Glusoamine for osteoarthritis: dawn of a new era?
Explore the source record for details and available documents.
Dietary Supplements↗
Biomedical subjects
T McAlindon
Publications and source records attributed to T McAlindon.
Glucosamine and chondroitin for osteoarthritis?
The current body of evidence currently supports modest efficacy for glucosamine and chondroitin in the treatment of OA symptoms. The products are safe and could play a valuable role in the management of this disorder. Nevertheless, further independent studies are needed to confirm these findings and to determine the clinical applicability of these compounds. Physicians need to become involved in these treatment decisions but are confused by wide variability in the formulation and purity of the numerous preparations available to consumers. The notion that glucosamine and chondroitin might have disease-modifying effects in OA is highly appealing and supported by preliminary data. Research is needed to confirm these findings and to evaluate the impact of glucosamine and chondroitin on all aspects of OA progression.
Chondroitin↗
Osteoarthritis: new insights. Part 2: treatment approaches.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.
Acupuncture Therapy↗
Osteoarthritis: new insights. Part 1: the disease and its risk factors.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.
Age Distribution↗
In vitro and in vivo spin echo diffusion imaging characteristics of synovial fluid: potential non-invasive differentiation of inflammatory and degenerative arthritis.
OBJECTIVE: This study was undertaken to analyse the diffusion characteristics of synovial fluid in degenerative and inflammatory arthropathies. DESIGN AND PATIENTS: Ten in vitro specimens of synovial fluid from patients with both degenerative and inflammatory arthropathy were studied at body temperature with a navigator-corrected spin echo diffusion sequence (B values 0-512 s/mm2), on a Philips 1.5-T Gyroscan. Subsequently synovial fluid from knee joint effusions of 25 patients (10 patients with osteoarthritis, 10 patients with effusions following trauma and 5 patients with effusions secondary to inflammatory arthritis) was evaluated with the same navigator-corrected spin echo diffusion sequence. RESULTS: Both in vitro and in vivo study demonstrated decreased diffusion in patients with effusions secondary to degenerative joint disease (less than 2.40 x 10(-5) cm2/s) relative to patients with effusions accompanying knee trauma (greater than 2.75 x 10(-5) cm2/s) and inflammatory arthritis (in vitro and in vivo greater than 3.00 x 10(-5) cm2/s). CONCLUSION: Synovial fluid in degenerative arthritis shows less diffusion or free water movement than synovial fluid in inflammatory arthritis. Diffusion characteristics of synovial fluid may be used to predict the nature of the underlying form of arthritis in patients presenting with knee joint effusions.
Diagnosis, Differential↗
Update on the epidemiology of systemic lupus erythematosus: new spins on old ideas.
Systemic lupus erythematosus is a serious autoimmune disease of obscure etiology with a propensity for widespread organ involvement. Its manifestations range from ephemeral symptoms to life-threatening events such as thromboses and strokes. Although once considered rare, SLE now appears to be relatively common in certain subsets of the population. Considerable publicity for this disorder as a "silent killer" has heightened public awareness and may have contributed to the increases in the number of individuals reporting this diagnosis in surveys. Epidemiologic studies face numerous challenges in disease classification and case ascertainment. Despite this, such studies have increased in size and number, and have generated novel etiologic hypotheses, ranging from environmental pollutants to viral infections.
Humans↗
Exercise for knee osteoarthritis.
Adverse outcomes in knee osteoarthritis include pain, loss of function, and disability. These outcomes can have devastating effects on the quality of life of those suffering from the disease. Treatments have generally targeted pain, assuming that disability would improve as a direct result of improvements in pain. However, there is evidence to suggest that determinants of pain and disability differ. In general, treatments have been more successful at decreasing pain rather than disability. Many of the factors that lead to disability can be improved with exercise. Exercise, both aerobic and strength training, have been examined as treatments for knee osteoarthritis, with considerable variability in the results. The variability between studies may be due to differences in study design, exercise protocols, and participants in the studies. Although there is variability among studies, it is notable that a majority of the studies had a positive effect on pain and or disability. The mechanism of exercise remains unclear and merits future studies to better define a concise, clear exercise protocol that may have the potential for a public health intervention.
Aged↗
Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis.
