Arthritis The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Sucupira as a Potential Plant for Arthritis Treatment and Other Diseases Tue, 03 Nov 2015 11:08:57 +0000 Trees of the genus Pterodon, commonly known as “sucupira-branca” or “faveira,” are native to central Brazil. The Pterodon fruits are traditionally used in ethnomedicine as an infusion, in small doses, and at regular time intervals as an antirheumatic, anti-inflammatory, tonic, and depurative agent. The various compounds present in the Pterodon class are, generally, water-insoluble and derived from the fusion of high-molecular weight pentacarbonate units. Scientific research has shown that the major compounds isolated from Pterodon species are linear and/or tetracyclic diterpenes with vouacapane skeletons that partly underlie the pharmacological activities of the fruit-derived oil. Material from Pterodon species has several biological properties, such as analgesic, anti-inflammatory, and anticancer effects. Therefore, recent studies have sought to microencapsulate these extracts to protect them from potential chemical degradation and improve their water solubility, ensuring greater stability and quality of the end products. This review presents a succinct overview of the available scientific evidence of the biological activity and toxicity of Pterodon species in addition to other important aspects, including phytochemical and technological features. Jaqueline Hoscheid and Mara Lane Carvalho Cardoso Copyright © 2015 Jaqueline Hoscheid and Mara Lane Carvalho Cardoso. All rights reserved. A Systematic Review Investigating the Presence of Inflammatory Synovitis in Hip and Knee Joint Replacement Surgery Sun, 18 Oct 2015 07:21:10 +0000 Synovial tissue can display an inflammatory response in the presence of OA. There is increasing interest to better understand the role of inflammation in OA, particularly with regard to those who require joint replacement. A systematic review of inflammatory synovitis in OA of literature databases was undertaken from their inception until October 14, 2014. Independent critical appraisal of each study was undertaken using the CASP appraisal tool. From a total of sixty-six identified citations, twenty-three studies were deemed eligible for review. The studies presented moderate to strong methodological quality. Strong correlation was identified between histological and imaging synovitis severity. Correlation was weaker between clinical symptoms and imaging and/or histological synovitis severity. There was little consensus, with regard to expressed cytokines and chemokines at the different stages of OA disease progression. Few studies investigated the influence of inflammatory synovitis on the outcome of major joint replacement. Research into inflammatory synovitis in OA is an emerging field. Longitudinal studies applying proven imaging modalities, histological analysis, and longer follow-up are required in order to further define our understanding of the role of synovitis in the pathogenesis of OA and its effects on outcomes following major joint replacement. Sherif Hosny, Francesco Strambi, Nidhi Sofat, and Richard Field Copyright © 2015 Sherif Hosny et al. All rights reserved. Relationship between Tibial Baseplate Design and Rotational Alignment Landmarks in Primary Total Knee Arthroplasty Mon, 28 Sep 2015 10:00:21 +0000 This study evaluated the influence of modern tibial baseplate designs when using the anterior tibial cortex as a primary rotational landmark for the tibial baseplate in TKA. Eighty patients undergoing TKA were randomized in two groups. Group 1 included 25 females and 15 males receiving a posterior-stabilized (PS) symmetric tibial baseplate while Group 2 included 24 females and 16 males receiving a PS anatomical tibial component. Identical surgical technique, including the use of the surgical transepicondylar femoral axis (sTEA) and the anterior tibial cortex (“Curve-on-Curve”) as rotational alignment landmarks, was used. All patients underwent CT evaluation performed with the knee in full extension. Three observers independently measured the rotational alignment of the tibial component in relation to the sTEA. The rotational alignment of the symmetric baseplate showed an average external rotation of 1.3° (minimum 5°, maximum −1°): 91% of the knees showed 0 ± 3° with respect to the surgical sTEA, being internally rotated in 20%. The rotational alignment of the anatomical baseplate showed an average external rotation of 4.1° (minimum 0.4°, maximum 8.9°): only 47.5% of the knees showed 0 ± 3°, being externally rotated in 100%. The difference between the two groups was statistically significant. This study confirms the reliability of the “Curve-on-Curve” technique as an adequate rotational alignment anatomical landmark in TKA: the use of an asymmetric tibial baseplate might lead to external rotation of the tibial component when this technique is intraoperatively chosen. Pier Francesco Indelli, Angelo Graceffa, Andrea Baldini, Brielle Payne, Gennaro Pipino, and Massimiliano Marcucci Copyright © 2015 Pier Francesco Indelli et al. All rights reserved. Role of Health Literacy in Self-Reported Musculoskeletal Disorders Tue, 18 Aug 2015 12:31:19 +0000 Self-report of musculoskeletal conditions is often used to estimate population prevalence and to determine disease burden and influence policy. However, self-report of certain musculoskeletal conditions is frequently inaccurate, suggesting