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Knee and hip osteoarthritis (OA) are highly prevalent joint diseases that lead to chronic pain, disability, and increased mortality. In this review, we provide a summary of nonsurgical treatments available for knee and hip OA that have evidence to support their use. We also provide a summary of the treatments available for knee and hip OA that do not have sufficient evidence to support their use. Treatments covered in this review include pharmacologic and nonpharmacologic modalities. [ABSTRACT FROM AUTHOR]

Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis (OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST) study. Participants completed a 20-m walk test wearing sensors on their trunk and ankles. Parameters describing spatiotemporal features of gait and symmetry, variability and complexity were extracted. We used an ensemble ML technique ("super learning") to identify gait variables in our cross-sectional data associated with the presence/absence of unilateral knee pain. We then used logistic regression to determine the association of selected gait variables with odds of mild knee pain. Of 2066 participants (mean age 63.6 [SD: 10.4] years, 56% female), 21.3% had mild unilateral pain while walking. Gait parameters selected in the ML process as influential included step regularity, sample entropy, gait speed, and amplitude dominant frequency, among others. In adjusted cross-sectional analyses, lower levels of step regularity (i.e., greater gait variability) and lower sample entropy(i.e., lower gait complexity) were associated with increased likelihood of unilateral mild pain while walking [aOR 0.80 (0.64–1.00) and aOR 0.79 (0.66–0.95), respectively]. [ABSTRACT FROM AUTHOR]

An editorial is presented on reexamining remission definitions in rheumatoid arthritis while considering the twenty-eight–joint disease activity score, c-reactive protein level, and patient global assessment. Topics include definitions performed best in predicting long-term good function and lack of radiographic progression; and committee endorsed a stringent definition using measures from the validated core set of outcome measures.

Objectives: It remains difficult to characterize the source of pain in knee joints either using radiographs or magnetic resonance imaging (MRI). We sought to determine if advanced machine learning methods such as deep neural networks could distinguish knees with pain from those without it and identify the structural features that are associated with knee pain.Methods: We constructed a convolutional Siamese network to associate MRI scans obtained on subjects from the Osteoarthritis Initiative (OAI) with frequent unilateral knee pain comparing the knee with frequent pain to the contralateral knee without pain. The Siamese network architecture enabled pairwise learning of information from two-dimensional (2D) sagittal intermediate-weighted turbo spin echo slices obtained from similar locations on both knees. Class activation mapping (CAM) was utilized to create saliency maps, which highlighted the regions most associated with knee pain. The MRI scans and the CAMs of each subject were reviewed by an expert radiologist to identify the presence of abnormalities within the model-predicted regions of high association.Results: Using 10-fold cross-validation, our model achieved an area under curve (AUC) value of 0.808. When individuals whose knee WOMAC pain scores were not discordant were excluded, model performance increased to 0.853. The radiologist review revealed that about 86% of the cases that were predicted correctly had effusion-synovitis within the regions that were most associated with pain.Conclusions: This study demonstrates a proof of principle that deep learning can be applied to assess knee pain from MRI scans.Key Points: • Our article is the first to leverage a deep learning framework to associate MR images of the knee with knee pain. • We developed a convolutional Siamese network that had the ability to fuse information from multiple two-dimensional (2D) MRI slices from the knee with pain and the contralateral knee of the same individual without pain to predict unilateral knee pain. • Our model achieved an area under curve (AUC) value of 0.808. When individuals who had WOMAC pain scores that were not discordant for knees (pain discordance < 3) were excluded, model performance increased to 0.853. [ABSTRACT FROM AUTHOR]

Importance: Individually calibrated biomechanical footwear therapy may improve pain and physical function in people with symptomatic knee osteoarthritis, but the benefits of this therapy are unclear.Objective: To assess the effect of a biomechanical footwear therapy vs control footwear over 24 weeks of follow-up.Design, Setting, and Participants: Randomized clinical trial conducted at a Swiss university hospital. Participants (N = 220) with symptomatic, radiologically confirmed knee osteoarthritis were recruited between April 20, 2015, and January 10, 2017. The last participant visit occurred on August 15, 2017.Interventions: Participants were randomized to biomechanical footwear involving shoes with individually adjustable external convex pods attached to the outsole (n = 111) or to control footwear (n = 109) that had visible outsole pods that were not adjustable and did not create a convex walking surface.Main Outcomes and Measures: The primary outcome was knee pain at 24 weeks of follow-up assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore standardized to range from 0 (no symptoms) to 10 (extreme symptoms). The secondary outcomes included WOMAC physical function and stiffness subscores and the WOMAC global score, all ranging from 0 (no symptoms) to 10 (extreme symptoms) at 24 weeks of follow-up, and serious adverse events.Results: Among the 220 randomized participants (mean age, 65.2 years [SD, 9.3 years]; 104 women [47.3%]), 219 received the allocated treatment and 213 (96.8%) completed follow-up. At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, -1.3 [95% CI, -1.8 to -0.9]; P < .001). The results were consistent for WOMAC physical function subscore (between-group difference, -1.1 [95% CI, -1.5 to -0.7]), WOMAC stiffness subscore (between-group difference, -1.4 [95% CI, -1.9 to -0.9]), and WOMAC global score (between-group difference, -1.2 [95% CI, -1.6 to -0.8]) at 24 weeks of follow-up. Three serious adverse events occurred in the biomechanical footwear group compared with 9 in the control footwear group (2.7% vs 8.3%, respectively); none were related to treatment.Conclusions and Relevance: Among participants with knee pain from osteoarthritis, use of biomechanical footwear compared with control footwear resulted in an improvement in pain at 24 weeks of follow-up that was statistically significant but of uncertain clinical importance. Further research would be needed to assess long-term efficacy and safety, as well as replication, before reaching conclusions about the clinical value of this device.Trial Registration: ClinicalTrials.gov Identifier: NCT02363712. [ABSTRACT FROM AUTHOR]

