المؤلفون: Waddell, Lily M., Musbahi, Omar, Collins, Jamie E., Jones, Morgan H., Selzer, Faith, Losina, Elena, Katz, Jeffrey N.

المصدر: Arthritis Care and Research; June 2024, Vol. 76 Issue: 6 p882-888, 7p

مستخلص: Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.

المؤلفون: Messier, Stephen P., Gill, Malia E., Mihalko, Shannon L., Beavers, Daniel P., Queen, Kate, Miller, Gary D., Losina, Elena, Katz, Jeffrey N., Loeser, Richard F., DeVita, Paul, Hunter, David J., Quandt, Sara A., Lyles, Mary F., Hudson, David, Callahan, Leigh F.

المصدر: Arthritis Care and Research; April 2024, Vol. 76 Issue: 4 p503-510, 8p

مستخلص: The purpose of this study was to determine whether clinical, health‐related quality of life (HRQL), and gait characteristics in adults with knee osteoarthritis (OA) differed by obesity category. This cross‐sectional analysis of 823 older adults (mean age 64.6 years, SD 7.8 years) with knee OA and overweight or obesity compared clinical, HRQL, and gait outcomes among obesity classifications (overweight or class I, body mass index [BMI] 27.0–34.9; class II, BMI 35.0–39.9; class III BMI ≥40.0). Patients with class III obesity had worse Western Ontario McMasters Universities Arthritis Index knee pain (0–20) than the overweight or class I (mean 8.6 vs 7.0; difference 1.5; 95% confidence interval [CI] 1.0–2.1; P< 0.0001) and class II (mean 8.6 vs 7.4; difference 1.1; 95% CI 0.6–1.7; P= 0.0002) obesity groups. The Short Form 36 physical HRQL measure was lower in the class III obesity group compared to the overweight or class I (mean 31.0 vs 37.3; difference −6.2; 95% CI −7.8 to −4.7; P< 0.0001) and class II (mean 31.0 vs 35.0; difference −3.9; 95% CI −5.6 to −2.2; P< 0.0001) obesity groups. The class III obesity group had a base of support (cm) during gait that was wider than that for the overweight or class I (mean 14.0 vs 11.6; difference 3.3; 95% CI 2.6–4.0; P< 0.0001) and class II (mean 14.0 vs 11.6; difference 2.4; 95% CI 1.6–3.2; P< 0.0001) obesity groups. Among adults with knee OA, those with class III obesity had significantly higher pain levels and worse physical HRQL and gait characteristics compared to adults with overweight or class I or class II obesity.

المؤلفون: McDermott, Gregory C., Monshizadeh, Armaan, Selzer, Faith, Zhao, Sizheng S., Ermann, Joerg, Katz, Jeffrey N.

المصدر: Arthritis Care and Research; April 2024, Vol. 76 Issue: 4 p541-549, 9p

مستخلص: Patients with axial spondyloarthritis (axSpA) often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay. We identified patients meeting modified New York criteria for ankylosing spondylitis (AS) or 2009 Assessment of Spondyloarthritis International Society criteria for axSpA in the Mass General Brigham health care system between December 1990 and October 2021. We determined the duration of diagnostic delay, defined as the duration of back pain symptoms reported at diagnosis, as well as disease manifestations and specialty care prior to diagnosis from the electronic health record. We obtained each patient's Social Vulnerability Index (SVI) by mapping their address to the US Centers for Disease Control SVI Atlas. We examined associations among disease manifestations, SVI, and diagnostic delay using ordinal logistic regression. Among 554 patients with axSpA who had a median diagnostic delay of 3.8 years (interquartile range 1.1–10), peripheral arthritis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45–0.93) and older age at symptom onset (OR 0.83, 95% CI 0.78–0.88 per five years) were associated with shorter delay. AS at diagnosis (OR 1.85, 95% CI 1.30–2.63), a history of uveitis prior to diagnosis (OR 2.77, 95% CI 1.73–4.52), and higher social vulnerability (defined as national SVI 80th to 99th percentiles; OR 1.99, 95% CI 1.06–3.84) were associated with longer diagnostic delay. Older age at back pain onset and peripheral arthritis were associated with shorter delay, whereas uveitis was associated with longer diagnostic delay. Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors.

المؤلفون: MacFarlane, Lindsey A., Arant, Kaetlyn R., Kostic, Aleksandra M., Mass, Hanna, Jones, Morgan H., Collins, Jamie E., Losina, Elena, Katz, Jeffrey N.

