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JAMA The Journal of the American Medical Association 04/2013; 309(15):1583-1584. · 30.03 Impact Factor
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ABSTRACT: BACKGROUND: Vitamin D is important for bone, cartilage and muscle function but there are few studies on its association with joint pain. OBJECTIVE: To investigate whether serum vitamin D predicts change in knee and hip pain in older adults. METHODS: Longitudinal population-based cohort study of randomly selected older adults (n=769) aged 50-80 years (mean 62 years); 50% were male. Serum 25-hydroxyvitamin D (25-OHD) was assessed at baseline by radioimmunoassay, and pain at baseline, 2.6 and/or 5 years using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. We used linear regression with adjustment for age, sex, body mass index and season, then further adjusted for potential structural mechanisms (radiographic osteoarthritis, bone marrow lesions, chondral defects and muscle strength). RESULTS: Mean total knee WOMAC score was 3.2 (range 0-39). 4.2% of participants had moderate vitamin D deficiency at baseline (25-OHD 12.5-25 nmol/l). 25-OHD <25 nmol/l predicted change in knee pain (using total WOMAC score) over 5 years (β=2.41, p=0.002) with a similar effect size for hip pain over 2.4 years (β=2.20, p=0.083). Results were consistent within pain subscales, and the association was independent of demographic, anthropometric and structural covariates. No association was present when 25-OHD was analysed as a continuous measure. CONCLUSIONS: Moderate vitamin D deficiency independently predicts incident, or worsening of, knee pain over 5 years and, possibly, hip pain over 2.4 years. Therefore correcting moderate vitamin deficiency may attenuate worsening of knee or hip pain in elderly people but giving supplements to those with a higher 25-OHD level is unlikely to be effective.
Annals of the rheumatic diseases 04/2013; · 8.11 Impact Factor
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ABSTRACT: Objective. To systematically review the evidence for association between serum 25-hydroxyvitamin D (25-(OH)D) and OA and the effect of vitamin D therapy on OA.Methods. An English Medline, EMBASE and Cochrane Library search for vitamin D and OA from January 1980 to June 2012 was performed. Randomized controlled trials (RCTs), cohort, case-control and cross-sectional studies in adults were included. The methodological quality of the selected studies was assessed and a best-evidence synthesis was used to summarize the results due to the heterogeneity of the studies.Results. Of the 86 evaluated articles, 2 RCTs and 13 observational studies were included in the final analyses. The number of participants ranged from 64 to 1644 (0-100% women). The RCTs were only reported in abstract form and showed inconsistent results, most likely due to variations in their study design. There was insufficient or limited evidence for associations between 25-(OH)D and hand or hip OA. For knee radiographic OA as assessed by the Kellgren and Lawrence (KL) score, there was moderate evidence showing that low levels of 25-(OH)D were associated with increased progression of radiographic OA. Strong evidence for an association between 25-(OH)D and cartilage loss was apparent when joint space narrowing and changes in cartilage volume were considered collectively as cartilage loss.Conclusion. 25-(OH)D appears to be implicated in structural changes of knee OA rather than symptoms, and further well-designed RCTs are required to determine whether vitamin D supplementation can slow disease progression. There is insufficient evidence for other sites.
