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The objectives of this study are to ascertain the determinants of quality of life (QoL) and hand function among persons with hand osteoarthritis (OA) and to assess the influence of hand function on QoL among persons with OA.Two hundred and four participants in a clinical trial completed the baseline assessment. Demographic, socioeconomic, QoL (AqoL-4D), hand function (Functional Index for Hand Osteoarthritis, FIHOA), pain assessment, radiographic and clinical characteristics of participants were measured using standard methods. Univariate and multivariate analyses were performed to evaluate potential associations.We studied 204 participants (76% female, age 65.63 ± 8.13 years, body mass index 28.7 ± 6.5 kg/mThe results indicate increasing impairment in hand function decreases the QoL of persons with hand OA. Some determinants were significantly associated with hand function and QoL. Determinants related to hand functions may be modifiable. In future, appropriate intervention strategies should be implemented, and further studies should be conducted to identify the effectiveness of those interventions.

Background Thumb osteoarthritis (OA) is a common and disabling condition. Adherence to prescribed conservative interventions may affect outcomes of thumb OA trials. Purpose The aim of the study was to determine whether baseline pain and hand function is associated with treatment adherence over 12 weeks in participants with thumb base OA. Study design Observational cohort study nested within a randomized-controlled trial. Methods Ninety-four participants from the intervention group were included in the analysis. Baseline pain and function were assessed using a 100 mm Visual Analogue Scale and the Functional Index for Hand Osteoarthritis questionnaire (0-30), respectively. Participants received a combination of treatments including education, orthosis, hand exercises, and topical anti–inflammatory gel. Adherence was measured using a daily self-reported diary. Participants were classified as non–adherent, partially adherent or fully adherent if they completed none, 1 and/or 2 or all 3 of the interventions as prescribed. Ordinal logistic regression modelling was performed. Results At 12-week follow-up, half of the participants were fully adherent to the treatments (n = 46, 48.9%), 30.9% of participants were partially adherent (n = 29) and 20.2% were non–adherent (n = 19, 20.2%). High baseline pain was a significantly associated with better adherence in the unadjusted model [OR = 3.15, 95% CI (1.18, 8.42)] and adjusted model [OR = 3.20, 95% CI (1.13, 8.20)]. Baseline function was not associated with adherence [OR = 1.03, 95% CI (0.47, 2.23)]. Conclusion High baseline pain was associated with better adherence in participants with thumb base OA. Higher baseline functional impairment was not associated with better adherence.

Summary Objective To investigate heterogeneous effects of a combination of conservative therapies compared with an education comparator for thumb base (TB) osteoarthritis (OA) according to clinically relevant characteristics. Methods Pre-planned subgroup analysis of the COMBO trial (n = 204) which compared a combination of education on self-management and ergonomic principles, a prefabricated neoprene splint, hand exercises, and diclofenac sodium gel, with education alone for radiographic and symptomatic TB OA. Primary outcomes were change in pain (visual analogue scale [VAS], 0–100 mm) and hand function (Functional Index for Hand Osteoarthritis questionnaire, 0–30) from baseline to week-6. Other outcomes were grip and tip-pinch strength and patient's global assessment (PGA) (VAS, 0–100 mm). Possible treatment effect modifiers were the presence of interphalangeal joint pain, erosive hand OA, radiographic thumb carpometacarpal joint subluxation (higher vs equal or lower than the sample mean), and baseline radiographic OA severity (Kellgren Lawrence grade). Linear regression models were fitted, adding interaction terms for each subgroup of interest. Results The treatment effects of the combined intervention at 6 weeks were greater in participants with lower joint subluxation compared with those with greater subluxation (pain −11.6 [95%CI −22.2, −9.9] and 2.6 [−5.5, 10.7], respectively, difference between the subluxation groups 14.2 units (95% CI 2.3, 26.1), p-value 0.02; and PGA −14.0 [−22.4, −5.5] and 1.5 [−6.2, 9.3), respectively, difference between the subluxation groups 15.5 units (95% CI 4.2, 26.8), p-value 0.03). There was no statistically significant heterogeneity for the other subgroups. Conclusion A combination of conservative therapies may provide greater benefits over 6 weeks in individuals with lower joint subluxation, although the clinical relevance is uncertain given the wide confidence intervals. Treatment strategies may need to be customized for those with greater joint subluxation. Trial registration number ACTRN 12616000353493.

