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Use of Vitamin D Supplements in Osteoarthritis: An Observational Study in a Tertiary Health Care Facility.
Thomas, JE, Bhat, AK, Rao, M, Guddattu, V, Sekhar M, S
Journal of the American College of Nutrition. 2019;(3):227-234
Abstract
OBJECTIVE The purpose of the study was to assess impact of vitamin D supplements on the disease progression and overall health of osteoarthritis (OA) patients. METHODOLOGY A cohort study was carried out for 8 months (August 2017-March 2018) in the Orthopedics Department of Kasturba Hospital, Manipal, India, a tertiary care hospital. One hundred and forty-two patients who were diagnosed with OA (grades 1-3) with low serum 25(OH)D levels (severely deficient, deficient, or insufficient) were selected for the study. These patients were categorized into two cohorts: a control cohort (CC) and a study cohort (SC). CC members were patients (n = 71) who had not received vitamin D supplements, and SC members were patients (n = 71) who had received vitamin D supplements. Severity grading of OA, pain score, and health assessment were performed using the Kellgren-Laurence grading score, visual analogue scale (VAS), and WOMAC, respectively, at baseline and after 3 months of follow-up. RESULTS Subjects in the both CC and SC reported no statistically significant difference (similar in both group) in severity grade (p = 0.303), pain score (p = 0.099), parathyroid hormone (PTH) (p = 0.083), and health status (p = 0.76) at baseline. After 3 months of follow-up (post vitamin D supplementation), OA patients have shown statistically significant difference in severity grades, serum 25(OH)D status, PTH level (p < 0.001), and overall health status (p = 0.001) in the SC with respect to baseline. Likewise, percentage distribution of positive changes was significantly higher in severity grade, pain score, serum 25(OH)D level, overall health status (p < 0.001), and PTH (p = 0.040) of SC as compared to CC at follow-up. CONCLUSION Vitamin D supplements have significantly improved serum 25(OH)D levels, PTH, severity grade, and pain score of OA patients. Most importantly, vitamin D supplements have shown improvement in the overall health of OA patients, emphasizing the place of vitamin D supplements in the management of OA. Clinical Trial Registry-India (CTRI) registration no: CTRI/2017/12/011031.
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Sulphurous mud-bath therapy for treatment of chronic low back pain caused by lumbar spine osteoarthritis.
Costantino, M, Conti, V, Corbi, G, Marongiu, F, Marongiu, MB, Filippelli, A
Internal and emergency medicine. 2019;(1):187-190
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Hyperlipidaemia and incident osteoarthritis of the hand: a population-based case-control study.
Frey, N, Hügle, T, Jick, SS, Meier, CR, Spoendlin, J
Osteoarthritis and cartilage. 2017;(7):1040-1045
Abstract
OBJECTIVE Preclinical evidence suggests that increased cholesterol levels might be involved in the pathophysiology of osteoarthritis of the hand (HOA), but evidence from observational studies remains scarce. We aimed to analyse the association between hyperlipidaemia and incident HOA. DESIGN We conducted a matched (1:1) case-control study using the UK-based Clinical Practice Research Datalink (CPRD). Cases were patients aged 30-89 years with an incident diagnosis of HOA between 1995 and 2014. In multivariable conditional logistic regression analyses, we calculated odds ratios (OR) for incident HOA in patients with hyperlipidaemia, categorized by gender, age, previous duration of hyperlipidaemia, and recent statin treatment. RESULTS Among 19,590 cases and 19,590 controls, we observed an increased risk of HOA in patients with hyperlipidaemia (OR 1.37, 95% confidence intervals (CI) 1.28-1.47), when compared to patients without hyperlipidaemia. Thus, of all HOA cases in our study population, 3.6% may have been attributable to the presence of hyperlipidaemia (population attributable risk). Most patients with HOA were elderly, but the strength of the association between HOA and hyperlipidaemia inversely correlated with increasing age, with the highest OR of 1.72 (95% CI 1.24-2.38) in patients aged 29-49 years. Categorization by previous hyperlipidaemia duration, as well as sub-classification of patients with hyperlipidaemia into those with and without recent statin use did not meaningfully change the effect estimate. CONCLUSIONS Our results suggest that hyperlipidaemia may be an independent risk factor for new onset HOA.
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Association Between Sedentary Time and Quality of Life From the Osteoarthritis Initiative: Who Might Benefit Most From Treatment?
