Back pain in osteoarthritis of the knee.

To quantify the relationship between Stanford Health Assessment Questionnaire (HAQ) disability and arterial stiffness in patients with rheumatoid arthritis (RA). A consecutive series of 114 patients with RA but without overt arterial disease, aged 40-65 years, were recruited from rheumatology clinics. A research nurse measured blood pressure (BP), arterial stiffness (heart rate-adjusted augmentation index), fasting lipids, glucose, erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). A self-completed patient questionnaire included HAQ, damaged joint count, EuroQol measure of health outcome, and Godin physical activity score. Multiple linear regression (MLR) adjusted for age, sex, smoking pack-years, cholesterol, mean arterial BP, physical activity, daily fruit and vegetable consumption, arthritis duration, ESR, and RA criteria. Mean age was 54 years (81% women) with a median HAQ of 1.13 (interquartile range 0.50; 1.75). Median RA duration was 10 years, 83% were RF-positive, and median ESR was 16 mm/h. Mean arterial stiffness was 31.5 (SD 7.7), BP 125/82 mm Hg, cholesterol 5.3 mmol/l, and 24% were current smokers. Current therapy included RA disease-modifying agents (90%), prednisolone (11%), and antihypertensive therapy (18%). Arterial stiffness was positively correlated with HAQ (r = 0.42; 95% CI 0.25 to 0.56). On MLR, a 1-point increase in HAQ disability was associated with a 2.8 increase (95% CI 1.1 to 4.4; p = 0.001) in arterial stiffness. Each additional damaged joint was associated with a 0.17 point increase (95% CI 0.04 to 0.29; p = 0.009) in arterial stiffness. The relationship between EuroQol and arterial stiffness was not statistically significant. In patients with RA who are free of overt arterial disease, higher RA disability is associated with increased arterial stiffness independently of traditional cardiovascular risk factors and RA characteristics.

The purpose of this study was to develop a brief measure of severity for rheumatoid arthritis (RA) that would not be seriously confounded by psychological functioning. The Rheumatoid Arthritis Severity Scale (RASS), designed for use by physicians on their own patients, consists of three visual analogue scales: Disease Activity, Functional Impairment and Physical Damage. Ninety-four RA outpatients completed the Health Assessment Questionnaire (HAQ) Disability, Pain Severity, Health State subscales and the Symptom Checklist-90-Revised (SCL-90-R) Anxiety, Depression and Somatization subscales. Rheumatologists completed the RASS on their own patients. Results suggest that the RASS is internally consistent (alpha=0.85) and valid. RASS Disease Activity, Functional Impairment, Physical Damage correlated with HAQ Disability (r=0.40, 0.68, 0.61; P<0.01), Pain (r=0.37, 0.34, 0.34; P<0.01) and Health State (r=-0.27, -0.36, -0.27; P<0.01). RASS Physical Damage uniquely predicted longer illness duration (years with RA). In contrast to the HAQ, RASS subscales shared less variance with anxiety, somatization and depression scores. Preliminary data suggest that the RASS may be a quick, reliable, valid physician-completed RA severity scale that compares favourably with the longer, patient-completed HAQ.

541 THE IMPACT OF INTRA-ARTICULAR HYALURONIC ACID ON GAIT VARIABILITY IN KNEE OSTEOARTHRITIS PATIENTS

Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes. We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20% improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as % predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine). A baseline HAQ disability score of less than the median was predictive of at least a 20% improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P<0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment. A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.

