المؤلفون: Cheema, Haadiya, Brophy, Robert, Collins, Jamie, Cox, Charles L., Guermazi, Ali, Kumara, Mahima, Levy, Bruce A., MacFarlane, Lindsey, Mandl, Lisa A., Marx, Robert, Selzer, Faith, Spindler, Kurt, Katz, Jeffrey N., Murray, Eleanor J.

المصدر: Osteoarthritis & Cartilage; Mar2024, Vol. 32 Issue 3, p319-328, 10p

مستخلص: Randomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects. We describe a process for synthesizing expert knowledge and apply this to long-term follow-up of an RCT of treatments for meniscal tears in patients with knee osteoarthritis (OA). We identified 2 post-randomization events likely to impact accurate assessment of pain outcomes beyond 5 years in trial participants: loss to follow-up and total knee replacement (TKR). We conducted literature searches for covariates related to pain and TKR in individuals with knee OA and combined these with expert input. We synthesized the evidence into graphical models. We identified 94 potential covariates potentially related to pain and/or TKR among individuals with knee OA. Of these, 46 were identified in the literature review and 48 by expert panelists. We determined that adjustment for 50 covariates may be required to estimate the long-term effects of knee OA treatments on pain. We present a process for combining literature reviews with expert input to synthesize existing knowledge and improve covariate selection. We apply this process to the long-term follow-up of a randomized trial and show that expert input provides additional information not obtainable from literature reviews alone. [ABSTRACT FROM AUTHOR]

: Copyright of Osteoarthritis & Cartilage is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Mass, Hanna¹ (AUTHOR), Katz, Jeffrey N.^1,2,3,4 (AUTHOR) jnkatz@bwh.harvard.edu

المصدر: Skeletal Radiology. Nov2023, Vol. 52 Issue 11, p2045-2055. 11p.

مصطلحات موضوعية: *OSTEOARTHRITIS, *KNEE osteoarthritis, *KNEE pain, *MENISCUS injuries, *PATHOLOGY, *OLDER people, *AGE groups

مستخلص: Importance: Knee osteoarthritis (OA) is a common cause of pain and disability in older persons, affecting approximately 14 million individuals in the USA. Meniscal damage is also common in this age group with a prevalence of 35% in a middle-aged and older community sample and 82% in persons with evidence of radiographic knee osteoarthritis. This paper systematically reviews evidence on the association of meniscal pathology and incident radiographic knee OA. Observations: We included 15 articles, published between 2013 and 2021, assessing the relationship between meniscal pathology and OA incidence (Fig. 1). The menisci are crucial load-bearing structures, and the resulting increase in biomechanical stress due to meniscal damage increases the risk for OA development. While some discrepancies are present in the literature, a clinically meaningful association has been generally established between the presence of a meniscal tear or meniscal extrusion and subsequent development of incident OA. Of note, larger radial tears as well as complex and more severe tears exhibit the strongest association with the development of incident OA. The relationship between other features of meniscal morphology—such as meniscal volume and meniscal coverage—and incident OA is less clearly documented. Conclusions and relevance: The early detection of meniscal pathology can be used to trigger preventative and therapeutic strategies designed to avert or delay knee OA in this at-risk population. [ABSTRACT FROM AUTHOR]

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 & Research; Aug2023, Vol. 75 Issue 8, p1783-1787, 5p

مصطلحات موضوعية: LEUKOCYTE count, SYNOVITIS, SYNOVIAL fluid, KNEE pain, MAGNETIC resonance imaging, KNEE osteoarthritis, INFLAMMATION

مستخلص: Objective: 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. Methods: 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. Results: 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%). Conclusion: 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. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 & Research; Mar2023, Vol. 75 Issue 3, p491-500, 10p

مصطلحات موضوعية: GASTRIC bypass, KNEE osteoarthritis, TOTAL knee replacement, COST effectiveness, SLEEVE gastrectomy, KNEE pain

مستخلص: Objective: 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. Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 & Research; Feb2023, Vol. 75 Issue 2, p340-347, 8p

