| 1. |
- Dell'Isola, Andrea, et al.
(författare)
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The coexistence of diabetes, hypertension and obesity is associated with worse pain outcomes following exercise for osteoarthritis: A cohort study on 80,893 patients
- 2024
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Ingår i: Osteoarthritis and Cartilage. - 1063-4584 .- 1522-9653.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate how the co-occurrence of diabetes, hypertension and overweight/obesity is associated with pain following an exercise intervention for knee and hip osteoarthritis (OA).Methods Register-based cohort study. We included people from the Swedish Osteoarthritis Register who underwent education and exercise for knee or hip OA. Diabetes and hypertension were defined using medical records and dispensation of medication. Body Mass Index (BMI) was used to identify people with overweight (≥25 to <30), and obesity (≥30). We used linear mixed-effect models with patients nested into clinics to estimate the associations between the exposures and pain (Numeric Rating Scale 0–10), adjusting for age, sex, education, and physical activity.Results We analysed 80,893 patients with knee or hip OA. The accumulation of metabolic conditions was associated with worse pain at baseline and follow-ups. When obesity, hypertension and diabetes coexisted, patients treated for knee OA reported more pain at baseline (adjusted mean pain difference 0.9 [95 %CI: 0.8; 1.0]), 3 months (1.0 [0.9; 1.1]) and 12 months (1.3 [1.1; 1.4]) compared to those without any of the conditions. Similar results were observed for patients treated for hip OA when obesity, hypertension and diabetes coexisted (baseline (0.7 [0.5; 0.8], 3 (0.8[0.6; 1.0]) and 12 months (1.1[0.8; 1.3]).Conclusions When diabetes, hypertension and obesity coexist with OA, patients not only experience heightened baseline pain compared to metabolically healthy individuals, but the disparity increases after an education and exercise intervention suggesting that a one-size-fits-all approach may be inadequate in addressing the complex interplay between metabolic health and OA.
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| 2. |
- Dell'Isola, Andrea, et al.
(författare)
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Within-person change in patient-reported outcomes and their association with the wish to undergo joint surgery during a digital first-line intervention for osteoarthritis
- 2023
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier. - 1063-4584 .- 1522-9653. ; 31:9, s. 1257-1264
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To study the association between within-person changes in patient-reported outcomes (PROMs) and wish for joint surgery during participation in a digital first-line intervention comprising exercise and education for knee/hip osteoarthritis (OA).Methods: Retrospective observational registry study. Participants enrolled between 01/06/2018 and 30/10/2021 with follow-up data at 3 months (n=13,961). We used asymmetric fixed effect (conditional) logistic regressions to study the association between change in wish to undergo surgery at last available time point (3,6,9 or 12 months) and improvement or worsening of PROMs pain (0-10), quality of life (EQ5D-5L, 0.243-0.976), overall health (0-10), activity impairment (0-10), walking difficulties (yes/no), fear of movement (yes/no) and Knee/Hip injury and Osteoarthritis Outcome Score 12 Items (KOOS-12/HOOS-12, 0-100) function and quality of life (QoL) subscales.Results: The proportion of participants wishing to undergo surgery declined by 2% (95% CI 1.9, 3.0), from 15.7% at the baseline to 13.3% at 3 months. Generally, improvements in PROMs were associated with reduced likelihood of wishing for surgery while worsening was associated with increased likelihood. For pain, activity impairment EQ-5D and KOOS/HOOS QoL, a worsening led to a change in the probability of wish for surgery of larger absolute magnitude than an improvement in the same PROM.Conclusions: Within-person improvements in PROMs are associated with reduced wish for surgery, while worsenings with an increased wish for surgery. Larger improvements in PROMs may be needed to match the magnitude of the change in wish for surgery associated with a worsening in the same PROM.
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| 3. |
- Johansson, Helena, 1981, et al.