OBJECTIVE: This study was undertaken to determine the contribution of meniscal extrusion and cartilage loss to joint space narrowing on conventional radiographs by correlation with magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty-two consecutive patients, 32 patients with osteoarthritis and 30 without osteoarthritis, over the age of 60 years that were referred for both radiographic and MRI of the knee were included in the study. In each case, relative joint space narrowing on conventional AP radiographs was assessed utilizing the Kellgren-Lawrence scoring system. Subsequently, the degree of meniscal extrusion and the integrity of articular cartilage were evaluated from MR in the same patients. RESULTS: Each of 30 patients with normal joint space (Kellgren Grade 0) were noted to have normal articular cartilage, grade 1 meniscal extrusion was identified in only three of these patients. In comparison, meniscal extrusion was identified in all 32 patients with joint space narrowing (Kellgren Grades 1-4). Definite thinning or loss of articular cartilage was identified in only 15 of the 32 cases. In 17 patients with radiographic joint space narrowing (Kellgren Grades 1-3) and meniscal extrusion, no loss of articular cartilage was observed. A statistically significant correlation (P<0.001) was observed between Kellgren Grade and degree of meniscal extrusion and cartilage thinning on MRI. CONCLUSION: Conventional radiographs are an unreliable method of evaluating for articular cartilage loss in patients with early osteoarthritis. Initial joint space narrowing on conventional radiographs is secondary to meniscal extrusion rather than thinning of articular cartilage in most cases.
Aged↗
The association of peripheral monocyte derived interleukin 1beta (IL-1beta), IL-1 receptor antagonist, and tumor necrosis factor-alpha with osteoarthritis in the elderly.
OBJECTIVE: To examine the association of peripheral blood mononuclear cell (PBMC) derived interleukin 1beta (IL-1beta), IL-1 receptor antagonist (IL-1Ra), tumor necrosis factor alpha (TNF-alpha), and radiographic osteoarthritis (OA) in the elderly. METHODS: A total of 703 subjects (436 women, 267 men, mean age 78.5+/-4.5 yrs) had both knee and hand radiographs, and cytokines were measured during the 22nd biennial examination of the Framingham Cohort. PBMC derived IL-1beta , IL-1Ra, and TNF-alpha production was assessed using a non-cross reacting polyclonal radioimmunoassay. Knee OA was defined as a score of > 2 using a modified Kellgren and Lawrence scale. The presence of osteophytes and joint space narrowing were scored separately on a 0-3 scale, in which disease was defined a priori as a score > 0 for each feature. Sex-specific odds ratios were calculated for knee OA after adjusting for weight, history of knee injury, and use of estrogen and nonsteroidal antiinflammatory drugs. RESULT: No uniform associations were found for IL-1beta or IL-1Ra in men, or for TNF-alpha production and radiographic OA in either sex. We found possible associations for the highest levels of IL-1beta production and the presence of knee osteophytes [OR=2.0 (1.2-3.5)] and joint space narrowing [OR=1.7 (1.1-2.8)] in women. Our data suggested a possible protective effect for IL-1Ra production and hand OA in women [OR=0.6 (0.4-1.0)]. CONCLUSION: We found no consistent association of PBMC cytokine production and radiographic OA. However, women with the highest production of IL-1beta and IL-1Ra had respectively higher rates of knee OA and lower rates of hand OA than expected.
Aged↗
Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham.
STUDY DESIGN: A 25-year follow-up study of 606 members of the population-based Framingham cohort, who had received lateral lumbar radiographs in 1967-1968 and 1992-1993, and completed an interview on back symptoms at the second examination. OBJECTIVES: To evaluate whether calcific lesions in the posterior wall of the abdominal aorta, the source of the feeding arteries of the lumbar spine, are associated with disc degeneration or back pain, which would suggest that ischemia of the lumbar spine leads to disc degeneration. METHODS: The presence of radiographic aortic calcification was ascertained in front of each lumbar segment from L1 through L4, and disc degeneration at intervertebral spaces from L1-L2 through L4-L5. The associations between aortic calcification, disc degeneration, and back pain were tested using logistic regression with adjustment for age and sex. RESULTS: At the baseline examination, aortic calcification was significantly associated with general disc degeneration, that is, disc space narrowing or endplate sclerosis at any lumbar level (odds ratio 1.6; 95% confidence interval 1.0-2.5; P = 0.034). In longitudinal, level-specific analyses, comparing local aortic calcifications with disc degeneration at the matching level, aortic calcifications predicted disc deterioration, that is, a decrease in disc space or appearance of endplate sclerosis, between the examinations (odds ratio 1.5; 95% confidence interval 1.3-1.8; P < 0.001). Furthermore, subjects in whom aortic calcifications developed between the examinations had disc deterioration twice as frequently as those in whom aortic calcifications did not develop (odds ratio 2.0; 96% confidence interval 1.2-3.5; P = 0.013). Also, individuals with severe (Grade 3) posterior aortic calcification in front of any lumbar segment were more likely than others to report back pain during adult life (odds ratio 1.6; 95% confidence interval 1.1-2.2; P = 0.014). CONCLUSIONS: Advanced aortic atherosclerosis, presenting as calcific deposits in the posterior wall of the aorta, increases a person's risk for development of disc degeneration and is associated with the occurrence of back pain.