Introduction Due to the complex shape of the carpometacarpal (CMC) joint, a fixed joint collapse deformity of the thumb CMC (CMC1) and metacarpophalangeal (MCP1) joint can present in advanced stages of CMC1 osteoarthritis (OA), resulting in adduction of the first metacarpal (MC1) and hyperextension of the MCP1. Purpose of the Study To determine whether joint collapse deformity is associated with worse pain and/or functional impairment. Study Design Cross-sectional. Methods This study used the baseline data from 140 patients enrolled in a longitudinal study of treatment for CMC1 OA. (efficacy of combined conservative therapies on clinical outcomes in patients with CMC1 OA). Joint collapse was determined at baseline using a pinch gauge. Pain was assessed on a visual analog scale (0-100) and function was assessed using the Functional Index for Hand Osteoarthritis questionnaire (0-30). Pain and function and the presence of joint collapse were entered in a univariate logistic regression. The final adjusted model for pain and joint collapse included age and sex. The final adjusted model for function and joint collapse included Kellgren Lawrence grade and grip strength. Results About 20% of participants demonstrated joint collapse on the tip-pinch test. The presence of joint collapse was associated with increased pain in the unadjusted [P = .047, OR = 2.45, 95% CI (1.01, 5.910)] and adjusted model [P = .049, OR = 2.45, 95% CI (1.00, 5.98)]. Conclusion CMC1 patients with joint collapse reported increased pain compared with those without joint collapse. Future studies should determine the relationship between thumb hypermobility and joint collapse and how to manage these conditions effectively.

To explore the person-level predictors of adherence to a step count intervention following total knee replacement (TKR).Prospective cohort study, nested within the PATHway trial.Participants who had recently undergone TKR were recruited from 3 rehabilitation hospitals in Sydney, Australia, for the main trial. Only data from participants who were randomized to the TKR intervention group were analyzed. Participants in the intervention group (n = 51) received a wearable tracker to monitor the number of steps taken per day. Step count adherence was objectively measured at 3 months as the number of steps completed divided by the number prescribed and multiplied by 100 to express adherence as a percentage. Participants were classified into 4 groups: withdrawal, low adherence (0%-79%), adherent (80%-100%), and100% adherent. Ordinal logistic regression was used to identify which factors predicted adherence to the prescribed step count.Of the 51 participants enrolled, nine (18% of 51) withdrew from the study before 3 months. Half of participants were classified as100% adherent (n = 24%, 47%). Ten were classified as low adherence (20%), and 8 participants were classified as adherent (16%). In the univariable model, lower age (OR 0.90; 95% CI 0.83-0.97), higher patient activation (OR 1.03; 95% CI 1.00-1.06), and higher technology self-efficacy (OR 1.03; 95% CI 1.00-1.06) were associated with higher adherence. After adjusting for age in the multivariable model, patient activation and technology self-efficacy were not significant.Younger age, higher patient activation, and higher technology self-efficacy were associated with higher adherence to a step count intervention following TKR in the univariable model. Patient activation and technology self-efficacy were not associated with higher adherence following adjustment for age.

To determine how physically active individuals are following total knee replacement (TKR) and how accurately they self-report their step count adherence compared to objective measure following TKR.Observational cohort study, nested within the PATHway randomised-clinical trial. Participants (n = 102) who had recently undergone TKR were recruited for the main trial. Only participant data from the intervention group were used for this study (n = 51). Participants in the intervention group received an activity tracker to monitor their physical activity and fortnightly health-coaching sessions for 3 months. Adherence was objectively measured as percentage of steps completed divided by the amount prescribed by the health coach. Participants were asked to self-report their adherence on a 1-10 numerical rating scale during health coaching sessions.Data from 44 participants were available, resulting in a total of 224 paired measurements. Participant step count increased over the first 8 weeks of follow-up, and plateaued from 8 weeks onwards at approximately 7500 steps/day. About two-thirds (65.8%) of participants accurately self-reported their step count adherence up until 12 weeks, the remaining one-third (34.2%) underestimated their adherence. Paired t-tests demonstrated statistically significant differences between the paired measurements from weeks 2 to 10.Participants were generally active and completed the step goal most occasions. Two-thirds accurately self-reported their step goal adherence. Self-reported measures should be combined with an objective measure of adherence for greater accuracy. A further understanding of how people engage with activity trackers can be used to promote behaviour change in physiotherapy-led interventions.

Objective Hand osteoarthritis (OA) trials often target exclusively the thumb base joint, although concomitant widespread interphalangeal (IP) joint involvement is frequent. We aimed to compare hand strength and function between individuals with isolated thumb base OA and those with coexistent IP joint pain and erosive OA. Methods Baseline data from a thumb base OA trial were analyzed (n = 204). Participants were age ≥40 years with symptomatic and radiographic thumb base OA. Only the index hand was included. Self-reported IP joint pain (in any proximal, distal, or thumb IP joint), hand function score (Functional Index for Hand Osteoarthritis questionnaire [range 0-30]), and hand grip and tip-pinch strength test results were obtained at baseline. Radiographs were scored for OA severity at each joint (Kellgren/Lawrence grade) and for the presence of erosive OA at the thumb base or IP joints. Multiple linear regression was used adjusting for age, sex, body mass index, and radiographic thumb base OA severity. Results Compared to individuals with isolated thumb base OA (62%), those with concomitant IP joint pain (17%) and erosive OA (21%) had significantly worse hand function (β = 1.82 [95% confidence interval (95% CI) 0.36, 3.28] and β = 1.47 [95% CI 0.74, 2.88], respectively). In addition, coexistence of erosive OA was independently associated with lower grip and tip-pinch strength (β = -5.14 [95% CI -7.58, -2.70] and β = -0.61 [95% CI -1.05, -0.17], respectively). Conclusion Concomitant IP joint pain and erosive OA are associated with worse hand function in individuals with thumb base OA. Patient stratification based on these characteristics may improve the design of future thumb base OA trials.