Objective: Lateral wedge shoe insoles decrease medial knee loading, but trials have shown no effect on pain in medial knee osteoarthritis (OA). However, loading effects of insoles are inconsistent, and they can increase patellofemoral loading. We undertook this study to investigate the hypothesis that insoles would reduce pain in preselected patients. Methods: Among patients with painful medial knee OA, we excluded those with patellofemoral OA and those with a pain rating of <4 of a possible 10. We further excluded participants who, in a gait analysis using lateral wedges, did not show at least a 2% reduction in knee adduction moment (KAM), compared to wearing their shoes and a neutral insole. We then randomized subjects to lateral wedge versus neutral insole for 8‐week periods, separated by an 8‐week washout. The primary outcome measure was knee pain (0–10 scale) during the past week, and secondary outcome measures included activity pain and pain rated in the Knee Injury and Osteoarthritis Outcome Score questionnaire. We carried out mixed model analyses adjusted for baseline pain. Results: Of 83 participants, 21 (25.3%) were excluded from analysis because of insufficient reduction in KAM. In the 62 patients included in analysis, the mean ± SD age was 64.2 ± 9.1 years, and 37.1% were women. Lateral wedge insoles produced a greater reduction in knee pain than neutral insoles (mean difference of 0.7 on 0–10 scale [95% confidence interval 0.1, 1.2]) (P = 0.02). Findings for secondary outcome measures were mixed. Conclusion: In participants prescreened to eliminate those with patellofemoral OA and biomechanical nonresponders, lateral wedge insoles reduced knee pain, but the effect of treatment was small and is likely of clinical significance in only a minority of patients. Targeting patients may identify those who respond to this treatment. [ABSTRACT FROM AUTHOR]

Objectives: To determine meniscal extrusion and cartilage coverage on magnetic resonance (MR) images and factors associated with these parameters in knees of middle-aged and elderly persons free from radiographic tibiofemoral osteoarthritis (OA).Methods: Seven hundred eighteen persons, free of radiographic tibiofemoral OA, aged 50-90 years from Framingham, MA, USA, were included. We measured meniscal extrusion on 1.5 T MRI of both knees to evaluate both medial and lateral meniscal body extrusion and cartilage coverage. We also determined meniscal morphology and structural integrity. The multivariable association with age, body mass index (BMI), and ipsilateral meniscal damage was also evaluated.Results: The mean meniscal body extrusion medially was 2.7 mm and laterally 1.8 mm. The tibial cartilage coverage was about 30% of ipsilateral cartilage surface (both compartments). The presence of ipsilateral meniscal damage was associated with more extrusion in only the medial compartment, 1.0 mm in men and 0.6 mm in women, and less cartilage coverage proportion, -5.5% in men and -4.6% in women.Conclusions: Mean medial meniscal body extrusion in middle-aged or older persons without radiographic tibiofemoral OA approximates the commonly used cutoff (3 mm) to denote pathological extrusion. Medial meniscal damage is a factor associated with medial meniscal body extrusion and less cartilage coverage.Key Points: • Medial meniscal extrusion in middle-aged/older persons without OA is around 3 mm. • Lateral meniscal extrusion in middle-aged/older persons without OA is around 2 mm. • Meniscal damage is associated with medial meniscal extrusion and less cartilage coverage. [ABSTRACT FROM AUTHOR]

Objective: Obesity, defined by anthropometric measures, is a well‐known risk factor for knee osteoarthritis (OA), but there is a relative paucity of data regarding the association of body composition (fat and muscle mass) with risk of knee OA. We undertook this study to examine the longitudinal association of body composition categories based on fat and muscle mass with risk of incident knee OA. Methods: We included participants from the Multicenter Osteoarthritis Study, a longitudinal cohort of individuals with or at risk of knee OA. Based on body composition (i.e., fat and muscle mass) from whole‐body dual x‐ray absorptiometry, subjects were categorized as obese nonsarcopenic (obese), sarcopenic obese, sarcopenic nonobese (sarcopenic), or nonsarcopenic nonobese (the referent category). We examined the relationship of baseline body composition categories with the risk of incident radiographic OA at 60 months using binomial regression with robust variance estimation, adjusting for potential confounders. Results: Among 1,653 subjects without radiographic knee OA at baseline, significantly increased risk of incident radiographic knee OA was found among obese women (relative risk [RR] 2.29 [95% confidence interval {95% CI} 1.64–3.20]), obese men (RR 1.73 [95% CI 1.08–2.78]), and sarcopenic obese women (RR 2.09 [95% CI 1.17–3.73]), but not among sarcopenic obese men (RR 1.74 [95% CI 0.68–4.46]). Sarcopenia was not associated with risk of knee OA (for women, RR 0.96 [95% CI 0.62–1.49]; for men, RR 0.66 [95% CI 0.34–1.30]). Conclusion: In this large longitudinal cohort, we found body composition–based obesity and sarcopenic obesity, but not sarcopenia, to be associated with risk of knee OA. Weight loss strategies for knee OA should focus on obesity and sarcopenic obesity. [ABSTRACT FROM AUTHOR]