مصطلحات موضوعية: KNEE pain, MENISCUS injuries, KNEE osteoarthritis, SYMPTOMS, MAGNETIC resonance imaging, KNEE injuries

مستخلص: Objective: 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. Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

المصدر: JAMA: Journal of the American Medical Association; 12/13/2022, Vol. 328 Issue 22, p2242-2251, 10p

مصطلحات موضوعية: KNEE pain, CONTROL (Psychology), CLINICAL trials, ATTENTION control, OBESITY, KNEE osteoarthritis

مصطلحات جغرافية: NORTH Carolina

مستخلص: Key Points: Question: Does a weight loss and exercise program in community settings lead to improvement in knee pain in patients with osteoarthritis and overweight or obesity? Findings: This randomized clinical trial included 823 patients with knee osteoarthritis and overweight or obesity treated with diet and exercise vs an attention control. After 18 months, the adjusted mean difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (range, 0-20) was −0.6, a difference that met statistical significance. Meaning: In patients with knee osteoarthritis and overweight or obesity, an 18-month program of weight loss and exercise based in community settings, compared with an attention control group, led to a small difference in knee pain of uncertain clinical importance. Importance: Some weight loss and exercise programs that have been successful in academic center–based trials have not been evaluated in community settings. Objective: To determine whether adaptation of a diet and exercise intervention to community settings resulted in a statistically significant reduction in pain, compared with an attention control group, at 18-month follow-up. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted in community settings in urban and rural counties in North Carolina. Patients were men and women aged 50 years or older with knee osteoarthritis and overweight or obesity (body mass index ≥27). Enrollment (N = 823) occurred between May 2016 and August 2019, with follow-up ending in April 2021. Interventions: Patients were randomly assigned to either a diet and exercise intervention (n = 414) or an attention control (n = 409) group for 18 months. Main Outcomes and Measures: The primary outcome was the between-group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score (range, 0 [none] to 20 [severe]; minimum clinically important difference, 1.6) over 18 months, tested using a repeated-measures mixed linear model with adjustments for covariates. There were 7 secondary outcomes including body weight. Results: Among the 823 randomized patients (mean age, 64.6 years; 637 [77%] women), 658 (80%) completed the trial. At 18-month follow-up, the adjusted mean WOMAC pain score was 5.0 in the diet and exercise group (n = 329) compared with 5.5 in the attention control group (n = 316) (adjusted difference, −0.6; 95% CI, −1.0 to −0.1; P =.02). Of 7 secondary outcomes, 5 were significantly better in the intervention group compared with control. The mean change in unadjusted 18-month body weight for patients with available data was −7.7 kg (8%) in the diet and exercise group (n = 289) and −1.7 kg (2%) in the attention control group (n = 273) (mean difference, −6.0 kg; 95% CI, −7.3 kg to −4.7 kg). There were 169 serious adverse events; none were definitely related to the study. There were 729 adverse events; 32 (4%) were definitely related to the study, including 10 body injuries (9 in diet and exercise; 1 in attention control), 7 muscle strains (6 in diet and exercise; 1 in attention control), and 6 trip/fall events (all 6 in diet and exercise). Conclusions and Relevance: Among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to a statistically significant but small difference in knee pain over 18 months. The magnitude of the difference in pain between groups is of uncertain clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT02577549 This randomized clinical trial assesses the effect of a diet and exercise intervention vs an attention control condition on knee pain at 18-month follow-up among individuals aged 50 years or older with knee osteoarthritis and overweight or obesity. [ABSTRACT FROM AUTHOR]

: Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Hunter, David J., Deveza, Leticia A., Collins, Jamie E., Losina, Elena, Katz, Jeffrey N., Nevitt, Michael C., Lynch, John A., Roemer, Frank W., Guermazi, Ali, Bowes, Michael A., Dam, Erik B., Eckstein, Felix, Kwoh, C. Kent, Hoffmann, Steve, Kraus, Virginia B.