المصدر: Arthritis Care and Research; August 2023, Vol. 75 Issue: 8 p1783-1787, 5p

مستخلص: Inflammation is a potential pain generator and treatment target in knee osteoarthritis (OA). Inflammation can be detected on magnetic resonance imaging (MRI) and by synovial fluid white blood cell count (WBC). However, the performance characteristics of synovial fluid WBC for the detection of synovitis have not been established. This study was undertaken to determine the sensitivity and specificity of synovial fluid WBC in identifying inflammation in knee OA using MRI effusion‐synovitis as the gold standard. We identified records of patients seen at an academic center with a diagnosis code for knee OA, a procedural code for knee aspiration, and a laboratory order for synovial fluid WBC in the same encounter, as well as an MRI within 12 months of the aspiration. MRIs were read for effusion‐synovitis using the MRI OA Knee Score (MOAKS). We dichotomized effusion‐synovitis as 1) none or small, or 2) medium or large. We calculated the sensitivity and specificity of synovial fluid WBC using MRI effusion‐synovitis (medium/large) as the gold standard. We used the Youden index to identify the best cut point. We included 75 patients. Mean ± SD age was 63 ± 12 years, and 69% were female. The synovial fluid WBC was higher in the medium/large effusion‐synovitis group (median 335 [interquartile range (IQR) 312]) than in the none/small group (median 194 [IQR 272]). The optimal cut point was 242, yielding a sensitivity of 71% (95% confidence interval [95% CI] 56–83%) and specificity of 63% (95% CI 41–81%). The sensitivity and specificity of synovial fluid WBC in identifying effusion‐synovitis on MRI were limited. Further research is needed to better understand the association between MRI and effusion‐synovitis measured by synovial fluid and to determine which measure more strongly relates to synovial histopathology and patient outcomes.

المؤلفون: Kostic, Aleksandra M., Leifer, Valia P., Selzer, Faith, Hunter, David J., Paltiel, A. David, Chen, Antonia F., Robinson, Malcolm K., Neogi, Tuhina, Collins, Jamie E., Messier, Stephen P., Edwards, Robert R., Katz, Jeffrey N., Losina, Elena

المصدر: Arthritis Care and Research; August 2023, Vol. 75 Issue: 8 p1752-1763, 12p

مستخلص: Class III obesity (body mass index >40 kg/m2) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost‐effectiveness of Roux‐en‐Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR. Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long‐term clinical benefits, costs, and cost‐effectiveness of weight‐loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight‐loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality‐adjusted life expectancy (QALE), and incremental cost‐effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty. LSG increased QALE by 1.64 quality‐adjusted life‐years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost‐effective in 67% of iterations at a willingness‐to‐pay threshold of $50,000/QALY. For patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.

المؤلفون: Losina, Elena, Song, Shuang, Bensen, Gordon P., Katz, Jeffrey N.

المصدر: Arthritis Care and Research; April 2023, Vol. 75 Issue: 4 p876-884, 9p

مستخلص: To determine the prevalence of chronic and occasional opioid use and identify risk factors of opioid use among persons with knee osteoarthritis (OA). We used the Medicare Current Beneficiary Survey to select a knee OAcohort. We obtained data on demographics characteristics, marital status, comorbidities, insurance, and prescription medication coverage from survey data and linked Medicare claims. We included all prescribed medication records classified as opioid under the First Databank therapeutic antiarthritics or analgesics categories. We stratified individuals with knee OAinto 3 opioid use groups: 1) nonusers (0 prescriptions/year), 2) occasional users (1–5 prescriptions/year), and 3) chronic users (6+ prescriptions/year). We built multivariable logistic regression models using a generalized estimating equation to determine correlates of chronic opioid use. Among 3,549 Medicare beneficiaries with knee OA and a mean ± SD age of 78 ± 7 years, 68% were female, 9% were chronic users, and 21% used opioids occasionally. Multivariable analysis showed that non‐Hispanic ethnicity (odds ratio [OR] 4.8, 95% confidence interval [95% CI] 2.2–10.2), divorced status (vs. married; OR 2.3, 95% CI 1.5–3.5), Medicaid eligibility (OR 1.9, 95% CI 1.3–2.7), depression (OR 1.9, 95% CI 1.5–2.5), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.4–2.5), and inability to walk without assistive devices (vs. no difficulty walking; OR 2.4, 95% CI 1.5–3.7) were independently associated with chronic opioid use. A total of 9% of persons with knee OA use opioids chronically. Efforts to find nonopioid regimens for treating knee OA pain should be tailored to patients at high risk for chronic use.

