Osteoarthritis and cartilage open最新文献_第3页

The PIKASO trial (Preventing Injured Knees from Osteoarthritis: Severity Outcomes): Rationale and design features for a randomized controlled trial

Osteoarthritis and cartilage open

Pub Date : 2024-12-23 DOI: 10.1016/j.ocarto.2024.100563

Cale A. Jacobs , Morgan H. Jones , Jamie E. Collins , Lily M. Waddell , Xiaojuan Li , Carl S. Winalski , Brian Pietrosimone , Virginia Byers Kraus , Miguel Otero , Elizabeth Wellsandt , Laura C. Schmitt , Kurt P. Spindler , Donald D. Anderson , Scott A. Rodeo , Robert A. Magnussen , Brian R. Wolf , Joe M. Hart , Austin V. Stone , Caitlin E. Conley , Yvonne M. Golightly , Elena Losina

Objective

Given the high burden and increasing prevalence of post-traumatic osteoarthritis (PTOA), identifying clinically beneficial strategies to prevent or delay its onset could improve the quality of life of those at high risk of developing the disease.

Methods

Preventing Injured Knees from OsteoArthritis: Severity Outcomes (PIKASO) is a multicenter blinded, parallel, two-arm randomized controlled trial of 512 individuals aged 18–45 years undergoing anterior cruciate ligament reconstruction (ACLR). This study is designed to evaluate the efficacy of a 12-month intervention of oral metformin vs. placebo in decreasing the rate of structural knee changes and pain. Participants will be asked to take up to 1500 mg/day of either metformin or placebo as tolerated. The primary outcomes are Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale scores averaged between 12 and 24 months after randomization, and MRI derived cartilage structural change at 24 months. The trial will be deemed successful if at least one of the two primary outcomes reaches the preplanned effect size with sufficient statistical certainty. In this paper, we describe PIKASO elements according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.

Results

Our multidisciplinary team developed the methods and statistical analysis plan for a placebo controlled, randomized clinical trial to determine whether metformin alters pain and early osteoarthritic changes after ACLR.

Discussion

This manuscript outlines the rationale, study design, and implementation of the PIKASO trial aiming to prevent the onset of PTOA after ACLR.

Trial registration

clinicaltrials.gov NCT06096259.

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引用次数: 0

Inter-assay variability in the measurement of urinary C-terminal cross-linked telopeptide of type II collagen following anterior cruciate ligament reconstruction 前交叉韧带重建后尿II型胶原c端交联末端肽测定的测定间变异性。

Osteoarthritis and cartilage open

Pub Date : 2024-12-18 DOI: 10.1016/j.ocarto.2024.100561

Lachlan M. Batty , Kate E. Webster , Natasha Vassileff , Jereme G. Spiers , Haydn J. Klemm , Brian Devitt , Timothy S. Whitehead , Andrew F. Hill , Julian A. Feller

Objective

To compare urinary C-terminal cross-linked telopeptide of type II collagen (u-CTX-II) concentrations and trends as measured by two different commercially available enzyme-linked immunosorbent assays (ELISA) in a cohort of patients in the first year following anterior cruciate ligament (ACL) reconstruction.

Design

22 ACL-injured patients undergoing reconstructive surgery (mean age 25.2 (SD 8.0) years; 12 (54.5 %) male) had urine samples taken on the day of surgery (baseline) and at 6 and 12 months post-operatively. Concentrations of u-CTX-II were measured using the CloudClone® and the CartiLaps® ELISA. u-CTX-II concentrations were normalized to urinary creatinine (Cr).

Results

The u-CTX-II concentrations were significantly different between the 2 assays at each timepoint (p ≤ 0.01). When measured using the CloudClone® Assay, mean (standard error) u-CTX-II concentrations were 26.5 (2.5) ng/mmol Cr, 29.4 (3.8) ng/mmol Cr and 40.6 (6.9) ng/mmol Cr at the baseline, 6-month and 12-month timepoints respectively. When measured using the CartiLaps® Assay, at the same respective timepoints, u-CTX-II concentrations were 981.2 (256.5) ng/mmol Cr, 867.0 (234.3) ng/mmol Cr and 764.3 (220.3) ng/mmol Cr. Concentrations of u-CTX-II using the CloudClone® Assay increased with time (p = 0.04). Concentrations of u-CTX-II using the CartiLaps® Assay decreased over time (p = 0.2).