inadequate communication to the patient of their diagnosis. The aim of this study is to determine the association between functional health literacy (FHL) and self-reported musculoskeletal conditions in a representative population survey. FHL was measured using Newest Vital Sign in 2824 randomly selected adults. Participants also self-reported medically diagnosed arthritis, gout, and osteoporosis. Multiple logistic regression was adjusted for age and sex. The prevalence of self-reported arthritis, gout, and osteoporosis was 25.2%, 4.9%, and 5.6%, respectively. The prevalence of those at risk for inadequate FHL was 24.0% and high likelihood of inadequate FHL was 21.0%. However, over 50% of respondents with arthritis or gout had at risk/inadequate FHL, increasing to 70% of those self-reporting osteoporosis. After adjustment for age and sex, respondents in the arthritis subgroup of “don’t know” and self-reported osteoporosis were significantly more likely to have inadequate FHL than the general population. This study indicates a substantial burden of low health literacy amongst people with musculoskeletal disease. This has implications for provider-patient communication, individual healthcare, population estimates of musculoskeletal disease, and impact of public health messages. Catherine L. Hill, Sarah L. Appleton, Julie Black, Elizabeth Hoon, Rima E. Rudd, Robert J. Adams, and Tiffany Gill Copyright © 2015 Catherine L. Hill et al. All rights reserved. Screening Optimization of Latent Tuberculosis Infection in Rheumatoid Arthritis Patients Wed, 29 Jul 2015 11:01:07 +0000 Objective. Rheumatoid arthritis (RA) patients are at increased risk of latent tuberculosis infection (LTBI) but there are no clear guidelines for LTBI screening with Tuberculin Skin Test (TST) or Quantiferon TB Gold testing (QFT-G). Methods. A retrospective study was conducted in a high risk, largely foreign-born, inner city, RA population. After screening 280 RA patients, 134 patients who had both TST and QFT-G testing performed during their initial evaluation were included. Results. Out of 132 RA patients included in our analysis, 50 (37.8%) patients were diagnosed with LTBI with either positive TST 42 (31.8%) or QFT-G 23 (17.4%). 15 (11.4%) were positive and 82 (62.1%) were negative for both tests. The agreement between TST and QFT-G was 73.5% (Kappa 0.305, CI = 95% 0.147–0.463, ).  Conclusions. There was low-moderate agreement between TST and QFT-G. In the absence of clearly defined gold standard and limitations associated with both tests, we propose early screening with both tests for patients who need prompt treatment with BRMs. Patients who are not immediate candidates for BRM treatment may be safely and cost effectively screened with a two-step process: initial screening with TST and if negative, IGRA testing. Patients positive for either test should be promptly treated. Bella Mehta, Ekaterini Zapantis, Olga Petryna, and Petros Efthimiou Copyright © 2015 Bella Mehta et al. All rights reserved. Pain Sensitisation in Women with Active Rheumatoid Arthritis: A Comparative Cross-Sectional Study Tue, 21 Jul 2015 07:58:11 +0000 Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA () and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold () and pain tolerance () than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies. Nora Vladimirova, Anders Jespersen, Else Marie Bartels, Anton W. Christensen, Henning Bliddal, and Bente Danneskiold-Samsøe Copyright © 2015 Nora Vladimirova et al. All rights reserved. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis Wed, 11 Mar 2015 09:17:35 +0000 The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, )) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement. Rajiv Gandhi, Michael G. Zywiel, Nizar N. Mahomed, and Anthony V. Perruccio Copyright © 2015 Rajiv Gandhi et al. All rights reserved. Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis Sat, 28 Feb 2015 14:11:57 +0000 Objective. To evaluate the effectiveness of a whole-foods, plant-based diet (WFPB) to reduce symptoms of osteoarthritis. Methods. Six-week, prospective randomized open-label study of patients aged 19–70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure. Results. Forty participants were randomized. Thirty-seven of them, 18 control and 19 intervention, completed the study. The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality, physical functioning, role physical, and the physical component summary scale. The differences between the intervention and control PGIC scales were statistically significant over time. Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward. Conclusion. Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients. Chelsea M. Clinton, Shanley O’Brien, Junwen Law, Colleen M. Renier, and Mary R. Wendt Copyright © 2015 Chelsea M. Clinton et al. All rights reserved. Adherence to Methotrexate in Rheumatoid Arthritis: A Danish Nationwide Cohort Study Wed, 25 Feb 2015 14:13:14 +0000 Objectives. To study adherence to methotrexate (MTX) and factors of importance thereof in patients with rheumatoid arthritis (RA). Methods. Patients with a hospital diagnosis of RA (ICD10 codes M05.X or M06.X) after January 1, 1997, and aged ≥18 years at the date of first diagnosis/contact, with at least one prescription of MTX (L04AX03), were included. Results. A total of 18,703 (47.6%) patients had ever used MTX among 39,286 with a diagnosis of RA; among the MTX users, 16,503 (88.2%) had filed more than one MTX prescription. The median time from diagnosis to first MTX prescription was 0.66 (IQR 0.26–1.80) years. In those who filed more than one MTX prescription, the mean adherence time for ≥7.5 mg MTX per week was 1,925 (IQR 467–3,056) days for patients treated in private practice versus 1,892 (IQR 452–3,316) days for patients treated in hospital. The main determinants of nonadherence were female gender, younger age, and time from diagnosis to initiation of MTX. Conclusions. Treatment at hospital or in private practice did not influence the adherence to MTX. Nonmodifiable factors of importance were gender and age, while adherence to MTX therapy decreased with time lapse between diagnosis and prescription. Henning Bliddal, Stine A. Eriksen, Robin Christensen, Tove Lorenzen, Michael S. Hansen, Mikkel Østergaard, Lene Dreyer, George Luta, and Peter Vestergaard Copyright © 2015 Henning Bliddal et al. All rights reserved. Early Metacarpal Bone Mineral Density Loss Using Digital X-Ray Radiogrammetry and 3-Tesla Wrist MRI in Established Rheumatoid Arthritis: A Longitudinal One-Year Observational Study Tue, 17 Feb 2015 09:53:46 +0000 Objectives. Early change in rheumatoid arthritis (RA) is characterised by periarticular osteopenia. We investigated the relationship of early metacarpal digital X-ray radiogrammetry bone mineral density (DXR-BMD) change rate (RC-BMD, mg/cm2/month) to longitudinal changes in hand and feet radiographic and wrist MRI scores over 1 year. Materials and Methods. 10 RA patients completed the study and had wrist 3T-MRI and hand and feet X-rays at various time points over 1 year. MRI was scored by RAMRIS, X-ray was done by van der Heijde modified Sharp scoring, and RC-BMD was analysed using dxr-online. Results. There was good correlation amongst the two scorers for MRI measures and ICC for erosions: 0.984, BME: 0.943, and synovitis: 0.657. Strong relationships were observed between RC-BMD at 12-week and 1-year change in wrist marrow oedema (BME) (, ) but not with erosion, synovitis, or radiographic scores. Conclusion. Early RC-BMD correlates with 1-year wrist BME change, which is a known predictor of future erosion and joint damage. However, in our pilot study, early RC-BMD did not show relationships to MRI erosion or radiographic changes over 1 year. This may reflect a slower kinetic in the appearance of MRI/radiographic erosions, generating the hypothesis that RC-BMD may be a more sensitive and early structural prognostic marker in RA follow-up. Anshul Rastogi, Jakob Algulin, Pamela Mangat, Adrian K. P. Lim, Keshthra Satchithananda, Joseph V. Hajnal, and Peter C. Taylor Copyright © 2015 Anshul Rastogi et al. All rights reserved. Antibodies to Infliximab and Adalimumab in Patients with Rheumatoid Arthritis in Clinical Remission: A Cross-Sectional Study Wed, 11 Feb 2015 09:49:33 +0000 Objective. To investigate if antibodies towards biological TNF-α inhibitors (anti-TNFi Abs) are present in patients with rheumatoid arthritis (RA) in clinical remission and to relate any anti-TNFi Abs to circulating level of TNF-α inhibitor (TNFi). Methods. Patients with RA, treated with infliximab or adalimumab, and in clinical remission (DAS28(CRP) < 2.6) were included from 6 out-patient clinics. In blood samples, presence of anti-TNFi Abs was determined by radioimmunoassay, and concentration of bioactive TNFi was measured by a cell-based reporter gene assay. Results. Anti-TNFi Abs were present in 8/44 patients (18%) treated with infliximab and 1/49 patients (2%) treated with adalimumab (). In the former group, anti-TNFi Abs corresponded with low levels of TNFi (). Anti-TNFi Ab-positive patients had shorter disease duration at initiation of TNFi therapy () but were similar for the rest of the compared parameters. Conclusions. In RA patients in clinical remission, anti-TNFi Abs occur frequently in patients treated with infliximab, while they occur rarely in patients treated with adalimumab. Presence of anti-infliximab Abs is accompanied by low or undetectable levels of infliximab. These data suggest that continued infliximab treatment may be redundant in a proportion of RA patients treated with infliximab and in clinical remission. Grith P. Eng, Klaus Bendtzen, Henning Bliddal, Michael Stoltenberg, Marcin Szkudlarek, Viktoria Fana, Hanne M. Lindegaard, Emina Omerovic, Pil Højgaard, Elmo K. Jensen, and Pierre N. Bouchelouche Copyright © 2015 Grith P. Eng et al. All rights reserved. The Safety and Efficacy of an Enzyme Combination in Managing Knee Osteoarthritis Pain in Adults: A Randomized, Double-Blind, Placebo-Controlled Trial Sat, 31 Jan 2015 11:18:25 +0000 This randomized, double-blind, placebo-controlled, and comparator-controlled trial evaluated the safety and efficacy of an enzyme combination, as Wobenzym, in adults with moderate-to-severe osteoarthritis (OA) of the knee. Adults () received Wobenzym, diclofenac (a nonsteroidal anti-inflammatory drug, NSAID), or placebo for 12 weeks. Improvement in pain scores (Lequesne Functional Index) did not differ between subjects treated with Wobenzym or diclofenac, and both treatment groups improved compared to placebo (). Reduction in total WOMAC scores (secondary outcome measure) did not differ between Wobenzym and diclofenac, although only diclofenac emerged as different from placebo (). The median number of rescue medication (paracetamol) tablets consumed was less in the Wobenzym group compared to placebo (), while there