Objective: Using a qualitative design this study aimed to (1) explore the experience of people living with osteoarthritis (OA), (2) gain an understanding of their navigation of the health system and, (3) explore their opinions on the role of exercise and joint replacement surgery for the management of OA.Methods: Purposive sampling was used to recruit 26 participants with knee OA, aged 45 years and over, from Tasmania, Australia. Semi-structured interviews were audio-recorded, transcribed, coded, and thematically analysed to document participant understanding and experience of OA and their opinions on the role of exercise and surgery in managing OA.Results: Of the 26 participants, 80% (n = 21) were female with a mean age of 66 years. The main theme identified was that individuals with knee OA were navigating a maze of OA treatments. Three related subthemes were that participants: (i) perceived their general practitioner did not have an ongoing role in their OA care, (ii) self-directed their management and, (iii) sampled from a 'smorgasbord' of treatment options, including low-value care options. Two other major themes were: the role of exercise for OA management, and surgery as a last resort. Conclusion:Our findings suggest that OA patients may not be choosing consistent, high-value care for their OA. This highlights the importance of an evidence-based multi-disciplinary approach to guide patients to self-manage their OA and support their navigation of the health system. Reducing emphasis on the pathway to surgery and streamlining access to conservative management strategies may assist people to receive high-value care.

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Background Hip osteoarthritis (OA) commonly affects older adults and leads to high morbidity. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. Known predictors of THR include pain and radiographic OA. Hip structure has also been shown to worsen hip OA and predict THR. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. The purpose of this study is to describe predictors of THR in community dwelling older adults.Methods At baseline, participants had assessment of radiographicOA and cam impingement (from pelvic radiographs), shape mode scores (from dual energy X-ray absorptiometry (DXA)) and hip bone mineral density (BMD) (from DXA). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression.Results Incidence of THR for OA over 14 years was 5.0% (40 / 802). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.57 per SD; 95% CI 1.01-2.46), shape mode 4 score (non-spherical femoral head) (RR 0.65/SD; 95% CI 0.44-0.97), cam impingement (α >60°) (RR 2.66/SD; 95% CI 1.38-5.13), neck of femur BMD (RR 1.85/SD, 95% CI 1.4-2.44) and bone marrow lesions (BMLs) increased risk of THR (RR 5.62/unit; 95% CI 1.1 – 28.81). There was a trend for hip effusions to increase the risk of THR (RR 1.88/SD; 95% CI 0.24 to 14.78).Conclusion In addition to hip pain and radiographic hip OA, measures of hip shape, cam impingement, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.

BackgroundLow-grade inflammation may play a role in osteoarthritis (OA). Although some studies reported that inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) were increased in OA, the findings for associations between hs-CRP and OA are inconsistent. The link between serum levels of hs-CRP and bone marrow lesions (BMLs) in OA patients has not been explored., Similarly, the findings for the associations between resistin and OA are controversial and little is known if resistin is associated with BMLs.ObjectivesThe aims of this study were, therefore, to describe the association between serum levels of hs-CRP, resistin and BMLs cross-sectionally and longitudinally in patients with knee OA.MethodsA total of 192 patients (mean 63 years, range 50-79, female 53%) with symptomatic knee OA were selected from a randomised placebo controlled clinical trial studying the effect of vitamin D supplementation on OA. Serum levels of hs-CRP and resistin were tested at baseline and 24 months later using enzyme-linked immunosorbent assay (ELISA). T2 weighted fat-supressed fast spin echo magnetic resonance imaging (MRI) was performed at baseline and 24 months to assess compartmental and total knee BMLs scores and their changes using modified Whole-Organ MRI Score system (WORMS). Linear or logistic regression analyses were used to determine the association of baseline hs-CRP and resistin with total knee BMLs as well as changes or increases in BMLs before and after adjustment for age, sex, BMI, treatment (vitamin D/placebo) and CRP/resistin as appropriate.ResultsAt baseline, quartiles of serum level of hs-CRP were associated with total knee bone marrow lesions in multivariable analyses (OR: 1.45 per quartile, 95% CI: 1.01, 2.09). Serum levels of resistin were associated with total knee BMLs (β: 0.04 per ng/ml, 95% CI: 0.01, 0.08). Longitudinally, quartiles of serum levels of hs-CRP predicted increases in total knee BMLs (OR: 1.51 per quartile, 95% CI: 1.08, 2.12; Figure 1), and changes in serum levels of hs-CRP were associated with changes in total knee BMLs (β: 0.09, 95% CI: 0.04, 0.34). Baseline resistin levels were not significantly associated with change in total BMLs. Change in serum levels of resistin were only associated with changes in lateral tibiofemoral BMLs (β: 0.16, 95%CI: 0.01, 0.05) and not total knee BMLs (β: 1.01, 95%CI: 0.97, 1.04).ConclusionsThis is the first study to report that serum levels of hs-CRP are associated with total knee BMLs and predict worsening knee BMLs over 2 years in patients with knee OA, suggesting inflammatory involvement in the pathogenesis of BMLs. Serum resistin levels are associated with BMLs in knee OA, but the causal relationship is unknown.AcknowledgementsWe especially thank the participants who made this study possible, and we gratefully acknowledge the role of the Vitamin D Effect on Osteoarthritis Study staff and volunteers in collecting the data, particularly Jodi Barling, Judy Hankin and Alice Noone.Disclosure of InterestNone declared