Conclusion

Using two commercially available assays, u-CTX-II differed significantly in terms of both concentration and trends in the first year following ACL reconstruction. The specific assay used is critical to consider when interpreting results and has implications for pooling data and meta-analysis.

目的：比较两种不同的市售酶联免疫吸附试验（ELISA）在前交叉韧带（ACL）重建后第一年患者尿c端交联II型胶原末端肽（u-CTX-II）的浓度和趋势。设计：22例接受重建手术的acl损伤患者(平均年龄25.2岁（SD 8.0）；12例（54.5%）男性患者在手术当天（基线）、术后6个月和12个月采集尿样。使用CloudClone®和软骨酶联免疫吸附测定u-CTX-II的浓度。u-CTX-II浓度与尿肌酐（Cr）归一化。结果：各时间点u-CTX-II浓度在两种检测方法间差异有统计学意义（p≤0.01）。使用CloudClone®Assay测定时，基线、6个月和12个月时间点的u-CTX-II平均（标准误差）浓度分别为26.5 (2.5)ng/mmol Cr、29.4 (3.8)ng/mmol Cr和40.6 (6.9)ng/mmol Cr。在同一时间点，使用软骨法测定u-CTX-II浓度分别为981.2 (256.5)ng/mmol Cr、867.0 (234.3)ng/mmol Cr和764.3 (220.3)ng/mmol Cr。使用CloudClone®法测定u-CTX-II浓度随时间增加（p = 0.04）。使用软骨法检测u-CTX-II的浓度随时间降低（p = 0.2）。结论：使用两种市售的检测方法，u-CTX-II在ACL重建后的第一年的浓度和趋势都有显著差异。在解释结果时，所使用的特定测定方法至关重要，并且对汇集数据和荟萃分析具有影响。

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引用次数: 0

Protocol for the MERINO study: A randomized placebo-controlled trial assessing the efficacy, safety, and cost-effectiveness of methotrexate in people with erosive hand osteoarthritis MERINO研究方案：一项随机安慰剂对照试验，评估甲氨蝶呤对糜烂性手骨关节炎患者的疗效、安全性和成本效益。

Osteoarthritis and cartilage open

Pub Date : 2024-12-15 DOI: 10.1016/j.ocarto.2024.100558

Alexander Mathiessen , Line Gaundal , Joseph Sexton , Dag Sjølie , Pernille Steen Pettersen , Barbara Slatkowsky-Christensen , Ida Kristin Haugen

Objective

Previous studies on the efficacy of methotrexate in people with hand osteoarthritis (OA) have shown conflicting results. The MERINO trial aims to investigate the efficacy and safety of methotrexate in people with painful inflammatory erosive hand OA.

Design

In total 163 participants with erosive hand OA, synovitis by ultrasound, and finger joint pain of 40–80 mm on a visual analogue scale (VAS) will be recruited from a rheumatology outpatient clinic. Participants are randomized 1:1 to receive either encapsulated oral methotrexate 20 mg/week or placebo for 12 months in a double-blind manner. The primary endpoint is VAS finger joint pain at 6 months. Key secondary outcomes are hand function by the Australian/Canadian hand index (AUSCAN) at 6 months and radiographic progression by the Verbruggen-Veys anatomical phase scoring system at 12 months. Other secondary endpoints include hand stiffness, disease activity, health-related quality of life, grip strength, clinical joint counts, synovitis by ultrasound and MRI, bone marrow lesions by MRI, cost-effectiveness, and symptoms in knees and hips. Adverse events will be recorded. The primary analysis will be performed on full analysis set.

Conclusions

The findings of this trial will be clinically relevant for patients with erosive hand OA and may influence future treatment recommendations.

Clinical trial registration

EU CT number: 2023-510523-30-00, NCT04579848.

目的：以往关于甲氨蝶呤治疗手骨关节炎（OA）疗效的研究显示了相互矛盾的结果。MERINO试验旨在研究甲氨蝶呤治疗疼痛性炎症性糜烂性手性关节炎的疗效和安全性。设计：将从风湿病门诊招募163名患有糜烂性手部OA、超声检查的滑膜炎、视觉模拟评分（VAS） 40-80 mm手指关节疼痛的参与者。参与者以1:1的比例随机接受胶囊口服甲氨蝶呤20mg /周或安慰剂，双盲治疗12个月。主要终点是6个月时VAS手指关节疼痛。主要的次要结果是6个月时澳大利亚/加拿大手指数（AUSCAN）的手功能和12个月时Verbruggen-Veys解剖阶段评分系统的放射学进展。其他次要终点包括手部僵硬、疾病活动度、健康相关生活质量、握力、临床关节计数、超声和MRI检查的滑膜炎、MRI检查的骨髓病变、成本效益以及膝盖和臀部的症状。不良事件将被记录。主要分析将在完整的分析集上进行。结论：该试验的结果将对糜烂性手性骨关节炎患者具有临床相关性，并可能影响未来的治疗建议。临床试验注册：EU CT号：2023-510523-30-00，NCT04579848。