At a time when advancing understanding of osteoarthritis (OA) has created opportunities for new treatments, development of treatments has remained considerably behind advances in other rheumatic diseases. We describe elements of trial design and measurements that have inhibited success and offer suggestions that may help break the log jam. Among the problems with trials that include pain as an outcome measure are reliance on a single, non‐optimal pain outcome, overestimation of likely effects of treatments on pain, and failure to identify patient subgroups most likely to respond to specific treatments. With regard to the use of structure modification as an outcome measure, demonstrating structure modification is often highly challenging, even with the use of magnetic resonance imaging. Many OA patients have advanced disease that is unlikely to respond to treatments that prevent cartilage loss. Further, prevention of cartilage loss and reduction of pain correlate weakly at best, and in at least some patients, reduction in pain may actually increase joint damage, making it impossible to demonstrate dual treatment effects on structure and pain in such scenarios. For structure outcomes, treatment effects on pain‐sensitive structures such as bone and synovium may be more achievable than preventing cartilage loss. We suggest that changes in trial design related to some of these issues may increase the chances that new exciting and effective OA treatments will become available. [ABSTRACT FROM AUTHOR]

Objective: National estimates of arthritis prevalence rely on a single survey question about doctor‐diagnosed arthritis without using survey information on joint symptoms, even though some subjects with only the latter have been shown to have arthritis. The sensitivity of the current surveillance definition is only 53% and 69% in subjects ages 45–64 years and ages ≥65 years, respectively, resulting in misclassification of nearly one‐half and one‐third of subjects in those age groups. This study was undertaken to estimate arthritis prevalence based on an expansive surveillance definition that is adjusted for the measurement errors in the current definition. Methods: Using the 2015 National Health Interview Survey, we developed a Bayesian multinomial latent class model for arthritis surveillance based on doctor‐diagnosed arthritis, joint symptoms, and whether symptom duration exceeded 3 months. Results: Of 33,672 participants, 19.3% of men and 16.7% of women ages 18–64 years and 15.7% of men and 13.5% of women ages ≥65 years affirmed joint symptoms without doctor‐diagnosed arthritis. The measurement error–adjusted prevalence of arthritis was 29.9% (95% Bayesian probability interval [95% PI] 23.4–42.3) in men ages 18–64 years, 31.2% (95% PI 25.8–44.1) in women ages 18–64 years, 55.8% (95% PI 49.9–70.4) in men ages ≥65 years, and 68.7% (95% PI 62.1–79.9) in women ages ≥65 years. Arthritis affected 91.2 million adults (of 247.7 million; 36.8%) in the US in 2015, which included 61.1 million persons between 18 and 64 years of age (of 199.9 million; 30.6%). Our arthritis prevalence estimate was 68% higher than the previously reported national estimate. Conclusion: Arthritis prevalence in the US population has been substantially underestimated, especially among adults younger than 65 years of age. [ABSTRACT FROM AUTHOR]

Objective To examine trends in rheumatoid arthritis (RA) as an underlying cause of death (UCD) in 31 countries across the world from 1987 to 2011. Methods Data on mortality and population were collected from the World Health Organization mortality database and from the United Nations Population Prospects database. Age-standardized mortality rates (ASMRs) were calculated by means of direct standardization. We applied joinpoint regression analysis to identify trends. Between-country disparities were examined using between-country variance and the Gini coefficient. Due to low numbers of deaths, we smoothed the ASMRs using a 3-year moving average. Changes in the number of RA deaths between 1987 and 2011 were decomposed using 2 counterfactual scenarios. Results The absolute number of deaths with RA registered as the UCD decreased from 9,281 (0.12% of all-cause deaths) in 1987 to 8,428 (0.09% of all-cause deaths) in 2011. The mean ASMR decreased from 7.1 million person-years in 1987-1989 to 3.7 million person-years in 2009-2011 (48.2% reduction). A reduction of ≥25% in the ASMR occurred in 21 countries, while a corresponding increase was observed in 3 countries. There was a persistent reduction in RA mortality, and on average, the ASMR declined by 3.0% per year. The absolute and relative between-country disparities decreased during the study period. Conclusion The rates of mortality attributable to RA have declined globally. However, we observed substantial between-country disparities in RA mortality, although these disparities decreased over time. Population aging combined with a decline in RA mortality may lead to an increase in the economic burden of disease that should be taken into consideration in policy-making. [ABSTRACT FROM AUTHOR]

Objective Many persons with knee pain have joint pain outside the knee, but despite the impact and high frequency of this pain, its distribution and causes have not been studied. We undertook this study to test the hypothesis of those studying gait abnormalities who have suggested that knee pain causes pain in adjacent joints but that pain adaptation strategies are highly individualized. Methods We studied persons ages 50-79 years with or at high risk of knee osteoarthritis who were recruited from 2 community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, and we followed them up for 5-7 years. We excluded those with knee pain at baseline and compared those who had developed knee pain at the first follow-up examination (the index visit) with those who had not. We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint-specific pain adjusted for age, sex, body mass index, and symptoms of depression, and we performed sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, 693 persons had knee pain at the index visit and 2,793 did not. A total of 79.6% of those with bilateral knee pain and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee, compared with 49.9% of those without knee pain. There was an increased risk of pain at most extremity joint sites, without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusion Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. [ABSTRACT FROM AUTHOR]