There is little evidence on intra-articular (IA) treatment in knee osteoarthritis (KOA) and there is a lack of long-term follow-up studies. To assess the long-term effectiveness and safety of IA oxygen-ozone (O2O3) and hyaluronic acid (HA) in terms of functioning in KOA patients over a 31-week period. Patients aged ⩾ 60 years with KOA were randomly allocated to receive 4 IA knee injections (1/week) of O2O3 or HA (T0-T3) and a follow-up visit 4 weeks after the fourth injection (T4). In this extension study we assessed VAS and safety in patients with Visual Analogue Scale (VAS) ⩾ 4 at the at 6-month follow-up visit (T5), undergoing a second treatment cycle (T5-T8) and 1-month follow-up visit (T9). Forty-two patients (aged 70.5 ± 5.8 years) were randomly allocated to O2O3 (n= 22) or HA group (n= 20). Twenty-three underwent another IA cycle: 12 (54.6%) in the O2O3 group and 11 (55.0%) in the HA group. Both groups showed significant reduction in VAS (p< 0.013) compared to baseline during both cycles. At follow-up visits (T4 and T9), VAS was significantly lower in the HA group (p< 0.013). There were no differences in adverse events occurrence between groups. IA O2O3 might be comparable to HA in terms of effectiveness and safety in reducing pain in KOA patients, although at both follow-up visits (T4 and T9) VAS was significantly lower in the HA group.

SAT0470 Validity and Reliability of The Chinese Version of The Paindetect Questionnaire in Subjects with Knee Osteoarthritis

FRI0523 Zoledronic acid plus prednisolone versus zoledronic acid alone or placebo in the treatment of knee osteoarthritis: a randomised trial

National variations in back pain: Ecological fallacy or cultural differences?

To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA). Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs. Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15-0.27), 0.16 (0.11-0.21), and -0.15 (-0.21 to -0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39-0.48), 0.27 (0.23-0.32), and -0.34 (-0.38 to -0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28). Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.

BackgroundA first-year interim analysis of this two-year study suggested that intra-articular injections of highly purified, natural-origin polynucleotides and hyaluronic acid (HA) as a fixed combination (PNHA) might improve knee function and joint pain more effectively than HA alone in patients with knee osteoarthritis (OA). The purpose of the second-year analysis herein described was to verify whether the first-year interim outcomes persist over the whole two-year period.MethodsRandomised, double-blind, HA-controlled clinical trial in 100 knee OA patients (98 randomised, 79 completing the study) in a high-specialisation tertiary care setting. The hypothesised difference of efficacy between PNHA and HA for the original sample size estimate is 20%. Treatment cycle: three intra-articular knee injections of either PNHA or HA, at baseline and weekly for two weeks. Evaluations: Western Ontario and McMaster Universities (WOMAC) score and Knee Society Score (KSS) as, respectively, primary and secondary endpoints, evaluated at baseline and after 2, 6, 12, and 24 months; synovial fluid levels of mediators (at baseline and the end of the treatment cycle). Adverse effects investigated at each control visit. Statistical analysis: Kruskal-Wallis test for independent samples (nonparametric one-way analysis of variance) after correction of means for age, Body Mass Index and Kellgren-Lawrence grade. If significant, pairwise post-hoc Sidak multiple comparisons.ResultsKSS total score and KSS pain item: significant improvement in both groups, with significantly more pain improvement in patients treated with PNHA (2-point reduction) than HA (1-point reduction). Both groups experienced significant long-term reductions in WOMAC total scores: significantly stronger in PNHA-treated patients after 24 months with a steady difference of 16% favouring PNHA in WOMAC pain subscore. No clinically significant adverse events in either group.ConclusionsThe outcomes of the 2-year study confirmed that a short cycle of intra-articular treatment (3 weekly double-blind injections) with polynucleotides (long-acting viscosupplementation properties, chondrocyte activation, pain-relieving properties) in fixed combination with high molecular weight hyaluronic acid is more effective in improving knee function and pain in knee OA patients than HA alone. PNHA may be elective for viscosupplementation in knee OA patients with fastidious and resistant pain and worsening disease.Trial registrationNCT02417610.Registration, 15/04/2015.ClinicalTrials.gov database link:

