The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. The prevalence and progression of radiographic knee osteoarthritis over 6 years in a population-based cohort of middle-aged subjects The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Adipose Mesenchymal Stromal Cell-Based Therapy for Severe Osteoarthritis of the Knee: A Phase I Dose-Escalation Trial. EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Knee osteoarthritis and all-cause mortality: the Wuchuan Osteoarthritis Study. Prevalence of Radiographic Knee Osteoarthritis in Saudi Arabia Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. The Bristol 'OA500 study': progression and impact of the disease after 8 years. Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032. Mesenchymal stem cell therapy for knee osteoarthritis. Preliminary report of four patients Does hand osteoarthritis predict future hip or knee osteoarthritis? Magnetic resonance imaging-based three-dimensional bone shape of the knee predicts onset of knee osteoarthritis: data from the osteoarthritis initiative.
Background : Knee osteoarthritis ( OA ) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair , st and ing , walking and climbing stairs . Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocol s in combination to conventional conservative therapy for knee OA . Methods : It was a single blind RCT study with a 12-months follow-up . Totally , 56 patients with knee OA were assigned into 2 r and om groups . The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs ( NSAIDs ) and 10 sessions acupuncture and physiotherapy modalities . Non-exercise group received similar treatments except exercise program . The changes in patients ’ pain and functional status were evaluated by visual analog scale ( VAS ) , knee and osteoarthritis outcome score ( KOOS ) question naire and functional tests ( 4 steps , 5 sit up , and 6 min walk test ) before and after treatment ( 1 and 3 months after intervention ) , and 1 year later at the follow-up . Results : The results showed that the patients with knee OA in exercise group had significant improvement in pain , disability , walking , stair climbing , and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group . At third follow up ( 1 year later ) there was significant difference between groups in VAS and in three items of KOOS question naire in functional status . Conclusion : Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy , acupuncture , and modalities for knee OA Since the proportion of the ageing population in Japan is increasing , a comprehensive and evidence based strategy is urgently required for the prevention of musculoskeletal diseases , including osteoarthritis ( OA ) and osteoporosis ( OP ) , both of which affect the activities of daily living ( ADL ) and quality of life ( QOL ) and increase morbidity and mortality . However , few prospect i ve , longitudinal studies for the purpose of developing such a strategy have been conducted , and little information is available regarding the prevalence and incidence of musculoskeletal disorders , including OA and OP , as well as pain and disability in the Japanese population . It is difficult to design rational clinical and public health approaches for the diagnosis , evaluation and prevention of OA and OP without such epidemiological data . The Research on Osteoarthritis/osteoporosis Against Disability ( ROAD ) study was established in 2005 by N.Y. , T.A. , H.O. , S.M. , H.K. and K.N. ( principal investigators ) . The principal investigators are affiliated with the 22nd Century Medical and Research Center , University of Tokyo Details of the development of early knee osteoarthritis ( OA ) are largely unknown . The prevalence and progression of  radiographic knee OA  over 6 years in middle-aged subjects with chronic knee pain is investigated . In a prospect i ve population -based study , tibiofemoral ( TF ) and patellofemoral ( PF ) radiographs were grade d in 128 subjects ( mean age 45 ± 6.2 years ) for the presence of osteophytes and joint space narrowing ( JSN ) . Radiographic progression was defined as : ( i ) the presence of osteophytes and /or JSN in subjects with no previous OA or ( ii ) an increase in the grade and /or number of already existing osteophytes and /or JSN . Altogether 56 % ( 72/128 ) of subjects had knee OA , the majority of them was diagnosed with OA grade 1 . In 57 % of cases , radiographic OA was based on the presence of osteophytes alone versus 13 % on JSN . More than 1/3 of subjects had isolated PF joint involvement . Knee OA progression rate over 6 years was 56 % ( 71/128 ) . During 6 years , a non-linear course of radiographic OA progression with intermittent periods of progression and stabilization was observed . Individual course of OA revealed distinct subsets of radiographic progression . Osteophytosis is an important early radiographic sign of OA and its progression . Isolated PF joint involvement is a frequent expression of knee OA . In middle-aged subjects , the progression rate of knee OA over 6 years was 56 % . A non-linear course of radiographic OA progression was observed . Several radiographic subsets refer to the heterogeneity of the OA process Osteoarthritis ( OA ) is one of the leading musculoskeletal disorders in the adult population . It is associated with cartilage damage triggered by the deterioration of the extracellular matrix tissue . The present study explores the effect of intra-articular injection of autologous microfragmented adipose tissue to host chondrocytes and cartilage proteoglycans in patients with knee OA . A prospect i ve , non-r and omized , interventional , single-center , open-label clinical trial was conducted from January 2016 to April 2017 . A total of 17 patients were enrolled in the study , and 32 knees with osteoarthritis were assessed .  