or markedly increased) relative to the automated TNCC. Intra-observer and inter-observer agreement was good to excellent. The results of the study suggest that interpretation of canine synovial fluid samples of low volume can be aided by methodical manual counting of cells on direct smears. [ABSTRACT FROM AUTHOR]

Objective--To determine changes in Canine Brief Pain Inventory scores for dogs with osteoarthritis after administration of a monoclonal antibody (mAb) against nerve growth factor (NGF) that was modified by use of a proprietary process for administration to dogs. Animals--11 adult dogs. Procedures--Dogs received the anti-NGF mAb (0.2 mg/kg, IV) at various evaluation times during the study period; at other evaluation times, dogs received an equivalent volume of PBS solution IV. Owners determined Canine Brief Pain Inventory pain severity (PS) and pain interference (PI) scores immediately before (baseline) and 2, 4, and 6 weeks after administration of the anti-NGF mAb; owners were unaware of the evaluation time at which the mAb had been administered. Results--Compared with baseline PS scores (median, 4.75; range, 0.75 to 8.5), dogs had significantly lower PS scores 2 weeks (median, 3; range, 1 to 5.5) and 4 weeks (median, 2.25; range, 0.25 to 725) after administration of anti-NGF mAb. Compared with baseline Pi scores (median, 5.33; range, 1.17 to 9.33), dogs had significantly lower PI scores 2 weeks (median, 3; range, 0.67 to 6.83) and 4 weeks (median, 3.33; range, 0.67 to 6.67) after administration of anti-NGF mAb. The PS and PI scores 6 weeks after mAb administration were lower than baseline scores, although values were not significantly different. Conclusions and Clinical Relevance--Results of this study suggested the evaluated anti-NGF mAb decreased PS and PI scores for 4 weeks after administration. This treatment may be effective for alleviation of signs of pain in dogs with osteoarthritis for up to 4 weeks. [ABSTRACT FROM AUTHOR]

Objective--To determine the optimal method for use of the Canine Brief Pain Inventory (CBPI) to quantitate responses of dogs with osteoarthritis to treatment with carprofen or placebo. Animals--150 dogs with osteoarthritis. Procedures--Data were analyzed from 2 studies with identical protocols in which owner-completed CBPIs were used. Treatment for each dog was classified as a success or failure by comparing the pain severity score (PSS) and pain interference score (PIS) on day 0 (baseline) with those on day 14. Treatment success or failure was defined on the basis of various combinations of reduction in the 2 scores when inclusion criteria were set as a PSS and PIS > 1, 2, or 3 at baseline. Statistical analyses were performed to select the definition of treatment success that had the greatest statistical power to detect differences between carprofen and placebo treatments. Results--Defining treatment success as a reduction of > 1 in PSS and > 2 in PIS in each dog had consistently robust power. Power was 62.8% in the population that included only dogs with baseline scores > 2 and 64.7% in the population that included only dogs with baseline scores > 3. Conclusions and Clinical Relevance--The CBPI had robust statistical power to evaluate the treatment effect of carprofen in dogs with osteoarthritis when protocol success criteria were predefined as a reduction > 1 in PIS and > 2 in PSS. Results indicated the CBPI can be used as an outcome measure in clinical trials to evaluate new pain treatments when it is desirable to evaluate success in individual dogs rather than overall mean or median scores in a test population. [ABSTRACT FROM AUTHOR]

The clinical safety and efficacy of a transmucosal oral spray ( TMOS) formulation of meloxicam was evaluated for the control of pain and inflammation associated with osteoarthritis in dogs. A total of 280 client-owned dogs were enrolled at fourteen veterinary clinics: there were 187 dogs in the meloxicam TMOS group and 93 in the placebo control group. Dogs received placebo or treatment spray once daily for twenty-eight days. Improvement in signs of osteoarthritis was measured using client-specific outcome measures ( CSOM) made at days 14 and 28 and veterinary assessments of lameness and pain on palpation made at day 28. A significantly higher number of dogs in the meloxicam TMOS group were treatment successes at 28 days (72.6%) compared with the placebo group (46.9%), based on CSOM scores. Total CSOM scores were significantly lower in the meloxicam TMOS-treated group compared with the placebo group at both 14 and 28 days. Differences between treatment groups were not observed in veterinary assessments. Gastrointestinal effects of meloxicam were observed in some animals. Meloxicam TMOS was found to be safe and effective in dogs for the control of pain and inflammation associated with osteoarthritis. [ABSTRACT FROM AUTHOR]