was no difference between diclofenac and placebo. Adverse events were similar in frequency in Wobenzym and placebo groups (7.2% and 9.1% of subjects, resp.) and higher in diclofenac group (15.6%). Wobenzym is comparable to the NSAID diclofenac in relieving pain and increasing function in adults with moderate-to-severe painful knee OA and reduces reliance on analgesic medication. Wobenzym is associated with fewer adverse events and, therefore, may be appropriate for long-term use. Wolfgang W. Bolten, Michael J. Glade, Sonja Raum, and Barry W. Ritz Copyright © 2015 Wolfgang W. Bolten et al. All rights reserved. Validity and Agreement between the 28-Joint Disease Activity Score Based on C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients with Rheumatoid Arthritis Tue, 06 Jan 2015 10:15:42 +0000 Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109 Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit. To assess the extent of agreement between the two DAS28 definitions, the “European League Against Rheumatism” (EULAR) response criteria based on each definition were calculated with cross-classification. Weighted Kappa (κ) coefficients were calculated, and Bland-Altman plots were used to illustrate degree of agreement between DAS28 definitions. Results. The 75 eligible patients were classified as EULAR good, moderate, and nonresponders with good agreement (61/75; 81%) between DAS28-CRP and DAS28-ESR ( (95% CI: 0.63 to 0.88)). Conclusions. According to our findings, DAS28-CRP and DAS28-ESR are interchangeable when assessing RA patients and the two versions of DAS28 are comparable between studies. Louise Nielung, Robin Christensen, Bente Danneskiold-Samsøe, Henning Bliddal, Christian Cato Holm, Karen Ellegaard, Hanne Slott Jensen, and Else Marie Bartels Copyright © 2015 Louise Nielung et al. All rights reserved. Epicardial Fat Thickness as Cardiovascular Risk Factor and Therapeutic Target in Patients with Rheumatoid Arthritis Treated with Biological and Nonbiological Therapies Wed, 10 Dec 2014 12:25:43 +0000 Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality. Epicardial adipose tissue (EAT) thickness may act as a therapeutic target during treatments with drugs modulating the adipose tissue. We evaluate EAT thickness in RA patients treated with biological and nonbiological disease-modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted with a cohort of 34 female RA patients and 16 controls matched for age and body mass index (BMI). Plasma glucose, basal insulin, plasma lipids, and high-sensitivity C-reactive protein (hs-CRP) were assessed. EAT thickness and left ventricular mass (LVM) were measured by echocardiography. No significant differences in waist circumference (WC), blood pressure, fasting blood glucose, basal insulin, and lipid parameters were found between the groups. The control group showed lower concentrations () of hs-CRP and LVM () than those of the two RA groups. Patients treated with TNF-α inhibitors showed significantly lower EAT thickness than those treated with nonbiological DMARDs (8.56 ± 1.90 mm versus 9.71 ± 1.45 mm; ). Women with no RA revealed reduced EAT thickness (5.39 ± 1.52 mm) as compared to all RA patients (). Results suggest that RA patients have greater EAT thickness than controls regardless of BMI and WC. Marcos M. Lima-Martínez, Ediris Campo, Johanmary Salazar, Mariela Paoli, Irama Maldonado, Carlota Acosta, Marianela Rodney, Miguel Contreras, Julio O. Cabrera-Rego, and Gianluca Iacobellis Copyright © 2014 Marcos M. Lima-Martínez et al. All rights reserved. Progression of Gene Expression Changes following a Mechanical Injury to Articular Cartilage as a Model of Early Stage Osteoarthritis Sun, 16 Nov 2014 09:25:59 +0000 An impact injury model of early stage osteoarthritis (OA) progression was developed using a mechanical insult to an articular cartilage surface to evaluate differential gene expression changes over time and treatment. Porcine patellae with intact cartilage surfaces were randomized to one of three treatments: nonimpacted control, axial impaction (2000 N), or a shear impaction (500 N axial, with tangential displacement to induce shear forces). After impact, the patellae were returned to culture for 0, 3, 7, or 14 days. At the appropriate time point, RNA was extracted from full-thickness cartilage slices at the impact site. Quantitative real-time PCR was used to evaluate differential gene expression for 18 OA related genes from four categories: cartilage matrix, degradative enzymes and inhibitors, inflammatory response and signaling, and cell apoptosis. The shear impacted specimens were compared to the axial impacted specimens and showed that shear specimens more highly expressed type I collagen (Col1a1) at the early time points. In addition, there was generally elevated expression of degradative enzymes, inflammatory response genes, and apoptosis markers at the early time points. These changes suggest that the more physiologically relevant shear loading may initially be more damaging to the cartilage and induces more repair efforts after loading. R. S. McCulloch, M. S. Ashwell, C. Maltecca, A. T. O'Nan, and P. L. Mente Copyright © 2014 R. S. McCulloch et al. All rights reserved. Evaluation of Antiarthritic Potential of Methanolic Extract of Gentiana kurroo Royle Thu, 06 Nov 2014 11:45:38 +0000 Rheumatoid arthritis is a systemic disorder which involves the activation of immune system against the self-tissues. The main