Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?

Duncan, Rachel; Peat, George; Thomas, Eva R; Hay, EM; McCall, I.W.; Croft, Peter

doi:10.1136/ard.2006.052548

Cited by 151 publications

(117 citation statements)

References 32 publications

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“…OA was defined as the presence of at least one knee with a Kellgren-Lawrence Grade 2 or greater. As described by Duncan et al [10], only one knee per individual, the index knee, was analyzed. In patients with unilateral knee pain, the index knee was the painful knee.…”

Section: Methodsmentioning

confidence: 99%

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

Sanghi

Mishra

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

134

100

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Background Animal, epidemiologic, and human clinical studies suggest a putative role for vitamin D in osteoarthritis (OA). Inadequate sunlight exposure and lower serum levels of 25(OH)D appear in some reports to be associated with an increased risk for progression of knee OA. Questions/purposes We asked whether treatment with vitamin D would (1) reduce knee pain (WOMAC and VAS), (2) improve function (WOMAC), and (3) change levels of relevant biochemical markers in patients with knee OA with vitamin D insufficiency. Methods This randomized controlled pilot trial prospectively enrolled 107 patients with knee OA with vitamin D insufficiency (25(OH)D B 50 nmol/L) to receive oral vitamin D or placebo. The primary outcome measures were pain and function, and the secondary were biochemical markers. At baseline, the two groups were comparable. The patients were followed for 1 year. Results At 12 months, knee pain had decreased in the vitamin D group by mean À0.26 (95% CI, À2.82 to À1.43) on VAS and À0.55 (95% CI, À0.07 to 1.02) on the WOMAC, whereas in the placebo group, it increased by mean 0.13 (95% CI, À0.03 to 0.29) on the VAS and 1.16 (95% CI, 0.82 to 1.49) on the WOMAC (effect size = 0.37 and 0.78). Likewise knee function improved in the vitamin D group by mean À1.36 (95% CI, À1.87 to À0.85) over the placebo group which had a mean 0.69 (95% CI, À0.03 to 1.41; effect size = 0.06). There were significant biochemical changes in serum total calcium, 25(OH)D and alkaline phosphatase.

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Section: Methodsmentioning

confidence: 99%

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

Sanghi

Mishra

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

134

100

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“…A number of studies indicate that only half of the patients with radiographic OA feel pain, and that there is a weak correlation between pain severity and radiographic changes (31)(32)(33)(34). Even studies showing significant associations between changes in joint structure and symptoms have found that 51% of the subjects with knee pain for >1 year do not show any typical radiographic joint changes, and that up to 50% of patients with the radiographic changes of OA have no symptoms (35). This suggests that the ability of radiography to distinguish painful and non-painful knees in the general population is limited, possibly because of a lack of sensitivity in detecting structural changes, differences in pain susceptibility, other personal determinants of OA symptoms, and obscure structure/pain relationships (36).…”

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confidence: 99%

The sources of pain in osteoarthritis: a pathophysiological review

2014

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summaryThe pain of osteoarthritis (OA) has multifaceted etiologies within and outside the joint. It is believed to be driven by both nociceptive and neuropathic mechanisms, as well as abnormal excitability in the pain pathways of the peripheral and central nervous system. Inflammation in the joint triggers a cascade of events that leads to peripheral sensitization, increased sensitivity of nociceptive primary afferent neurons, and hyperexcitability of the nociceptive neurons in the central nervous system. Pain receptors have been found in the synovium, ligaments, capsule, subchondral bone and surrounding tissues, with the exception of articular cartilage. The bone-related causes of pain in OA include subchondral microfractures, bone stretching with elevation of the periosteum due to osteophyte growth, bone remodeling and repair, bone marrow lesions, and bone angina caused by decreased blood flow and increased intra-osseous pressure. Central factors alter pain processing by setting the gain in such a way that, when a peripheral input is present, it is processed against a background of central factors that can enhance or diminish the experience of pain. As a complex phenomenon with a strong subjective component, pain can also be influenced by the nature of the underlying disease, personal predisposition (biological and psychological), and environmental and psychosocial factors. This review examines the current literature regarding the sources and mechanisms of pain in OA.

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“…A radiographic finding is a standard addition to a clinical review. However, the discrepancy between a radiographic finding in osteoarthrosis and events in a painful knee in the general population (22) has been identified (23) and well documented (24, 25) long ago. According to recent research, agreement between ACR clinical criteria of arthrosis and radiographic findings of arthrosis is low, sensitivity is 41% and specificity 75% (26).…”

Section: Discussionmentioning

confidence: 99%

Arthrosonography and the Biomarker Cartilage Oligomeric Matrix Protein in the Detection of Knee Osteoarthrosis Effusion

Živanović¹,

Rackov²,

Vucetic³

et al. 2009

Journal of Medical Biochemistry

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Kratak sadr`aj: Osteoartroza (OA) kolena je dege nera tivna bolest sa inflamatornim epizodama koje artrosonografija objektivno prikazuje. Oligomerni protein matriksa hrska vi ce -COMP je korisan marker za ranu destrukciju hrskavice. Cilj rada je uporedna analiza klini~kog, artrosonografskog pregleda i koncentracije COMP u serumu bolesnika radi detekcije zglobne inflamacije. Analizom je obuhva}eno 88 bolesnika sa OA kolena. Klini~kim pregledom je utvr|en izliv, artrosonografskim veli~ina sinovitisa i efuzije, analizom seruma koncentracija COMP (ng/ml). Minimalan izliv je imalo 34,1% bolesnika, umeren 22,7%, zna~ajan 4,5%. Sen zitivnost klini~ke dijagnoze izliva je 73%, a specifi~nost 73% (p=0,000). Efuziju je imalo 75% bolesnika, u suprapatelarnom recesusu (SR) efuziju je imalo 28,4% bolesnika, medijalnom (MR) 27,3%, lateralnom (LR) 62,5%. U SR efuzija je bila 10,13±4,35 mm, MR 8,53±2,27 mm, LR 11,38±4,44 mm. Sinovitis je na|en kod 67% bolesnika, u SR veli~ine 4,84±3,57 mm, MR 3,15±1,86 mm, LR 6,09±2,80 mm. Srednja vrednost veli~ine efuzije kod bole sni ka sa zna~ajnim izlivom u SR je bila 13,85 (10,36-17,43) mm (p=0,000), MR 4,9 (0-10,22) mm (p=0,008), LR 12,0 (11,34-14,50) mm (p=0,000), sa mo u LR sa umerenim izlivom 6,94 (1,16-8,13) mm i mi nimalnim izlivom 4,9 (0 -7,25) mm. Postoji zna~ajna pove za nost veliine sinovitisa i efuzije u SR, MR i LR (p=0,000). Srednja vrednost koncentracije COMP kod bolesnika bez efuzije je bila 54 (44,5-58) ng/mL, sa efuzijom 57 (48,25) ng/mL (p=0,030). Artrosonografija i odre|ivanje koncentracija COMP predstavljaju senzitivne metode u dijagnostikovanju zglobne efuzije.

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Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?

Cited by 151 publications

References 32 publications

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

The sources of pain in osteoarthritis: a pathophysiological review

Arthrosonography and the Biomarker Cartilage Oligomeric Matrix Protein in the Detection of Knee Osteoarthrosis Effusion

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