Adherence has been proposed as a major barrier to implementing and maintaining the benefits of osteoarthritis (OA) core treatments and is influenced by many factors. Although there are reasonable data to support factors influencing adherence to exercise/physical activity in knee/hip OA populations, there is less research examining alternative interventions, or in the hand OA population. This problem is complicated by the lack of gold-standard measurement of adherence for core osteoarthritis treatments. The predictors of treatment adherence are not well understood, and findings are contradictory. Strategies incorporating behavior change techniques should be implemented to improve and maintain long-term adherence.

We aimed to investigate the yearly online public interest for gout, low back pain, neck pain, osteoarthritis, and rheumatoid arthritis, the most popular topics searched for these conditions, and the association between the change in their interest over time and the sociodemographic index of the search location.We conducted online searches in Google Trends for the aforementioned conditions between 2004 and 2020. The search volumes for each condition (relative to all searches conducted in the period) and the top and rising related queries and topics were downloaded and summarized.There was a rise in the online interest for musculoskeletal conditions between 2008 and 2020, with low back pain (annual percent change, 7.4; 95% confidence interval [CI], 7.1-7.7) and neck pain (annual percent change, 7.2; 95% CI, 6.9-7.5) presenting the highest increases. There was a negative, statistically significant, but small association between change in online interest and the country's sociodemographic index for low back pain (-0.007; 95% CI, -0.011 to-0.003), neck pain (-0.005; 95% CI, 0.009 to -0.001), and rheumatoid arthritis (-0.009; 95% CI, -0.017 to -0.001) between 2013 and 2020. The interest for the cause and symptoms of the selected conditions increased over time, except for gout. The proportion of queries and topics related to treatment of all conditions decreased over time.The worldwide interest in musculoskeletal conditions increased between 2008 and 2020. The public seems more interested in understanding what musculoskeletal conditions are and less interested in which treatment options are available. The results can guide the development of educational campaigns for musculoskeletal conditions.

Aim To investigate the associations of ultrasound and radiographic features of thumb-base osteoarthritis (OA) with thumb-base pain and hand function at baseline and 12 weeks. Method Data from a randomized controlled trial conducted in participants with symptomatic radiographic thumb-base OA were analyzed. Participants who finished follow up were included in this secondary analysis. Pain and hand function were assessed using self-reported measures. All participants underwent ultrasound examinations for synovitis, power Doppler signal (PDS), and osteophytes, and underwent radiography for osteophytes, joint space narrowing (JSN), and subchondral bone sclerosis at baseline. Hand pain and function were reassessed after the 12-week follow up. The associations of ultrasound and radiographic findings with clinical features were further evaluated, using linear regression analyses, after adjustment for relevant confounding factors. Results A total of 166 participants (average age 66.2 years; 76.5% female) were included. At baseline, radiographic JSN and subchondral bone sclerosis were associated with hand function. There was a significant association between ultrasound-detected PDS and patient's global assessment (PGA) at baseline. Baseline radiographic JSN was significantly associated with the changes in stiffness and PGA from baseline to 12 weeks. There was no association between ultrasound features and changes in the clinical outcomes over 12 weeks. Conclusion This study indicates that radiographic features significantly correlate with hand function, and ultrasound PDS is closely related to the PGA at baseline in thumb-base OA. Radiographic JSN may be a predictor for stiffness and PGA in thumb-base OA.

AIMS: To determine: 1) inter-rater reliability of quantitative measurements of ultrasound-detected synovitis, meniscal extrusion, and osteophytes; and 2) construct (convergent) validity via correlations and absolute agreements between ultrasound- and gold-standard magnetic resonance imaging (MRI)-outcomes in knee osteoarthritis. METHODS: Dynamic ultrasound images for supra-patellar synovitis, meniscal extrusion, and osteophytes were acquired and quantified by a physician operator, musculoskeletal ultrasonographer, and medical student independently. On the same day, 3T MRI images were acquired. Effusion-synovitis, meniscal extrusion, and osteophytes were quantified on sagittal or coronal proton-density-weighted fat-suppressed noncontrast TSE sequences, respectively. Intra-class correlation coefficients (ICCs), Pearson's correlations (r), and Bland-Altman plots were used to analyze inter-rater reliability, and correlations, and agreements between the two imaging modalities. RESULTS: Eighty-nine participants [48 females (53.9%)] with mean (standard deviation) age of 61.5 ± 6.9 years were included. The inter-rater reliability was excellent for osteophytes (ICC range = 0.90-0.96), meniscal extrusion (ICC range = 0.90-0.93), and synovitis (ICC range = 0.86-0.88). The correlations between ultrasound pathologies and their MRI counterparts were very strong (ICC range = 0.85-0.98) except for lateral meniscal extrusion [0.66 (95% CI, 0.52-0.76)]. Bland-Altman plots showed 0.01, 0.05, 0.10, 0.53, and 0.60 mm larger size in ultrasound medial tibial and medial femoral osteophytes, medial meniscal extrusions, synovitis, and lateral meniscal extrusions with 95% limits of agreements [±0.39, ±0.44, ±0.85, ±0.70, and ±0.90 (SDs)] than MRI measures, respectively. The lines of equality were within 95% CI of the mean differences (bias) only for medial osteophytes and medial meniscal extrusion. CONCLUSION: The quantitative assessment of synovitis, meniscal extrusion, and osteophytes generally showed excellent inter-rater reliability and strong correlations with MRI-based measurements. Absolute agreement was strong for medial tibiofemoral pathologies.