Surgical intervention ( lipoaspiration ) followed by tissue processing and intra-articular injection of the final microfragmented adipose tissue product into the affected knee(s ) was performed in all patients . Patients were assessed for visual analogue scale ( VAS ) , delayed gadolinium-enhanced magnetic resonance imaging of cartilage ( dGEMRIC ) and immunoglobulin G ( IgG ) glycans at the baseline , three , six and 12 months after the treatment . Magnetic resonance sequence in dGEMRIC due to infiltration of the anionic , negatively charged contrast gadopentetate dimeglumine ( Gd-DTPA2− ) into the cartilage indicated that the contents of cartilage glycosaminoglycans significantly increased in specific areas of the treated knee joint . In addition , dGEMRIC consequently reflected subsequent changes in the mechanical axis of the lower extremities . The results of our study indicate that the use of autologous and microfragmented adipose tissue in patients with knee OA ( measured by dGEMRIC MRI ) increased glycosaminoglycan ( GAG ) content in hyaline cartilage , which is in line with observed VAS and clinical results Background Osteoarthritis ( OA ) of the knee is one of the leading causes of disability in the United States . One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies , as they can be used to increase physical activity and promote exercise , which are key components of knee OA management . Objective Currently , no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available , and similarly , no data on whether mHealth technologies can impact outcomes are available . Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored , comprehensive management strategy for patients with knee OA . Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor ( thereby both encouraging changes in mobility as well as tracking them ) combined with education about the benefits of walking on patient mobility . The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors . Activity monitors will capture step count estimates and will compare those with patients ’ step goals , calories burned , and distance walked . Patients using the novel smartphone app will be able to enter information on their daily pain , mood , and sleep quality . The relationships among activity and pain , activity and mood , and sleep will be assessed , as will patient satisfaction with and adherence to the mobile app . Results We present information on an upcoming trial that will prospect ively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid . Conclusions We anticipate the results of this study will support the concept that mHealth technologies provide continuous , real-time feedback to patients with OA on their overall level of activity for a more proactive , personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders OBJECTIVE Patients with unilateral hip or knee replacements for end-stage osteoarthritis ( OA ) are at high risk for future progression of OA in other joints of the lower extremities , often requiring additional joint replacements . Although the risks of future surgery in the contralateral cognate joints ( i.e. , contralateral hip replacement after an initial hip replacement ) have been evaluated , the evolution of end-stage hip OA to OA involving the knee joints , and vice versa ( i.e. , noncognate progression ) has not been investigated . Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA , we investigated the pattern of evolution of end-stage lower extremity OA in a large , clinical cohort . METHODS Total joint replacement ( TJR ) was selected as a marker of end-stage OA , and a data base comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed . Of the 5,894 patients identified , 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement  were analyzed to determine the relative likelihood of subsequent TJRs .  Patients with the systemic inflammatory arthropathy , rheumatoid arthritis ( RA ) , were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process . RESULTS The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups . However , in OA patients for whom the second TJR was in a noncognate joint , that joint was > 2-fold more likely to be on the contralateral limb than on the ipsilateral limb ( hip to knee P < 0.001 ; knee to hip P = 0.013 ) . In contrast , among the RA cohort , the evolution was r and om and no laterality for noncognate TJR was observed at either the hip or the knee ( P = 0.782 ) . CONCLUSION This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonr and omly ; after 1 joint is replaced , the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb . Thus , OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints . The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading UNLABELLED : Osteoarthritis ( OA ) is the most widespread musculoskeletal disorder in adults . It leads to cartilage damage associated with subchondral bone changes and synovial inflammation , causing pain and disability . The present study aim ed at evaluating the safety of a dose-escalation protocol of intra-articular injected adipose-derived stromal cells ( ASCs ) in patients with knee OA , as well as clinical efficacy as secondary endpoint . A bicentric , uncontrolled , open phase I clinical trial was conducted in France and Germany with regulatory agency approval for ASC expansion procedure in both countries . From April 2012 to December 2013 , 18 consecutive patients with symptomatic and severe knee OA were treated with a single intra-articular injection of autologous ASCs . The study design consisted of three consecutive cohorts ( six patients each ) with dose escalation : low dose ( 2 × 10(6 ) cells ) , medium dose ( 10 × 10(6 ) ) , and high dose ( 50 × 10(6 ) ) . The primary outcome parameter was safety evaluated by recording adverse events throughout the trial , and secondary parameters were pain and function subscales of the Western Ontario and McMaster Universities Arthritis Index . After 6 months of follow-up , the procedure was found to be safe , and no serious adverse events were reported . Four patients experienced transient knee joint pain and swelling after local injection . Interestingly , patients treated with low-dose ASCs experienced significant improvements in pain levels and function compared with baseline . Our data suggest that the intra-articular injection of ASCs is a safe therapeutic alternative to treat severe knee OA patients . A placebo-controlled double-blind phase IIb study is being initiated to assess clinical and structural efficacy . SIGNIFICANCE Although this phase I study included a limited number of patients without a placebo arm , it showed that local injection of autologous adipose-derived stem cells was safe and well tolerated in patients with knee osteoarthritis . This study also provides encouraging preliminary evidence of efficacy . Larger and controlled long-term studies are now m and atory to confirm whether this new strategy of cell therapy can improve pain and induce structural benefit in osteoarthritis BACKGROUND Osteoarthritis ( OA ) is the most common joint disease encountered throughout Europe . A task force for the EULAR St and ing Committee for Clinical Trials met in 1998 to determine the method ological and logistical approach required for the development of evidence based guidelines for treatment of knee OA . The guidelines were restricted to cover all currently available treatments for knee OA diagnosed either clinical ly and /or radiographically affecting any compartment of the knee . METHODS The first stage was the selection of treatment modalities to be considered . The second stage comprised a search of the electronic data bases Medline and Embase using a combination of subject headings and keywords . All European language publications in the form of systematic review s , meta-analyses , r and omised controlled trials , controlled trials , and observational studies were included . During stage three all the relevant studies were quality scored . The summary statistics for vali date d outcome measures , when available , were recorded and , where practical , the numbers needed to treat and the effect size for each treatment were calculated . In the fourth stage key clinical propositions were determined by expert consensus employing a Delphi approach . The final stage ranked these propositions according to the available evidence . A second set of propositions relating to a future research agenda was determined by expert consensus using a Delphi approach . RESULTS Over 2400 English language publications and 400 non-English language publications were identified . Seven hundred and forty four studies presented outcome data of the effects of specific treatments on knee OA . Quantitative analysis of treatment effect was possible in only 61 studies . Recommendations for the management of knee OA based on currently available data and expert opinion are presented . Proposals for a future research agenda are highlighted . CONCLUSIONS These are the first clinical guidelines on knee OA to combine an evidence based approach and a consensus approach across a wide range of treatment modalities . It is apparent that certain clinical propositions are supported by substantial research based evidence , while others are not . There is thus an urgent need for future well design ed trials to consider key clinical questions BACKGROUND Previous studies showed that knee osteoarthritis ( OA ) is associated with increased mortality in Caucasians . While prevalence of knee OA is higher in Chinese than in Caucasians , no study has examined whether knee OA increases mortality in Chinese population . METHODS Between 8/2005 - 10/2005 1025 residents aged ≥50 years were recruited in r and omly selected rural communities in Wuchuan , China . Subjects completed a home interview and had weight-bearing posteroanterior semiflexed view of radiographs at tibiofemoral joints and skyline view of radiographs at patellofemoral joints , and