Objective To examine neuromuscular factors that predict the incidence and progression of knee instability symptoms in older adults with or at high risk of knee osteoarthritis (OA). Methods At the 60-month clinic visit, participants in the Multicenter Osteoarthritis Study underwent evaluation of quantitative vibratory sense at the knee and isokinetic quadriceps muscle strength. At this 60-month visit, participants were also asked about knee buckling and sensations of knee shifting or slipping without buckling in the past 3 months and then were asked the same questions at the 72- and 84-month follow-up visits. We performed a person-based analysis using Poisson regression analysis with robust error variance to estimate adjusted relative risks (RRs) for the association of vibratory sense and muscle strength with the incidence and worsening of knee slipping/shifting, buckling, and overall knee instability symptoms (either buckling or knee shifting/slipping), with adjustment for relevant confounders. Results A total of 1,803 participants (61% women) were included. Approximately one-third of the participants reported incident or worsening of instability symptoms over the study period. After adjustment for relevant confounders, better vibratory acuity (adjusted RR 0.78, 95% confidence interval [95% CI] 0.56-1.09), P = 0.020 for trend) and greater quadriceps strength (adjusted RR 0.53, 95% CI 0.38-0.75, P < 0.001) protected against incident knee instability symptoms. Greater quadriceps strength (adjusted RR 0.73, 95% CI 0.58-0.92, P = 0.008) also protected against worsening of knee instability symptoms. Conclusion Vibratory acuity and quadriceps muscle strength are important predictors of the incidence and worsening of knee instability over 2 years. These neuromuscular factors are potentially modifiable and should be considered in interventional studies of instability in persons with or at risk of knee OA. [ABSTRACT FROM AUTHOR]

Objective. There are unique challenges to designing and carrying out high-quality trials testing therapeutic devices in OA and other rheumatic diseases. Such challenges include determining the mechanisms of action of the device and the appropriate sham. Design of device trials is more challenging than that of placebo-controlled drug trials. Our aim was to develop recommendations for designing device trials. Methods. An Arthritis Research UK study group comprised of 30 rheumatologists, physiotherapists, podiatrists, engineers, orthopaedists, trialists and patients, including many who have carried out device trials, met and (using a Delphi-styled approach) came to consensus on recommendations for device trials. Results. Challenges unique to device trials include defining the mechanism of action of the device and, therefore, the appropriate sham that provides a placebo effect without duplicating the action of the active device. Should there be no clear-cut mechanism of action, a three-arm trial including a no-treatment arm and one with presumed sham action was recommended. For individualized devices, generalizable indications and standardization of the devices are needed so that treatments can be generalized. Conclusion. A consensus set of recommendations for device trials was developed, providing a basis for improved trial design, and hopefully improvement in the number of effective therapeutic devices for rheumatic diseases. [ABSTRACT FROM AUTHOR]

Objective To identify patterns of coexisting lesions seen on magnetic resonance imaging (MRI) in knees that are free of radiographic osteoarthritis (OA) and to examine the relationship of these MRI-detected lesions to incident OA. Methods Study subjects were individuals enrolled in the Multicenter Osteoarthritis Study, a prospective cohort study. In each subject, 1 knee in which radiographic OA was absent in both the tibiofemoral and patellofemoral joints at baseline was selected for study, with followup for 84 months. We used a novel approach, latent class analysis, to group the constellation of MRI lesions in each joint, i.e., cartilage damage, bone marrow lesion, meniscal tear, meniscal extrusion, synovitis, and effusion, into a manageable number of subgroups. The association of these subgroups with incident radiographic OA in the same joint was assessed using logistic regression. Results Among 885 eligible knees (203 with incident disease in the tibiofemoral joint, 64 with incident disease in the patellofemoral joint), 4 latent subgroups in the tibiofemoral joint were identified (described briefly as minimal lesions, mild lesions, moderate lesions [but limited meniscal lesions], and severe lesions). The odds ratios of incident tibiofemoral joint OA in the latter 3 subgroups (compared to the knees with minimal lesions as the referent) were 5.6, 1.8, and 5.0, respectively. A similar set of 4 subgroups in the patellofemoral joint was identified, except that the fourth subgroup had limited meniscal lesions. The odds ratios of incident disease in the patellofemoral joint were 3.8, 5.1, and 13.7 in the subgroups with mild lesions, moderate lesions, and severe lesions, respectively. Conclusion Different patterns of coexisting MRI lesions, which have different implications with regard to risk of knee OA, were identified. Meniscal damage seemed to play a different role in the development of incident disease in tibiofemoral versus patellofemoral joints. [ABSTRACT FROM AUTHOR]