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引用次数: 0

Intra-articular injection of inorganic pyrophosphate improves IL-1β-induced cartilage damage in rat model of knee osteoarthritis in vivo 关节内注射无机焦磷酸盐可改善il -1β诱导的大鼠膝关节骨性关节炎模型的软骨损伤。

Osteoarthritis and cartilage open

Pub Date : 2024-12-14 DOI: 10.1016/j.ocarto.2024.100560

Émilie Velot, Mathilde Guibert, Meriem Koufany, Arnaud Bianchi

Objective

Osteoarthritis (OA) is the most common form of chronic joint disease, affecting mainly the elderly population. This disorder is caused by cartilage degeneration with complex changes in the chondrocyte phenotype. Inorganic pyrophosphate (PPi) was shown to counteract the detrimental effect of interleukin (IL)-1β challenging in an in vitro OA model based on rat articular chondrocytes. It also maintained the differentiated articular phenotype, mostly by down regulating wingless-related integration site (Wnt)-5a secretion. These observations suggest a PPi protective role for chondrocyte in vitro.

Methods

To address this hypothesis in vivo, we investigated the impact on knee joint of three intra-articular injection (IAI) of PPi in a rat model of cartilage damage induced by IAI of IL-1β, where cartilage degradation and synovial inflammation are similar to that observed in OA. Cartilage and synovial membrane were collected after 7 days of challenge by IL-1β.

Results

PPi was able to reduce the deleterious effect of IL-1β. This effect was observable on the expression of cartilage extracellular matrix metabolism markers and confirmed by histology with safranin O and hematoxylin-eosin-saffron (HES) staining. Inorganic pyrophosphate also repressed the Wnt5a expression induced by IL-1β. No effect was observed on the inflammatory response of the synovial membrane.

Conclusion

These results demonstrate that PPi improves IL-1β-induced cartilage damage in rat but not the associated inflammation of synovial membrane. Thus, PPi could become a molecule of interest to restrict the progression of this disorder.

目的：骨关节炎（OA）是最常见的慢性关节疾病，主要影响老年人。这种疾病是由软骨变性和软骨细胞表型的复杂变化引起的。在基于大鼠关节软骨细胞的体外OA模型中，无机焦磷酸盐（PPi）被证明可以抵消白细胞介素(IL)-1β的不利影响。它还维持了分化的关节表型，主要是通过下调无翼相关整合位点(Wnt)-5a的分泌。这些观察结果表明，PPi在体外对软骨细胞具有保护作用。方法：为了在体内验证这一假设，我们在IL-1β诱导的大鼠软骨损伤模型中研究了三次关节内注射（IAI） PPi对膝关节的影响，其中软骨退化和滑膜炎症与OA中观察到的相似。IL-1β攻毒7 d后收集软骨和滑膜。结果：PPi能减轻IL-1β的有害作用。这种影响可以观察到软骨细胞外基质代谢标志物的表达，并通过红花素O和苏木精-伊红-藏红花（HES）染色的组织学证实。无机焦磷酸盐也能抑制IL-1β诱导的Wnt5a表达。未观察到对滑膜炎症反应的影响。结论：PPi对il -1β诱导的大鼠软骨损伤有改善作用，但对滑膜炎症无改善作用。因此，PPi可能成为一种抑制这种疾病进展的分子。

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引用次数: 0

Knee joint extension limitation in female patients with knee osteoarthritis affects the infrapatellar fat pad hardness and hemoglobin concentration by isometric quadriceps exercise 女性膝关节骨性关节炎患者膝关节伸展受限对等长股四头肌运动对髌下脂肪垫硬度和血红蛋白浓度的影响。

Osteoarthritis and cartilage open

Pub Date : 2024-12-11 DOI: 10.1016/j.ocarto.2024.100559

Syoya Nakanishi , Masahiro Tsutsumi , Takashi Kitagawa , Toshinori Miyashita , Makoto Wada , Shintarou Kudo

Objective

To investigate whether there is a difference in hardness and hemoglobin concentration changes in the infrapatellar fat pad (IFP) during isometric quadriceps exercise (IQE) in patients with knee osteoarthritis (KOA) between those with and without knee extension limitation.