were followed until end of 2013 . A knee was defined as having radiographic osteoarthritis ( ROA ) if either Kellgren/Lawrence ( KL ) score at tibiofemoral joint ≥2 or presence of OA at patellofemoral joint based on OARSI criteria . Symptomatic knee osteoarthritis ( SxOA ) was defined if both pain ( i.e. , knee pain occurred on most days in past month ) and ROA were present at the same knee . We examined the relation of knee SxOA and knee ROA to the all-cause mortality , respectively , using Cox-proportional hazard models adjusting for potential confounders . RESULTS Over the follow-up period 99 subjects  died . The mortality rates were 32.6 ( 95 % confidence interval ( CI ) : 19.6 - 54.0 ) and 10.9 ( 95 % CI : 8.8 - 13.5 ) per 1000 person-years among subjects with and without SxOA , respectively . Multivariable adjusted hazard ratio of all-cause mortality for knee SxOA was 1.9 ( 95 % CI : 1.0 - 3.5 ) . However , no such association was observed for knee ROA ( hazard ratio = 1.2 , 95 % CI : 0.7 - 1.9 ) . CONCLUSIONS Knee SxOA was associated with an increased risk of all-cause mortality among the residents in the rural areas of China Abstract : In this cross-sectional study we looked at the radiographic evidence of  osteoarthritis ( OA ) of the knee in 300 r and omly chosen patients attending 14 primary care facilities for different medical conditions .  Radiographic OA was seen in 89 out of 167 males ( 53.3 % ) and in 81 out of 133 females ( 60.9 % ) . The patella was involved with radiographic osteoarthritic changes in 80.7 % and 87.8 % of female and male OA patients , respectively . In most cases the medial compartment joint space was narrowed . Radiographic OA of the knee is very common in Saudi patients , especially in the patellofemoral compartment BACKGROUND Diary recording of pain and disabling activities in osteoarthritis ( OA ) is widely recommended , but , to our knowledge , its impact on symptoms has not been investigated . Exercise programmes have been shown to be effective when patients are closely supervised by nurses or physiotherapists ; however , data are lacking on the efficacy of an unsupervised home based exercise regimen in patients with OA . OBJECTIVES To evaluate the clinical efficacy of patient administered assessment tools and an unsupervised home based exercise programme alone or in combination in patients with OA . METHODS The study was a 24 week , open cluster r and omised controlled trial with a factorial design . Rheumatologists ( n = 867 ) were assigned to four groups according to the treatment given : st and ardised tools ( ST ; n = 220 ) , exercises ( EX ; n = 213 ) , both tools and exercises ( ST+EX ; n = 213 ) , or usual care ( n = 221 ) . Each rheumatologist was to enroll four patients who met the American College of Rheumatology criteria for OA ( three with knee OA , one with hip OA ) . " Tools " consisted of weekly recording of pain and disabling activities in a diary . A home based exercise programme was performed daily at least four times per week with the aid of videotape and booklet . In addition to exercise and assessment , all patients received 12.5 mg or 25 mg of the non-steroidal anti-inflammatory drug rofecoxib once daily . Outcome variables were : pain ( measured on a visual analogue scale , 0 - 100 ) ; Western Ontario and McMaster Universities Osteoarthritis Index , function subscale ( 0 - 100 ) ; and patient assessment of the quality of care ( 0 - 100 ) . RESULTS Overall , 2957 patients with OA ( 2216 knee , 741 hip ) were included . After 24 weeks , both pain and function improved in the ST , EX , ST+EX , and usual care groups ( mean ( SD ) -17 ( 27 ) , -20 ( 29 ) , -15 ( 27 ) , -19 ( 29 ) ; and -11 ( 19 ) , -12 ( 19 ) , -10 ( 19 ) , -11 ( 20 ) , respectively ) , without significant differences between groups . However , patients in the EX and ST+EX groups were more likely to agree that their rheumatologist had done his best to preserve their functional and physical activities . CONCLUSION Although patients ' assessment s favoured the exercise programme , results from this study failed to demonstrate a short term symptomatic effect of the two non-pharmacological treatments ( weekly recording of condition and exercise ) in patients with OA concurrently receiving nonsteroidal anti-inflammatory drugs OBJECTIVE To study the natural history of peripheral joint osteoarthritis ( OA ) and assess its impact over eight years in a prospect i ve study of 500 patients . METHODS 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic . All were invited for review 3 and 8 years after entry . Joint sites involved , pain severity , change in index joints , global change in the condition , use of medication , surgery and walking aids were all recorded at each visit , and after eight years disability was assessed by the  health assessment question naire ( HAQ ) and  anxiety and depression by the Hospital anxiety and depression scale ( HAD ) . RESULTS At eight-year review , 349 patients were seen : 90 % of those remaining alive . Outcome was heterogeneous . Sixty patients ( 17.2 % ) reported worsening in all three subjective parameters ( pain , index joint and global change ) compared with 22 ( 6.3 % ) who improved in all three parameters . Using this definition of