targets of this disease are the joints. Being systemic the development of this disease involves different mechanisms and thus the exact cause of this disease remains unknown. Although different drugs have been developed, none has been found to be the cure for this disease. In the current study the rat carrageenin paw was used as a model for acute inflammation and mycobacterium induced adjuvant arthritic model was used for exploring the antiarthritic potential of methanolic extract of Gentiana kurroo. In this study the different extracts tested showed less inhibition of acute inflammation than methanolic extract. The methanolic extract was further used in different doses and the anti-inflammatory efficacy was found to be dose dependent. The results obtained were significant with the control and the standard groups. In the arthritic model the methanolic extract showed decrease in the paw volume of arthritic animals and also in the arthritic symptoms. Again the results obtained were found to be significantly dose dependent. From the results obtained it can be concluded that this extract may serve as a source of drug against the rheumatoid arthritis. Khan Mubashir, Bashir A. Ganai, Khalid Ghazanfar, and Seema Akbar Copyright © 2014 Khan Mubashir et al. All rights reserved. Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches Wed, 01 Oct 2014 00:00:00 +0000 This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen’s effect size was calculated to inform the sample size in future trials. Twenty-eight participants (16 males, 12 females) participated. Patient mobility milestones such as straight leg raise were achieved on average 1.3 days (95% CI −3.4 to 0.7, ) earlier in the MV group. Knee extensor strength at 6 weeks after surgery was higher (95% CI −0.38 to 0.61, ) in the MV group. No trends for differences between the groups were observed in knee kinematics, TUG, WOMAC, or step count. Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach, but a larger study is required to confirm these findings. This trial is registered with NCT056445. Richard W. Nutton, Frazer A. Wade, Fiona J. Coutts, and Marietta L. van der Linden Copyright © 2014 Richard W. Nutton et al. All rights reserved. Psychometric Properties of the 8-Item English Arthritis Self-Efficacy Scale in a Diverse Sample Thu, 21 Aug 2014 11:13:13 +0000 Arthritis self-efficacy is important for successful disease management. This study examined psychometric properties of the 8-item English version of the Arthritis Self-Efficacy Scale (ASES-8) and differences in ASES-8 scores across sample subgroups. In 401 participants with self-reported doctor-diagnosed arthritis, exploratory factor analysis and tests of internal consistency were conducted. Concurrent validity was examined by associating ASES-8 scores with disease-specific, psychosocial, functional, and behavioral measures expected to be related to arthritis self-efficacy. All analyses were conducted for the full sample and within subgroups (gender, race, age, education, and weight status). Exploratory factor analysis for the entire sample and in all 12 subgroups demonstrated a one factor solution (factor loadings: 0.61 to 0.89). Internal consistency was high for measures of Cronbach’s alpha (0.87 to 0.94), omega (0.87 to 0.93), and greatest lower bound (0.90 to 0.95). ASES-8 scores were significantly correlated with all measures assessed , demonstrating concurrent validity. Those with a high school education or greater had higher ASES-8 scores than those with less than a high school education ; no other subgroup differences were found. The ASES-8 is a valid and reliable tool to measure arthritis self-efficacy efficiently and thereby reduce participant burden in research studies. Sara Wilcox, Danielle E. Schoffman, Marsha Dowda, and Patricia A. Sharpe Copyright © 2014 Sara Wilcox et al. All rights reserved. Individual and Community Socioeconomic Status: Impact on Mental Health in Individuals with Arthritis Mon, 04 Aug 2014 00:00:00 +0000 To examine the impact of individual and community socioeconomic status (SES) measures on mental health outcomes in individuals with arthritis, participants with self-reported arthritis completed a telephone survey assessing health status, health attitudes and beliefs, and sociodemographic variables. Regression analyses adjusting for race, gender, BMI, comorbidities, and age were performed to determine the impact of individual and community level SES on mental health outcomes (i.e., Medical Outcomes Study SF-12v2 mental health component, the Centers for Disease Control and Prevention Health-Related Quality of Life Healthy Days Measure, Center for Epidemiological Studies Depression [CES-D] scale). When entered singly, lower education and income, nonmanagerial occupation, non-homeownership, and medium and high community poverty were all significantly associated with poorer mental health outcomes. Income, however, was more strongly associated with the outcomes in comparison to the other SES variables. In a model including all SES measures simultaneously, income was significantly associated with each outcome variable. Lower levels of individual and community SES showed most consistent statistical significance in association with CES-D scores. Results suggest that both individual and community level SES are associated with mental health status in people with arthritis. It is imperative to consider how interventions focused on multilevel SES factors may