Design

In this cross-sectional study, data were collected at an orthopedic clinic from March 2022 to April 2023. Among patients diagnosed with KOA, those with knee joint extension range of motion <0° and >0° were defined as the limited group (n = 16) and non-limited group (n = 13), respectively. Ultrasonography was performed at rest and during IQE to measure IFP hardness based on shear wave velocity. Near-infrared spectroscopy was performed to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) in the IFP before (baseline), during (IQE task), and post IQE. IFP hardness and O2Hb, HHb, and cHb concentration were analyzed using a linear mixed model for the groups and measurement points.

Results

IFP hardness changes during IQE were significantly less in the limited group than in the non-limited group (limited: mean difference [MD] = −0.136, 95 % confidence interval [CI] [−0.475, 0.203]; non-limited: MD = −1.154, 95 % CI [−1.530, −0.778]). O2Hb concentration did not significantly change at post compared with baseline in the limited group but did in the non-limited group (limited: MD = −0.024, 95 % CI [−0.961, 0.913]; non-limited: MD = −4.118, 95 % CI [−5.156, −3.079]).

Conclusions

The limited group revealed no IFP hardness and hemoglobin concentration change following IQE, whereas the opposite was observed for the non-limited group, indicating oxygenation.

目的：探讨膝盖骨关节炎（KOA）患者行等长股四头肌运动（IQE）时，髌下脂肪垫（IFP）硬度及血红蛋白浓度变化是否存在差异。设计：在这项横断面研究中，数据收集于2022年3月至2023年4月在一家骨科诊所。在确诊为KOA的患者中，将膝关节伸展活动范围为0°的患者分别定义为受限组（n = 16）和非受限组（n = 13）。在静止和IQE期间进行超声检查以测量基于剪切波速的IFP硬度。采用近红外光谱法测量IFP在IQE前（基线）、IQE任务期间和IQE后的氧合血红蛋白（O2Hb）、脱氧血红蛋白（hbb）和总血红蛋白（cHb）。采用组和测点的线性混合模型分析IFP硬度和O2Hb、hbb和cHb浓度。结果：IQE期间，限制组IFP硬度变化明显小于非限制组(限制：平均差[MD] = -0.136, 95%可信区间[CI] [-0.475, 0.203]；是非:MD = -1.154, 95% CI[-1.530, -0.778])。与基线相比，限制组术后O2Hb浓度无显著变化，而非限制组有显著变化(限制：MD = -0.024, 95% CI [-0.961, 0.913]；是非:MD = -4.118, 95% CI[-5.156, -3.079])。结论：限制组IQE后IFP硬度和血红蛋白浓度无变化，非限制组则相反，提示有氧合作用。

{"title":"Knee joint extension limitation in female patients with knee osteoarthritis affects the infrapatellar fat pad hardness and hemoglobin concentration by isometric quadriceps exercise","authors":"Syoya Nakanishi , Masahiro Tsutsumi , Takashi Kitagawa , Toshinori Miyashita , Makoto Wada , Shintarou Kudo","doi":"10.1016/j.ocarto.2024.100559","DOIUrl":"10.1016/j.ocarto.2024.100559","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether there is a difference in hardness and hemoglobin concentration changes in the infrapatellar fat pad (IFP) during isometric quadriceps exercise (IQE) in patients with knee osteoarthritis (KOA) between those with and without knee extension limitation.</div></div><div><h3>Design</h3><div>In this cross-sectional study, data were collected at an orthopedic clinic from March 2022 to April 2023. Among patients diagnosed with KOA, those with knee joint extension range of motion <0° and >0° were defined as the limited group (n = 16) and non-limited group (n = 13), respectively. Ultrasonography was performed at rest and during IQE to measure IFP hardness based on shear wave velocity. Near-infrared spectroscopy was performed to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) in the IFP before (baseline), during (IQE task), and post IQE. IFP hardness and O2Hb, HHb, and cHb concentration were analyzed using a linear mixed model for the groups and measurement points.</div></div><div><h3>Results</h3><div>IFP hardness changes during IQE were significantly less in the limited group than in the non-limited group (limited: mean difference [MD] = −0.136, 95 % confidence interval [CI] [−0.475, 0.203]; non-limited: MD = −1.154, 95 % CI [−1.530, −0.778]). O2Hb concentration did not significantly change at post compared with baseline in the limited group but did in the non-limited group (limited: MD = −0.024, 95 % CI [−0.961, 0.913]; non-limited: MD = −4.118, 95 % CI [−5.156, −3.079]).</div></div><div><h3>Conclusions</h3><div>The limited group revealed no IFP hardness and hemoglobin concentration change following IQE, whereas the opposite was observed for the non-limited group, indicating oxygenation.</div></div>","PeriodicalId":74377,"journal":{"name":"Osteoarthritis and cartilage open","volume":"7 1","pages":"Article 100559"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tibiofemoral cartilage strain and recovery following a 3-mile run measured using deep learning segmentation of bone and cartilage 利用骨骼和软骨的深度学习分割技术测量 3 英里跑步后的胫骨软骨应变和恢复情况。