المصدر: Arthritis Care & Research; Jul2022, Vol. 74 Issue 7, p1142-1153, 12p

مصطلحات موضوعية: PATELLOFEMORAL joint, BONE spurs, KNEE pain, BIOMARKERS, MAGNETIC resonance imaging, OSTEOARTHRITIS, CANCELLOUS bone, PARSIMONIOUS models

الشركة/الكيان: NATIONAL Institutes of Health (U.S.)

مستخلص: Objective: To determine the optimal combination of imaging and biochemical biomarkers for use in the prediction of knee osteoarthritis (OA) progression. Methods: The present study was a nested case–control trial from the Foundation of the National Institutes of Health OA Biomarkers Consortium that assessed study participants with a Kellgren/Lawrence grade of 1–3 who had complete biomarker data available (n = 539 to 550). Cases were participants' knees that had radiographic and pain progression between 24 and 48 months compared to baseline. Radiographic progression only was assessed in secondary analyses. Biomarkers (baseline and 24‐month changes) that had a P value of <0.10 in univariate analysis were selected, including quantitative cartilage thickness and volume on magnetic resonance imaging (MRI), semiquantitative MRI markers, bone shape and area, quantitative meniscal volume, radiographic progression (trabecular bone texture [TBT]), and serum and/or urine biochemical markers. Multivariable logistic regression models were built using 3 different stepwise selection methods (complex models versus parsimonious models). Results: Among baseline biomarkers, the number of locations affected by osteophytes (semiquantitative), quantitative central medial femoral and central lateral femoral cartilage thickness, patellar bone shape, and semiquantitative Hoffa‐synovitis predicted OA progression in most models (C statistic 0.641–0.671). In most models, 24‐month changes in semiquantitative MRI markers (effusion‐synovitis, meniscal morphologic changes, and cartilage damage), quantitative central medial femoral cartilage thickness, quantitative medial tibial cartilage volume, quantitative lateral patellofemoral bone area, horizontal TBT (intercept term), and urine N‐telopeptide of type I collagen predicted OA progression (C statistic 0.680–0.724). A different combination of imaging and biochemical biomarkers (baseline and 24‐month change) predicted radiographic progression only, which had a higher C statistic of 0.716–0.832. Conclusion: The present study highlights the combination of biomarkers with potential prognostic utility in OA disease‐modifying trials. Properly qualified, these biomarkers could be used to enrich future trials with participants likely to experience progression of knee OA. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lenhard, Nora K., Sullivan, James K., Ross, Eric L., Song, Shuang, Edwards, Robert R., Hunter, David J., Neogi, Tuhina, Katz, Jeffrey N., Losina, Elena

المصدر: Arthritis Care & Research; May2022, Vol. 74 Issue 5, p776-789, 14p

مصطلحات موضوعية: KNEE pain, KNEE osteoarthritis, MENTAL depression, DULOXETINE, MEDICAL screening, QUALITY-adjusted life years

مستخلص: Objective: Duloxetine is a treatment approved by the US Food and Drug Administration for both osteoarthritis (OA) pain and depression, though uptake of duloxetine in knee OA management varies. We examined the cost‐effectiveness of adding duloxetine to knee OA care in the absence or presence of depression screening. Methods: We used the Osteoarthritis Policy Model, a validated computer microsimulation of knee OA, to examine the value of duloxetine for patients with knee OA who have moderate pain by comparing 3 strategies: 1) usual care, 2) usual care plus duloxetine for patients who screen positive for depression on the Patient Health Questionnaire 9 (PHQ‐9), and 3) usual care plus universal duloxetine. Outcome measures included quality‐adjusted life years (QALYs), lifetime direct medical costs, and incremental cost‐effectiveness ratios (ICERs), discounted at 3% annually. Model inputs, drawn from the published literature and national databases, included annual cost of duloxetine ($721–937); average pain reduction for duloxetine (17.5 points on the Western Ontario and McMaster Universities Osteoarthritis Index pain scale [0–100]), and likelihood of depression remission with duloxetine (27.4%). We considered 2 willingness‐to‐pay (WTP) thresholds of $50,000/QALY and $100,000/QALY. We varied parameters related to the PHQ‐9 and the cost of duloxetine, efficacy, and toxicities to address uncertainty in model inputs. Results: The screening strategy led to an additional 17 QALYs per 1,000 subjects and increased costs by $289/subject (ICER = $17,000/QALY). Universal duloxetine led to an additional 31 QALYs per 1,000 subjects and $1,205 per subject (ICER = $39,300/QALY). Under the majority of sensitivity analyses, universal duloxetine was cost‐effective at the $100,000/QALY threshold. Conclusion: The addition of duloxetine to usual care for knee OA patients with moderate pain, regardless of depressive symptoms, is cost‐effective at frequently used WTP thresholds. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: MacFarlane, Lindsey A., Cook, Nancy R., Kim, Eunjung, Lee, I-Min, Iversen, Maura D., Gordon, David, Buring, Julie E., Katz, Jeffrey N., Manson, JoAnn E., Costenbader, Karen H.