influence existing disparities. Chivon A. Mingo, Kathryn R. Martin, Jack Shreffler, Britta Schoster, and Leigh F. Callahan Copyright © 2014 Chivon A. Mingo et al. All rights reserved. Zingiber officinale: A Potential Plant against Rheumatoid Arthritis Tue, 27 May 2014 06:18:17 +0000 Rheumatoid arthritis (RA) is an autoimmune disease particularly affecting elderly people which leads to massive bone destruction with consequent inflammation, pain, and debility. Allopathic medicine can provide only symptomatic relief. However, Zingiber officinale is a plant belonging to the Zingiberaceae family, which has traditionally been used for treatment of RA in alternative medicines of many countries. Many of the phytochemical constituents of the rhizomes of this plant have therapeutic benefits including amelioration of RA. This review attempts to list those phytochemical constituents with their reported mechanisms of action. It is concluded that these phytochemicals can form the basis of discovery of new drugs, which not only can provide symptomatic relief but also may provide total relief from RA by stopping RA-induced bone destruction. As the development of RA is a complex process, further research should be continued towards elucidating the molecular details leading to RA and drugs that can stop or reverse these processes by phytoconstituents of ginger. Abdullah Al-Nahain, Rownak Jahan, and Mohammed Rahmatullah Copyright © 2014 Abdullah Al-Nahain et al. All rights reserved. Weight Status and Differences in Mobility Performance, Pain Symptoms, and Physical Activity in Older, Knee Osteoarthritis Patients Sun, 25 May 2014 12:57:52 +0000 Knee osteoarthritis (OA) is a leading cause of functional disability among American adults. Obesity is a strong independent risk factor for OA. While research emphasizes the role of obesity in the OA-physical function relationship, the extent to which weight status impacts salient physical, health, and pain measures in older, knee OA patients is not well delineated. The primary aim of this study was to assess differences in mobility performance (stair climb and 400-meter walk), mobility-related self-efficacy, pain symptoms (WOMAC), and measures of accelerometer-determined physical activity (PA) as a function of weight status. Analysis of covariance was conducted to examine differences on the dependent variables. Obese class III patients were outperformed by their counterparts on nearly every measure of mobility, mobility-related self-efficacy, and the assessment of pain symptoms. These outcomes did not differ among other weight comparisons. Normal weight subjects outperformed classes I, II, and III counterparts on most measures of PA (engagement in moderate or greater PA and total weekly steps). Additionally, overweight participants outperformed obese class II participants and obese class I participants outperformed obese classes II and III participants on total weekly steps. Collectively, these findings underscore the meaningful differences observed in relevant OA outcomes as a function of increasing levels of body weight. Matthew J. Garver, Brian C. Focht, Justin Dials, Mark Rose, Alexander R. Lucas, Steven T. Devor, Charles F. Emery, Kevin V. Hackshaw, and W. Jack Rejeski Copyright © 2014 Matthew J. Garver et al. All rights reserved. Fibroblast-Like Synoviocytes Induce Calcium Mineral Formation and Deposition Tue, 20 May 2014 12:37:22 +0000 Calcium crystals are present in the synovial fluid of 65%–100% patients with osteoarthritis (OA) and 20%–39% patients with rheumatoid arthritis (RA). This study sought to investigate the role of fibroblast-like synoviocytes (FLSs) in calcium mineral formation. We found that numerous genes classified in the biomineral formation process, including bone gamma-carboxyglutamate (gla) protein/osteocalcin, runt-related transcription factor 2, ankylosis progressive homolog, and parathyroid hormone-like hormone, were differentially expressed in the OA and RA FLSs. Calcium deposits were detected in FLSs cultured in regular medium in the presence of ATP and FLSs cultured in chondrogenesis medium in the absence of ATP. More calcium minerals were deposited in the cultures of OA FLSs than in the cultures of RA FLSs. Examination of the micromass stained with nonaqueous alcoholic eosin indicated the presence of birefringent crystals. Phosphocitrate inhibited the OA FLSs-mediated calcium mineral deposition. These findings together suggest that OA FLSs are not passive bystanders but are active players in the pathological calcification process occurring in OA and that potential calcification stimuli for OA FLSs-mediated calcium deposition include ATP and certain unidentified differentiation-inducing factor(s). The OA FLSs-mediated pathological calcification process is a valid target for the development of disease-modifying drug for OA therapy. Yubo Sun, David R. Mauerhan, Atiya M. Franklin, Natalia Zinchenko, Harry James Norton, Edward N. Hanley Jr., and Helen E. Gruber Copyright © 2014 Yubo Sun et al. All rights reserved. Quantitative Gait Analysis Detects Significant Differences in Movement between Osteoarthritic and Nonosteoarthritic Guinea Pig Strains before and after Treatment with Flunixin Meglumine Mon, 19 May 2014 07:21:29 +0000 A computer-aided gait analysis system was used to contrast two guinea pig strains with differing propensity for osteoarthritis (OA), with/without administration of a nonsteroidal anti-inflammatory drug. Walking