Aged↗
Nutrition: risk factors for osteoarthritis.
Explore the source record for details and available documents.
Antioxidants↗
Are risk factors for patellofemoral and tibiofemoral knee osteoarthritis different?
OBJECTIVE: To determine whether patellofemoral (PF), tibiofemoral (TF), and combined patterns of knee osteoarthritis (OA) differ in their strengths of associations with any of the known risk factors for knee OA, and especially to evaluate whether body mass index (BMI) correlates with all 3 patterns, or only with tibiofemoral disease, as previously suggested. METHODS: We obtained anteroposterior and lateral knee radiographs on 608 participants at the 22nd biennial examination of the Framingham cohort study (1992-3). The presence or absence of OA in the TF and PF compartments of each knee was scored, and subjects were classified on the basis of the pattern of compartmental involvement in their 2 knees. The strength of association of age, sex, BMI, chondrocalcinosis, and knee injury was computed for PF, TF, and combined pattern of knee OA using multiple logistic regression. RESULTS: The mean age and BMI of the sample were 80.7 yrs (SD 5.0) and 25.4.kg-2 (SD 3.7), respectively. PF, TF, and combined patterns of knee OA were present in 5.3, 23.0 and 19.7%, respectively. Elevated BMI was a risk factor for all 3 patterns of disease (adjusted OR for highest vs lowest tertile of BMI 3.7, 1.9, and 7.0 for PF, TF, and combined pattern, respectively). Risk factor profiles were broadly similar for TF and PF OA, with the possible exception of knee injury in men (adjusted OR = 2.0 for PF, 3.7 for TF OA). Risk factors were generally more strongly associated with the combined pattern of OA. CONCLUSION: Obesity is an important risk factor for PF, TF, and combined patterns of knee OA. The relationships of these patterns with the risk factors investigated here appear similar and are strongest for the combined pattern.
Aged↗
Occupational activity and osteoarthritis of the knee.
OBJECTIVES: To test the hypothesis that specific occupational physical activities are risk factors for knee osteoarthritis (OA). METHODS: A population-based case-control study of knee osteoarthritis was carried out in which 109 men and women with painful, radiographically confirmed knee OA were compared with 218 age and sex matched controls who had not suffered knee pain and had normal radiographs. Information collected included a lifetime occupational history and details of specific workplace physical activities. RESULTS: After adjustment for obesity and Heberden's nodes, the risk of knee OA was significantly elevated in subjects whose main job entailed more than 30 minutes per day squatting (OR 6.9, 95% CI 1.8-26.4) or kneeling (OR 3.4, 95% CI 1.3-9.1), or climbing more than ten flights of stairs per day (OR 2.7, 95% CI 1.2-6.1). The increase in risk associated with kneeling or squatting appeared to be more marked in subjects whose jobs entailed heavy lifting, but the size of the study did not permit precise delineation of any such interaction. CONCLUSIONS: These data suggest that prolonged or repeated knee bending is a risk factor for knee OA, and that risk may be higher in jobs which entail both knee bending and mechanical loading.
Activities of Daily Living↗
Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease.