(författare)
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Low risk for hip fracture and high risk for hip arthroplasty due to osteoarthritis among Swedish farmers
- 2018
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 29:3, s. 741-749
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty. Introduction The risks of hip fracture and hip arthroplasty are influenced by factors including socioeconomic status, education, urbanization, latitude of residence, and physical activity. Farming is an occupation encompassing rural living and high level of physical activity. Therefore, we aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. Methods We studied the risk of hip fracture, and hip arthroplasty due to primary osteoarthritis, in all men and women aged 35 years or more in Sweden between 1987 and 2002. Documented occupations were available in 3.5 million individuals, of whom 97,136 were farmers. The effects of age, sex, income, education, location of residence, and occupation on risk of hip fracture or hip arthroplasty were examined using a modification of Poisson regression. Results A total of 4027 farmers and 93,109 individuals with other occupations sustained a hip fracture, while 5349 farmers and 63,473 others underwent a hip arthroplasty. Risk of hip fracture was higher with greater age, lower income, lower education, higher latitude, and urban area for all men and women. Compared to all other occupations, male farmers had a 20% lower age-adjusted risk of hip fracture (hazard ratio (HR) 0.80, 95% CI 0.77-0.84), an effect that was not seen in female farmers (HR 0.96, 95% CI 0.91-1.01). Both male and female farmers had a higher age-adjusted risk for hip arthroplasty. Conclusions Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty.
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| 4. |
- Roos, Ewa M., et al.
(författare)
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Substantial disability 3 months after arthroscopic partial meniscectomy: : A prospective study of patient-relevant outcomes
- 2000
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Ingår i: Arthroscopy. - : Elsevier BV. - 0749-8063. ; 16:6, s. 619-626
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Tidskriftsartikel (refereegranskat)abstract
- To our knowledge, this is the first prospective study using validated questionnaires to assess patient-relevant outcomes after arthroscopic partial meniscectomy. Data from the Knee Injury and Osteoarthritis Outcome Score (KOOS), the SF-36 Medical Outcomes Study Short-Form Health Survey, and the Lysholm Knee Scoring Scale were available for 74 consecutive patients (50 males, 24 females; mean age, 45 years) with isolated meniscus tear (n = 47) or meniscus tear combined with cartilage damage (n = 27). At postoperative follow-up (mean, 14.4 weeks) significant improvement was seen, but despite only minor pain and other symptoms postoperatively, significant physical disability and handicap were reported. Postoperatively, 30% of patients were active in sports compared with 63% before injury. A sedentary lifestyle was reported by 38% compared with 9% before injury. We conclude that patient-relevant outcomes provide additional information and should be assessed after arthroscopic partial meniscectomy. We further suggest that preoperative information for the meniscectomy patient should include a realistic expected functional outcome.
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| 5. |
- Lohmander, L Stefan, et al.
(författare)
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Can we identify a 'high risk' patient profile to determine who will experience rapid progression of osteoarthritis?
- 2004
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 12 Suppl A, s. 49-52
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Tidskriftsartikel (refereegranskat)abstract
- Disease modifying drugs for osteoarthritis (OA) that may halt or retard joint destruction and at the same time possibly improve symptoms are being developed and tested at various stages in clinical trials. This has, for at least two reasons, focused attention on the need for identification of patient groups at high risk for incident or progressive OA. First, well characterized such groups may be useful in clinical trials. Second, assuming that disease modifying OA drugs become available in the future, primary target groups in need of such therapy have to be identified. Risk factors for incident OA may differ from those for OA progression. Interactions between risk factors for OA is little understood. Factors that have consistently been reported as associated with radiographic OA progression are obesity, generalized OA, alignment and synovitis. Other factors such as bone scintigraphic lesions, joint injury nad biomarkers (such as type II collagen fragments, COMP and HA) show promise. Further evaluation of these variables and their individual and combined influence will be useful to design a risk profile for OA incidence and progression.
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| 6. |
- Roemer, Frank W., et al.