In osteoarthritis (OA) clinical trials, reliable and responsive outcome measures to document physical and functional improvements are limited.This study aimed to assess whether the use of an activity tracker in an OA clinical trial is a responsive measurement tool. Secondary objectives assessed feasibility and validity.We recruited 65 participants in a prospective cohort study nested in a placebo-controlled clinical trial of platelet-rich plasma injection in knee OA. Participants wore an activity tracker (Fitbit Flex 2), and a smartphone was preloaded with a mobile application (OApp) designed to monitor load rates as a surrogate of knee loading. Participants used the systems for 7 days at baseline and for 7 days before the 2-month follow-up assessment. Effect size (ES) and standardised response mean (SRM) were calculated for change in step count and knee loading rate and regularly used knee OA outcome measures. Correlation coefficients (r) were calculated to examine the strength of the association between outcome measures.. Step count showed a trivial ES and SRM and mean knee loading rate measurements a moderate ES and SRM. We found a weak but significant correlation between change in mean steps per day and global improvement overall (r= 0.28) and Western Ontario and McMaster Universities Osteoarthritis Index function (r = -0.28). Compliance was high with the activity trackers.Despite good feasibility, this study did not show significant responsiveness or validity of the activity trackers as compared with currently recommended outcome measures in OA clinical trials. The main challenge is the lack of a gold standard outcome measure to validate against, and because of the complex interplay between pain and measured function, a lack of correlation does not necessarily represent a failed validation in this context.ACTRN12617000853347. This trial is a substudy of the "Platelet-rich plasma as a symptom-and disease-modifying treatment for knee osteoarthritis - the RESTORE trial".

Osteoarthritis (OA) is a complex heterogeneous articular disease with multiple joint tissue involvement of varying severity and no regulatory-agency-approved disease-modifying drugs (DMOADs). In this review, we discuss the reasons necessitating the development of DMOADs for OA management, the classifications of clinical phenotypes or molecular/mechanistic endotypes from the viewpoint of targeted drug discovery, and then summarize the efficacy and safety profile of a range of targeted drugs in Phase 2 and 3 clinical trials directed to cartilage-driven, bone-driven, and inflammation-driven endotypes. Finally, we briefly put forward the reasons for failures in OA clinical trials and possible steps to overcome these barriers.

This systematic review aimed to evaluate the effects of therapeutic exercise on physical and psychosocial outcomes in community-dwelling adults aged 80 years or older. Databases were searched from inception to July 8, 2020. Randomized controlled trials (RCTs) were screened by two reviewers who extracted data and assessed study quality. Sixteen RCTs (1,660 participants) were included. Compared to nonexercise controls there was no evidence of an effect of exercise on performance based (standardized mean differences: 0.58, 95% confidence interval: [−0.19, 1.36]; I2: 89%; six RCTs; 290 participants; very low-quality evidence) or self-reported physical function (standardized mean differences: 1.35, 95% confidence interval: [−0.78, 3.48]; I2: 96%; three RCTs; 280 participants; very low-quality evidence) at short-medium term follow-up. Four RCTs reporting psychosocial outcomes could not be combined in meta-analysis and reported varying results. Exercise appeared to reduce the risk of mortality during follow-up (risk ratio: 0.47, 95% confidence interval: [0.32, 0.70]; I2: 0.0%; six RCTs; 1,222 participants; low-quality evidence).

Objective To describe the measurement of adherence to unsupervised, conservative treatments for knee osteoarthritis (OA), including the methods of adherence measurement, parameters for assessing adherence and any values used to quantify adherence. Methods A systematic review with search terms related to knee OA, conservative treatments and adherence was conducted. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42020158188). Seven electronic databases (MEDLINE, AMED, EMBASE, CINAHL, SportDiscus, PsychINFO, PEDro) were searched from inception to February 02, 2021. Studies that included unsupervised, conservative treatment(s) for knee OA measuring adherence were eligible. Studies were independently screened for inclusion by two researchers. Data was extracted by one researcher and verified by a second researcher. Extracted data included: study type, population, type of treatment, adherence measurement methods, time-points, recall, parameters and values used to quantify adherence. Results Of 5033 references identified, 242 studies comprising of 261 treatments were included in the review. The majority of studies were randomised controlled trials investigating therapeutic exercise (n ​= ​107, 41.0%). The most common adherence measurement across all treatments was through self-reported diary (n ​= ​137, 52.5%) and the most common parameter was assessing the frequency of the treatment (n ​= ​79, 30.3%). Only a small number of studies provided values for quantifying satisfactory adherence (n ​= ​26, 9.3%). Conclusion There is a wide variety in the reporting of adherence to conservative treatments for knee OA and standardised methods for measuring and reporting adherence are needed. Developing a tool to measure adherence to conservative treatments for knee OA is a priority.