Rheumatology (Oxford, England) 03/2013; · 4.24 Impact Factor
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ABSTRACT: OBJECTIVE: Obesity is characterised by hyperinsulinemia, which is associated with diabetes, hypertension and coronary heart disease. The aim of this study was to determine if body fat and muscle measures predict the natural increase in leptin over 2.6 years in older adults. METHODS: 190 subjects (50% females) aged between 50 to 79 years were selected to perform the serum measurements for leptin. Height and weight were measured and body mass index (BMI) was calculated. Fat and lean mass of the whole body and the trunk were acquired through dual energy X-ray absorptiometry (DXA). Leg muscle strength and handgrip strength were measured using dynamometry. RESULTS: In multivariable analyses, leg muscle strength was negatively associated with both baseline leptin (β: -0.05 μg/l per Kg, 95% CI: -0.08, -0.02) and follow-up leptin (β: -0.04 μg/l per Kg, 95% CI: -0.07, -0.01). BMI, and percentage total fat and trunk fat and their respective change per annum (cpa) were significantly and positively associated with leptin. Lean mass was negatively associated with baseline leptin. Gender specific analyses produced similar associations between leg muscle strength, fat measures and follow-up leptin in males and females. CONCLUSION: Besides positive associations between body fat, trunk fat and leptin, we found that leg muscle strength was negatively associated with leptin after 2.6 years in a sample of older population. This suggests interventions to maintain or increase muscle strength may have a protective effect on hyperleptinemia. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 11/2012; · 3.17 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: Disease progression of osteoarthritis is usually assessed using radiographs. Utilizing sensitive measures such as magnetic resonance imaging (MRI) may allow us to understand the progressive trajectory of this disease from initial to joint failure stages. This review aims to describe the recent epidemiological and clinical evidence about osteoarthritis disease progression and the risk factors associated with disease progression. RECENT FINDINGS: Changes in MRI-detected structural abnormalities, including increases in cartilage defects and bone marrow lesions (BMLs), loss of cartilage volume and thickness, and alterations of compositional measures, have been utilized to assess osteoarthritis disease progression. Both clinical risk factors (such as obesity or body fat, muscle weakness, malalignment, metabolic disorders, inflammation, and joint pain) and joint structural factors (such as cartilage defects, BMLs, meniscal pathology, synovitis, and radiographic features) have been associated with osteoarthritis disease progression. With the modification of these factors through interventions such as weight loss, we may slow the progression. SUMMARY: MRI techniques allow us to measure osteoarthritis disease progression and to discover novel risk factors for prevention and innovative strategies for treatment. These also allow identifying persons at greatest risk of disease progression, which may enhance the efficiency of clinical trials through reducing sample size and shortening follow-up period.
Current opinion in rheumatology 10/2012; · 4.60 Impact Factor
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ABSTRACT: To describe the natural history of knee cartilage defects, and their relationship to cartilage volume loss and risk of knee replacement in a longitudinal study of older adults.
395 randomly selected older adults (mean age 62.7 years) had magnetic resonance imaging of their right knee at baseline and approximately 2.9 years later to determine cartilage defect grade (0-4), cartilage volume, medial and lateral tibial bone size, and presence of bone marrow lesions (BMLs). Height, weight, body mass index (BMI) and radiographic osteoarthritis were measured by standard protocols.
At baseline higher grade cartilage defects (grade ≥2) were significantly associated with age, BMI, lateral tibial bone size, BMLs, and radiographic osteoarthritis. Over 2.9 years, the average defect score increased statistically significantly in all compartments; however, the majority of defects remained stable and regression of defects was rare. Baseline factors associated with increase in defect score over 2.9 years were radiographic osteoarthritis, tibial bone size, BMI and being female. In multivariate analysis, baseline cartilage defect grade predicted cartilage volume loss at the medial tibia, lateral tibia and patella over 2.9 years (β = -1.78% to -1.27% per annum per 1 grade increase, P < 0.05 for all comparisons), and risk of knee replacement over 5 years (odds ratio (OR) = 1.73 per 1 grade increase, P = 0.001).
Knee cartilage defects in older adults are common but less likely to regress than in younger life. They independently predict cartilage volume loss and risk of knee replacement, suggesting they are potential targets for intervention.
Osteoarthritis and Cartilage 09/2012; 20(12):1541-7. · 3.90 Impact Factor
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ABSTRACT: OBJECTIVES: This study describes the longitudinal association between objectively assessed physical activity (PA) and knee structural change measured using MRI. METHODS: 405 community-dwelling adults aged 51-81 years were measured at baseline and approximately 2.7 years later. MRI of the right knee at baseline and follow-up was performed to evaluate bone marrow lesions (BMLs), meniscal pathology, cartilage defects, and cartilage volume. PA was assessed at baseline by pedometer (steps/day). RESULTS: Doing ≥10 000 steps/day was associated with BML increases (RR 1.97, 95% CI 1.19 to 3.27, p=0.009). Participants doing ≥10 000 steps/day had a 1.52 times (95% CI 1.05 to 2.20, p=0.027) greater risk of increasing meniscal pathology score, which increased to 2.49 (95% CI 1.05 to 3.93, p=0.002) in those with adverse meniscal pathology at baseline. Doing ≥10 000 steps/day was associated with a greater risk of increasing cartilage defect score in those with prevalent BMLs at baseline (RR 1.36, 95% CI 1.03 to 1.69, p=0.013). Steps/day was protective against volume loss in those with more baseline cartilage volume but led to increased cartilage loss in those with less baseline cartilage volume. (p=0.046 for interaction). CONCLUSIONS: PA was deleteriously associated with knee structural change, especially in those with pre-existing knee structural abnormalities. This suggests individuals with knee abnormalities should avoid doing ≥10 000 steps/day. Alternatives to weight-bearing activity may be needed in order to maintain PA levels required for other aspects of health.
