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Background: Direct injection of corticosteroids into the joint is a standard treatment for knee osteoarthritis (OA). However, the treatment is somewhat controversial with regard to the benefit of both single and repeated injections; evidence that they are beneficial comes from small studies that show only modest improvements. The aim of this study was to estimate the short- and long-term clinical efficacy and safety of hylan G-F 20 versus intra-articular corticosteroids (IACS) for the treatment of pain in knee OA using Bayesian network meta-analysis. Methods: Based on a pre-specified protocol, MEDLINE, Embase, and CENTRAL were searched from inception to June 2018 to identify randomized controlled trials. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials was used to assess the included studies. Hylan G-F 20 and IACS were compared using Bayesian network meta-analysis. Efficacy was evaluated at 1, 3, and 6 months, and at the final follow-up for safety outcomes. A pain hierarchy was used to select 1 pain outcome per study. Results: Forty-two trials were included for analysis. The network meta-analysis of pain showed that hylan G-F 20 may be equivalent to IACS in the short-term, but by 6 months the benefit relative to IACS was statistically significant, standardized mean difference (95% credible interval): –0.13 (–0.26, –0.01). There were no statistical differences in adverse events. Conclusions: Hylan G-F 20 may perform better in relieving pain at 6 months post-injection compared to IACS. Both agents were relatively well tolerated, with no clear differences in safety. [ABSTRACT FROM AUTHOR]

ABSTRACT Viscosupplementation (VS) is still controversial. One of the key points is the lack of well-identified factors of response. We aimed to identify clinical and radiological factors associated with lack of relevant response after intra-articular (IA) hyaluronic acid (HA) injections in symptomatic knee osteoarthritis patients. A post hoc analysis of the HAV-2012 trial, a controlled, multicentre, double-blind, randomized, non-inferiority trial comparing 3 weekly IA injections of HA (HAnox-M or BioHA) for symptomatic tibiofemoral OA was performed. At inclusion, demographic, anthropometric, clinical data (WOMAC score, patient global assessment, presence of knee effusion), and radiological data (OARSI grade, patello-femoral involvement) were recorded. VS response was defined according to OMERACT-OARSI response criteria at month 6. Predictors of response were investigated in univariate then in multivariate analysis. One hundred and sixty-six patients with full available data were included. As baseline characteristics and treatment effectiveness were similar between the 2 HA groups, their data were pooled. The mean age was 65.2 [63.7-66.8] years; 101 (60.8%) were women; 73 (44.0%) had severe TF space narrowing. At 6 months, 113 patients (68.1%) were responders. Multivariate analysis showed that obesity (BMI ≥30 kg/m2) and radiological severity (OARSI grade 3) were significantly associated with VS failure ( p = 0.001 and p = 0.008, respectively). Moreover, the association of obesity and severe TF space narrowing significantly increased the risk of VS failure. Baseline pain intensity and functional impairment were not associated with VS response. Consequently, IA injection of HA for knee OA should mainly be considered in subjects with low BMI and mild TF space narrowing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2269-2274, 2017. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish consensus for potential early symptomatic knee osteoarthritis (ESKOA) clinical definition and referral criteria from primary care to rheumatologists, based on available data from literature and a qualitative approach, in order to perform studies on patients fulfilling such criteria and to validate the obtained ESKOA definition. A complex methodological approach was followed including: (1) three focus groups (FG), including expert clinicians, researchers and patients; (2) a systematic literature review (SLR); (3) two discussion groups followed by a Delphi survey. FG and SLR were performed in parallel to inform discussion groups in order to identify relevant constructs to be included in the modified Delphi survey. ESKOA is defined in the presence of: (a) two mandatory symptoms (knee pain in the absence of any recent trauma or injury and very short joint stiffness, lasting for less than 10 min, when starting movement) even in the absence of risk factors, or (b) knee pain, and 1 or 2 risk factors or (c) three or more risk factors in the presence of at least one mandatory symptom, with symptoms lasting less than 6 months. These criteria are applicable in the absence of active inflammatory arthritis, generalized pain, Kellgren-Lawrence grade >0, any recent knee trauma or injury, and age lower than 40 years. Knee pain in the absence of any recent trauma lasting for less than 6 months was considered as the referral criterion to the rheumatologist for the suspicion of ESKOA. This consensus process has identified provisional clinical definition of ESKOA and defined potential referral criterion to rheumatologist, in order to test ESKOA obtained definition in prospective validation studies. [ABSTRACT FROM AUTHOR]