Osteoarthritis and cartilage open

Pub Date : 2024-12-05 DOI: 10.1016/j.ocarto.2024.100556

Patrick X. Bradley , Sophia Y. Kim-Wang , Brooke S. Blaisdell , Alexie D. Riofrio , Amber T. Collins , Lauren N. Heckelman , Eziamaka C. Obunadike , Margaret R. Widmyer , Chinmay S. Paranjape , Bryan S. Crook , Nimit K. Lad , Edward G. Sutter , Brian P. Mann , Charles E. Spritzer , Louis E. DeFrate

Objective

We sought to measure the deformation of tibiofemoral cartilage immediately following a 3-mile treadmill run, as well as the recovery of cartilage thickness the following day. To enable these measurements, we developed and validated deep learning models to automate tibiofemoral cartilage and bone segmentation from double-echo steady-state magnetic resonance imaging (MRI) scans.

Design

Eight asymptomatic male participants arrived at 7 a.m., rested supine for 45 min, underwent pre-exercise MRI, ran 3 miles on a treadmill, and finally underwent post-exercise MRI. To assess whether cartilage recovered to its baseline thickness, participants returned the following morning at 7 a.m., rested supine for 45 min, and underwent a final MRI session. These images were used to generate 3D models of the tibia, femur, and cartilage surfaces at each time point. Site-specific tibial and femoral cartilage thicknesses were measured from each 3D model. To aid in these measurements, deep learning segmentation models were developed.

Results

All trained deep learning models demonstrated repeatability within 0.03 mm or approximately 1 % of cartilage thickness. The 3-mile run induced mean compressive strains of 5.4 % (95 % CI = 4.1 to 6.7) and 2.3 % (95 % CI = 0.6 to 4.0) for the tibial and femoral cartilage, respectively. Furthermore, both tibial and femoral cartilage thicknesses returned to within 1 % of baseline thickness the following day.

Conclusions

The 3-mile treadmill run induced a significant decrease in both tibial and femoral cartilage thickness; however, this was largely ameliorated the following morning.

目的：我们试图测量3英里跑步机跑步后胫骨股骨软骨的变形，以及第二天软骨厚度的恢复。为了实现这些测量，我们开发并验证了深度学习模型，通过双回声稳态磁共振成像（MRI）扫描自动分割胫股软骨和骨骼。设计：8名无症状男性参与者于早上7点到达，仰卧休息45分钟，进行运动前MRI检查，在跑步机上跑3英里，最后进行运动后MRI检查。为了评估软骨是否恢复到其基线厚度，参与者于第二天早上7点返回，仰卧休息45分钟，并进行最后一次MRI检查。这些图像用于在每个时间点生成胫骨、股骨和软骨表面的3D模型。从每个3D模型中测量特定部位的胫骨和股骨软骨厚度。为了帮助这些测量，开发了深度学习分割模型。结果：所有经过训练的深度学习模型在软骨厚度的0.03 mm或约1%范围内具有重复性。3英里跑步对胫骨和股软骨的平均压缩应变分别为5.4% （95% CI = 4.1至6.7）和2.3% （95% CI = 0.6至4.0）。此外，胫骨和股骨软骨厚度在第二天恢复到基线厚度的1%以内。结论：3英里跑步机运动导致胫骨和股骨软骨厚度显著降低；不过，这种情况在第二天早上就大大改善了。

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引用次数: 0

Frontal plane mechanical leg alignment estimation from knee x-rays using deep learning 使用深度学习的膝关节x射线的正面机械腿对齐估计。