المصدر: All PTHMS Faculty Publications

مصطلحات موضوعية: Knee pain, Vitamin D, Dietetics and Clinical Nutrition, Orthopedics, Rehabilitation and Therapy

الوصف: Objective: Knee pain from osteoarthritis is frequent in the adult population. Prior trials have had conflicting results concerning vitamin D's therapeutic effects on knee pain and few trials have investigated marine omega-3 fatty acids (n-3 FA). Methods: The double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL) randomized 25,871 U.S. adults in a two-by-two factorial design to vitamin D and n-3 FA. We identified a subgroup with chronic knee pain prior to randomization and assessed knee pain at baseline and annually during follow-up with the Western Ontario and McMaster Universities Arthritis Index (WOMAC; 0-100, 100 worst). Repeated measures modeling tested the effect of randomized treatment on WOMAC Pain over follow-up after adjustment for age and sex. Analyses were repeated for WOMAC Function and Stiffness. Results: We included 1,398 participants who returned at least one knee pain questionnaire. Mean age was 67.7 years, 66% were female, and mean WOMAC Pain was 37 (SD 19). Mean follow-up time was 5.3 years (SD 0.7). WOMAC Pain did not differ between vitamin D or n-3 FA and placebo at any time point during follow-up. Linear time by treatment interactions were not statistically significant for either treatment (vitamin D p= 0.41, n-3 FA p= 0.77). Vitamin D and n-3 FA supplementation did not significantly affect WOMAC Function or Stiffness scores over time. Conclusion: Vitamin D and n-3 FA supplementation for a mean of 5.3 years did not reduce knee pain or improve function or stiffness in a large sample of U.S adults with chronic knee pain.

العلاقة: https://digitalcommons.sacredheart.edu/pthms_fac/297Test

الإتاحة: https://doi.org/10.1002/art.41416Test
https://digitalcommons.sacredheart.edu/pthms_fac/297Test

المؤلفون: Messier, Stephen P., Callahan, Leigh F., Beavers, Daniel P., Queen, Kate, Mihalko, Shannon L., Miller, Gary D., Losina, Elena, Katz, Jeffrey N., Loeser, Richard F., Quandt, Sara A., DeVita, Paul, Hunter, David J., Lyles, Mary F., Newman, Jovita, Hackney, Betsy, Jordan, Joanne M.

مصطلحات موضوعية: Osteoarthritis, Knee pain, Clinical trial, Pragmatic, Community based research

الوصف: Background: Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA. Methods/Design This is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m2) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective. Discussion Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by ...

وصف الملف: application/pdf

العلاقة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322619/pdfTest/; BMC Musculoskeletal Disorders; Messier, S. P., L. F. Callahan, D. P. Beavers, K. Queen, S. L. Mihalko, G. D. Miller, E. Losina, et al. 2017. “Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial.” BMC Musculoskeletal Disorders 18 (1): 91. doi:10.1186/s12891-017-1441-4. http://dx.doi.org/10.1186/s12891-017-1441-4Test.; http://nrs.harvard.edu/urn-3:HUL.InstRepos:32072230Test

الإتاحة: https://doi.org/10.1186/s12891-017-1441-4Test
http://nrs.harvard.edu/urn-3:HUL.InstRepos:32072230Test