ObjectivesTo compare the efficacy and safety of topical non-steroidal anti-inflammatory drugs (NSAIDs), including salicylate, for the treatment of osteoarthritis (OA).MethodsPubMed, Embase, Cochrane Library and Web of Science were searched from 1966 to January 2017. Randomised controlled trials (RCTs) comparing topical NSAIDs with placebo or each other in patients with OA and observational studies comparing topical NSAIDs with no treatment or each other irrespective of disease were included. Two investigators identified studies and independently extracted data. Bayesian network and conventional meta-analyses were conducted. The primary outcomes were pain relief for RCTs and risk of adverse effects (AEs) for observational studies.Results43 studies, comprising 36 RCTs (7 900 patients with OA) and seven observational studies (218 074 participants), were included. Overall, topical NSAIDs were superior to placebo for relieving pain (standardised mean difference (SMD)=−0.30, 95% CI −0.40 to –0.20) and improving function (SMD=−0.35, 95% CI −0.45 to –0.24) in OA. Of all topical NSAIDs, diclofenac patches were most effective for OA pain (SMD=−0.81, 95% CI −1.12 to –0.52) and piroxicam was most effective for functional improvement (SMD=−1.04, 95% CI −1.60 to –0.48) compared with placebo. Although salicylate gel was associated with higher withdrawal rates due to AEs, the remaining topical NSAIDs were not associated with any increased local or systemic AEs.ConclusionsTopical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population. However, confirmation of the cardiovascular safety of topical NSAIDs still warrants further observational study.

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BackgroundOsteoarthritis (OA) is the most prevalent chronic joint disease in China. The aim of this study was to examine the association between metabolic syndrome (MetS) and knee OA in a population-based Chinese study.MethodsData included in this analysis is from a cross-sectional study, i.e., the Xiangya Hospital Health Management Center Study. MetS was diagnosed according to the criteria defined by the Chinese Diabetes Society. Radiographic knee OA was defined as changes equivalent to Kellgren-Lawrence (K-L) grade 2 or above at least one side. Associations between MetS and its components with OA were evaluated by conducting multivariable adjusted logistic regression.ResultsA total of 5764 participants were included in the present study. The unadjusted OR (1.27, 95%CI: 1.10–1.47, P = 0.001), age-sex adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.041) and multivariable adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.043) all suggested a positive association between MetS and knee OA. Besides, its components (e.g., overweight, hypertension and dyslipidemia) were also associated with the prevalence of radiographic knee OA respectively, after adjusting for some confounding factors. In addition, with the accumulation of MetS components, the prevalence of knee OA increased. Furthermore, MetS as a whole was associated with the prevalence of knee osteophyte (OSP) (OR = 1.72, 95%CI: 1.42–2.09, P < 0.001), but not joint space narrowing (JSN) (OR = 1.06, 95%CI: 0.91–1.23, P = 0.449).ConclusionsThe findings of the present study indicated that there was a positive association between the prevalence of MetS and knee OA. However, MetS as a whole was associated with the higher prevalence of knee OSP, but not JSN, which should shed light on our understanding the association between MetS and OA.

ObjectiveTo examine the correlation between dietary selenium (Se) intake and the prevalence of osteoporosis (OP) in the general middle-aged and older population in China.MethodsData for analyses were collected from a population based cross-sectional study performed at the Xiangya Hospital Health Management Centre. Dietary Se intake was evaluated using a validated semi-quantitative food frequency questionnaire. OP was diagnosed on the basis of bone mineral density scans using a compact radiographic absorptiometry system. The correlation between dietary Se intake and the prevalence of OP was primarily examined by multivariable logistic regression.ResultsThis cross-sectional study included a total of 6267 subjects (mean age: 52.2 ± 7.4 years; 42% women), and the prevalence of OP among the included subjects was 9.6% (2.3% in men and 19.7% in women). Compared with the lowest quartile, the energy intake, age, gender and body mass index (BMI)-adjusted odds ratios of OP were 0.72 (95% confidence interval [CI] 0.55–0.94), 0.72 (95% CI 0.51–1.01) and 0.47 (95% CI 0.31–0.73) for the second, third and fourth quartiles of dietary Se intake, respectively (P for trend = 0.001). The results remained consistent in male and female subjects. Adjustment for additional potential confounders (i.e., smoking status, drinking status, physical activity level, nutritional supplements, diabetes, hypertension, fibre intake, and calcium intake) did not cause substantial changes to the results.ConclusionsIn the middle-aged and older humans, participants with lower levels of dietary Se intake have a higher prevalence of OP in a dose-response manner.

| INTRODUC TI ONOsteoarthritis (OA) is a prevalent joint degenerative disease and the major cause of disability for the elderly population worldwide. In the USA, over 20 million of people suffer from OA and this figure is estimated to double over the next two decades. 1 The main symptom of OA is chronic musculoskeletal pain, which is associated with physical disability and dysfunction. 2,3 The major treatments for OA include pain alleviation and improvement of functional activity, and for end-stage patients, joint replacement is often needed. 4-6 Many factors may increase the risk of OA, such as metabolic factors, mechanical factors, and inflammatory factors, 7 among which, obesity is considered the most important one. 8 Meanwhile, the prevalence of obesity, which leaves the affected population vulnerable to multiple comorbidities, 9 has been growing alarmingly all over the world. 10,11 Recently, a lot of attention has been paid by the academic circle to the association between obesity and OA in view of its high prevalence and modifiable status. Felson et al reported that obese AbstractObjectives: To examine the association between body composition and osteoarthritis (OA).Methods: An extensive literature review was performed to identify studies that examined the association between body composition and OA. The mean difference (MD), odds ratio (OR), relative risk (RR) and corresponding 95% confidence intervals (CIs) were determined using RevMan statistical software. Results:A total of 19 studies were included. The combined MD showed the fat mass of the subjects with knee OA was higher than that of the control group (MD 4.38,). Both fat mass and fat mass percentage were positively associated with knee OA (ORs ranged from 1.49, 95% CI: 1.15-1.92, to 2.37, 95% CI: 1.18-4.74).Similar findings were observed in hip and hand joints as well (ORs ranged from 1.20, 95% CI: 1.08-1.32, to 1.87, 95% CI: 1.11-3.15), and such results were also confirmed by most cohort studies of knee and hip OA (RRs ranged from 0.98, 95% CI: 0.95-1.01, to 3.60, 95% CI: 2.60-5.00). Lean mass was also positively associated with knee OA (OR 1.48, 95% CI: 1.13-1.94). However, lean mass percentage was negatively associated with knee OA (OR 0.65, 95% CI: 0.46-0.92). Conclusions:Both fat mass and fat mass percentage were likely to be risk factors for knee, hip and hand OA. Similarly, lean mass also seemed to be a risk factor for knee OA, while lean mass percentage seemed to be a protective factor. K E Y W O R D Sbody composition, fat mass, lean mass, meta-analysis, osteoarthritis