More Weight Loss Linked To Greater Decrease in Knee Arthritis Pain Interview with:

Wake Forest professor of Health and Exercise Science Steve Messier, Friday, June 15, 2018.

Prof. Messier

Professor Steve Messier
Director of the J.B. Snow Biomechanics Laboratory
J.B Snow Biomechanics Laboratory
Wake Forest University Why did you undertake this study?

Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273.

We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial.

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Which NSAID for Knee Pain Works Best? Interview with:
“dog” by Neil Mullins is licensed under CC BY 2.0Deborah S. Cummins, PhD

Director, Research, Quality and Scientific Affairs
American Academy of Orthopaedic Surgeons
On behalf of the researchers:
David Jevsevar, MD, MBA; Gregory A. Brown, MD, PHD, and Deborah S. Cummins, PhD What is the background for this study? What are the main findings?

Response: It is estimated that individuals have a 45% risk of developing knee osteoarthritis (OA) in their lifetime. As a result of the shifting demographics of the US, where an increasing percentage of the population is older than 65, the burden of knee OA will continue to increase. To help deal with this burden, effective nonsurgical treatments are needed to manage knee OA symptoms associated with pain and function before surgical intervention becomes necessary. To determine which non-surgical options are best, we performed a network meta-analysis exploring mixed treatment comparisons for nonsurgical treatment of knee osteoarthritis in order to effectively rank the various nonsurgical treatment options from best to worst.

Our network meta-analysis suggests that the single most effective nonsurgical treatment for improving knee function is function is naproxen, followed by diclofenac, celecoxib, and ibuprofen. When considering pain and function together, our data suggest that naproxen is the most effective treatment followed by IA corticosteroid injection.

The single most effective short-term (4-6 weeks) treatment for decreasing pain is intra-articular (IA) corticosteroid injection, followed by ibuprofen, IA platelet rich plasma, and naproxen. Additionally, intra-articular hyaluronic acid injections never achieved a rank in the top five treatments for pain, function, or combined pain and function. An analysis of 12 articles also found that HA is not significantly different than IA placebo in effect.

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Oral Glucosamine Found No More Effective Than Placebo For Osteoarthritis Pain Interview with:

Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands

Dr. Runhaar

Jos Runhaar, PhD
Erasmus MC
Department of General Practice
The Netherlands What is the background for this study? What are the main findings?

Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages.

For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding.

The study did show, however, that glucosamine can be extremely beneficial for pets, and specifically dogs who have joint related issues. Knowing the most valuable sources of glucosamine for dogs is important, as it can be extracted and gained from multiple sources, and each have their own varied levels of quality and potency.

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Pharmaceutical Grade Chondroitin Sulfate As First-Line Treatment of Osteoarthritis Interview with:

Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège

Dr. Reginster

Jean-Yves Reginster M.D.,PH.D.
Professor of Epidemiology, Public Health and Health Economics
Head of the Bone and Cartilage Metabolism Unit
University of Liège What is the background for this study? What are the main findings?

Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA).

This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.

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Osteoarthritis: Specific Micro RNAs As Predictors of Disease Severity

Dr Christian Beyer Department of Internal Medicine 3 - Rheumatology and Immunology University of Erlangen-Nuremberg, Interview with:
Dr Christian Beyer
Department of Internal Medicine 3 – Rheumatology and Immunology
University of Erlangen-Nuremberg, Germany.

MedicalResearch: What are the main findings of the study?

Dr. Beyer: Our study aimed to identify specific micro RNAs as preditors for osteoarthritis. Osteoarthritis is a progressive and long-standing disease. It’s early and very early stages are clinically silent, which means that patients do not experience symptoms or present with obvious signs of the disease. Preventive measures and early therapies, however, would be probably most effective in treating this very common condition. Thus, markers to identify individuals at risk for osteoarthritis or in early clinical stages are highly important, but are not available for clinical routine yet. Micro RNAs are group of molecules that have signaling functions in the human body and that can reflect states of disease and health. Since they are very stable and easily accessible in the peripheral blood (by venous puncture without complicated procedures like biopsies), the represent promising biomarkers in many different fields of medicine. In this context, we wondered if specific micro RNAs might predict the development of severe osteoarthritis. Indeed, we could identify thre micro RNAs, named mir-454, mir-885-5p and let-7e, out of a total of 377 micro RNAs, that help to predict the risk for developing severe osteoarthritis.

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Osteoarthritis: Total Hip, Knee Replacements Reduce Cardiovascular Risk

Bheeshma Ravi, Interview with:
Bheeshma Ravi, MD
Orthopedic Surgery
University of Toronto Medical Center What are the main findings of the study?

Dr. Ravi:  This study suggests that in persons with moderate-severe osteoarthritis of the hip or knee, total joint replacement is associated with a significant reduction in the risks for serious cardiovascular events.

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Knee Osteoarthritis: Exercise Impact on Pain and Disability Interview with:
Carsten Juhl, PhD, MPH
Research Physiotherapist
Forskningsenheden for Muskuloskeletal Funktion og Fysioterapi (FoF)
Institut for idræt og biomekanik
Syddansk Universitet What are the main findings of the study?

Dr. Juhi:  The main findings of this study including 48 RCTs with more than 4000 patients were that

  • [1] exercise therapy programs focusing on a single type of exercise were more efficacious in reducing pain and patient-reported disability than those mixing several types of exercise with different goals within the same session;
  • [2] the number of supervised sessions enhances the benefits of the aerobic exercise;
  • [3] exercise focusing on the knee extensor muscle strength only, may increase the benefits of resistance training and
  • [4] exercise seems to be effective therapy for knee osteoarthritis, regardless of age, sex, BMI, radiographic status or baseline pain.

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Osteoarthritis: Increased Risk of Cardiovascular Disease Interview with:
M Mushfiqur Rahman, MSc. PhD candidate
School of Population and Public Health
University of British Columbia, Statistical Analyst
Arthritis Research Centre of Canada
5591 No. 3 Road, Richmond
BC, Canada, V6X 2C7;  What are the main findings of the study?

Author’s response: Using 18 years of administrative health records from British Columbia, Canada, our aim was to determine whether osteoarthritis increases the risk of cardiovascular disease in a longitudinal study. We also examined the risks of specific cardiovascular conditions such as, myocardial infarction, ischemic heart disease, congestive heart failure, and stroke after adjusting for age, sex, socio-economic status, diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and a co-morbidity score.

We observed a significant increase in the risk of cardiovascular disease, ischemic heart disease, and congestive heart failure among individuals with osteoarthritis compared with age-sex matched non-osteoarthritis individuals. Our data suggests that adult women and men aged 65 years and older with osteoarthritis had higher risks of developing these conditions. The risks were also higher among severe osteoarthritis patients who had undergone total joint replacement surgeries. Men aged between 20-64 years with osteoarthritis did not show higher risks of developing these conditions.
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Medial Knee Osteoarthritis: Lateral Wedge Insoles Interview with:
Matthew Parkes
Research Statistician
Research in Osteoarthritis Manchester (ROAM)
Arthritis Research UK Epidemiology Unit
Centre for Musculoskeletal Research
Institute of Inflammation and Repair
The University of Manchester
Manchester Academic Health Science Centre
Manchester M13 9PT What are the main findings of the study?

Answer: Looking at all trials of lateral wedge insoles, they seem to reduce pain slightly.

However, looking at trials which compare lateral wedges to flat wedges, they don’t appear to differ in terms of pain reduction.

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