Background. Knee osteoarthritis (OA) and frailty are two conditions that are associated with functional limitation and disability in elders, yet their relation to one another is not known. Methods. We included participants from two large, multicenter studies enriched with community dwelling older adults with knee OA (Multicenter Osteoarthritis Study and Osteoarthritis Initiative). Knee OA was defined radiographically (ROA) and symptomatically (SOA). Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 of the following: (i) weight loss >5% between two consecutive visits; (ii) inability to arise from chair five times without support; (iii) poor energy. Cross-sectional and longitudinal associations of knee OA with prevalent and incident frailty, respectively, were examined using binomial regression with robust variance estimation, adjusting for potential confounders. Results. In the cross-sectional analyses, frailty was more prevalent among participants with ROA (4.39% vs 2.77%; PR 1.60 [1.07, 2.39]) and SOA (5.88% vs 2.79%; PR 1.92 [1. 35, 2.74]) compared with those without ROA or SOA, respectively. In the longitudinal analyses, risk of developing frailty was greater among those with ROA (4.73% vs 2.50%; RR 1.45 [0.91, 2.30]) and SOA (6.30% vs 2.83%; RR 1.66 [1.11, 2.48]) than those without ROA or SOA, respectively. Conclusions. Knee OA is associated with greater prevalence and risk of developing frailty. Understanding the mechanisms linking these two common conditions of older adults would aid in identifying novel targets for treatment or prevention of frailty. [ABSTRACT FROM PUBLISHER]

Objective To study the effect of valgus malalignment on knee osteoarthritis (OA) incidence and progression. Methods We measured the mechanical axis from long limb radiographs from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) to define limbs with valgus malalignment (mechanical axis of ≥1.1° valgus) and examined the effect of valgus alignment versus neutral alignment (neither varus nor valgus) on OA structural outcomes. Posteroanterior radiographs and knee magnetic resonance (MR) images were obtained at the time of the long limb radiograph and at followup examinations. Lateral progression was defined as an increase in joint space narrowing (on a semiquantitative scale) in knees with OA, and incidence was defined as new lateral narrowing in knees without radiographic OA. We defined lateral cartilage damage and progressive meniscal damage as increases in cartilage or meniscus scores at followup on the Whole-Organ Magnetic Resonance Imaging Score scale (for the MOST) or the Boston Leeds Osteoarthritis Knee Score scale (for the OAI). We used logistic regression with adjustment for age, sex, body mass index, and Kellgren/Lawrence grade, as well as generalized estimating equations, to evaluate the effect of valgus alignment versus neutral alignment on disease outcomes. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs). Results We studied 5,053 knees (881 valgus) of subjects in the MOST cohort and 5,953 knees (1,358 valgus) of subjects in the OAI cohort. In both studies, all strata of valgus malalignment, including 1.1° to 3° valgus, were associated with an increased risk of lateral disease progression. In knees without radiographic OA, valgus alignment >3° was associated with incidence (e.g., in the MOST, adjusted OR 2.5 [95% CI 1.0-5.9]). Valgus alignment >3° was also associated with cartilage damage on MR imaging in knees without OA (e.g., in the OAI, adjusted OR 5.9 [95% CI 1.1-30.3]).We found a strong relationship of valgus malalignment with progressive lateral meniscal damage. Conclusion Valgus malalignment increases the risk of knee OA radiographic progression and incidence as well as the risk of lateral cartilage damage. It may cause these effects, in part, by increasing the risk of meniscal damage. [ABSTRACT FROM AUTHOR]

Background. The majority of interventions for knee osteoarthritis aim to reduce knee pain with the assumption that improvements in function will automatically follow. However, this assumption is not universally true, and a paradoxical decline in function is not uncommon following reduction in knee pain. Objective. The purpose of this study was to examine what factors beyond knee pain are important for functional decline among people with reductions in knee pain. Design. This was an observational cohort study. Methods. The Multicenter Osteoarthritis Study (MOST) is a National Institutes of Health-funded longitudinal study of people who have or are at high risk for knee osteoarthritis. This study included individuals who had a meaningful reduction in pain in either knee over 30 months, defined as a 41% decrease in visual analog scale pain score with an absolute decrease of ≥20/100. Meaningful decline in walking speed was defined as a decrease of 0.1 m/s during a 20-m walk. To examine the association of risk factors with meaningful decline in walking speed, risk ratios were calculated and adjusted for potential confounders. Results. Of the 465 people with a meaningful reduction in knee pain (mean [SD] age-63.3 [7.8] years, 67% female, 82% Caucasian, mean [SD] body mass index-31.3 [6.3] kg/m2), 20% had a meaningful decline in walking speed. Adjusting for confounders, participants with new comorbidity and those with widespread pain had 1.8 and 1.7 times the risk of decline compared with their counterparts with no comorbidity or widespread pain (adjusted risk ratio=1.8 [95% confidence interval1.1-3.0] and 1.7 [95% confidence interval=1.1-2.8], respectively). Limitations. Generalizability is limited to people with a reduction in knee pain. Conclusions. Reductions in knee pain are not always accompanied by improvements in walking speed. Health providers should consider that the onset of new comorbidity and presence of widespread pain may increase the risk of functional decline despite a reduction in knee pain. [ABSTRACT FROM AUTHOR]

