Tag: knee osteoarthritis

In Knee Osteoarthritis, Inactivity may be more Complex than Believed

Photo by Towfiqu barbhuiya

Knee osteoarthritis (OA) is a common cause of pain and joint stiffness. And while physical activity is known to ease symptoms, only one in 10 people regularly exercise. Understanding what contributes to patients’ inactivity is the focus of a world first study from the University of South Australia. Here, researchers have found that people with knee OA unconsciously believe that activity may be dangerous to their condition, despite medical advice telling them otherwise.

The study, published in PAIN, found that of those surveyed, 69% of people with knee pain had stronger implicit (unconscious) beliefs that exercise was dangerous than the average person without pain. It’s an interesting finding that not only highlights the conflicted nature of pain and exercise, but also that what people say and what people think, deep down, may be entirely different things.

Lead researcher, and UniSA PhD candidate based at SAHMRIBrian Pulling, says the research provides valuable insights for clinicians treating people with knee OA.

“Research shows that physical activity is good for people with knee OA, but most people with this condition do not move enough to support joint or general health,” Pulling says.

“To understand why people with OA might not be active, research studies typically use questionnaires to assess fear of moving. But unfortunately, questionnaires are limited – what we feel deep down (and how our system naturally reacts to something that is threatening) may be different to what we report. And we still know that many people are avoiding exercise, so we wanted to know why.”

To assess this, the researchers developed a tool that can detect and evaluate people’s implicit beliefs about exercise; that is, whether they unconsciously think activity is dangerous for their condition.

“We found that that even among those who said they were not fearful about exercise, they held unconscious beliefs that movement was dangerous,” Pulling says.

“Our research shows that people have complicated beliefs about exercise, and that they sometimes say one thing if asked directly yet hold a completely different implicit belief.

“People are not aware that what they say doesn’t match what they choose on the new task; they are not misrepresenting their beliefs.

“This research suggests that to fully understand how someone feels about an activity, we must go beyond just asking directly, because their implicit beliefs can sometimes be a better predictor of actual behaviour than what people report. That’s where our tool is useful.”

The online implicit association test presents a series of words and images to which a participant must quickly associate with being either safe or dangerous. The tool intentionally promotes instant responses to avoid deliberation and other influencing factors (such as responding how they think they should respond).

Associate Professor Tasha Stanton says that the new tool has the potential to identify a group of people who may have challenges increasing their activity levels and undertaking exercise.

“What people say and what people do are often two different things, Assoc Prof Stanton says.

“Having access to more accurate and insightful information will help health professionals better support their patients to engage with activity and exercise. It may also open opportunities for pain science education, exposure-based therapy, or cognitive functional therapy…things that would not usually be considered for someone who said that they were not scared to exercise.”

Researchers are now looking to see if implicit beliefs are directly associated with behaviour and are asking for people to complete the Implicit Association Test (takes seven minutes). At the end of the test participants are given their results in comparison to the rest of the population.

To take the test, please click here: https://unisasurveys.qualtrics.com/jfe/form/SV_0OZKUqzBNtiKGF0

Source: University of South Australia

Is Stem Cell Therapy for Knee Osteoarthritis Worthwhile?

Photo by Towfiqu barbhuiya: https://www.pexels.com/photo/person-feeling-pain-in-the-knee-11349880/

Cell therapy has been explored as a new regenerative treatment for osteoarthritis, but the efficacy of stem cell transplantation from different sources for the treatment of knee osteoarthritis (KOA) remains controversial. A recent analysis of all relevant published studies indicates that stem cell transplantation from different sources is effective for treating knee osteoarthritis, the most prevalent chronic joint disease.

The review and meta-analysis, which is published in the Journal of Orthopaedic Research, included 16 studies involving 875 patients with knee osteoarthritis (441 in the stem cell transplantation group and 434 in the control group). Stem cell treatment was associated with significant reductions in patient-reported pain from the third month onwards. The most significant pain relief at different postoperative months came from fat-derived and umbilical cord–derived stem cells. A patient’s own fat-derived stem cells resulted in better pain alleviation compared with those from other donors. Also, a patient’s own fat-derived stem cells led to the most effective recovery of knee joint function.

“Stem cell transplantation proved safe and effective for knee osteoarthritis treatment,” the authors wrote. “Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimising patient trauma.”

Source: Wiley

Are Stem Cell Therapies Really Superior for Knee Osteoarthritis?

Photo by Towfiqu barbhuiya: https://www.pexels.com/photo/person-feeling-pain-in-the-knee-11349880/

In a study published in Nature Medicine, investigators explored the mesenchymal stem cells’ potential as a game-changing treatment option for knee osteoarthritis. This type of treatment seeks to regenerate damaged tissue, treating the problem directly instead of seeking only to relieve symptoms. However, the availability of robust data from well-designed randomised controlled trials has been limited, particularly in comparison to the gold-standard of treatment for knee osteoarthritis (OA), corticosteroid injections (CSI).

Characterised by extensive damage to joints and debilitating pain, knee OA affects millions of people worldwide is the most common cause of chronic knee pain and has long posed a substantial clinical and economic burden.