worsening or improvement , strong baseline predictors of clinical outcome did not emerge . For further description , the group was split according to the index joint sites involved at entry to the study , there being 111 with knee OA alone , 87 with h and and knee OA , 72 with h and disease alone , and 29 with hip disease alone . Forty-four percent of those with lone h and disease at entry had acquired significant knee or hip OA 8 years later . The mean HAQ and HAD scores at 8 years were high , especially in those with knee disease , indicating significant disability as a result of the disease . Those with knee or knee and h and disease had the worst outcome in all parameters recorded . The data showed a general decrease in use of NSAIDs over the eight years , but an increase in utilization of analgesics , surgery ( especially for hip disease ) and walking aids . CONCLUSIONS Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous , but generally bad outcome over 8 years , the disease result ing in high levels of physical disability , anxiety and depression , with a high level of utilization of healthcare re sources , including joint replacement , drugs and walking aids . The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites . Progression and outcome may depend on a complex set of psychosocial factors , as well as biological ones Background Osteoarthritis ( OA ) is a prevalent joint disorder with a need for efficient and evidence -based management strategies . Objectives The primary purpose of this study is to compare the effects of a multidisciplinary outpatient clinic , including a brief group-based educational programme , with a traditional individual outpatient clinic for patients with hip , knee , h and or generalized OA . A secondary purpose is to investigate the effects of a telephone follow-up call . Methods This is a pragmatic r and omised single-blind controlled study with a total of 400 patients with hip , knee , h and or generalized OA between 40 and 80 years referred to an outpatient rheumatology hospital clinic . The r and omisation is stratified according to the diagnostic subgroups . The experimental group is exposed to a multidisciplinary and multifaceted intervention , including a 3.5 hour group-based patient education programme about OA in addition to individual consultations with members of a multidisciplinary team . The control intervention is based on regular care with an individual outpatient consultation with a rheumatologist ( treatment as usual ) . Primary outcomes are patient satisfaction measured at 4 months and cost-effectiveness measured at 12 months . Secondary outcomes are pain and global disease activity measured on a numeric rating scales ( NRS ) , generic and disease specific functioning and disability using Short Form-36 ( SF-36 ) health survey , the Western Ontario and McMaster Universities Osteoarthritis Index 3 ( WOMAC ) , the Australian/Canadian Osteoarthritis H and Index ( AUSCAN ) , and a patient-generated measure of disability ( Patient-Specific Functional scale , PSFS ) . Global perceived effect of change in health status during the study period is also reported . At 4-month follow-up , patients in both groups will be r and omly allocated to a 10-minute telephone call or no follow-up ( " treatment as usual " ) . After additional 8 months ( 12-month follow-up ) the four groups will be compared in a secondary analysis with regard to health outcomes and health care costs . Discussion This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs . Trial registration Current Controlled Trials IS RCT OBJECTIVE To estimate the current and future ( to year 2032 ) impact of osteoarthritis ( OA ) health care seeking . METHOD  Population -based study with prospect ively ascertained data from the Skåne Healthcare Register ( SHR ) , Sweden , encompassing more than 15 million person-years of primary and specialist outpatient care and hospitalizations . We studied all Skåne region residents aged ≥45 by the end of 2012 ( n = 531 , 254 ) and determined the prevalence of doctor-diagnosed OA defined as the proportion of the prevalent population that had received a diagnosis of OA of the knee , hip , h and , or other locations except the spine between 1999 and 2012 . We projected consultation prevalence of OA until year 2032 using Statistics Sweden 's ( SCB ) projected age and sex structure and prevalence of overweight and obesity . RESULTS In 2012 the proportion of population aged ≥45 with any doctor-diagnosed OA was 26.6 % ( 95 % confidence interval ( CI ) : 26.5 - 26.8 ) ( men 22.4 % , women 30.5 % ) . The most common locations were knee ( 13.8 % ) , hip ( 5.8 % ) and h and ( 3.1 % ) . Of the prevalent cases 26.8 % had OA in multiple joints . By the year 2032 , the proportion of the population aged ≥45 with doctor-diagnosed OA is estimated to increase from 26.6 % to 29.5 % ( any location ) , from 13.8 % to 15.7 % for the knee and 5.8 - 6.9 % for the hip . CONCLUSION In 2032 , at least an additional 26,000 individuals per 1 million population aged ≥45 years are estimated to have consulted a physician for OA in a peripheral joint compared to 2012 . These findings underscore the need to address modifiable risk factors and develop new effective OA treatments Background : Osteoarthritis ( OA ) is a cartilage degenerative process , involving the immune system , producing local inflammatory reactions , with production of pro‐inflammatory cytokines and metalloproteinases . No treatment is still available to improve or reverse the process . Stem cell therapy opened new horizons for treatment of many incurable diseases . Mesenchymal stem cells ( MSCs ) due to their multi‐lineage potential , immunosuppressive activities , limited immunogenicity and relative ease of growth in culture , have attracted attentions for clinical use OBJECTIVE To evaluate the risk of future hip or knee osteoarthritis ( OA ) in subjects with h and OA at baseline and to evaluate whether the concurrent presence of h and OA , other risk factors for OA , or an OA biomarker ( type II collagen C-telopeptide degradation product [ CTX-II ] ) further increases the risk . METHODS Radiographs of the h and s ( baseline ) and the hips and knees ( baseline and 6.6 years later ) were obtained in a r and omly selected subset of participants in the Rotterdam Study who were ages 55 years and older . Radiographs were scored for the presence of OA using the Kellgren/Lawrence ( K/L ) system . A total of 1,235 subjects without OA of the hip/knee ( K/L score 0 - 1 ) at baseline were included in the study . CTX-II levels were measured at baseline . The independent risk of future hip/knee OA in subjects with h and OA at baseline was assessed by logistic regression , as stratified for age , sex , body mass index , family history of OA , and heavy workload . RESULTS Overall 12.1 % of the participants ( 19.7 % of those with h and OA versus 10.0 % of those without ) developed hip or knee OA ( odds ratio [ OR ] 2.1 [ 95 % confidence interval ( 95 % CI ) 1.3 - 3.1 ] ) . Subjects with h and OA had an increased risk of future hip OA ( OR 3.0 [ 95 % CI 1.6 - 5.4 ] ) , which was further increased in those with a family history of OA . Subjects with h and OA had an OR of 1.6 [ 95 % CI 1.0 - 2.8 ) for the future development of knee OA , which was further increased in those who were overweight . Concurrent h and OA and high levels of CTX-II further increased the risk of having hip or knee OA at followup ( OR 4.2 [ 95 % CI 2.3 - 7.8 ] ) . CONCLUSION The presence of h and OA at baseline showed an increased risk of future hip/knee OA ( higher for hip OA than for knee OA ) . The concurrent presence of h and OA and other OA risk factors or high CTX-II levels further increased the risk of future hip/knee OA OBJECTIVE To examine whether magnetic resonance imaging (MRI)-based 3-dimensional ( 3-D ) bone shape predicts the onset of  radiographic knee osteoarthritis ( OA ) .  METHODS We conducted a case-control study using data from the Osteoarthritis Initiative by identifying knees that developed incident tibiofemoral radiographic knee OA ( case knees ) during followup , and matching them each to 2 r and om control knees . Using knee MRIs , we performed active appearance modeling of the femur , tibia , and patella and linear discriminant analysis to identify vectors that best classified knees with OA versus those without OA . Vectors were scaled such that -1 and + 1 represented the mean non-OA and mean OA shapes , respectively . We examined the relation of 3-D bone shape to incident OA ( new-onset Kellgren and Lawrence [ K/L ] grade ≥2 ) occurring 12 months later using conditional logistic regression . RESULTS A total of 178 case knees ( incident OA ) were matched to 353 control knees . The whole joint ( i.e. , tibia , femur , and patella ) 3-D bone shape vector had the strongest magnitude of effect , with knees in the highest tertile having a 3.0 times higher likelihood of developing incident radiographic knee OA 12 months later compared with those in the lowest tertile ( 95 % confidence interval [ 95 % CI ] 1.8 - 5.0 , P < 0.0001 ) . The associations were even stronger among knees that had completely normal radiographs before incidence ( K/L grade of 0 ) ( odds ratio 12.5 [ 95 % CI 4.0 - 39.3 ] ) . Bone shape at baseline , often several years before incidence , predicted later OA . CONCLUSION MRI-based 3-D bone shape predicted the later onset of radiographic OA . Further study is warranted to determine whether such methods can detect treatment effects in trials and provide insight into the pathophysiology of OA development
Among all the studies , the most relevant indexes used to measure effectiveness of spa therapy were improved including VAS , Lequesne , and WOMAC Score .
Conclusions The mud-pack therapy , balneotherapy , mud-bath therapy , and spa therapy have proved to be effective in the treatment and in the secondary prevention of knee osteoarthritis , by reducing pain , nonsteroidal anti-inflammatory drug consumption , and functional limitation and improving quality of life of affected patients
Background Osteoarthritis ( OA ) is the most common musculoskeletal disease in the world .
OA is the result of an inflammatory and degenerative process affecting the entire joint .
Osteoarthritis , especially involving the knee , has a relevant socioeconomic impact in terms of drugs , hospital admissions , work absences , and temporary or permanent invalidity .
Therapy of knee osteoarthritis is based on pharmacological and nonpharmacological measures .