IntroductionPostsurgical rehabilitation is critical for optimal recovery in people undergoing orthopaedic surgery. Currently, knee and lumbar spine postsurgical care is not standardised, economically sustainable, nor based on quality evidence, contributing to substantial clinical variation, poor outcomes and increasing healthcare costs. This protocol describes the design of a randomised controlled trial aiming to evaluate the effectiveness and cost-effectiveness of a postsurgical clinical pathway augmented by disruptive technology and compared with standardised rehabilitation alone, in decreasing pain and improving function after total knee replacement (TKR) or lumbar laminectomy (with or without fusion).MethodsAn assessor-blinded, parallel group, randomised controlled trial will be conducted to recruit 204 consenting participants (102 per arm) of whom 50% are undergoing TKR and 50% lumbar surgery. The intervention group will receive a 6-month technology-enabled rehabilitation package in addition to usual postsurgical care. The package includes (1) an exercise program delivered via the Physitrack app on the iPad, (2) a health-coaching program delivered via video calls and motivational messages, (3) use of physical activity tracker with goal setting and motivational reminders (Fitbit). For those undergoing TKR, the intervention will also include knee joint range of motion self-monitoring via the Goniometer app. The control group will receive usual postsurgical care. Participants will be followed up at 3, 6 and 12 months from the enrolment date. The primary outcome is pain measured with the Numerical Rating Scale at 3 months. Secondary outcomes include pain-related disability, quality of life, computer self-efficacy, physical activity participation and sedentary behaviour. Data analysis will be blinded and by intention-to-treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life-year gained.Ethics and disseminationThis protocol is approved by the human research ethics committee of the University of Sydney. Dissemination will occur through lay summary, infographics, conferences and journal publications.Trial registration numberACTRN12618001448235.

Trapeziometacarpal joint osteoarthritis (OA) produces significant functional impairment due to pain and loss of strength in both power and precision grips, but few studies have related radiographic scores to functional and pain-based measures.To investigate the association between markers of radiographic disease and outcomes for symptomatic and functional disease.This study in an exploratory analysis of baseline data from the first 100 participants in a clinical trial evaluating the efficacy of combined conservative therapies for base of thumb OA (COMBO).Functional Index for Hand Osteoarthritis (FIHOA) scores and Visual Analogue Scale (VAS) scores for pain were recorded for the index hand. Bilateral isometric grip and tip-pinch strength measurements were taken, as well as posteroanterior and Eaton stress-view hand radiographs. Generalized estimating equations (GEEs), univariate, and multivariate analyses were used according to whether the data were bilateral or unilateral.A total of 79 females and 21 males were included, with a median Kellgren-Lawrence (KL) grade of 3 in the index hand. Higher KL and Eaton grades were associated with lower grip strength in the GEE analysis (B-coefficients of -1.25 and -1.16, and P-values of .002 and .010, respectively). Higher KL grade was also associated with poorer function and higher pain levels in the multivariable analysis (B-coefficients of 1.029 and 3.681, and P-values of .021 and .047, respectively). Lower radial subluxation ratios were associated with lower grip strength in the GEE analysis, and higher pain scores in the multivariable analysis (B-coefficients of 2.06 and -42.1, and P-values of .006 and .031, respectively). Greater pain scores were also associated with poorer function (B-coefficient 0.082, P-value .001).More advanced radiographic trapeziometacarpal OA severity is associated with lower grip strength and poorer self-reported functional outcomes. Lower subluxation ratios were associated with higher pain scores and lower grip strength.

Osteoarthritis (OA) is a complex musculoskeletal disease and a leading cause of pain and disability worldwide. Hip and knee OA alone are major contributors to global disability, having notable effects on individual well-being, increasing the reliance of individuals on health-care services and contributing to a rise in the socioeconomic burden. Consistent, coordinated and tailored approaches are important for providing appropriate care to all people with OA, but despite the scale of the challenge many individuals are still not offered the safe, best-evidence treatments recommended for OA care. This Review discusses the core priority treatments for OA, including exercise and physical activity, weight-loss, education and support for self-management. Additional physical or psychological evidence-based adjunctive therapies and combined therapies that can be used to tailor individual programmes are also discussed. These options include cognitive behavioural therapy, heat therapy, walking aids and splints, manual therapies and transcutaneous electrical nerve stimulation. International examples of OA treatment options, models of care and resources available are also given. Many challenges still need to be addressed to advance the uptake of these conditions, including further discussion around the risks and costs involved with all treatments. Various core and adjunctive therapies are available for osteoarthritis (OA) that can have beneficial effects on the well-being of the individual; however, challenges remain in implementing best-evidence, high-value care.