(författare)
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Molecular and Structural Biomarkers of Inflammation at Two Years After Acute Anterior Cruciate Ligament Injury Do Not Predict Structural Knee Osteoarthritis at Five Years
- 2019
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Ingår i: Arthritis and Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 71:2, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the role of inflammatory biomarkers at 2 years post–anterior cruciate ligament (ACL) injury to predict radiographic knee osteoarthritis (OA) and magnetic resonance imaging (MRI)–defined knee OA at 5 years postinjury, with a secondary aim of estimating the concordance of inflammatory biomarkers assessed by MRI and synovial fluid (SF) analysis. Methods: We studied 113 patients with acute ACL injury. Knee scans using 1.5T MRIs were read for Hoffa- and effusion-synovitis. Biomarkers of inflammation that we assessed included interleukin-6 (IL-6), IL-8, IL-10, tumor necrosis factor, and interferon-ɣ in serum and SF, and IL-12p70 in serum. We defined the outcome as radiographic knee OA (ROA) or MRI-defined OA (MROA) at 5 years. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were evaluated in models that included MRI features only (model 1), inflammation biomarkers only (serum [model 2a] or SF [model 2b]), both MRI features and serum biomarkers (model 3a), or both MRI features and SF (model 3b) biomarkers. Linear regression analysis was used to evaluate the association between MRI features and SF biomarkers. Results: At 5 years postinjury, ROA was present in 26% of the injured knees, and MROA was present in 32%. The AUCs for ROA in each model were 0.44 (95% confidence interval [95% CI] 0.42, 0.47) for model 1, 0.62 (95% CI 0.59, 0.65) for model 2a, 0.53 (95% CI 0.50, 0.56) for model 2b, 0.58 (95% CI 0.55, 0.61) for model 3a, and 0.50 (95% CI 0.46, 0.53) for model 3b. The AUCs for MROA in each model were 0.67 (95% CI 0.64, 0.70) for model 1, 0.49 (95% CI 0.47, 0.52) for model 2a, 0.56 (95% CI 0.52, 0.59) for model 2b, 0.65 (95% CI 0.61, 0.68) for model 3a, and 0.69 (95% CI 0.66, 0.72) for model 3b. The concordance between MRI and SF biomarkers was statistically significant only for effusion-synovitis and IL-8. Conclusion: Neither MRI-detected inflammation nor selected SF/serum inflammation biomarkers at 2 years postinjury predicted ROA or MROA at 5 years postinjury. Concordance between MRI and SF inflammatory biomarkers was weak.
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| 7. |
- Roos, Ewa M., et al.
(författare)
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Knee Injury and Osteoarthritis Outcome Score (KOOS) - Development of a self-administered outcome measure
- 1998
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - 0190-6011. ; 28:2, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is self- administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.
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| 8. |
- Runhaar, Jos, et al.
(författare)
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Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis : A systematic review and individual patient data meta-Analysis from the OA trial bank
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 76:11, s. 1862-1869
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Forskningsöversikt (refereegranskat)abstract
- Objective To evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) based on baseline pain severity, body mass index (BMI), sex, structural abnormalities and presence of inflammation using individual patient data. Methods After a systematic search of the literature and clinical trial registries, all randomised controlled trials (RCTs) evaluating the effect of any oral glucosamine substance in patients with clinically or radiographically defined hip or knee OA were contacted. As a minimum, pain, age, sex and BMI at baseline and pain as an outcome measure needed to be assessed. Results Of 21 eligible studies, six (n=1663) shared their trial data with the OA Trial Bank. Five trials (all independent of industry, n=1625) compared glucosamine with placebo, representing 55% of the total number of participants in all published placebo-controlled RCTs. Glucosamine was no better than placebo for pain or function at short (3 months) and long-Term (24 months) follow-up. Glucosamine was also no better than placebo among the predefined subgroups. Stratification for knee OA and type of glucosamine did not alter these results. Conclusions Although proposed and debated for several years, open trial data are not widely made available for studies of glucosamine for OA, especially those sponsored by industry. Currently, there is no good evidence to support the use of glucosamine for hip or knee OA and an absence of evidence to support specific consideration of glucosamine for any clinically relevant OA subgroup according to baseline pain severity, BMI, sex, structural abnormalities or presence of inflammation.