Objectives: Compared with subcutaneous adipose tissue (SCAT), infrapatellar fat pad (IFP), the main knee intra-articular adipose tissue (IAAT), has an inflammatory phenotype in patients with osteoarthritis (OA). We phenotyped suprapatellar fat pad (SPFP) and hip acetabular fat pad (AFP), two other IAATs, to determinate the unique signature of IAATs compared with SCAT.Methods: IFP, SPFP, AFP and autologous SCAT were obtained from patients with OA during total knee (n=38) or hip replacement (n=5). Fibrosis and adipocyte area were analysed by histology and vascularisation, leucocyte and mast cell infiltration were analysed by immunohistochemistry for von Willebrand factor, leucocytes and tryptase, respectively. Secretion of interleukin (IL)-6, IL-8 and prostaglandin E2 (PGE2) was assessed by ELISA. The mRNA expression of adipocyte-associated genes (ATGL, LPL, PPAR-γ, FABP4 and CD36) and developmental genes (SFRP2, HoxC9 and EN1) was determined. The inflammatory response of isolated fibroblast-like synoviocytes (FLS) to autologous IFP and SPFP conditioned media was examined.Results: Fibrosis, vascularisation and leucocyte and mast cell infiltration were greater in IAATs than SCAT, and levels of IL-6, IL-8 and PGE2 were greater in all IAATs than SCAT. IFP and SPFP induced a similar inflammatory response to FLS. Adipocyte area was smaller in IAATs than SCAT. Adipocyte-associated and developmental genes showed a similar gene expression pattern in all IAATs, different from SCAT.Conclusions: IFP but also SPFP and AFP (gathered under the term 'IAAT') may play a deleterious role in OA by affecting joint homeostasis because of their inflammatory phenotype and their close interaction with synovium in the same functional unit. [ABSTRACT FROM AUTHOR]

Background: Viscosupplementation is a symptomatic treatment of the knee osteoarthritis based on the intra-articular injection of hyaluronic acid (IAHA). Although many studies have investigated its effect on symptoms, few clinical studies have focused on its effects on biologicals markers of cartilage metabolism. In this study, we assessed the effect of an intra-articular injection of a reticulated hyaluronic acid compound on the level of a specific biomarker of type II collagen degradation.Methods: Eighty one patients with symptomatic knee osteoarthritis were included in this randomized placebo controlled trial testing a reticulated hyaluronic acid (HA) with mannitol (KARTILAGE® CROSS, 16 mg/ml, one single injection of 2.2 mL; IAHA) versus saline solution. Primary outcome was the percentage of patients with a reduction of at least 10 nmol/l of serum Coll2-1 between baseline and day 90 (D90, 3 months after injection). Secondary outcomes concerned clinical evaluation and tolerance to the study product.Results: A significant effect of IAHA was revealed by the sensitivity analysis of the decrease in cartilage marker. In the intention-to-treat population, the percentage of patients showing a decrease in the levels of serum Coll2-1 between inclusion and D90 showed was higher in HA (56.8%) than in placebo group (28.6%; P = 0.01). The same significant difference was observed between groups in the per protocol population (57.1% vs 29.0%; P = 0.02) corresponding to all patients having received the intra-articular injection (IA), being evaluated for the primary outcome on D-10 and D90, and with no major defined deviation. No significant differences between groups were observed on the changes in function (Lequesne index) or pain and on the number of adverse events.Conclusions: This is the first randomized double-blind placebo controlled trial showing that IA injection of reticulated HA with mannitol in knee osteoarthritis patients can reduce the serum levels of Coll2-1, a marker specific of type II collagen degradation. This finding suggests that IAHA may have a beneficial effect on cartilage degradation and that Coll2-1 could be used for the assessment of a single intra-articular treatment in clinical trials.Trial Registration: NCT02951585 ; clinicaltrial.gov. Retrospectively registered on October 28, 2016. [ABSTRACT FROM AUTHOR]