SUMMARY – The aim of the study was to determine the prevalence of neuropathic pain in knee osteoarthritis patients using painDETECT questionnaire, and to evaluate correlations between pain intensity, gender, age and types of treatment, and the presence of neuropathic pain. The study included 122 patients. All participants completed a questionnaire on sociodemographic data, duration of symptoms, types of treatment and preventable risk factors (body mass index and waist circumference). The presence of neuropathic pain was assessed by painDETECT, according to which subjects were classified into three groups (neuropathic pain likely, possible, or unlikely). Neuropathic pain was likely in 18 (14.8%), possible in 30 (24.6%) and unlikely in 74 (60.7%) subjects. A significant positive correlation was found between visual analog scale for pain and painDETECT score. There was no statistically significant difference in gender, age, waist circumference and body mass index among three groups of participants according to painDETECT score. In conclusion, knee osteoarthritis patients with neuropathic pain component were experiencing higher levels of pain, implicating poorer pain control with common analgesics. Recognizing these patients as a distinct subgroup would allow clinicians to improve their treatment by using unconventional analgesics with central activity.

IntroductionThe objectives of this study were to determine the predictive factors of long-term radiographic outcome of rheumatoid arthritis (RA) and to describe the relationship between joint damage and disability over the course of the disease.MethodsA cohort of 191 patients with early RA referred from primary care physicians were prospectively followed for 10 years. To determine the predictive factors of radiographic outcome, univariate analysis of the relationship between baseline values and outcome measures was undertaken using a chi-squared or Fisher's exact test. Stepwise multiple logistic regression was also performed to select independent prognostic factors.ResultsFrom data available for 112 patients, univariate analysis revealed a total Sharp score at 10 years that was significantly correlated with erythrocyte sedimentation rate (ESR), presence and level of IgA rheumatoid factor, presence of an anti-citrullinated protein antibody (ACPA), serum level of matrix metalloproteinase-3 and radiographic score at baseline. Logistic regression identified the baseline erosion score to be the most important baseline parameter as an independent prognostic factor of total radiographic score at 10 years (odds ratio = 5.64; 95% confidence interval = 1.78 to 17.86). After excluding radiographic scores from the entry parameters, the presence of ACPA and ESR were also predictive of the final total Sharp score. The Health Assessment Questionnaire (HAQ) score was strongly correlated with disease activity parameters, such as disease activity score and pain, at baseline and at three, five and 10 years. No correlation was found between total radiographic Sharp score and HAQ score throughout the study.ConclusionsIn this prospective study, baseline radiographic score, ESR and ACPA were the best predictive factors of 10-year radiographic outcome in early RA. HAQ disability was associated with disease activity throughout the 10-year follow-up but not with joint damage. This discrepancy with previous reports may be due in part to the early start of therapy with disease-modifying anti-rheumatic drugs.

Osteoarthritis (OA) of the knee is associated with decline in functional capacity and ultimately leads to Total Knee Arthroplasty (TKA) in many of these patients. Exercise regimens prior to surgery may potentially enhance pre and post TKA functional performance. However, assessment of such performance should involve biomechanical factors that characterize the mechanisms with which tasks are performed, and not just the quantity of task performed. The present overall study investigated walking biomechanics of end stage knee OA and TKA patients. Throughout the three sub-studies that comprised the overall investigation, particular emphasis was placed on heelstrike and the loading response phase of gait, in addition to functional ability parameters. The first sub-study investigated gait biomechanics and fatigue during a 6 minute walk for patients with end stage knee OA. Results demonstrated that even if patients were able to maintain their gait velocity throughout the walk, subtle but statistically significant differences at the ankle were present after the 6 minute walk. Knee OA patients may be experiencing higher loading conditions at the knee after 6 min. In order to adapt to fatigue, knee OA patients appear to adopt ankle strategies alleviating the load from a painful knee, rather than knee strategies, causing greater instability and reduced performances. A single walking trial for gait analysis may be insufficient to assess gait compensations due to fatigue in daily activities. In light of the initial results on end stage knee OA walking biomechanics, the second sub-study included investigation of the effects of a 4 to 6 weeks exercise program on TKA outcomes. Results demonstrated that exercise therapy was effective at improving function and reducing pain to a certain extent pre-surgery. However, assessment of the walking biomechanics raised the question of whether improving physical ability improved knee OA condition or caused further knee joint degeneration and possibly the onset of OA in the opposite leg. Control patients exhibited a more careful gait pattern with lower speed and gait parameters reflecting potentially lower impact at heelstrike which may be more beneficial for knee OA conditions. The exercisers' walking characteristics showed evidence of an overstriding gait pattern with potentially reduced shock absorption mechanisms that can lead to lower leg injuries. The third sub-study investigated walking biomechanics of prehab and non prehab subjects one month after surgery and results suggested that the effects of the pre-surgery exercise program did not remain post-surgery. Even if patients in the exercise group