The detection of knee osteoarthritis (OA) is a subjective task, and even two highly experienced and well-trained readers might not always agree on a specific case. This problem is noticeable in OA population studies, in which different scoring projects provide significantly different scores for the same knee X-rays. Here we propose a method for quantitative assessment and comparison of knee X-ray scoring projects in OA population studies. The method works by applying an image analysis method that automatically detects OA in knee X-ray images, and comparing the consistency of the scores when using each of the scoring projects as "gold standard." The method was applied to compare the osteoarthritis initiative (OAI) clinic reading derived Kellgren and Lawrence (K&L) scores to central reading, and showed that when using the derived K&L scores the automatic image analysis method was able to accurately differentiate between healthy joints and moderate OA joints in ~70% of the cases. When the OAI central reading scores were used as gold standard, the detection accuracy was elevated to ~77%. These results show that the OAI central readings scores are more consistent with the X-rays, indicating that the central reading better reflects the radiographic features associated with OA, compared to the OAI K&L scores derived from clinic readings. [ABSTRACT FROM AUTHOR]

The article presents an interview with Dr. David T. Felson, professor of Medicine and Public Health and principal investigator of the Multidiscplinary Clinical Research Center at Boston University. He explores the issues and opportunities that exist for women who have arthritis. He comments on the sex-based differences across the spectrum of arthritis conditions, factors affecting the onset and progression of arthritis, and the use of alternative approaches to reduce joint pain.

The article discusses a study on the prevalence of and number of individuals affected by arthritis and other rheumatic conditions in the U.S. The study used the National Health Interview Survey (NHIS) for the analysis of overall arthritis. The best available prevalence estimates were applied to the corresponding 2005 U.S. population estimates from the Census Bureau to estimate the number affected with each condition. The study found that more than 21% of adults in the U.S. have self-reported doctor-diagnosed arthritis.

The article discusses a study on the prevalence of arthritis and other rheumatic conditions in the U.S. The study derived prevalence estimates from published studies of smaller, defined populations. The best available prevalence estimates, for specific conditions, were applied to the corresponding 2005 U.S. population estimates from the Census Bureau to estimate the number affected with each condition. The study found that among U.S. adults, nearly 27 million have clinical osteoarthritis and 711,000 have polymyalgia rheumatica.

Background: Knee buckling is common in persons with advanced knee osteoarthritis and after orthopedic procedures. Its prevalence in the community is unknown. Objective: To examine the prevalence of knee buckling in the community, its associated risk factors, and its relation to functional limitation. Design: Cross-sectional, population-based study. Setting: The Framingham Osteoarthritis Study. Participants: 2351 men and women age 36 to 94 years (median, 63.5 years). Measurements: Participants were asked whether they had experienced knee buckling or ‘giving way’ and whether it led to falling. They were also asked about knee pain and limitations in function by using the Short Form-12 and Western Ontario and McMaster Universities Osteoarthritis Index, had isometric tests of quadriceps strength, and underwent weight-bearing radiography and magnetic resonance imaging of the knee. Radiographs were scored for osteoarthritis by using the Kellgren—Lawrence scale, and magnetic resonance images were read for anterior cruciate ligament tears. The relationship of buckling to functional limitation was examined by using logistic regression that adjusted for age, sex, body mass index, and knee pain severity. Results: Two hundred seventy-eight participants (11.8%) experienced at least 1 episode of knee buckling within the past 3 months; of these persons, 217 (78.1%) experienced more than 1 episode and 35 (12.6%) fell during an episode. Buckling was independently associated with the presence of knee pain and with quadriceps weakness. Over half of those with buckling had no osteoarthritis on radiography. Persons with knee buckling had worse physical function than those without buckling, even after adjustment for severity of knee pain and weakness. For example, 46.9% of participants with buckling and 21.7% of those without buckling reported limitations in their work (adjusted odds ratio, 2.0 [95% CI, 1.5 to 2.7]). Limitation: Causal inferences are limited because of the study's cross-sectional design. Conclusion: In adults, knee buckling is common and is associated with functional loss. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the association between development of knee pain and the enlargement of bone marrow lesions (BMLs). The authors asked twice the subjects with knee ostheoarthritis (OA) or at high risk of knee OA about the presence of knee pain, aching or stiffness. They used magnetic resonance imaging and multiple logistic regression to assess whether an increased BML score is predictive of the development of knee pain.

The authors reflect on the futility of current approaches to chondroprotection. They argue that in vivo chondroprotection will likely be disappointing even in the face of real in vitro or ex vivo efficacy. They suggest that a new conceptual approach is needed before therapies that protect against structural progression in osteoarthritis can be successfully developed.

The article presents an overview of osteoarthritis, which is the most prevalent form of arthritis, with associated risk of loss of mobility, especially in people over 65 years of age who have other medical conditions. The burden to society both in terms of suffering and use of resources is expected to increase due to the prevalence of obesity and aging. Osteoarthritis is a disease of the joint, including the subchondral bone, menisci, ligaments, periarticular muscle, capsule and synovium.