Objective.To investigate the associations of Outcome Measures in Rheumatology (OMERACT) ultrasound scores for knee osteoarthritis (OA) with pain severity, other symptoms, and OA severity on radiographs and magnetic resonance imaging (MRI).Methods.Participants with symptomatic and mild to moderate radiographic knee OA underwent baseline dynamic ultrasound (US) assessment according to standardized OMERACT scanning protocol. Using the published US image atlas, a physician operator obtained semiquantitative or binary scores for US pathologies. Clinical severity was measured on numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscores. OA severity was assessed using the Kellgren-Lawrence (KL) grade on radiographs and MRI Osteoarthritis Knee Score (MOAKS) on noncontrast-enhanced MRI. Separate linear regression models were used to determine associations of US OA pathologies with pain and KOOS subscores, and Spearman correlations were used for US scores with KL grade and MOAKS.Results.Eighty-nine participants were included. Greater synovial hypertrophy, power Doppler (PD), and meniscal extrusion scores were associated with worse NRS pain [β 0.92 (95% CI 0.25–1.58), β 0.73 (95% CI 0.11–1.35), and β 1.01 (95% CI 0.22–1.80), respectively]. All greater US scores, except for cartilage grade, demonstrated significant associations with worse KOOS symptoms, whereas only PD and meniscal extrusion were associated with worse KOOS pain. All US scores, except for PD, were significantly correlated with KL grade. US pathologies, except for cartilage, revealed moderate to good correlation with their MOAKS counterparts, with US synovitis having the greatest correlation (0.69, 95% CI 0.60–0.78).Conclusion.OMERACT US scores revealed significant associations with pain severity, KL grade, and MOAKS.

Importance Most clinical guidelines do not recommend platelet-rich plasma (PRP) for knee osteoarthritis (OA) because of lack of high-quality evidence on efficacy for symptoms and joint structure, but the guidelines emphasize the need for rigorous studies. Despite this, use of PRP in knee OA is increasing. Objective To evaluate the effects of intra-articular PRP injections on symptoms and joint structure in patients with symptomatic mild to moderate radiographic medial knee OA. Design, setting, and participants This randomized, 2-group, placebo-controlled, participant-, injector-, and assessor-blinded clinical trial enrolled community-based participants (n = 288) aged 50 years or older with symptomatic medial knee OA (Kellgren and Lawrence grade 2 or 3) in Sydney and Melbourne, Australia, from August 24, 2017, to July 5, 2019. The 12-month follow-up was completed on July 22, 2020. Interventions Interventions involved 3 intra-articular injections at weekly intervals of either leukocyte-poor PRP using a commercially available product (n = 144 participants) or saline placebo (n = 144 participants). Main outcomes and measures The 2 primary outcomes were 12-month change in overall average knee pain scores (11-point scale; range, 0-10, with higher scores indicating worse pain; minimum clinically important difference of 1.8) and percentage change in medial tibial cartilage volume as assessed by magnetic resonance imaging (MRI). Thirty-one secondary outcomes (25 symptom related and 6 MRI assessed; minimum clinically important difference not known) evaluated pain, function, quality of life, global change, and joint structures at 2-month and/or 12-month follow-up. Results Among 288 patients who were randomized (mean age, 61.9 [SD, 6.5] years; 169 [59%] women), 269 (93%) completed the trial. In both groups, 140 participants (97%) received all 3 injections. After 12 months, treatment with PRP vs placebo injection resulted in a mean change in knee pain scores of -2.1 vs -1.8 points, respectively (difference, -0.4 [95% CI, -0.9 to 0.2] points; P = .17). The mean change in medial tibial cartilage volume was -1.4% vs -1.2%, respectively (difference, -0.2% [95% CI, -1.9% to 1.5%]; P = .81). Of 31 prespecified secondary outcomes, 29 showed no significant between-group differences. Conclusions and relevance Among patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA. Trial registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617000853347.