BackgroundThe complete circulating long non-coding RNAs (lncRNAs) signature of rheumatoid arthritis (RA) and osteoarthritis (OA) is still uncovered. The lncRNA integrin subunit beta 2 (ITGB2)-anti-sense RNA 1 (ITGB2-AS1) affects ITGB2 expression; however, there is a gap in knowledge regarding its expression and clinical usefulness in RA and OA. This study investigated the potential of serum ITGB2-AS1 as a novel diagnostic biomarker and its correlation with ITGB2 expression and its ligand intercellular adhesion molecule-1 (ICAM-1), disease activity, and severity in RA and primary knee OA patients.SubjectsForty-three RA patients, 35 knee OA patients, and 22 healthy volunteers were included.ResultsCompared with healthy controls, serum ITGB2-AS1 expression was upregulated in RA patients but wasn’t significantly altered in knee OA patients, whereas serum ICAM-1 protein levels were elevated in both diseases. ITGB2-AS1 showed discriminative potential for RA versus controls (AUC = 0.772), while ICAM-1 displayed diagnostic potential for both RA and knee OA versus controls (AUC = 0.804, 0.914, respectively) in receiver-operating characteristic analysis. In the multivariate analysis, serum ITGB2-AS1 and ICAM-1 were associated with the risk of developing RA, while only ICAM-1 was associated with the risk of developing knee OA. A panel combining ITGB2-AS1 and ICAM-1 showed profound diagnostic power for RA (AUC = 0.9, sensitivity = 86.05%, and specificity = 91.67%). Interestingly, serum ITGB2-AS1 positively correlated with disease activity (DAS28) in RA patients and with ITGB2 mRNA expression in both diseases, while ICAM-1 positively correlated with ITGB2 expression in knee OA patients.ConclusionOur study portrays serum ITGB2-AS1 as a novel potential diagnostic biomarker of RA that correlates with disease activity. A predictive panel combining ITGB2-AS1 and ICAM-1 could have clinical utility in RA diagnosis. We also spotlight the association of ICAM-1 with knee OA diagnosis. The correlation of serum ITGB2-AS1 with ITGB2 expression in both diseases may be insightful for further mechanistic studies.

Background: Osteoarthritis is a disorder of the moving joints. Pain functioning are the main complaints of the disease osteoarthritis of the knee. The purpose of the study was to analyze the effect of a combination of quadricep exercise and hip abductor exercise on pain in knee among osteoarthritis patients.Subjects and Method: The study was carried out at the East Java Regional Hospital for the period of December 2022 to March 2023. The study population was knee joint osteoarthritis patients of degree 1 to degree 2. The sampling technique used in this study was purposive sampling, with inclusion and exclusion criteria. The number of samples in quantitative research was 60 respondents. The dependent variable is pain, while the independent variable is quadriceps exercise and hip abductor exercise. The instrument used is the WOMAC questionnaire. Analysis of the study was using the Wilcoxon test and the Mann Whitney test.Results: There was a significant difference in pain between the control and intervention groups after conducting a combination of quadriceps exercises and hip abductor exercises (p=0.043)Conclusion: The combination of quadriceps exercise and hip abductor exercise is effective on pain reduction in knee osteoarthritis patients.Keywords: quadriceps, hip abductor, osteoarthritis.Correspondence: Dia Metasari. Master of Nursing, Universitas Airlangga, Indonesia. Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, East Java 60115. Email: dia.metasari-2021@fkp.unair.ac.id. Mobile: +628563040303.Indonesian Journal of Medicine (2023), 08(02): 186-193https://doi.org/10.26911/theijmed.2023.08.02.08