This report describes an atypical biceps brachii tendon injury with acute, traumatic fragmentation of the supraglenoid tuberosity and partial rupture of the origin of the biceps brachii tendon in two dogs. Both dogs had foreleg lameness after an acute traumatic event. Radiographic examination revealed an irregular appearance to the cranial aspect of the supraglenoid tuberosity and the presence of osseous fragments in the intertubercular groove. Arthroscopic evaluation showed a partial tear of the biceps brachii tendon with fragmentation of the cranial aspect of the supraglenoid tuberosity. Biceps brachii tenotomy was performed and the osteochondral fragments were left to retract with the severed tendon. Both dogs returned to full activity six weeks after surgery and showed no lameness at one year followup. Radiographs showed no change to the position of the osteochondral fragment and no evidence of osteoarthritis. Resolution of lameness after tenotomy suggests the predominant feature of this condition was biceps brachii tendinopathy and fragment removal or fixation is unnecessary to achieve a functional outcome. Fragmentation of the supraglenoid tuberosity and biceps brachii tendinopathy should be considered a differential diagnosis for young dogs with acute foreleg lameness attributable to shoulder pain. [ABSTRACT FROM AUTHOR]

Objective--To determine efficacy of a single intra-articular injection of an autologous platelet concentrate for treatment of osteoarthritis in dogs. Design--Randomized, controlled, 2-center clinical trial. Animals--20 client-owned dogs with osteoarthritis involving a single joint. Procedures--Dogs were randomly assigned to a treatment or control group. In all dogs, severity of lameness and pain was scored by owners with the Hudson visual analog scale and the University of Pennsylvania Canine Brief Pain Inventory, respectively, and peak vertical force (PVF) was determined with a force platform. Dogs in the treatment group were then sedated, and a blood sample (55 mL) was obtained. Platelets were recovered by means of a point-of-use filter and injected intra-articularly within 30 minutes. Control dogs were sedated and given an intra-articular injection of saline (0.9% NaCI) solution. Assessments were repeated 12 weeks after injection of platelets or saline solution. Results--Dogs weighed between 18.3 and 63.9 kg (40.3 and 140.6 lb) and ranged from 1.5 to 8 years old. For control dogs, lameness scores, pain scores, and PVF at week 12 were not significantly different from pretreatment values. In contrast, for dogs that received platelet injections, lameness scores (55% decrease in median score), pain scores (53% decrease in median score), and PVF (12% increase in mean PVF) were significantly improved after 12 weeks, compared with pretreatment values. Conclusions and Clinical Relevance--Results suggested that a single intra-articular injection of autologous platelets resulted in significant improvements at 12 weeks in dogs with osteoarthritis involving a single joint. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) management remains a great challenge and there is considerable effort to understand its pathophysiology and to identify new therapeutic targets and biomarkers. Canine OA surgically induced by the transection of the anterior cruciate ligament (ACLT) is a widely used and relevant model. This study reports a proteome mapping of dog serum and an analysis of the differentially expressed proteins between before and after ACLT. In the first part of the study, 261 picked protein spots were identified from preparative 2D gels and 71 different proteins were identified among the 261 spots present on the reference map. Canine serum proteome mapping reveals the presence of proteins of interest, such as fetuin B, complement C3 and Cl s and pregnancy zone protein. The comparison between serum from dogs before and after ACLT reveals the differential expression of several proteins that could play a key role in the pathogenesis of OA. A number of proteins, such as fetuin B and complement C3, were increased in dog OA serum whereas others, such as hyaluronan binding protein 2, inter-alpha-trypsin inhibitor H4 (ITIH4), complement Cls and C4 and haptoglobin were decreased. Some of these proteins could be candidate biomarkers for diagnosis, prognosis and treatment evaluation. The results of the study also reinforced the similarities between dog experimental OA and human cases of OA. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the efficacy of mavacoxib, a cox-2 inhibitor, to improve the peak vertical force (PVF) and vertical impulse (VI) of lame clientowned dogs with severe coxofemoral osteoarthrosis (OA) by using a force platform. A group of ten canarian presa dogs with lameness and pain for a severe osteoarthrosis due to hip dysplasia were used for this study. Five additional sound dogs of the same breed were used as control groups. A single force platform used to register vertical forces was mounted in a 7 m runway. Mean (± SD) values for speed of dogs were 1.6±0.5 m/s. Data corresponding with 5 valid trials were recorded at walk at day 0, 7, 60 and 180 after starting treatment procedure. The dosing regimen consisted of a loading oral dose of 2 mg/kg to be repeated after 14 days, thereafter the dosing interval was 1 month. OA dogs showed a significant improvement of PVF after two months of about 7% bm in the force exerted by diseased limbs and a significant VI improvement after two months of about 1.6% bm in the VI exerted by diseased limbs. This study clearly showed that dogs treated with mavacoxib increased PVF over time, as soon as seven days after medical therapy, demonstrating a high potential for clinical use in the treatment of lameness associated with OA of hip joint. [ABSTRACT FROM AUTHOR]