Osteoarthritis and cartilage open

Pub Date : 2024-11-30 DOI: 10.1016/j.ocarto.2024.100551

Kenneth Chen , Christoph Stotter , Christopher Lepenik , Thomas Klestil , Christoph Salzlechner , Stefan Nehrer

Objective

Lower limb malalignment can complicate symptoms and accelerate knee osteoarthritis (OA), necessitating consideration in study population selection. In this study, we develop and validate a deep learning model that classifies leg alignment as “normal” or “malaligned” from knee antero-posterior (AP)/postero-anterior (PA) radiographs alone, using an adjustable hip-knee-ankle (HKA) angle threshold.

Material and methods

We utilized 8878 digital radiographs, including 6181 AP/PA full-leg x-rays (LLRs) and 2697 AP/PA knee x-rays (2292 with positioning frame, 405 without). The model's evaluation involved two steps: In step 1, the model's predictions on knee images cropped from LLRs were compared against the ground truth from the original LLRs. In step 2, the model was tested on knee AP radiographs, using corresponding same-day LLRs as a proxy for ground truth.

Results

The model effectively classified alignment, with step one achieving sensitivity and specificity of 0.92 for a threshold of 7.5°, and 0.90 and 0.85 for 5°. For positioning frame images, step two showed a sensitivity of 0.85 and specificity of 0.81 for 7.5°, and 0.79 and 0.74 for 5°. For non-positioning frame images, sensitivity and specificity were 0.91 and 0.83 for 7.5°, and 0.9 and 0.86 for 5°.

Conclusion

The model developed in this study accurately classifies lower limb malalignment from AP/PA knee radiographs using adjustable thresholds, offering a practical alternative to LLRs. This can enhance the precision of study population selection and patient management.

目的：下肢错位可使膝关节骨性关节炎（OA）症状复杂化并加速发病，在研究人群选择时需要加以考虑。在本研究中，我们开发并验证了一个深度学习模型，该模型使用可调节的髋关节-膝关节-踝关节（HKA）角度阈值，仅从膝关节前后(AP)/后前（PA） x线片将腿部对齐分类为“正常”或“不对齐”。材料和方法：我们使用8878张数字x线片，包括6181张AP/PA全腿x线片（LLRs）和2697张AP/PA膝关节x线片（2292张带定位架，405张不带定位架）。该模型的评估包括两个步骤：第一步，将模型对从llr中裁剪的膝盖图像的预测与原始llr的真实情况进行比较。在步骤2中，在膝关节AP x线片上测试该模型，使用相应的当日llr作为地面真实值的代理。结果：该模型对对齐进行了有效分类，第一步对7.5°阈值的敏感性和特异性分别为0.92，对5°阈值的敏感性和特异性分别为0.90和0.85。对于定位帧图像，步骤二对于7.5°的灵敏度为0.85，特异度为0.81，对于5°的灵敏度为0.79，特异度为0.74。对于非定位帧图像，7.5°的灵敏度和特异性分别为0.91和0.83,5°的灵敏度和特异性分别为0.9和0.86。结论：本研究中开发的模型使用可调节阈值准确地从AP/PA膝关节x线片中分类下肢错位，为llr提供了一种实用的替代方案。这可以提高研究人群选择和患者管理的准确性。

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引用次数: 0

Everyday living with osteoarthritis in the global South: A qualitative focus group inquiry in Nigeria 日常生活与骨关节炎在全球南方：定性焦点小组调查在尼日利亚。

Osteoarthritis and cartilage open

Pub Date : 2024-11-29 DOI: 10.1016/j.ocarto.2024.100555

Tolulope Owoyemi , Ibidunni Alonge , Oladapo Adetunji , Emmanuel Ogbu , Adebimpe Ogunbanjo , Simon White , Adewale Adebajo , Christian Mallen , Opeyemi O. Babatunde , Krysia Dziedzic

Objective

Africa contributes significantly to the increasing global prevalence (>37 %), unmet need and treatment burden for people with osteoarthritis. Despite this, little research has examined the expressed needs of patients with osteoarthritis (OA) and joint pain in West-Africa. This study aimed to explore lived experiences, expressed needs and current care gaps for people living with osteoarthritis in low-health resource contexts using Nigeria as a case study.

Design

Qualitative study using Focus Groups. People aged 45 years and over living with osteoarthritis and joint pain were recruited at local health services or via wide advertisements in the community. Discussions were recorded and transcribed verbatim. Data were analyzed using thematic analysis (inductive approach).