المؤلفون: Kostic, Aleksandra M., Leifer, Valia P., Gong, Yusi, Robinson, Malcolm K., Collins, Jamie E., Neogi, Tuhina, Messier, Stephen P., Hunter, David J., Selzer, Faith, Suter, Lisa G., Katz, Jeffrey N., Losina, Elena

المصدر: Arthritis Care and Research; March 2023, Vol. 75 Issue: 3 p491-500, 10p

مستخلص: Class III obesity (body mass index [BMI] ≥40 kg/m2) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m2, our objective was to establish the value of Roux‐en‐Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m2. We used the Osteoarthritis Policy model to assess long‐term clinical benefits, costs, and cost‐effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality‐adjusted life‐years (QALYs), lifetime costs, and incremental cost‐effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters. The usual care + RYGB strategy increased the quality‐adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m2, usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness‐to‐pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost‐effective in 70% and 30% of iterations, respectively. RYGB offers good value among knee OA patients with BMI ≥40 kg/m2, while LSG may provide good value among those with BMI between 35 and 41 kg/m2.

المؤلفون: Katz, Jeffrey N., Collins, Jamie E., Jones, Morgan, Spindler, Kurt P., Marx, Robert G., Mandl, Lisa A., Levy, Bruce A., Wright, Rick, Jarraya, Mohamed, Guermazi, Ali, MacFarlane, Lindsey A., Losina, Elena, Chang, Yuchiao

المصدر: Arthritis Care and Research; February 2023, Vol. 75 Issue: 2 p340-347, 8p

مستخلص: Middle‐aged subjects with meniscal tear treated with arthroscopic partial meniscectomy (APM) experience greater progression of damage to joint structures on imaging than subjects treated nonoperatively. It is unclear whether these changes are clinically relevant. The goal of this study was to assess whether worsening in magnetic resonance imaging (MRI)–assessed tissue damage over 18 months leads to subsequent worsening in knee pain over the subsequent 3.5 years. We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of APM versus physical therapy for subjects ages ≥45 years with knee pain, cartilage damage, and meniscal tear. We assessed whether change in cartilage surface area damage score (and other structural measures) from baseline to 18 months, assessed on MRI with the MRI Osteoarthritis Knee Score (MOAKS) system, was associated with change in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (range 0–100; 100 = worst) from 18 to 60 months. The primary analysis included 168 subjects with complete MRI data at baseline and 18 months and KOOS data at 18 and 60 months. We did not observe clinically important associations between change in cartilage surface area score between baseline and 18 months and change in pain scores from 18 to 60 months. Pain scores in the worst tertile for cartilage surface area damage score progression worsened by 0.45 points more than in the best tertile (95% confidence interval –4.45, 5.35). Similarly, we did not observe clinically important associations between changes in bone marrow lesions, osteophytes, or synovitis and subsequent pain. We did not observe clinically important associations between early changes in cartilage damage and other structural measures and worsening in pain over the subsequent 3.5 years. Further follow‐up is required to assess this association over a longer follow‐up period.

المؤلفون: Ellrodt, Jack, Pincus, Theodore, Shadick, Nancy A., Stratton, Jacklyn, Santacroce, Leah, Katz, Jeffrey N., Smolen, Josef, Solomon, Daniel H.

المصدر: Journal of Clinical Rheumatology; August 2022, Vol. 28 Issue: 5 p265-269, 5p

المؤلفون: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Brophy, Robert H., Cole, Brian J., Spindler, Kurt P., Guermazi, Ali, Jones, Morgan H., Mandl, Lisa A., Martin, Scott, Marx, Robert G., Levy, Bruce A., Stuart, Michael, Safran‐Norton, Clare, Wright, John, Wright, Rick W., Losina, Elena, Katz, Jeffrey N.

المصدر: Arthritis Care and Research; August 2022, Vol. 74 Issue: 8 p1384-1390, 7p

مستخلص: Patients with meniscal tears reporting meniscal symptoms such as catching or locking have traditionally undergone arthroscopy. The present study was undertaken to investigate whether patients with meniscal tears who report meniscal symptoms have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT). We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each meniscal symptom (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6 months. We used linear regression models to determine whether the difference in improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score at 6 months between patients treated with APM versus PT was modified by the presence of each meniscal symptom. We also determined the percentage of participants with resolution of meniscal symptoms by treatment group. We included 287 participants. The presence (versus absence) of any of the meniscal symptoms did not modify the improvement in KOOS pain score between APM versus PT by >0.5 SD (all Pinteraction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% versus 46%, clicking 41% versus 25%). No difference in resolution of the other meniscal symptoms was observed. Meniscal symptoms were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of meniscal symptoms in isolation should not inform clinical decisions surrounding APM versus PT in patients with meniscal tear and knee OA.