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| 9. |
- Stefan Lohmander, L., et al.
(författare)
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Procollagen II C-propeptide in joint fluid : Changes in concentration with age, time after knee injury, and osteoarthritis
- 1996
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Ingår i: Journal of Rheumatology. - 0315-162X. ; 23:10, s. 1765-1769
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine in a cross sectional study the concentrations in joint fluid of the C-propeptide of collagen II (pCol II-C) in patients with knee injury and developing osteoarthritis (OA). Methods. Synovial fluid (SF) samples were collected from knees of healthy volunteers, from patients with injury to the knee causing lesions of the anterior cruciate ligament and/or menisci, and from patients with posttraumatic or primary OA. Concentrations of pCol II-C were determined by enzyme immunoassay with a polyclonal antiserum against the bovine propeptide. Results. The median concentration of pCol II-C in joint fluid in the reference group was 1.3 ng/ml (range 0.1-5.7 ng/ml). Median concentrations of pCol II-C in joint fluid were increased 2-4-fold in all 3 study groups over that in the reference group. Very high concentrations of propeptide were noted in samples from patients younger than about 18 years. Propeptide concentrations were increased after knee injury, with a suggested peak at about 1-4 years evident for patients with cruciate ligament injury. pCol II-C levels were increased at all stages of OA development, except in the most advanced phases. Conclusion. The increased levels of pCol II-C in SF may reflect an increased rate of synthesis of collagen II in the joint cartilage of patients with knee injury and developing OA. The increase reaches a maximum well before radiographic changes indicative of OA are apparent, and occurs during a disease phase characterized by signs of increased degradation of collagen II, aggrecan, and other matrix components. Further studies of markers of matrix metabolism of cartilage, bone, and other joint tissues in human and animal models of OA may aid in the identification of process markers, individuals at risk, and new therapeutic targets.
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| 10. |
- Abrahamsson, Sven Olof, et al.
(författare)
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Variations in cellular proliferation and matrix synthesis in intrasynovial and extrasynovial tendons : An in vitro study in dogs
- 1994
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 0363-5023. ; 19:2, s. 259-265
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Tidskriftsartikel (refereegranskat)abstract
- Intrasynovial and extrasynovial flexor tendon grafts recently have been shown to have dissimilar patterns of cellular survival and host integration within the digital sheath. In an effort to determine if fundamental differences exist between these two types of tendons, we investigated the biochemical composition and cellular activity of intrasynovial and extrasynovial tendon segments of 12 adult mongrel dogs in short-term explant culture in MCDB 105 and in DMEM media. Proteoglycan, collagen and noncollagen protein synthesis and content and DNA synthesis were determined following culture in both media. Intrasynovial tendon segments cultured in MCDB 105 medium synthesized significantly less collagen, noncollagen protein, and DNA and had similar amounts of proteoglycans compared to extrasynovial tendons. Comparison of intrasynovial and extrasynovial tendon segment responses in DMEM medium showed that intrasynovial tendons synthesized more proteoglycan, protein, and DNA than they did in MCDB 105. Extrasynovial tendons had similar rates of matrix component and DNA synthesis in both media. Findings that the synthesis of matrix components and DNA between intrasynovial flexor and extrasynovial peroneal tendon segments differ significantly indicate that intrasynovial flexor tendons may be specially adapted to the nutritional milieu provided by an intrasynovial environment. These data are supported by the selective successful stimulation of fibrocartilaginous segments within intrasynovial flexor tendons in media favored for the culture of cartilaginous tissue.
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