Pinto, D, Song, J, Lee, J, Chang, RW, Semanik, PA, Ehrlich-Jones, LS, Pellegrini, CA, Dunlop, DD
Archives of physical medicine and rehabilitation. 2017;(12):2485-2490
Abstract
OBJECTIVE To investigate the relationship between sedentary behavior and quality-adjusted life years (QALYs) among participants in the Osteoarthritis Initiative. DESIGN Longitudinal, observational design. SETTING Osteoarthritis Initiative cohort. PARTICIPANTS Individuals (N=1794) from a prospective, multicenter longitudinal cohort were classified into quantile groups based on average daily sedentary time (most sedentary, quartile 1 [Q1] ≥11.6h; 10.7h≤ Q2 <11.6h; 9.7h≤ Q3 <10.7h; least sedentary, Q4 <9.7h). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Individual QALYs were estimated over 2 years from the area under the curve of health-related utility scores derived from the Medical Outcomes Study 12-Item Short-Form Health Survey versus time. The relationship between baseline sedentary behavior and median 2-year QALYs was estimated using quantile regression adjusted for socioeconomic factors and body mass index. RESULTS Lower QALYs over 2 years were more frequently found among the most sedentary (Q1, median 1.59), and QALYs increased as time spent in baseline sedentary behavior decreased (median QALYs for Q2, 1.64; Q3, 1.65; Q4, 1.65). The relationship of sedentary time and median QALY change was only significant for the most sedentary Q1 group, where an additional hour of sedentary behavior significantly reduced QALYs by -.072 (95% confidence interval, -.121 to -.020). CONCLUSIONS Our findings suggest that individuals with the most extreme sedentary profiles may be vulnerable to additional losses of quality of life if they become more sedentary. Targeting these individuals to decrease sedentary behavior has the potential to be cost-effective.
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Simvastatin Effect on Calcium and Silicon Plasma Levels in Postmenopausal Women with Osteoarthritis.
Horecka, A, Hordyjewska, A, Blicharski, T, Kocot, J, Żelazowska, R, Lewandowska, A, Kurzepa, J
Biological trace element research. 2016;(1):1-5
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Abstract
Postmenopausal women more often suffered from knee osteoarthritis and its pathogenesis still remains unclear. Calcium and silicon are significant elements involved in bone and joint metabolism, especially in older people. Cardiovascular diseases are common worldwide and simvastatin is the most prescribed drug in such population of patients. The purpose of this study was to evaluate the effect of simvastatin administration on calcium and silicon concentration in the plasma of postmenopausal women with osteoarthritis. Sixty postmenopausal mild hypercholesterolemic women (mean age 61.4 years, range 54-68) were enrolled. Thirty patients received simvastatin (20 or 40 mg/day) for at least 1 year before being enrolled (simvastatin "+" group). Control group consists of remaining 30 women (simvastatin "-"group). Silicon and calcium concentrations were measured spectrophotometrically. Plasma simvastatin level was determined 3 h after the drug administration using HPLC-UV-Vis. Calcium but not silicon level was significantly lower in patients receiving simvastatin in comparison with non-statin group (1.91 ± 0.32 vs. 2.33 ± 0.19 mmol/l, p < 0.05). A weak but significant positive correlation between plasma silicon and simvastatin levels (r = 0.3, p < 0.05) was observed; this may be due to the fact that simvastatin contains silicon dioxide as an inactive ingredient. The mean simvastatin concentration was 9.02 ng/ml. All hypotheses were verified at the significance level of p < 0.05. A statistically significant decrease in the plasma calcium concentration of postmenopausal women, treated with simvastatin suggests that simvastatin may play a role in calcium metabolism in postmenopausal women with osteoarthritis. Positive correlation of simvastatin concentration with silicon level in the plasma suggests that both might prompt the positive effect of osteoarthritis treatment.
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Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative.
Veronese, N, Stubbs, B, Noale, M, Solmi, M, Luchini, C, Maggi, S
The American journal of clinical nutrition. 2016;(5):1403-1409
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Abstract
BACKGROUND The Mediterranean diet has positively influenced various medical conditions, but only a paucity of studies has considered the relation between the Mediterranean diet and quality of life (QOL) among people living in North America. OBJECTIVE We investigated whether a higher adherence to the Mediterranean diet (aMED) was associated with better QOL and decreased pain, stiffness, disability, and depression in a large cohort of North Americans from the Osteoarthritis Initiative. DESIGN aMED was evaluated through a validated Mediterranean diet score categorized into quintiles. Outcomes of interest were QOL [assessed with the 12-Item Short-Form Health Outcome Survey (SF-12)]; disability, pain, and stiffness [assessed in both knees with the Western Ontario and McMaster Universities Arthritis Index (WOMAC)]; and depressive symptoms [assessed with the Center for Epidemiologic Studies Depression Scale (CES-D)]. RESULTS Of the 4470 participants (2605 women; mean age: 61.3 y), those with a higher aMED had significantly more favorable scores on all outcomes investigated (P < 0.0001 for all comparisons). After adjustment for potential confounders in linear regression analyses, a higher aMED was significantly associated with a higher SF-12 physical composite scale value (β: 0.10; 95% CI: 0.05, 0.15; P < 0.0001), lower WOMAC scores (except for stiffness), and lower CES-D scores (β: -0.05; 95% CI: -0.09, -0.01; P = 0.01). An adjusted logistic regression analysis, taking as reference those in the 2 highest quintiles of the aMED score, confirmed these findings. CONCLUSION Higher aMED is associated with better QOL and decreased pain, disability, and depressive symptoms. This trial was registered at clinicaltrials.gov as NCT00080171.