We compared the assessment of active synovitis in knee osteoarthritis (OA) by utilising superb microvascular imaging (SMI) and conventional power Doppler (cPD) techniques, and then correlated each technique with paients' symptoms, radiographic features and magnetic resonance imaging (MRI)-detected synovitis. A subgroup of participants with symptomatic knee OA underwent dynamic ultrasound assessment for semi-quantitative scores for SMI and cPD in the suprapatellar, medial and lateral parapatellar knee recesses. Knee pain and other symptoms were evaluated with the knee injury and osteoarthritis outcome score (KOOS). OA severity was assessed using the Kellgren and Lawrence grade (KLG) on radiograph and effusion-synovitis and Hoffa's synovitis score of MRI osteoarthritis knee score on non-contrast-enhanced MRI sequences. The χ2 test and κ statistics were conducted to compare detectability of SMI and cPD for low-grade inflammation, and the Spearman's correlation and Fisher's r to z transformation were conducted to compare correlations of both techniques with symptoms and imaging severity. A total of 89 participants were included in the analyses. SMI increased the detection rate by 25.5% for grade 0 cPD, by 35.4% for grade 1 cPD and by 9% for grade 2 cPD. SMI showed significant correlations with KOOS symptoms, KLG, MRI effusion-synovitis and Hoffa's synovitis scores (r = -0.24 [-0.45, -0.01]; r = 0.31 [0.10, 0.50]; r = 0.49 [0.33, 0.63]; and r = 0.54 [0.37, 0.68]). The cPD was significantly correlated with KOOS pain, other symptoms, MRI effusion-synovitis and Hoffa's synovitis (r = -0.23 [-0.44, -0.01]; r = -0.29 [-0.49, -0.06]; r = 0.46 [0.28, 61], r = 0.46 [0.25, 0.63]). However, no significant differences were detected in their extent of correlations. SMI can detect low-grade inflammation implicated in OA disease better than cPD and reveal a significant correlation with symptoms, radiographic features and MRI synovitis. The added clinical value of SMI over cPD is still not clear.

Background Ultrasound can visualize both structural and inflammatory changes of osteoarthritis (OA) with greater accessibility. Therefore, the Outcome Measures in Rheumatology (OMERACT) Ultrasound Task Force recently proposed a semi-quantitative knee ultrasound scoring system1 which requires further validation. Objectives To investigate inter-rater reliability (IRR) of ultrasound pathologies between three raters with varying experiences and examine construct validity of these features against magnetic resonance imaging (MRI) using OMERACT semi-quantitative ultrasound image atlas and quantitative ultrasound measures. Methods According to standardized OMERACT scanning protocol, 20 participants with symptomatic and radiographic knee OA were scanned dynamically with a multi-frequency linear transducer (6-18MHz) of Aplio Platinum 500 machine, Toshiba, Japan. Following an initial calibration of ultrasound scores using the image atlas, three raters with varying experience (a physician operator certified with RhMSUS, a musculoskeletal ultrasonographer and a medical student) independently obtained semi-quantitative scores (0-3) for synovitis and power Doppler activity in suprapatellar recess, medial osteophytes and medial meniscal extrusion, as well as quantitative measurements (mm) of synovitis, effusion, synovial hypertrophy, medial osteophyte and meniscal extrusion (maximal measures). Semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) scores of effusion-synovitis, osteophyte and meniscal extrusion were independently calculated by an experienced researcher. 3-T Sagittal proton-density (PD) weighted fat-suppressed turbo spin-echo (TSE) non-contrast MRI sequences were used for quantitative effusion-synovitis, and coronal plane for osteophyte and meniscal extrusion. Weighted kappa coefficient (Kw) or intra-class correlation coefficient (ICC) were calculated for IRR, Spearman’s rank (rs) and Pearson (rp) correlation coefficients for construct validity and Bland-Altman plots for extent of agreement between ultrasound and MRI. Results Demographics were 60.2±8.3 years of age, 65% female, BMI of 28.6±4.5 of kg/m2; 60% with Kellgren and Lawrence (KL) grade 2 and 40% with a KL grade 3. Semi-quantitative OMERACT ultrasound scores (Table.1) revealed good to excellent IRR (Kw=0.73 -0.88) for osteophyte, and moderate to good IRR (Kw=0.42-0.66) for synovitis. Conversely, quantitative measures of ultrasound pathologies had excellent IRR (ICC= 0.84-0.95) except for synovial hypertrophy (ICC=0.67-0.72). A significant association was found between semi-quantitative ultrasound synovitis and MRI effusion-synovitis (rs= 0.48, p=0.03). All three quantitative ultrasound measurements were significantly associated with quantitative scores of MRI (Table. 2). In Bland–Altman plots for quantitative measurements, there were systemic offsets of 0.6 mm, 1.9 mm and 9.8 mm for osteophyte and meniscal extrusion and synovitis respectively (Fig. 1). Conclusion These is moderate to good IRR between operators with varying experience using the OMERACT knee scoring image atlas for osteophyte and synovitis. While quantitative ultrasound measurements showed excellent IRR and significant association with MRI quantitative outcomes, the absolute feature-specific agreement is called into question. References [1] Bruyn, G.A.W., et al., An OMERACT reliability exercise of inflammatory and structural abnormalities in patients with knee osteoarthritis using ultrasound assessment. Annals of the Rheumatic Diseases, 2016. 75(5): p. 842-846. Disclosure of Interests None declared

Background Thumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis. Methods This is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0–3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05. Results The study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes. In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [rs = 0.44 (P