Annals of the rheumatic diseases 08/2012; · 8.11 Impact Factor
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ABSTRACT: BACKGROUND: Osteoarthritis (OA) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss, implying that vitamin D supplementation may prevent the progression of knee OA. The aim of the VItamin D Effects on OA (VIDEO) study is to compare, over a 2- year period, the effects of vitamin D supplementation versus placebo on knee structural changes, knee pain, and lower limb muscle strength in patients with symptomatic knee OA. Methods/design: Randomised, placebo-controlled, and double-blind clinical trial aiming to recruit 400 subjects (200 from Tasmania and 200 from Victoria) with both symptomatic knee OA and vitamin D deficiency (serum [25-(OH)D] level of >12.5 nmol/liter and <60 nmol/liter). Participants will be randomly allocated to vitamin D supplementation (50,000 IU compounded vitamin D3 capsule monthly) or identical inert placebo group for 2 years. The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging (MRI) and Western Ontario and McMaster Universities Index of OA (WOMAC) knee pain score. The secondary endpoints will be other knee structural changes, and lower limb muscle strength. Several other outcome measures including core muscle images and central blood pressure will be recorded. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses. Both intention to treat and per protocol analyses will be utilized. DISCUSSION: The trial is designed to test if vitamin D supplementation will reduce loss of knee cartilage volume, prevent the progression of other knee structural abnormalities, reduce knee pain and strengthen lower limb muscle strength, thus modify disease progression in knee OA. Trial Registration: ClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.
Trials 08/2012; 13(1):131. · 2.02 Impact Factor
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ABSTRACT: Objectives. There have been no reported studies of the association between parity and cartilage in young individuals. The aim of this study was to describe the association between parity, cartilage volume and cartilage defects in women aged 31-41 years. Methods. Cross-sectional study of 144 women, mean age 36 years and BMI 25 kg/m(2), who were participants in an established prospective study. Parity was assessed using a questionnaire. Knee (medial tibial, lateral tibial and patellar) cartilage volume, cartilage defects (grade 0-4 depending on the severity of cartilage thickness loss at tibial and patellar sites) and tibial bone area were assessed using T1-weighted fat-suppressed MRI. Results. The prevalence of cartilage defects (grade ≥2) in this population was 13%. Parity was associated with a higher risk of cartilage defects at the patellar [prevalence ratio (PR) per birth 1.52, 95% CI 1.05, 2.21; PR parous vs nulliparous 1.93, 95% CI 0.66, 5.65], but not tibial sites, after adjustment for confounders including age, BMI, smoking, physical activity, knee injury and tibial bone area. This association between parity and patellar cartilage defects was stronger for those women who had three or more births (vs nulliparous, PR 5.27, 95% CI 1.39, 20.01). There were no significant associations between parity and cartilage volume. Conclusion. Parity was associated with knee cartilage defects primarily at the patellar site in this sample of young women. This association was more apparent with increasing number of live births, suggesting a possible adverse effect of parity on knee cartilage.
Rheumatology (Oxford, England) 08/2012; 51(11):2039-45. · 4.24 Impact Factor
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ABSTRACT: OBJECTIVE: To determine the association between inflammatory markers and change in knee pain over 5 years. METHODS: A total of 149 randomly selected subjects (mean 63 years, range 52-78; 46% female) was studied. Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α) and interleukin (IL)-6 were measured at baseline and 2.7 years later. Knee pain was recorded using the Western Ontario and McMasters osteoarthritis index questionnaire at baseline and 5 years later. Knee radiographic osteoarthritis of both knees was assessed at baseline, and knee bone marrow lesions, joint effusion and cartilage defects were determined using T1 or T2-weighted fat saturated MRI. RESULTS: After adjustment for confounding variables, baseline hs-CRP was positively associated with change in total knee pain (β=0.33 per mg/l, p=0.032), as well as change in the pain at night in bed (β=0.12 per ml/pg, p=0.010) and while sitting/lying (β=0.12 per ml/pg, p=0.002). Change in hs-CRP was also associated with change in knee pain at night and when sitting/lying (both p<0.05). Baseline TNFα and IL-6 were associated with change in pain while standing (β=0.06 per ml/pg, p=0.033; β=0.16 per ml/pg, p=0.035, respectively), and change in TNFα was positively associated with change in total knee pain (β=0.66 ml/pg, p=0.020) and change in pain while standing (β=0.26 ml/pg, p=0.002). Adjustment for radiographic osteoarthritis or MRI-detected structural abnormalities led to no or minor attenuation of these associations. CONCLUSION: Systemic inflammation is an independent predictor of worsening knee pain over 5 years.
