to define the exposures. ROA was defined as radiographic tibiofemoral OA (Kellgren & Lawrence (KL) grade !2) on fixed flexion PA radiographs. SxOA was defined as having both ROA and consistent frequent knee pain in the same knee. We also considered knee replacement as equivalent to ROA and to SxOA. The definition of consistent frequent knee pain was met if a participant reported knee pain on most days during the past month at telephone interview and at the clinic visit that occurred on average one month later. Knee-specific pain severity was measured using the WOMAC pain subscale; the higher of the two ratings was used. WSP was defined as pain above and below the waist, on both sides of the body and axially, using a standard homunculus, excluding knee pain. Incident WSP was defined as presence of WSP at 84 months among those who were free of WSP at 60 months. We assessed the relation of baseline ROA, SxOA, consistent frequent knee pain, and knee pain severity, respectively, to incident WSP using logistic regression, adjusting for baseline age, sex, BMI, comorbidities, physical activity, study site, depressive symptoms, pain catastrophizing, sleep and fatigue. Knee pain severity was also adjusted for in the ROA, SxOA and consistent frequent knee pain models. KL grade was also adjusted for in the consistent frequent knee pain and knee pain severity models. Results: At baseline, 1385 subjects were eligible for analysis (age mean, SD; 67.4, 7.8; BMI 30.5, 6.0 kg/m2, 55% women). Baseline presence of ROA and SxOA in either knee was not associated with incident WSP, respectively (Table). Similarly, baseline unilateral and bilateral ROA or SxOA were not associated with risk of incident WSP. In contrast, baseline presence of consistent frequent knee pain in either knee was significantly associated with a 50% higher incidence of WSP compared with those without consistent frequent knee pain (adjusted OR 1.49 95% CI 1.00, 2.21, p ¼ 0.05). The baseline presence of unilateral or bilateral consistent frequent knee pain was associated with 40% and 65% higher incidence of WSP, respectively, compared with those who did not have consistent frequent knee pain in either knee, albeit not significantly (Table). Knee pain severity was also significantly associated with increased risk of incident WSP, such that each point higher on the WOMAC pain subscale score was associated with a 13% increased risk of incident WSP (adjusted OR 1.13 95% CI 1.08, 1.19 p<0.001). Conclusions: Consistent frequent knee pain and severity of knee pain were significantly associated with incident WSP indicating that regional pain is involved in the development of WSP. In contrast, structural pathology independent of pain severity was not significantly associated with increased risk for incident WSP. These findings call into question the role of peripheral structural pathologic input in the development of WSP, and highlight the importance of pain symptomatology as an important factor that can contribute to the onset of WSP, suggesting a possible role for sensiti...

BackgroundOsteoarthritis (OA) is the most prevalent joint disease and the leading cause of disability from 60 years onwards. In fact, 14,8% of the Spanish population has OA.ObjectivesThis study aimed to analyze the indications and average doses prescribed in the treatment of knee osteoarthritis in Primary Care in Spain.MethodsThe EMARTRO study was designed as an observational, multicenter, transversal study to compare probability of suffering a comorbidities based on presence of symptomatic knee OA visited by GPs. Sociodemographic, anthropometric, clinical parameters and clinical variables of interest were recorded. The prescribed medications and doses indicated in syntomatic knee OA were analyzed in patients included in the EMARTRO study.ResultsA total of 1173 patients were included, of whom 646 had knee OA. Patients with OA had a mean (SD) BMI of 30.9 (5.1), systolic blood pressure 132.8 (14.5) and diastolic blood pressure 77.9 (9.1) mm Hg. They also had a mean of 4.3 (1.9) comorbidities, the most frequent were hypertension 358 (62.2%), dyslipidemia 336 (58.3%), diabetes mellitus II 126 (21.9%), and gastroesophageal reflux 110 (19.1%). As for the symptomatology, the patients presented a mean (SD) pain in Huskisson's VAS of 65.18 (15.27) mm and algofunctional Lequesne score of 11.35 (4.86).Patients were treated with a mean of 2,2 medications. The 45.5% of osteoarthritic patients were treated as monotherapy, 35.5% were taking 2 medications for osteoarthritis, 15.3% 3 and 3.7% 4 or more medications. It should be noted, taking into account the high levels of pain, that 15% of the patients did not receive any treatment.Regarding prescribed medications for knee OA, 378 (58.2%) patients were treated with paracetamol at a mean daily dose (SD) of 1,150.5 (1,815.5) mg; 232 (35.9%) received NSAIDs, with metamizole being the most prescribed at doses 1,092 (538) mg, ibuprofen at doses 1,136 (528,8) mg and naproxen at doses 941,8 (238,5) mg. Next, 131 (20.3%) patients were treated with opioids, tramadol being the most frequent at doses 102.7 (49.7) mg; 87 (13.3%) with SYSADOA being chondroitin sulphate the most frequent at doses 758.7 (247.7) mg. Finally, 87 (13.3%) of the patients were treated with COX-2, mainly with etoricoxib at doses of 69.3 (27.1) mg.ConclusionsAlthough the patients presented many concomitant pathologies, it is frequent to approach osteoarthritis in polytherapy. In addition, despite the high symptomatology, patients are treated primarily with a mild analgesic such as paracetamol at doses lower than those recommended. It is paradoxical the high prescription of NSAIDs in a population with a high prevalence of cardiovascular and gastrointestinal pathologies as well as an increase in the prescription of opioids.Disclosure of InterestM. Herrero Barbero Employee of: Bioiberica, S. Gimenez: None declared, J. Vergara: None declared, E. Viles I Lladό Employee of: Bioiberica, H. Martinez Employee of: Bioiberica, G. Rodríguez Roca: None declared, L. Sánchez Employee of: Bioiberica, J. A. Díaz Muñoz: None declared, ...