speed and static/dynamic gait parameters were determined at baseline. Flunixin meglumine was given and animals were evaluated 4, 24, and 72 hours after treatment. Body weight was compared using unpaired -tests. Knee joints were histologically evaluated using species-specific criteria; indices were analyzed using one-way ANOVA, Kruskal-Wallis test, followed by Dunn’s multiple comparisons. A generalized linear model followed by Tukey’s posttests juxtaposed gait parameters; walking speed was a covariate for other outcome measures. Body weight was not different between strains; OA-prone animals demonstrated more progressive chondropathy. At baseline, OA-prone animals had slower walking speeds, narrower hind limb bases of support, shorter stride lengths, and slower limb swing speeds relative to OA-resistant animals. These differences were not detected 4 or 24 hours after treatment. By 72 hours, OA-prone animals had returned to baseline values. These findings indicate a distinct voluntary gait pattern in a rodent model of bilateral primary OA, modification of which may allow rapid screening of novel therapies. Flunixin meglumine temporarily permitted OA-prone animals to move in a manner that was analogous to OA-resistant animals. K. S. Santangelo, A. C. Kaeding, S. A. Baker, and A. L. Bertone Copyright © 2014 K. S. Santangelo et al. All rights reserved. Treatment of Nongout Joint Deposition Diseases: An Update Thu, 08 May 2014 12:44:44 +0000 This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson’s disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators’ effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson’s disease. NSAIDs should be avoided because of the liver affection they may worsen. Tristan Pascart, Pascal Richette, and René-Marc Flipo Copyright © 2014 Tristan Pascart et al. All rights reserved. Productivity Improvements in Hip and Knee Surgery Thu, 20 Feb 2014 07:48:11 +0000 Productivity improvements that occur as technologies become widely used are not well documented. This study measured secular trends over 1998–2010 in productivity of hip and knee procedures gauged in terms of changes in physical function and pain after versus before surgery. We used data from the Health and Retirement Study. Health outcomes from surgery were measured by 6 physical functioning scales and 2 pain indicators. We used propensity score matching to obtain nonsurgery control groups. Not only were there substantial improvements in physical functioning and pain reduction after receipt of these procedures in all years, but also we documented improvements in health outcomes over time. Largest improvements were for reductions in numbers of Activity and Instrumental Activity of Daily Living limitations for knee procedures. Frank A. Sloan, Linda K. George, and Linyan Hu Copyright © 2014 Frank A. Sloan et al. All rights reserved. A Technique of Predicting Radiographic Joint Line and Posterior Femoral Condylar Offset of the Knee Tue, 11 Feb 2014 09:17:58 +0000 Purpose. To describe a reliable method of predicting native joint line and posterior condylar offset (PCO) using true lateral digital radiographs of the distal femur. Methods. PCO was measured relative to a line drawn parallel to the posterior cortex of the distal femur and the joint line was measured from the posterior condylar flare to the articular surface. A ratio was then calculated for these measurements relative to the width of the femur at the level of the flare. Two independent observers measured PCO and joint line ratio for 105 radiographs of the different knees and one repeated these measurements after one week. Results. There was a significant correlation between the width of the femoral diaphysis at the level of the posterior condylar flare with joint line () and PCO (). Joint line and PCO could be predicted within 4 mm and 2 mm, respectively, using the identified ratio between the width of the femoral diaphysis at the level of the posterior condylar flare with measured joint line and PCO. The inter- () and intra- () observer reliability for these ratios were high. Conclusion. These ratios could be used to predict the native joint line and PCO. Nicholas D. Clement, David F. Hamilton, and Richard Burnett Copyright © 2014 Nicholas D. Clement et al. All rights reserved. Glucosamine for Osteoarthritis: Biological Effects, Clinical Efficacy, and Safety on Glucose Metabolism Tue, 11 Feb 2014 00:00:00 +0000 Osteoarthritis is a chronic degenerative disorder that currently represents one of the main causes of disability within the elderly population and an important presenting complaint overall. The pathophysiologic basis of osteoarthritis entails a complex group of interactions among biochemical and mechanical factors that have been better characterized in light of a recent spike in research on the subject. This has led to an ongoing search for ideal therapeutic management schemes for these patients, where glucosamine is one of the most frequently used alternatives worldwide due to their chondroprotective properties and their long-term effects. Its use in the treatment of osteoarthritis is well established; yet despite being considered effective by many research groups, controversy surrounds their true effectiveness. This situation stems from several methodological aspects which hinder appropriate data analysis and comparison in this context, particularly regarding objectives and target variables. Similar difficulties surround the