OBJECTIVE: The generation of effective preventive strategies against knee osteoarthritis (OA) requires precise understanding of the individual risk factors for the condition. To identify these risk factors, we performed a population based case-control study of the disorder. METHODS: We compared 109 men and women with symptomatic, radiographically verified OA in the tibiofemoral (TFJ) and/or patellofemoral (PFJ) compartments of the knee joint with 218 community controls matched for age and sex. Information on risk factors was obtained by a structured interview and examination. RESULTS: Independent risk factors for knee OA included obesity (odds ratio [OR] 3.3; 95% confidence intervals [95% CI] 1.6-6.9), previous knee injury (OR 3.4; 95% CI 1.7-6.7), meniscectomy (OR 4.0; 95% CI 1.0-16.4), family history (OR 2.7; 95% CI 1.3-5.5) and Heberden's nodes (OR 2.0; 95% CI 1.1-3.6). Obesity and meniscectomy were stronger risk factors for medial TFJ disease, while Heberden's nodes and family history were more closely associated with PFJ involvement. CONCLUSION: Although based on small numbers, our results suggest that the relative contribution of mechanical and constitutional factors in the pathogenesis of OA in different compartments of the knee joint might vary. They also confirm the importance of significant knee injury and meniscectomy as risk factors for medial TFJ disease in the general population.
Aged↗
Environmental factors predicting nephritis in systemic lupus erythematosus.
OBJECTIVES: To evaluate social class, ethnic origin, and various endocrine variables as potential risk factors in the development of nephritis in patients with systemic lupus erythematosus (SLE). METHODS: A cross-sectional survey was carried out of all outpatients with SLE attending the lupus Clinic of St Thomas's Hospital from March to October 1992 using retrospective survival data. The main outcome measure was the duration of SLE before the onset of nephritis. RESULTS: Two hundred and ninety six women and 11 men were studied; the male patients were excluded from the analysis. Univariate analysis showed an increased risk of nephritis in patients with SLE of West Indian origin with 54 v 19% with nephritis at five years, in patients of lower social class, in patients who did not drink alcohol, and in those with a history of fetal loss after the onset of lupus. No significant effect of the age of onset of SLE, use of oral contraceptives, normal pregnancy, or smoking was seen. Multivariate analysis showed that ethnic origin did not influence the risk of nephritis independently of social class. CONCLUSIONS: Factors associated with socioeconomic deprivation may increase disease severity in patients with SLE.
Abortion, Spontaneous↗
Radiographic assessment of patellofemoral osteoarthritis.
OBJECTIVES: To determine the feasibility of assessing patellofemoral osteoarthritis using the 'skyline' view and to compare its reproducibility with the standard lateral view. METHODS: Fifty patients attending a rheumatology outpatient department with osteoarthritis of the knee had standard radiographs taken of both knees: standing weightbearing anteroposterior; lateral supine radiograph in 30 degrees of flexion; and a skyline view of the patellofemoral joint. After an initial training period using 20 sets of films the remaining 30 sets were read blind by five observers. Intraobserver and interobserver variability was assessed using the kappa statistic. The minimum joint space in each compartment was measured using a ruler. Two views of a single normal subject were measured to determine the effect of knee flexion. RESULTS: The final 30 study films were from 20 women and 10 men, median age 72.5, range 18-91 years. A grading system comprising assessment of osteophytosis, joint space narrowing, sclerosis, cysts, and attrition could easily be applied to the skyline patellofemoral view. Intraobserver reproducibility was better than the interobserver reproducibility for all features. The skyline view performed more reproducibly and over a wider range of categorisation for joint space narrowing than the lateral radiograph. Measurement using a ruler was easy to perform and precise to within 1 mm for the medial tibiofemoral and lateral facet of the patellofemoral joint. In normal knees the degree of flexion significantly affected the measurement. CONCLUSIONS: Radiographic grading of the skyline patellofemoral view is readily achieved, is more reproducible than assessment of the lateral view, and allows more precise localisation of change. Such views should be considered in radiological surveys of osteoarthritis of the knee.
Adolescent↗
Radiographic assessment of the knee joint in osteoarthritis.
The development of radiographic systems for the grading of osteoarthritis requires knowledge of the reproducibility of their individual component features. This paper reports the reproducibility, both within and between observers, for five commonly used radiographic features of osteoarthritis in the tibiofemoral and patellofemoral compartments of the knee joint. The results suggest that assessments of joint space narrowing, osteophyte, and bony contour in the tibiofemoral compartments are more reproducible than those of sclerosis and cyst. Patellofemoral assessments, with the exception of osteophyte, are considerably less reproducible between observers than tibiofemoral assessments.
Aged↗
The medical management of osteoarthritis of the knee: an inflammatory issue?
Explore the source record for details and available documents.
Anti-Inflammatory Agents↗