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BackgroundThe aim of this study was to investigate the effects of chondroitin sulfate (CS) on the serum levels of Coll2-1 in patients with knee OA.MethodsSeventy two patients with unilateral symptomatic knee OA were involved in a post-authorization open-label study evaluating CS (800 mg/day). The primary outcome was the % relative change in serum Coll2-1 (sColl2-1). The secondary outcomes were the evaluation of pain (VAS) and function (Lequesne’s Index). Responders and non-responders were classified according to OMERACT-OARSI recommendations. Finally, an original cut-off method was applied to categorize patients and interpret individual variations in serum levels of Coll2-1.ResultsPatients showed no difference in the sColl2-1 levels at baseline. When considering responders and non-responders from the ITT population, a significant difference was found for Coll2-1 at 3 months (p = 0.030) and 6 months (p = 0.038). A decrease in pain (VAS) and an improvement in function (LI) were recorded throughout the visits (p < 0.01). Considering an intra-batch cut-off of 21 %, CS decreased Coll2-1 serum levels between baseline and 1-month visit compared to the value of Coll2-1 before treatment (screening visit) which can be interpreted as a drastic reduction of the proportion of patients with an increase of Coll2-1 over 21 % (reduction from 13 to 3 %). It also consisted in a more important proportion of patients with a decrease in Coll2-1 (from 5 to 10 %).ConclusionThis study proposes a new approach for the analysis and the interpretation of the individual variation in biomarker levels and introduces the notion of metabolic responders.Trial registrationID ISRCTN63795830. The trial was retrospectively registered on 2 October, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1268-4) contains supplementary material, which is available to authorized users.

BackgroundOsteoarthritis (OA) is the most prevalent joint disease and the leading cause of disability from 60 years onwards. In fact, 14,8% of the Spanish population has OA. This study aimed to analyze the indications and average doses prescribed in the treatment of knee osteoarthritis in Primary Care in Spain.ObjectivesThis study aimed to analyze the comorbidity profile of men and women affected by symptomatic knee OA and the differences between genders in the perception of health status with regard to pain and loss of function due to their OA, quality of life and mental health.MethodsThe EMARTRO study was designed as an observational, multicenter, transversal study to compare probability of suffering a comorbidities based on presence of symptomatic knee OA visited by GPs. Sociodemographic, anthropometric, clinical parameters and clinical variables of interest were recorded. The probability of suffering comorbidities based on presence OA was estimated using the Odds Ratio estimation with conditioned logistic regression models. Depending on the variable, comparisons between groups were done using t-Student, Chi-square and Mann-Whitney.ResultsA total of 646 patients were included, 71% were women. Mean (SD) age was 67.9 (6.6) years.Patients were obese without gender differences, with a BMI of 30.4 (4.4) and 31.2 (5.5) (p=0.0651) in men and women, respectively.Men had a mean (SD) systolic blood pressure higher than women, 134.7 (15.0) vs 132.2 (14.5) mmHg (p=0.0453) and no differences were observed in diastolic pressure (p=0.5930).As regards to the concomitant pathologies, no increase was detected in the likelihood of suffering comorbidities linked to the gender [OR=0.607 (95% CI: 0.260–1.418) p=0.2490]. Men with OA were more likely to have angina pectoris [OR=4.493 (95% CI: 1.299–15.536) p=0.0176] and underwent coronary bypass [OR=3.706 (95% CI: 1.389–9.890) p=0089].Osteoarthritic women elicited more pain in Huskisson's VAS 62.8 (14.7) vs 66.8 (15.4) mm (p=0.0027) and worse function according to the Lequesne index 10.0 (4.9) vs 12.1 (4.7) (p<0.0001).In terms of quality of life according to the EuroQol, women presented worse quality of life in dimesion of mobility (p=0.0001) and in the dimensions of daily activities, pain/discomfort and anxiety/depression (p<0.0001).Finally, regarding mental health status, women had worse scores in the Goldberg scale to detect psychological disorders (p<0.0001) and more cases of anxiety and depression according to the HAD scale (p<0.0001).ConclusionsThe results of the present study indicate that women with osteoarthritis of the knee, despite having the same diagnosis and a similar comorbidity profile to men, have a worse perception of health status regarding the symptoms of their osteoarthritis, their quality of life and their mental health.Disclosure of InterestM. Herrero Barbero Employee of: Bioiberica, S. Gimenez: None declared, J. Vergara: None declared, E. Viles I Lladό Employee of: Bioiberica, H. Martinez Employee of: Bioiberica, G. Rodríguez Roca: None declared, L. Sánchez Emp...