Annals of the rheumatic diseases 05/2012; · 8.11 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs.
Therapeutic advances in musculoskeletal disease 04/2012; 4(2):77-97.
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ABSTRACT: Bone marrow lesions (BMLs) play an important role in knee osteoarthritis, but their etiology is not well understood. The aim of this longitudinal study was to describe the association between dietary factors, serum lipids, and BMLs.
In total, 394 older men and women (mean age, 63 years; range, 52 to 79) were measured at baseline and approximately 2.7 years later. BMLs were determined by using T2-weighted fat-saturation magnetic resonance imaging (MRI) by measuring the maximal area of the lesion. Nutrient intake (total energy, fat, carbohydrate, protein, and sugar) and serum lipids were assessed at baseline.
Cross-sectionally, dietary factors and lipids were not significantly associated with BMLs. Energy, carbohydrate, and sugar intake (but not fat) were positively associated with a change in BML size (β = 15.44 to 19.27 mm2 per 1 SD increase; all P < 0.05). High-density lipoprotein (HDL) cholesterol tended to be negatively associated with BML change (β = -11.66 mm2 per 1 SD increase; P = 0.088).
Energy, carbohydrate, and sugar intake may be risk factors for BML development and progression. HDL cholesterol seems protective against BMLs. These results suggest that macronutrients and lipids may be important in BML etiology and that dietary modification may alter BML natural history.
Arthritis research & therapy 01/2012; 14(1):R13. · 4.27 Impact Factor
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ABSTRACT: The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial.
A cross-sectional study of 491 women aged 50-80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry.
Ever use of OC was associated with significantly higher BMD at the total body (6%, p<.001) and spine (4%; p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5-10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.94).
Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance.
Contraception 10/2011; 84(4):357-62. · 2.72 Impact Factor
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ABSTRACT: To determine the association of knee bone size, cartilage volume, and body mass index (BMI) at baseline with knee cartilage loss over 2 years in younger or middle-aged adults.
A total of 324 subjects (mean age 45 yrs, range 26-61) were measured at baseline and about 2 years later. Knee cartilage volume and bone size were determined using T1-weighted fat-saturated magnetic resonance imaging.
In multivariable analysis, baseline knee bone size was negatively associated with annual change in knee cartilage volume at medial and lateral tibial sites (ß = -0.62% to -0.47%/cm(2), all p < 0.001). The associations disappeared at medial tibial site after adjustment for baseline cartilage volume and became of borderline statistical significance at lateral tibial site after adjustment for both baseline cartilage volume and osteophytes (ß = -0.29, p = 0.059). Baseline knee cartilage volume was consistently and negatively associated with annual change in knee cartilage volume at all 3 medial tibial, lateral tibial, and patellar sites (ß = -4.41% to -1.37%/ml, all p < 0.001). Baseline BMI was negatively associated with an annual change in knee cartilage volume, but only in subjects within the upper tertile of baseline cartilage volume, even after adjusting for cartilage defects (ß = -0.16% to -0.34%/kg/m(2), all p < 0.05).
Our study suggests that both higher baseline tibial bone area and knee cartilage volume (most likely due to cartilage swelling) are associated with greater knee cartilage loss over 2 years. A higher BMI was associated with greater knee cartilage loss only in subjects with higher baseline cartilage volume.
The Journal of Rheumatology 07/2011; 38(9):1973-80. · 3.69 Impact Factor
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ABSTRACT: Although several studies have examined the relationship between physical activity and knee osteoarthritis, the effect of physical activity on knee joint health is unclear. The aim of this systematic review was to examine the relationships between physical activity and individual joint structures at the knee.
Computer-aided searches were conducted up until November 2008, and the reference lists of key articles were examined. The methodological quality of selected studies was assessed based on established criteria, and a best-evidence synthesis was used to summarize the results.
We found that the relationships between physical activity and individual joint structures at the knee differ. There was strong evidence for a positive association between physical activity and tibiofemoral osteophytes. However, we also found strong evidence for the absence of a relationship between physical activity and joint space narrowing, a surrogate method of assessing cartilage. Moreover, there was limited evidence from magnetic resonance imaging studies for a positive relationship between physical activity and cartilage volume and strong evidence for an inverse relationship between physical activity and cartilage defects.