Objective Greater joint laxity and radial subluxation of the thumb metacarpal base have been shown to be risk factors for the development of trapeziometacarpal osteoarthritis in an asymptomatic and radiographically normal joint. Despite this, it is unknown whether joint laxity changes with disease progression from mild to severe osteoarthritis. This study aimed to investigate the relationship between joint laxity and osteoarthritis severity, using the trapeziometacarpal subluxation ratio as an indicator of joint laxity. Method Baseline data were used from the first 100 participants included in the COMBO (Efficacy of combined conservative therapies on clinical outcomes in base of thumb OA) trial. All participants had bilateral posteroanterior (PA) and Eaton stress view hand radiographs, as well as grip and tip-pinch strength measurements. The PA view was used to assess Kellgren-Lawrence and Eaton grades, and the Eaton stress view was used to assess the trapeziometacarpal joint subluxation ratios. Generalised estimating equations were utilized to account for the fact that hand data are paired, and within-person measurements are therefore not independent. Results Lower radial subluxation ratios were associated with higher Kellgren-Lawrence grades (B-coefficient -0.302; p-value 0.027), and lower grip strength scores (B-coefficient 2.06; p-value 0.006). Conclusions Radial subluxation ratios decreased with increasing disease severity, contrary to the progression from a normal joint to one with mild osteoarthritis, wherein higher joint laxity is a risk factor for disease. This may be explained by the mechanical stabilization provided by osteophytes and capsular changes in worsening osteoarthritis, as has been shown to be the case in the knee. Trial registration number ACTRN 12616000353493. Level of evidence III.

The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

Analgesics, including opioids, steroidal and nonsteroidal anti-inflammatory drugs, aspirin, acetaminophen, antiepileptics, and serotonin-norepinephrine reuptake inhibitors, are medications commonly used to treat many forms of pain. However, all of these agents may have significant adverse side effects. Adverse effects may occasionally be inseparable from desired effects. Side effects are often dose dependent and time dependent. It is critical that the prescribing practitioner and the dispensing pharmacist provide a thorough, understandable review of the potential side effects to all patients before these drugs are administered. Proper monitoring and follow-up during therapy are crucial.

Introduction Management of thumb base osteoarthritis (OA) using a combination of therapies is common in clinical practice; however, evidence for the efficacy of this approach is lacking. The aim of this study is to determine the effect of a combination of conservative therapies for the treatment of thumb base OA compared with an education control group. Methods and analysis This is a randomised, controlled, single-centre, two-arm superiority trial with 1:1 allocation ratio; with assessor and statistician blinded. Participants are blinded to the trial9s hypothesis and to the interventions received by the opposite group. A total of 204 participants will be recruited from the community and randomised using a computer-generated schedule. The intervention group will receive education for joint protection and OA, a splint for the base of the thumb, hand exercises and topical diclofenac sodium 1% gel over 6 weeks. The control group will receive education for joint protection and OA alone. Main inclusion criteria are pain ≥40 mm (Visual Analogue Scale, 0–100) at the base of the thumb, impairment in hand function ≥6 (Functional Index for Hand Osteoarthritis, 0–30) and radiographic thumb base OA (Kellgren Lawrence grade ≥2). Participants currently receiving any of the intervention components will be excluded. Outcomes will be measured at 2, 6 and 12 weeks. The primary outcome is change in pain and hand function from baseline to 6 weeks. Other outcomes include changes in grip and pinch strength, quality of life, presence of joint swelling and tenderness, duration of joint stiffness, patient9s global assessment and use of rescue medication. Analysis will be performed according to the intention-to-treat principle. Adverse events will be monitored throughout the study. Ethics and dissemination This protocol is approved by the local ethics committee (HREC/15/HAWKE/479). Dissemination will occur through presentations at international conferences and publication in peer-reviewed journals. Trial registration number ACTRN12616000353493; Pre-results.

Introduction The purpose of this study was to identify attitudes, beliefs and common practices of hand therapists in Australia regarding assessment and management of base of thumb osteoarthritis. Methods Monthly emails with a link to a 57-item cross-sectional survey were sent to members of the Australian Hand Therapy Association between November 2015 and February 2016. The survey included a case scenario of a patient with base of thumb osteoarthritis with questions about assessment and non-pharmacological and non-surgical treatment interventions for this case. Participants also rated their agreement with a series of 20 attitude and belief statements on a 6-point Likert scale. Data underwent descriptive analysis. Results A total of 124 therapists accessed the survey, of which 77 (62%) returned completed answers and 47 (38%) partially completed it. The majority were occupational therapists (n = 92, 74%), and the remaining were physiotherapists. The most common clinical assessment methods used for base of thumb osteoarthritis were palpation (96%), range of motion (90%), the grind test (85%), and pain on opposition across the palm (82%). The commonly reported treatments included a combination of orthosis prescription (92%), pain education (78%), heat (75%) and exercise (74%). Conclusion The findings highlight commonly used assessment tools and treatments for a typical patient with base of thumb osteoarthritis. Despite the low response rate, there is consistency among general treatment for base of thumb osteoarthritis. Variation exists within the specifics of exercise and orthosis prescription. The results of the survey reflect the lack of standardised recommendations for the management of base of thumb osteoarthritis.