Elbow dysplasia is a common debilitating condition of large and giant breed dogs. Environmental factors and a complex genetic heritability play a role in predisposing dogs to elbow dysplasia with two aetiopathogeneses suggested for the development of the disease. Osteochondrosis was initially thought to cause elbow dysplasia, but more recent evidence has strongly supported various forms of joint incongruity as the most likely cause in most cases. Radioulnar length discrepancies and humeroulnar curvature mismatch have been implicated as the cause of medial coronoid disease and ununited anconeal process, but radial incisure incongruity and biceps/brachialis muscle forces could possibly play a role in some dogs. Treatment of elbow dysplasia should address articular pathology, such as fragmented coronoid process, osteochondrosis, cartilage damage and ununited anconeal process as well as any identified underlying causes. Finally, several palliative procedures have been developed to address more advanced elbow disease and might offer improved outcomes compared to conventional medical management. [ABSTRACT FROM AUTHOR]

In this study the effects of pulsed electromagnetic field (PEMF) on pain relief and functional capacity of dogs with osteoarthritis (OA) were investigated, and compared with firocoxib. Patients were randomly assigned to two groups: twentyfive client-owned dogs were treated with PEMF once a day for 20 sessions, and fifteen dogs (control group) were treated with 5 mg/kg of firocoxib once daily for 20 days. Blinded clinical examination and owner's assessment were recorded before and after the therapy, as well as 4 and 12 months later. Data collections were statistically compared before and after treatments and between groups. Both groups showed decreased clinical signs of OA during the treatment. Compared with baseline, these improvements were statistically significant (P<0.01) during the therapies. Differences were recorded during observation time spans following the end of treatments. In the PEMF group the effects were sustained until the end of the study, whereas in the control group the progress tended to return to baseline values after the end of therapy. The beneficial effects of PEMF on pain relief and functional capacity make it a potential treatment modality for canine osteoarthritis compared to traditional pharmacological therapy, in absence of adverse effects and in favour of the quality of life. [ABSTRACT FROM AUTHOR]

The article focuses on a study which aims at comparing the radiographic osteoarthritis scores in dogs with less than and greater than 24 months of undergoing tibial plateau leveling osteotomy (TPLO). In the study, t-tests and regression analysis was used to analyze the radiographic osteoarthritis scores were determined in 60 dogs that underwent TPLO. It reveals progression of osteoarthritis over time following TPLO surgery.

A three-year-old intact female Great Pyrenees underwent total knee replacement for the treatment of osteoarthritis. The dog contracted septic arthritis 10 weeks following the procedure. Treatments including implant subtraction, debridement of tissue, and insertion of bone cement with antibiotics into the joint space were completed in the joint cavity. A temporary external skeletal fixator was used to stabilise the joint for four weeks. A second attempt at total knee replacement failed due to severe muscle contracture and bone loss. Therefore, it was decided to perform arthrodesis as a salvage procedure. At the 17 month follow-up examination, the patient was able to use the limb while standing and at all gait speeds. Based on these findings, two-stage arthrodesis can be a viable salvage procedure for infected total knee replacements. [ABSTRACT FROM AUTHOR]

Coxofemoral joint affections were recorded in 575 dogs of different breed, age and sex during the period from 2007 to 2010. Amongst that, hip dysplasia accounted for 54%, osteoarthritis 28% and fracture luxation 18%. The incidence of hip dysplacia in susceptible breeds less than one year of age was 64% and majority of them were in the age group of 4 to 8 months (71%). Labrador retriever was found to be the most prone breed (43%) for hip dysplasia. While osteoarthritis was highest in German shepherd dogs (30%) with highest incidence in more above four years old dogs (82%). Fracture luxation was found to be common in less than one year of age dogs (51%) and Labrador retriever (23%) was the most affected breed. The age wise distribution of coxofemoral joint affection was 45% in less than 1 year old dogs because of the active period of growth, 19% in 1 to 4 year of adult dogs and 36% in more than 4 year old dogs. Among sex both the populations were equally affected. [ABSTRACT FROM AUTHOR]

The article reports that University of Bristol researchers are considering recruiting additional dogs to a research about canine osteoarthritis (OA) and improvement of the treatment of pain for dogs with the condition.

Osteoarthritis (OA) can be either primary (caused by wear and tear or age-related disease) or secondary (caused by injury to the joint). Secondary OA is very common in dogs and is generally the result of elbow or hip dysplasia, osteochondrosis, or cranial cruciate ligament injury, all of which lead to instability or abnormal loading of the affected joint and ultimately loss of cartilage and bone spur formation in the affected joint. This article discusses the diagnosis and management of OA in dogs. [ABSTRACT FROM PUBLISHER]

An abstract of the article "Acute and chronic effects of tepoxalin on kidney function in dogs with chronic diseases and osteoarthritis," by Amy L. Lomas and colleagues.