This systematic review found that knee structures are affected differently by physical activity. Although physical activity is associated with an increase in radiographic osteophytes, there was no related increase in joint space narrowing, rather emerging evidence of an associated increase in cartilage volume and decrease in cartilage defects on magnetic resonance imaging. Given that optimizing cartilage health is important in preventing osteoarthritis, these findings indicate that physical activity is beneficial, rather than detrimental, to joint health.
Medicine and science in sports and exercise 03/2011; 43(3):432-42. · 3.71 Impact Factor
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ABSTRACT: There is controversy about whether pain and radiographic osteoarthritis (ROA) predict subsequent cartilage loss. The aim of this study was to describe the relationship between ROA, pain and cartilage loss in the knee.
We studied randomly selected subjects at baseline and approximately 2.9 years later (n= 399). The presence of ROA was assessed at baseline with a standing anteroposterior semiflexed radiograph scored using the Osteoarthritis Research Society International atlas for osteophytes (OP) and joint space narrowing (JSN). Pain was assessed by the Western Ontario McMaster Osteoarthritis Index. Subjects' medial and lateral tibial cartilage volumes were determined by magnetic resonance imaging at both time points.
In cross-sectional analysis, both medial and lateral tibial cartilage volumes were lower in those with ROA. Any medial ROA predicted medial tibial cartilage loss (3.2% (standard deviation (SD) 5.6) vs 1.9% (SD 5.3) per annum) while any lateral ROA predicted both medial (4.0% (SD 6.0) vs 2.2% (SD 5.3) per annum) and lateral (3.5% (SD 5.8) vs 1.6% (SD 4.2) per annum) tibial cartilage loss (all P < 0.05). In multivariate analysis, JSN and OP at both medial and lateral sites had independent dose-response associations with tibial cartilage loss at both sites. Pain was an independent predictor of lateral, but not medial, tibial cartilage loss after taking ROA into account.
Subjects with ROA (either JSN or OP) and, to a lesser extent, pain lose cartilage faster than subjects without ROA and the more severe the ROA the greater the rate of loss. These findings have implications for the design of clinical trials.
Internal Medicine Journal 02/2011; 42(3):274-80. · 1.54 Impact Factor
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ABSTRACT: We report a case of a 52-year-old woman with a 1-year history of rheumatoid arthritis-associated interstitial lung disease referred to hospital because of aggravated pulmonary symptoms in spite of intensive treatment including prednisone, azathioprine and triptergium glycoside. We subsequently initiated treatment with 25 mg of etanercept, subcutaneously injected twice weekly. Following 6 months of therapy with this agent, sustained improvement in dyspnea, cough was reported by the patient and respiratory function test showed marked improvement. The improvement was confirmed by reduced middle and lower lung markings on chest radiography and high-resolution CT scan. This report suggests etanercept may be effective in the treatment of rheumatoid arthritis-associated interstitial lung disease.
Clinical medicine insights. Case reports. 01/2011; 4:49-52.
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ABSTRACT: There are conflicting data on the natural history and clinical significance of bone marrow lesions (BMLs). The aims of this study were to describe the natural history of MRI-detected BMLs at the knee using a quantitative measure and examine the association of BMLs with pain, function and stiffness scores, and total knee replacement (TKR) surgery.
A total of 395 older males and females were randomly selected from the general population (mean age 63 years, range 52 to 79) and measured at baseline and approximately 2.7 years later. BMLs were determined using T2-weighted fat saturation MRI by measuring the maximum area of the lesion. Reproducibility was excellent (intraclass correlation coefficient (ICC): 0.97). Pain, function, and stiffness were assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. X-ray was used to assess radiographic osteoarthritis (ROA) at baseline.
At baseline, 43% (n = 168/395) had a BML. Of these 25% decreased in size and 24% increased. Of the remaining sample (n = 227), 7% developed a new BML. In a multivariable model, a change in BML size was associated with a change in pain and function scores (β = 1.13 to 2.55 per 1 SD increase, all P < 0.05), only in those participants without ROA. Lastly, baseline BML severity predicted TKR surgery (odds ratio (OR) 2.10/unit, P = 0.019).