Results

Three focus groups were conducted with people living with osteoarthritis (n = 30, age range 45–90 years) across socio-demographic strata. Participants described their experiences of living with osteoarthritis as emotionally, physically, and socio-economically challenging. Four main themes (and 14 sub-themes) were identified. Participants expressed the need for an information and health education campaign and access to appropriate health professionals (especially physiotherapists) for providing support, guidance, and assistance with self-management.

Conclusions

The provision of an accessible, and contextually appropriate patient education package, in line with evidence-based recommendations is a critical need for people living with osteoarthritis in Nigeria. This will promote evidence-based care for OA in low-resource settings, empowering patients to self-manage and reducing confusion related to inconsistent advice and mixed messages about cause, healthcare access and OA care.

目的：非洲对骨关节炎患者的全球患病率（2010年为37%）、未满足的需求和治疗负担的增加做出了重大贡献。尽管如此，很少有研究调查西非骨关节炎（OA）和关节疼痛患者的表达需求。本研究旨在以尼日利亚为例，探讨低健康资源环境下骨关节炎患者的生活经历、表达需求和当前护理差距。设计：使用焦点小组进行定性研究。45岁及以上患有骨关节炎和关节疼痛的人在当地卫生服务机构或通过社区的广泛广告招募。讨论被逐字记录下来。数据分析采用专题分析（归纳法）。结果：对骨关节炎患者（n = 30，年龄45-90岁）进行了三个焦点小组研究。参与者描述了他们患有骨关节炎的经历，在情感上、身体上和社会经济上都具有挑战性。确定了四个主要主题（和14个次级主题）。与会者表示，需要开展信息和健康教育运动，并有机会获得适当的保健专业人员（特别是物理治疗师），以便在自我管理方面提供支持、指导和协助。结论：根据循证建议，为尼日利亚骨关节炎患者提供可获得的、适合其具体情况的一揽子教育方案是一项关键需求。这将促进低资源环境中OA的循证护理，使患者能够自我管理，并减少因不一致的建议和关于病因、医疗保健获取和OA护理的混合信息而引起的困惑。

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引用次数: 0

Brain functional imaging contributions in osteoarthritis-related pain: A viewpoint 脑功能成像在骨关节炎相关疼痛中的作用：一种观点。

Osteoarthritis and cartilage open

Pub Date : 2024-11-28 DOI: 10.1016/j.ocarto.2024.100554

Camille Fauchon , Marie Binvignat , Francis Berenbaum , Philip G. Conaghan , Roland Peyron , Jérémie Sellam

Objective

Neuroimaging investigations are critical to provide a more direct assessment of brain disturbances associated with osteoarthritis (OA)-related pain, and to better understand its pathophysiology to develop new treatment strategies. This viewpoint aims to summarize the importance of the brain in OA pain.

Method

A European working group on pain in osteoarthritis GO-PAIN (Going Inside Osteoarthritis-related Pain Phenotyping) has been created to work on a global assessment of the OA-related pain. Relevant scientific literature was evaluated, summarized and discussed to expose advances in functional brain alterations related-to OA pain.

Results

Findings of neuroimaging studies are highly heterogenous and based on small sample size, but some key brain alterations associated with OA pain can be identified across experiments. A systematic literature review conducted by Hall and colleagues (2023) found lower activity, connectivity, and grey matter volume in the right anterior insula in patients with OA than in healthy controls. Other works also pointed out that activity of specific brain regions could serve as a potential surrogate biomarker, but several limitations and confounding factors needs to be addressed.

Conclusions

Brain functional imaging provides opportunities to accurately address an OA-related pain endophenotype. To encompass limitations and fill the gaps from the previous studies, we propose a blueprint for the next 5 years and stimulate ideas for others working in the field.