In spite of advances in diagnosis, medications, and short-term pain management solutions, the elusive goal of a disease-modifying OA drug has remained out of reach. In recent years though, the use of stem cell therapy has gained traction as a promising alternative to surgery and for improving patients’ quality of life.  

The initial findings of this study describe a first-of-its-kind randomized clinical trial to identify the most effective source of cellular injections for knee OA. The research team compared three types of cellular preparations, including autologous bone marrow aspirate concentrate (BMAC), autologous stromal vascular fraction (SVF), and allogenic human umbilical cord tissue MSCs (UCT) against CSI. The primary outcome measures were the visual analogue scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain from baseline to one year. The question driving the research was whether cell therapies could outperform corticosteroids in the treatment of knee osteoarthritis at the one-year mark.

While the findings showed each group had a measurable improvement in pain and function, there was no significant advantage to using any of the tested cell products compared to the gold standard anti-inflammatory corticosteroid treatment at the 12-month follow-up regarding the change in VAS pain score from baseline. Similarly, the analysis of the KOOS pain score produced consistent results, with no significant differences between groups at the 12-month mark in the change in score from baseline.

“The study demonstrated no superiority of any cell therapy over corticosteroids in reducing pain intensity over the course of a year,” says Scott D. Boden, MD, director of the Emory Orthopaedics and Spine Center, and a senior author on the study. “While there is much enthusiasm about the regenerative capacity of stem cells, the findings call into question the comparative effectiveness of various injections for knee osteoarthritis and underscores the importance of a personalised approach in selecting the right treatment for each patient’s unique needs.”

The study’s extensive reach also extended to evaluating the safety of these procedures measuring every adverse reaction, ranging from mild joint discomfort and swelling to unrelated hospitalisations. Importantly, the study found no study-related serious adverse events or symptomatic knee infections across any of the treatment groups at any point during the follow-up.

According to Dr Boden, future papers from the ongoing analysis of our data will determine if certain subgroups of patients might preferentially benefit from one of these treatments more than another. The findings offer an important step forward in answering key questions about the comparative effectiveness of certain OA treatment options, but more in-depth analysis using MRIs and cellular analysis of each injectate will continue to help inform standards of care.

Source: Emory University

Joint Loading may Predict Knee Osteoarthritis after ACL Surgery

Knee pain
Source: CC0

Arthritis in the knee’s patellofemoral joint (PFJ) is common following anterior cruciate ligament reconstruction (ACLR) and may be linked with altered loading at the joint. In a study published in the Journal of Orthopaedic Research, young adults post‐ACLR who exhibited lower PFJ loading during hopping were more likely to have PFJ osteoarthritis at one year and worsening PFJ osteoarthritis between one and five years post-procedure.

In the study, data for net PFJ contact force were normalised to each participant’s body weight. For every one body weight decrease in the peak PFJ contact force during hopping, the proportion of people at one year post-ACLR with early PFJ osteoarthritis increased by 37%, and the risk of worsening PFJ osteoarthritis between one and five years post-ACLR increased by 55%.

“Clinical interventions aimed at mitigating osteoarthritis progression may be beneficial for those with signs of lower PFJ loading post-ACLR,” the authors wrote.

Source: Wiley

An Effective Short-term Therapy for Knee Osteoarthritis

Knee pain
Source: CC0

With few solutions available, treatment of knee osteoarthritis is challenging, but a randomised control trial published in Arthritis and Rheumatology has found that, at least for short-term relief, ultrasound-guided genicular nerve block (GNB) was effective.

The global prevalence of knee osteoarthritis (OA) is ~22.9% of over-40s. Knee OA is a significant cause disability and potentially loss of independence. Treatment remains challenging, with nonsurgical management options such as education, weight loss, exercise therapy, and walking aids. Few recommended pharmacotherapeutic options exist for knee OA, with surgical joint replacement being a definitive treatment strategy for patients with severe disease who are unresponsive to conservative care. For many patients, such as people who are frail or elderly or people with complex comorbidities, surgical intervention may not be suitable.

In a 12-week parallel-group, placebo-controlled randomised trial of GNB, patients in the active arm received 3 injections of 5.7 mg celestone chronodose (1ml) and 0.5% bupivacaine (3ml) to the inferomedial, superomedial, and superolateral genicular nerves. Patients in the placebo arm received saline injections. An experienced radiologist or rheumatologist with the assistance of a senior sonographer used ultrasound to locate the nerves.

At baseline and at weeks 2, 4, 8, and 12, patients recorded their pain and disability on self-report scales. Patients in the active group reported improvements in pain scores at 2, 4, 8, and 12 weeks with a diminution of the effect over time. 

These results reflect comparator groups, which also reported an effect reduction at 12 weeks.

“This study demonstrates that genicular nerve block is an effective short-term therapy for pain management in people with knee osteoarthritis,” said corresponding author Ernst M. Shanahan, BMBS, MPH, MHPE, PhD, FAFOEM, FRACP, of Flinders University. “We think it may be a useful treatment option for this group of people, in particular those waiting for, or wishing to defer surgery.”