To determine the relationship between back symptoms and limitations in nine specific functional activities. A cross-sectional study. This study was conducted as part of the Framingham Heart Study, a population-based study performed on a representative sample of community-living residents of Framingham, Massachusetts. Subjects consisted of 1,007 surviving members of the original cohort who participated in the 22nd Biennial Examination in 1992–93. Ages ranged from 70 to 100. Subjects were asked whether they experienced pain, aching, or stiffness in their back on most days and whether they had difficulty performing nine specific functional skills. Odds ratios (ORs) and confidence intervals are reported for the entire sample and within categories of sex. The proportion of functional limitations attributable to back symptoms and the proportion of limitations ascribed by subjects to back symptoms among subjects with these limitations are also reported. The results provide evidence of a relationship between back symptoms and functional limitations. ORs were highest for difficulty standing in one place for about 15 minutes, pushing or pulling a large object, and walking half a mile. Of those with back symptoms, 43% to 63% of limitations in activities were due to back symptoms. Among all subjects, back symptoms were so prevalent that 18% to 34% of all functional limitations were attributable to back symptoms. The association between back symptoms and functional limitations was especially strong in women. Back symptoms account for a large percentage of functional limitations in older adults, especially in women. [ABSTRACT FROM AUTHOR]

Background: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions.Objective: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment.Design: Natural history study.Setting: A Veterans Administration hospital in Boston, Massachusetts.Patients: Persons 45 years of age and older with symptomatic knee osteoarthritis.Measurements: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment.Results: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment.Conclusion: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment. [ABSTRACT FROM AUTHOR]

Determines whether bone marrow lesions on magnetic resonance imaging are associated with pain in knee osteoarthritis. Patient characteristics; Presence of large lesions in persons with painful knees; Percent of patients with bone narrow lesions who had painful knees versus persons with non-painful knees; Non-association of bone marrow lesions with pain severity.

Use of statistical methods for early stopping of clinical trials allows more efficient and ethical utilization of subjects. In uncommon diseases, where the pool of potential subjects is limited, these methods provide a way to maximize the information gathered from trials. For trials in lupus, methods for early stopping should be more widely utilized. We discuss the ethics, practical aspects, pros and cons, and statistical foundations of some established methods for early stopping, with an emphasis on those that have available implementation in computer software. An example of the design and analysis of a treatment trial in systemic lupus erythematosus with the triangular test method of early stopping is also given. [ABSTRACT FROM AUTHOR]

Presents a study which investigated thiazide diuretic use and subsequent hip fracture in postmenopausal women. Methodology; Key findings and its implications.

Focuses on a study conducted by the Framingham Heart Study using cohort analysis to determine whether obesity is the possible cause of knee osteoarthritis. Description of osteoarthritis; Difference in risks of getting osteoarthritis for both obese women and men; Observance of an association between antecedent obesity and both symptomatic and asymptomatic radiographic osteoarthritis.

Presents a study on the nutritional aspects of osteoarthritis. Correlation of osteoarthritis progression to dietary patterns and serum levels of vitamin D; Risk factors for osteoarthritis; Incidence and prevalence of the disease.

Objective: To evaluate the effect of weight loss in preventing symptomatic knee osteoarthritis in women.Design: Cohort analytic study.Setting: The Framingham Study, based on a sample of a defined population.Patients: Women who participated in the Framingham Knee Osteoarthritis Study (1983 to 1985): Sixty-four out of 796 women studied had recent-onset symptomatic knee osteoarthritis (knee symptoms plus radiographically confirmed osteoarthritis) were compared with women without disease.Measurements: Recalled date of symptom onset was used as the incident date of disease. Historical weight was defined as baseline body mass index up to 12 years before symptom onset. Change in body mass index was assessed at several intervals before the current examination. Odds ratios assessing the association between weight change and knee osteoarthritis were adjusted for age, baseline body mass index, history of previous knee injury, habitual physical activity level, occupational physical labor, smoking status, and attained education.Results: Weight change significantly affected the risk for the development of knee osteoarthritis. For example, a decrease in body mass index of 2 units or more (weight loss, approximately 5,1 kg) over the 10 years before the current examination decreased the odds for developing osteoarthritis by over 50% (odds ratio, 0.46; 95% Cl, 0.24 to 0.86; P = 0.02). Among those women with a high risk for osteoarthritis due to elevated baseline body mass index (greater than or equal to 25), weight loss also decreased the risk (for 2 units of body mass index, odds ratio, 0.41; P = 0.02). Weight gain was associated with a slightly increased risk for osteoarthritis, which was not statistically significant.Conclusion: Weight loss reduces the risk for symptomatic knee osteoarthritis in women. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition. Methods. The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 ± 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. Results. Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. Conclusions. In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases. [ABSTRACT FROM AUTHOR]

This study explores the degree to which the association of knee osteoarthritis with physical disability changes with different definitions of osteoarthritis in 1,416 Framiagham Study elders. When all categories of radiographic osteoarthritis were aggregated into a single "arthritis" variable and dependence upon human assistance one or more functional activities combined into a single variable, elders with osteoarthritis had only moderately increased odds for dependence after controlling for age or sex (OR = 1.25). A definition of osteoarthritis based only upon symptoms produced larger odds for dependency (OR = 1.85). Elders with mild osteoarthritis and infrequent knee pain had no significantly elevated risk for dependence in any of the seven functional activities. Elders with infrequently symptomatic, moderate to marked radiographic osteoarthritis were at increased risk for dependence in stair climbing, walking a mile, housekeeping, and carrying bundles. Elders with radiographic osteoarthritis accompanied by frequent pain had an increased odds of dependence in stair climbing, walking a mile and housekeeping. Using a generic definition of "arthritis" and aggregating functional activities may underestimate the impact of osteoarthritis on physical disability in the elderly and obscure the task-specific nature of that relationship. [ABSTRACT FROM AUTHOR]

The original version of this article, published on 13 February 2020, unfortunately contained a mistake. [ABSTRACT FROM AUTHOR]

This article summarises evidence on structural pathology in the joint that causes joint pain. Evidence, mostly from studies using MRI scans in persons with and without joint pain has suggested that pain often originates in bone or synovium. [ABSTRACT FROM PUBLISHER]

Editorial. Examines the impact of the synovial fluid component, hyaluronic acid, in the treatment and relief of pain and stiffness associated with osteoarthritis of the knees. Hypotheses about the mechanism of action of the fluid; Clinical trials to test the effectiveness of the fluid; Lack of data supporting the long-term effectiveness of the fluid.