In a population based sample, BMLs (assessed by measuring maximal area) were not static, with similar proportions both worsening and improving. A change in BML size was associated with changes in pain in those without established ROA. This finding suggests that fluctuating knee pain may be attributable to BMLs in those participants with early stage disease. Baseline BMLs also predicted TKR surgery. These findings suggest therapeutic interventions aimed at altering the natural history of BMLs should be considered.
Arthritis research & therapy 12/2010; 12(6):R223. · 4.27 Impact Factor
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Dawn Dore,
Ashleigh Martens,
Stephen Quinn, Changhai Ding,
Tania Winzenberg,
Guangju Zhai,
Jean-Pierre Pelletier,
Johanne Martel-Pelletier,
François Abram,
Flavia Cicuttini,
Graeme Jones
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ABSTRACT: Recent evidence suggests that bone marrow lesions (BMLs) play a pivotal role in knee osteoarthritis (OA). The aims of this study were to determine: 1) whether baseline BML presence and/or severity predict site-specific cartilage defect progression and cartilage volume loss; and 2) whether baseline cartilage defects predict site-specific BML progression.
A total of 405 subjects (mean age 63 years, range 52 to 79) were measured at baseline and approximately 2.7 years later. Magnetic resonance imaging (MRI) of the right knee was performed to measure knee cartilage volume, cartilage defects (0 to 4), and BMLs (0 to 3) at the medial tibial (MT), medial femoral (MF), lateral tibial (LT), and lateral femoral (LF) sites. Logistic regression and generalized estimating equations were used to examine the relationship between BMLs and cartilage defects and cartilage volume loss.
At all four sites, baseline BML presence predicted defect progression (odds ratio (OR) 2.4 to 6.4, all P < 0.05), and cartilage volume loss (-0.9 to -2.9% difference per annum, all P < 0.05) at the same site. In multivariable analysis, there was a significant relationship between BML severity and defect progression at all four sites (OR 1.8 to 3.2, all P < 0.05) and BML severity and cartilage volume loss at the MF, LT, and LF sites (β -22.1 to -42.0, all P < 0.05). Additionally, baseline defect severity predicted BML progression at the MT and LF sites (OR 3.3 to 3.7, all P < 0.01). Lastly, there was a greater increase in cartilage volume loss at the MT and LT sites when both larger defects and BMLs were present at baseline (all P < 0.05).
Baseline BMLs predicted site-specific defect progression and cartilage volume loss in a dose-response manner suggesting BMLs may have a local effect on cartilage homeostasis. Baseline defects predicted site-specific BML progression, which may represent increased bone loading adjacent to defects. These results suggest BMLs and defects are interconnected and play key roles in knee cartilage volume loss; thus, both should be considered targets for intervention.
Arthritis research & therapy 12/2010; 12(6):R222. · 4.27 Impact Factor
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ABSTRACT: Low 25-hydroxyvitamin D (25OHD) levels may be associated with both sarcopenia (the age-related decline in muscle mass and function) and low physical activity (PA). Our objective was to describe prospective associations between 25OHD, muscle parameters, and PA in community-dwelling older adults.
Prospective, population-based study with a mean follow-up of 2·6 ± 0·4 years.
Six hundred and eighty-six community-dwelling older adults (49% women; mean ± SD 62 ± 7 years old).
Appendicular lean mass percentage (%ALM) and body fat assessed by Dual-energy X-ray Absorptiometry, leg strength by dynamometer, leg muscle quality (LMQ), PA assessed by pedometer, self-reported sun exposure by questionnaire, and serum 25OHD measured by radioimmunoassay.
Participants with 25OHD ≤50 nM had lower mean %ALM, leg strength, LMQ and PA (all P < 0·05). As a continuous function, baseline 25OHD was a positive independent predictor of change in leg strength (β = 5·74 kg, 95% CI 0·65, 10·82) and LMQ (β = 0·49 kg/kg, 95% CI 0·17, 0·82). Also, change in 25OHD was positively predicted by baseline %ALM (β = 2·03 pM/p.a., 95% CI 0·44, 3·62) leg strength (β = 0·30 pM/p.a., 95% CI 0·06, 0·53), LMQ (β = 4·48 pM/p.a., 95% CI 0·36, 8·61) and PA (β = 2·63 pM/p.a., 95% CI 0·35, 4·92) after adjustment for sun exposure and body fat.
25OHD may be important for the maintenance of muscle function, and higher skeletal muscle mass and function as well as general PA levels may also be beneficial for 25OHD status, in community-dwelling older adults.
Clinical Endocrinology 11/2010; 73(5):581-7. · 3.17 Impact Factor
