Objectives It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee OA (ROA). Methods The participants in this nested case-control study were selected from knees in the Osteoarthritis Initiative (OAI) that had a Kellgren Lawrence grading (KLG)=0 baseline (BL). These knees were evaluated annually with radiography and non contrast-enhanced magnetic resonance imaging (MRI) over 4-years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by radiographic knee osteoarthritis (ROA) (KLG >=2) on the postero-anterior knee radiographs at any assessment after baseline. Radiographs were assessed at P0 (time of onset of radiographic knee OA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from baseline to 48 months). Results 133 knees of 120 persons with ROA (83 females) were matched to 133 control knees (83 females). Odds ratios (OR) for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and PO were 1.56 (95% CI 0.86–2.81), 3.23 (1.72–6.06) and 4.7(1.10–2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1–2.95), 2.47 (1.45–4.23) and 2.40 (1.43–4.04), respectively. Conclusions Effusion-synovitis and Hoffa-synovitis strongly predicted the development of incident ROA.

Objective. We examined the dose-response relationship between weight reduction and pain/functional improvement in persons with symptomatic knee osteoarthritis (KOA) participating in a community-based weight loss program. Methods. Consecutive participants with KOA and enrolled in the 18-week Osteoarthritis Healthy Weight for Life weight-loss program were selected. In this completer-type analysis, participants were assessed at baseline, 6 weeks, and 18 weeks for body weight and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. The dose-response relationship between weight-change categories (>10%, 7.6-10%, 5.1-7.5%, 2.6-5.0%, and <2.5% of body weight loss) and change in KOOS scores was assessed by repeated-measures analysis of variance, controlling for sex and age, body mass index (BMI), and KOOS. The Western Ontario McMaster Universities Osteoarthritis Index function score derived from the KOOS was used to assess a meaningful clinical functional improvement. Results. A total of 1,383 persons (71% females) were enrolled. Mean 6 SD age, height, and weight were 64 6 8.7 years, 1.66 6 0.09 meters, and 95.1 6 17.2 kg, respectively. Mean 6 SD BMI was 34.4 6 5.2 kg/m 2 with 82% of participants obese at baseline. A total of 1,304 persons (94%) achieved a >2.5% reduction in body weight. There was a significant dose-response relationship between all KOOS subscales and percentage of weight change across all weight-change categories. Participants required ‡7.7% (95% confidence interval 5.2, 13.3) body weight loss to achieve a minimal clinically important improvement in function. Conclusion. There is a significant dose-response relationship between percentage of weight loss and symptomatic improvement. This study confirms the feasibility of weight loss as a therapeutic intervention in KOA in a community-based setting.

Is walking barefoot a risk factor for diabetic foot disease in developing countries?

Introduction: Valdecoxib is a cyclooxygenase 2 (COX-2) selective anti -inflammatory drug. It is associated with a reduced incidence of gastrointestinal complications and is potentially useful for patients with rheumatological diseases requiring longer term anti-inflammatory treatment.Areas covered: Due to a perceived increased risk of thrombotic events, particularly cardiovascular hazards and reports of unpredictable, potentially life threatening skin reactions, valdecoxib has been voluntarily withdrawn from the market since 2005. This review manuscript examines the therapeutic potential and the adverse events of valdecoxib utilising a pubmed and web of sciences search to select literature on this subject.Expert opinion: Whilst valdecoxib did have reduced incidence of gastrointestinal complications due to a perceived increased risk of thrombotic events it was withdrawn. The limitations of the research supporting the withdrawal of this potential are discussed.

Objectives ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- and older-onset patients are still incompletely understood. Methods We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: &lt;65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results A total of 1338 patients with AAV were included: 66% had disease onset at &lt;65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion Within 6 months of diagnosis of AAV, patients &gt;65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.