目的：神经影像学研究对于提供与骨关节炎（OA）相关疼痛相关的脑障碍更直接的评估，并更好地了解其病理生理以制定新的治疗策略至关重要。这一观点旨在总结脑在OA疼痛中的重要性。方法：成立了一个欧洲骨关节炎疼痛工作组GO-PAIN（进入骨关节炎相关疼痛表型），对骨关节炎相关疼痛进行全球评估。我们对相关的科学文献进行了评估、总结和讨论，以揭示与OA疼痛相关的功能性脑改变的进展。结果：神经影像学研究的结果是高度异质性的，并且基于小样本量，但可以通过实验确定与OA疼痛相关的一些关键的大脑改变。Hall及其同事（2023）进行的一项系统文献综述发现，OA患者右脑岛前部的活动性、连通性和灰质体积低于健康对照组。其他研究也指出，特定大脑区域的活动可以作为潜在的替代生物标志物，但需要解决一些限制和混杂因素。结论：脑功能成像提供了准确定位oa相关疼痛内表型的机会。为了弥补以往研究的局限性和空白，我们提出了未来5年的蓝图，并为该领域的其他工作人员提供了灵感。

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引用次数: 0

The rat osteoarthritis bone score for histological pathology relevant to human bone marrow lesions and pain 大鼠骨关节炎的组织学病理评分与人类骨髓病变和疼痛有关。

Osteoarthritis and cartilage open

Pub Date : 2024-11-27 DOI: 10.1016/j.ocarto.2024.100544

Daniel F. McWilliams , Mohsen Shahtaheri , Soraya Koushesh , Chitra Joseph , Peter RW. Gowler , Luting Xu , Victoria Chapman , Nidhi Sofat , David A. Walsh

Objectives

Histological osteochondral characteristics of inflammation, fibrosis, vascularity, cartilage islands, vessels entering cartilage, thickened trabeculae and cysts are associated with bone marrow lesions (BMLs) in human knee osteoarthritis (OA). We identified and developed a method for scoring comparable pathology in two rat OA knee pain models.

Methods

Rats (n = 8–10 per group) were injected with monoiodoacetate (MIA) or saline, or underwent meniscal transection (MNX) or sham surgery. Pain behaviour (weight bearing asymmetry and mechanical hindpaw withdrawal thresholds (PWTs)) were measured and knee samples obtained. Features associated with BMLs were evaluated using haematoxylin and eosin or Safranin-O stained knee sections. Sections were scored for chondropathy, osteophytes, synovitis and with the human OA Bone Score modified for rats (rOABS). rOABS reliability was assessed with intraclass correlation coefficient (ICC), groups were compared using Mann-Whitney U-tests, and associations examined with Spearman's rho.

Results

OABS features were more prevalent in each OA pain group than in controls. rOABS displayed good inter-rater reliability (ICC = 0.79). rOABS was higher in each model than controls; MIA 3.0 (2.3–4.0) vs vehicle 0.0 (0.0–0.0), and MNX 4.0 (2.3–4.8) vs sham 0.0 (0.0–0.0), each p < 0.003. rOABS was associated with OA cartilage involvement (rho = 0.69, p < 0.001), osteophyte (rho = 0.61, p < 0.001) and synovial inflammation (rho = 0.76, p < 0.001). Higher rOABS was associated with pain behaviour: weight bearing asymmetry (rho = 0.65, p < 0.001) and PWT (rho = −0.47, p = 0.003).

Conclusions

Subchondral pathology in rat OA models resembles human subchondral BMLs. rOABS reliably measured subchondral pathology and was associated with OA structure and pain behaviour.

目的：炎症、纤维化、血管、软骨岛、进入软骨的血管、小梁增厚和囊肿的组织学特征与人类膝关节骨性关节炎（OA）的骨髓病变（BMLs）有关。我们确定并开发了一种方法来评分两种大鼠OA膝关节疼痛模型的可比病理。方法：每组8 ~ 10只大鼠分别注射单碘乙酸酯（MIA）或生理盐水，或半月板横断（MNX）或假手术。测量疼痛行为（负重不对称和机械后爪退缩阈值（PWTs））并获得膝关节样本。使用血红素和伊红或红花素o染色的膝关节切片评估与bml相关的特征。对软骨病变、骨赘、滑膜炎和大鼠OA骨评分（rOABS）进行评分。rOABS信度采用类内相关系数（ICC）评估，组间比较采用Mann-Whitney u检验，关联检验采用Spearman’s rho。结果：与对照组相比，OA疼痛组的OABS特征更为普遍。rOABS具有良好的量表间信度（ICC = 0.79）。各模型的rOABS均高于对照组；MIA 3.0 (2.3-4.0) vs vehicle 0.0 (0.0-0.0), MNX 4.0 (2.3-4.8) vs sham 0.0(0.0-0.0)，各p结论：大鼠OA模型的软骨下病理与人软骨下BMLs相似。rOABS可靠地测量软骨下病理，并与OA结构和疼痛行为相关。

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引用次数: 0