assessment of the potential ability of glucosamine formulations to alter glucose metabolism. Nevertheless, evidence supporting diabetogenesis by glucosamine remains scarce in humans, and to date, this association should be considered only a theoretical possibility. Juan Salazar, Luis Bello, Mervin Chávez, Roberto Añez, Joselyn Rojas, and Valmore Bermúdez Copyright © 2014 Juan Salazar et al. All rights reserved. The Good Life: Assessing the Relative Importance of Physical, Psychological, and Self-Efficacy Statuses on Quality of Well-Being in Osteoarthritis Patients Wed, 25 Dec 2013 16:01:13 +0000 Background and Purpose. The purpose of the present study was to examine the interrelationships among physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being for people with osteoarthritis. It was predicted that exercise would mediate the relationships between physical dysfunction, self-efficacy, psychological distress, and quality of well-being. Methods. Participants were 363 individuals with osteoarthritis who were 60 years of age or older. Data were collected from the baseline assessment period prior to participating in a social support and education intervention. A series of structural equation models was used to test the predicted relationships among the variables. Results. Exercise did not predict quality of well-being and was not related to self-efficacy or psychological distress; it was significantly related to physical dysfunction. When exercise was removed from the model, quality of life was significantly related to self-efficacy, physical dysfunction, and psychological distress. Conclusions. Engagement in exercise was directly related to physical functioning, but none of the other latent variables. Alternatively, treatment focused on self-efficacy and psychological distress might be the most effective way to improve quality of well-being. Charles Van Liew, Maya S. Santoro, Arielle K. Chalfant, Soujanya Gade, Danielle L. Casteel, Mitsuo Tomita, and Terry A. Cronan Copyright © 2013 Charles Van Liew et al. All rights reserved. Application of a Simple In-House PCR-SSP Technique for HLA-B* 27 Typing in Spondyloarthritis Patients Thu, 19 Dec 2013 13:42:28 +0000 Background. Microlymphocytotoxicity (MLCT) and flowcytometry (FC) are the conventional serological methods to detect HLA-B* 27. Due to some disadvantages in these methods, most of the HLA laboratories have now switched over to molecular methods. Molecular techniques based on commercial kits are expensive; as such many laboratories with limited funds in developing countries cannot afford these techniques. Aims. Our main aim was to standardize a simple inexpensive in-house PCR-SSP technique for HLA-B* 27 typing. Materials and Methods. Sequence Specific primers were designed to amplify all the subtypes of B* 27 using IMGT-HLA sequence database. Accuracy was checked by retyping of 90 PCR-SSOP typed controls. Results. The presence of 149 bp specific band with control band on 2% agarose gel showed B* 27 positivity. No discrepancies were found when compared with PCR-SSOP results. The frequency of HLA-B* 27 was found to be significantly increased (68.75% versus 4.40%, O.R 46.909: value ) among 700 SpA patients as compared to controls. Clinically, 54% of patients had polyarticular arthritis with SI joints involvement (68%) and restricted spine flexion (60%). Conclusion. In-house PCR-SSP technique is very simple and inexpensive technique to detect B* 27 allele, which was strongly associated with SpA patients from Western India. Devraj J. Parasannanavar, Anjali Rajadhyaksha, and Kanjaksha Ghosh Copyright © 2013 Devraj J. Parasannanavar et al. All rights reserved. Association of Body Mass Index with Physical Function and Health-Related Quality of Life in Adults with Arthritis Thu, 12 Dec 2013 11:49:12 +0000 Arthritis and obesity, both highly prevalent, contribute greatly to the burden of disability in US adults. We examined whether body mass index (BMI) was associated with physical function and health-related quality of life (HRQOL) measures among adults with arthritis and other rheumatic conditions. We assessed objectively measured BMI and physical functioning (six-minute walk, chair stand, seated reach, walking velocity, hand grip) and self-reported HRQOL (depression, stiffness, pain, fatigue, disability, quality of life-mental, and quality of life, physical) were assessed. Self-reported age, gender, race, physical activity, and arthritis medication use (covariates) were also assessed. Unadjusted and adjusted linear regression models examined the association between BMI and objective measures of functioning and self-reported measures of HRQOL. BMI was significantly associated with all functional () and HRQOL measures () in the unadjusted models. Associations between BMI and all functional measures () and most HRQOL measures remained significant in the adjusted models (); depression and quality of life, physical, were not significant. The present analysis of a range of HRQOL and objective measures of physical function demonstrates the debilitating effects of the combination of overweight and arthritis and other rheumatic conditions. Future research should focus on developing effective group and self-management programs for weight loss for people with arthritis and other rheumatic conditions (registered on NCT01172327). Danielle E. Schoffman, Sara Wilcox, and Meghan Baruth Copyright © 2013 Danielle E. Schoffman et al. All rights reserved.