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A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain.
Conrozier, T, Mathieu, P, Bonjean, M, Marc, JF, Renevier, JL, Balblanc, JC
Alternative therapies in health and medicine. 2014;:32-7
Abstract
BACKGROUND Devil's claw (Harpagophytum procumbens), turmeric (Curcuma longa), and bromelain are nutraceuticals that have demonstrated anti-inflammatory and analgesic properties and may be potential solutions in the treatment of acute or chronic joint pain. Their analgesic effect, however, is generally considered mild to moderate, and the relevance of their clinical use remains subject to discussion. OBJECTIVES The aim of the study was to evaluate the clinical relevance of the efficacy of a marketed complex of 3 plant extracts-H procumbens, C longa, and bromelain (AINAT, 650 mg)-in the treatment of degenerative joint pain. METHODS A multicenter, observational, prospective, open-label survey was conducted in 8 rheumatology centers. The study included 2 groups, 1 group with participants suffering from chronic osteoarthritis (OA) pain and 1 group suffering from acute OA pain. SETTING The research team carried out the study under daily practice conditions. PARTICIPANTS A total of 42 patients (36 women; mean age = 67 y) suffering from acute or chronic, degenerative spine or joint pain participated. INTERVENTION Two 650-mg capsules of AINAT were administered 3 ×/d to patients with acute pain and 2 ×/d to patients with chronic pain. OUTCOME MEASURES At baseline, and during a follow-up visit at 15 d for the acute pain group and 60 d for the chronic pain group, the research team obtained each participant's global assessment (PGA) and each rheumatologist's global assessment (RGA), as well as each participant's pain score, using for each of them a 100-mm visual analogue scale (VAS). The clinical relevance of the efficacy was evaluated by comparing the outcome measures at endpoint to the values defining the patient acceptable symptom state (PASS) and by comparing the variations (in mm and %) between baseline and endpoint to those defining the minimal clinically important improvement (MCII). Tolerance was also assessed by collecting adverse events at each visit and by using a 4-point scale (very good to bad) at the endpoint. RESULTS At baseline, the VAS pain score (standard deviation) was 69.1 mm (15.4) and 68.0 mm (18.2) for patients with acute and chronic pain, respectively. At the endpoint, the scores decreased to 42.1 mm (21.1) and 37.8 mm (25.9), respectively. This reduction of pain, as a percentage as well as an absolute value, corresponds to the required definition of MCII, particularly in patients with chronic joint pain. At the endpoint, most of the patients in both groups reached the level of pain defined as the PASS. No withdrawals occurred due to treatment side effects. CONCLUSION The improvement of joint pain was clinically relevant in patients treated with AINAT for both acute and chronic OA pain. Considering its excellent tolerance profile, the tested complex of 3 plant extracts with antiinflammatory properties may be a valuable and safe alternative to NSAIDs in patients suffering from degenerative joint diseases.
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Osteoarthritis pain has a significant neuropathic component: an exploratory in vivo patient model.
Duarte, RV, Raphael, JH, Dimitroulas, T, Sparkes, E, Southall, JL, Ashford, RL, Kitas, GD
Rheumatology international. 2014;(3):315-20
Abstract
Osteoarthritis is the most common form of arthritis and includes manifestations of both nociceptive and neuropathic mechanisms. Intravenous lignocaine, a sodium channel blocker and neuronal membrane stabiliser, has been shown in controlled trials to be effective in neuropathic pain; however, the outcome of intravenous lignocaine in osteoarthritis patients has not been assessed yet. The existence of a neuropathic component to the pain of osteoarthritis was investigated by examining possible benefits upon sensory aspects of pain in osteoarthritis patients receiving intravenous lignocaine therapy. Retrospective observational study was carried out using health data routinely collected for non-research purposes. Patients with generalised osteoarthritis who had not responded to more conservative treatments were recruited sequentially and scheduled for intravenous lignocaine therapy either in the rheumatology or pain relief departments. Assessment of efficacy was carried out through a questionnaire including sensory, psychological and social aspects of pain. The sample consisted of 17 women (60.7%) and 11 men (39.3%) with an average age at the time of treatment of 59 ± 11 years. The average pain relief calculated from the NRS scores was 30.2 ± 21.4%, and the mean duration of pain relief was 10 ± 6 weeks. Pain intensity (p < 0.001), pain relief (p < 0.003) and mobility (p < 0.003) were all significantly improved after administration of lignocaine intravenous infusion therapy. Pain was significantly reduced in a group of osteoarthritis patients after administration of intravenous lignocaine. This suggests that part of the pain mechanism in this patient group may be neuropathic, appears to contribute significantly to the patients' pain, and requires further investigation in studies designed specifically for the purpose.