Weight Loss Protects against Structural Defects of Knee Osteoarthritis

Researchers conducting long-term follow ups of adults given knee X-rays found that a decrease in body mass index (BMI) was associated with both a lower incidence of the structural defects of knee osteoarthritis. Published in Arthritis & Rheumatology, also found reduced odds of these defects progressing.

In the study radiographic analyses were conducted of adults’ knees with and without the structural defects of knee osteoarthritis at baseline and at 4 to 5 years’ follow up from adults. A total of 9683 knees (from 5774 individuals) were assessed in an ‘incidence cohort’ along with 6075 knees (from 3988 individuals) in a ‘progression cohort.’

The researchers observed that a 1-unit drop in BMI was linked to a 4.76% reduction in odds of the incidence and progression of knee osteoarthritis. A 5-unit BMI drop, which can downgrade a BMI category (eg, from overweight to normal), reduced the odds of incidence and progression by 21.65%.

“These findings could be empowering for people with or at risk of knee osteoarthritis,” said lead author Zubeyir Salis, BEng, and a PhD student for Public Health at the University of New South Wales in Australia. “The current prevailing view is that knee osteoarthritis is part of ageing and that we have no control over it. However, my analyses suggest that some people could potentially prevent, slow or delay knee osteoarthritis by losing weight.”

Source: Wiley

Why Knee Osteoarthritis Risk is Higher in Women

By using a bioreactor aboard a flight that simulated zero gravity, researchers have found that the reason why women have a greater risk of developing knee osteoarthritis is down to genetic differences in knee meniscus tissue.

Better tests, prevention and treatments could be developed for knee osteoarthritis in women here on Earth, based on this research.

Though knee osteoarthritis is more common in females than in males, the difference cannot be explained solely by hormones. The researchers have pinpointed a genetic difference in the meniscus that makes about 50% of females more vulnerable to developing osteoarthritis than males or other females. Exposure to zero gravity is known to mimic the ageing process, as muscles atrophy and bones lose density. The zero gravity environment of space has greatly contributed to medical research.

Researchers ran the experiment aboard an aircraft flying in parabolic arcs to specially simulate zero gravity conditions, to mimic the damage that can happen to the meniscus due to lack of exercise.

“Some of the genes that were found in the females that responded more to simulated space microgravity were also associated with the development of knee osteoarthritis,” said principal investigator Adetola Adesida, professor of surgery in the Faculty of Medicine & Dentistry.

The results suggest that a blood test could screen for the high-risk gene, allowing for early interventions such as physiotherapy, and eventually even drug therapy. It might also allow women to stay in space longer.

“We’ve uncovered the mechanisms that lead to this higher response, and we are hoping to develop drugs to target those pathways and block those responses,” Adesida said.

Previously thought to be rather unimportant, meniscus acts as a load distributor for the body’s full weight. However, it is now known that just a small tear in the meniscus, often from a sports injury, increases the risk of later osteoarthritis, even if the damaged tissue has been removed. On the other hand, lack of use can also lead to deconditioning of the meniscus and increase arthritis risk.

Knee osteoarthritis is the most common joint problem, affecting an estimated 250 million people worldwide, including 14% of females older than 60 and 10% of males in the same age group.

Prof Adesida’s team has developed bioengineered meniscus tissue grown from cells that have been removed from the damaged menisci of otherwise healthy individuals. The hope is one day to be able to replace damaged tissue through transplant, preventing the development of knee osteoarthritis.

For their experiment on sex differences, the team studied how the bioengineered tissue functioned while at rest and under mechanical loading and unloading conditions. For the loading, they used a device that exerted hydrostatic pressure on the cells. For the unloading, they put the cells into a bioreactor designed by NASA to fly aboard the zero-gravity aircraft.

“Our loading and unloading experiment mimics what we actually see in a clinical situation where the development of spaceflight microgravity-induced knee osteoarthritic changes is possible,” he said.

“This will help us to have human relevant models to study knee osteoarthritis in the future. And our research has both Earth benefits and space benefits.”

The study findings were published in Frontiers in Bioengineering and Biotechnology.

Source: University of Alberta

No Risk of Developing Knee Osteoarthritis From Exercise

Photo by Ketut Subiyanto from Pexels

In an analysis of six global studies, investigators found no link between the amount and duration of physical activity with individuals’ risk of developing knee osteoarthritis.

The analysis, which is published in Arthritis & Rheumatology, included six global community-based studies which had a combined total of 5065 participants with and without knee osteoarthritis, who were followed for five to 12 years.
“Knowing that the amount of physical activity and time spent doing it is not associated with the development of knee osteoarthritis is important evidence for both clinicians and the public who may need to consider this when prescribing physical activity for health,” explained co–lead author Thomas Perry, BSc, PhD, at the University of Oxford.

As a next step, it will be important to understand the role of injury and specific types of activity within this association, noted co–lead author Lucy S. Gates, PhD, University of Southampton, and co–senior author Maria Sanchez-Santos, University of Oxford.

Source: Wiley