The author presents his thoughts on the interpretation of various meta-analyses concerning the use of intra-articular corticosteroids in the treatment of osteoarthiritis in the knee. The article points to a particular meta-analysis by researcher P. Jüni and colleagues that the author states contradict previous meta-analyses.

As the population ages, there is a growing burden owing to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis Study cohort was developed for this purpose. In this study, associations between variability in peak knee flexor and extensor torque at baseline and worsening of pain and physical function over the subsequent 60 mos were assessed in a cohort of 2680 participants. The highest quartile of baseline knee flexor torque variability was found to be associated longitudinally with worsening pain (fourth quartile β estimate, mean ± SE, 0.49 ± 0.19; P = 0.0115; with R² = 0.28 and P for trend across quartiles = 0.0370) and physical function scores (fourth quartile β estimate, mean ± SE, 1.39 ± 0.64; P = 0.0296; with R² = 0.25 and P for trend across quartiles = 0.0371), after adjusting for baseline knee osteoarthritis and maximum knee flexor torque. There were no associations between baseline knee extensor torque and worsening pain or physical function by 60 mos. The presence of greater variability in maximum knee flexor strength may identify patients who may benefit from therapies aimed at preventing worsening knee pain and physical function. [ABSTRACT FROM AUTHOR]

Purpose To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e. a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions. Design Secondary analysis of a randomized controlled trial. Setting Academic safety net hospital and seven federally qualified community health centers. Subjects Adults with cLBP (N = 299). Methods We report patient characteristics that were predictors of response and/or modified treatment effect across three 12-week treatments: yoga, physical therapy [PT], and a self-care book. Using preselected characteristics, we used logistic regression to identify predictors of "response," defined as a ≥30% improvement in the Roland Morris Disability Questionnaire. Then, using "response" as our outcome, we identified baseline characteristics that were treatment effect modifiers by testing for statistical interaction (P  < 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT. Results Overall, 39% (116/299) of participants were responders, with more responders in the yoga-or-PT group (42%) than the self-care (23%) group. There was no difference in proportion responding to yoga (48%) vs PT (37%, odds ratio [OR] = 1.5, 95% confidence interval = 0.88 − 2.6). Predictors of response included having more than a high school education, a higher income, employment, few depressive symptoms, lower perceived stress, few work-related fear avoidance beliefs, high pain self-efficacy, and being a nonsmoker. Effect modifiers included use of pain medication and fear avoidance beliefs related to physical activity (both P  = 0.02 for interaction). When comparing yoga or PT with self-care, a greater proportion were responders among those using pain meds (OR = 5.3), which differed from those not taking pain meds (OR = 0.94) at baseline. We also found greater treatment response among those with lower (OR = 7.0), but not high (OR = 1.3), fear avoidance beliefs around physical activity. Conclusions Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes. [ABSTRACT FROM AUTHOR]

Objective: Intra‐articular (IA) calcium crystal deposition is common in knee osteoarthritis (OA), but of unclear significance. It is possible that low‐grade, crystal‐related inflammation may contribute to knee pain. We examined the longitudinal relation of computed tomography (CT)–detected IA mineralization to the development of knee pain. Methods: We used data from the National Institutes of Health–funded longitudinal Multicenter Osteoarthritis Study. Participants had knee radiographs and bilateral knee CTs at baseline, and pain assessments every 8 months for 2 years. CT images were scored using the Boston University Calcium Knee Score. We longitudinally examined the relation of CT‐detected IA mineralization to the risk of frequent knee pain (FKP), intermittent or constant knee pain worsening, and pain severity worsening using generalized linear mixed‐effects models. Results: We included 2,093 participants (mean age 61 years, 57% women, mean body mass index 28.8 kg/m2). Overall, 10.2% of knees had IA mineralization. The presence of any IA mineralization in the cartilage was associated with 2.0 times higher odds of having FKP (95% confidence interval [CI] 1.38–2.78) and 1.86 times more frequent intermittent or constant pain (95% CI 1.20–2.78), with similar results seen for the presence of any IA mineralization in the meniscus or joint capsule. A higher burden of IA mineralization anywhere within the knee was associated with a higher odds of all pain outcomes (odds ratio ranged from 2.14 to 2.21). Conclusion: CT‐detected IA mineralization was associated with risk of having more frequent, persistent, and worsening knee pain over 2 years. Targeting IA mineralization may have therapeutic potential for pain improvement in knee OA. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the authors discuss Rheumatoid Arthritis (RA), including a report by Viatte and colleagues which offers insight regarding genetic factors that increase the risk of developing RA and the association of the factors with disease severity and increased risk of mortality.