Objective The infrapatellar fat pad (IFP) of the knee joint has an inflammatory phenotype in osteoarthritis (OA). Its close proximity to the synovial membrane suggests that the IFP could be involved in the induction of OA synovitis. This study was undertaken to investigate the response of fibroblast-like synoviocytes (FLS) to autologous IFP and subcutaneous adipose tissue (SCAT) from patients with severe knee OA. Methods Samples of IFP, SCAT, and autologous synovial membrane tissue close to the IFP were harvested during surgery from 28 patients with end-stage knee OA. FLS from 14 patients were stimulated with autologous IFP- or SCAT-conditioned medium, and levels of messenger RNA (mRNA) expression and protein release of interleukin-6 (IL-6), IL-8, secretory phospholipase A2 (sPLA2), cytosolic PLA2, cyclooxygenase 2 (COX-2), microsomal prostaglandin E synthase, prostaglandin E2 (PGE2), and matrix metalloproteinases (MMPs) 1, 3, 9, and 13 were evaluated. Both IFP- and SCAT-conditioned medium were evaluated by enzyme-linked immunosorbent assay for secretion of IL-6, soluble IL-6 receptor (sIL-6R), IL-8, tumor necrosis factor α (TNFα), PGE2, IL-1β, and interferon-γ. In addition, OA FLS were treated with PGE2 receptor antagonists to evaluate the contribution of IFP-derived PGE2 to the inflammatory response of FLS to the IFP. Results Stimulation of OA FLS with IFP-conditioned medium induced the mRNA expression and protein release of IL-6, IL-8, sPLA2, COX-2, PGE2, and MMPs 1, 3, 9, and 13. The extent of stimulation was consistently stronger with IFP-conditioned medium than with SCAT-conditioned medium. Moreover, secretion of IL-6, sIL-6R, IL-8, TNFα, and PGE2 was greater in IFP-conditioned medium than in SCAT-conditioned medium, especially PGE2, whose secretion was 75-fold stronger in IFP-conditioned medium ( P < 0.0001). PGE2 receptor antagonists dose-dependently inhibited the release of IL-6, IL-8, and PGE2 by IFP-stimulated FLS. Conclusion This study showed that the IFP has a potential role in the induction of synovial inflammation in patients with severe knee OA. Furthermore, secretion of PGE2 by the IFP may be involved in the OA inflammatory process. [ABSTRACT FROM AUTHOR]

Negative results of yet another IL-1 inhibitor in the treatment of knee osteoarthritis add to a pool of data indicating that this strategy does not reduce pain or inflammation and is thereby a dead end. Should we therefore shelve further plans to test or use this therapeutic strategy? [ABSTRACT FROM AUTHOR]

The article presents a commentary on the article "A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project," by Navarro-Sarabia F. et al., which was published in the November 2011 issue of "Annals of the Rheumatic Diseases."

Objective: Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA.Methods: In total, 336 patients from the placebo arm of SEKOIA trial completed the 3-year follow-up and were included in this post-hoc analysis. Statin use was recorded at baseline interview. Minimal medial tibiofemoral joint space was measured on plain radiographs by an automated method at baseline and then annually. Radiologic progression was defined as joint space narrowing≥0.5mm over 3 years.Results: Overall, 71 patients were statin users (21.1%). They had a higher BMI (31.1±5.3 vs. 29.3±5.2kg/m2, P=0.008), a higher sum of metabolic factors (≥3 factors: 43.7% vs 7.2%; P for trend<0.001) and a higher rate of radiological progression (49.3% vs. 32.1%, P=0.007) as compared to statin non-users. The significant association between radiological progression and statin use was independent of age, gender, WOMAC global score, disease duration, baseline joint space width, hypertension, type 2 diabetes, obesity (BMI>30kg/m2) and cardiovascular diseases [relative risk 1.49 (95% CI: 1.10-2.02), P=0.010].Conclusion: Among patients with knee OA, statin use was associated with radiological worsening over 3 years, regardless of other potential confounding factors (obesity, type 2 diabetes, hypertension, disease duration, symptom intensity and radiological severity). [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Cette étude visait à décrire la prévalence de l’arthrose du genou ou de la hanche, l’histoire naturelle de la maladie, ainsi que les facteurs pronostiques de son développement et les éléments déterminant le coût et l’accès aux soins pour une cohorte de patients en France. Méthodes: Les sujets âgés de 40 à 75ans, souffrant d’arthrose symptomatique du genou et/ou de la hanche uni- ou bilatérales (confirmées par les critères de l’ACR), au stade 2 ou supérieur dans la classification de Kellgren & Lawrence (KL), ont été recrutés à partir d’une enquête de prévalence en population générale pour constituer la cohorte multicentrique KHOALA. Les données de base collectées incluaient les données sociodémographiques et cliniques ; les scores WOMAC, IKS et Harris pour la douleur et la fonction ; le score MAQ pour l’activité physique ; l’index de comorbidité fonctionnelle ; le score GHQ28 pour le statut psychologique ; et les scores SF-36 (générique) et OAKHQOL (spécifique) pour l’évaluation de la qualité de vie. Des échantillons de sang et d’urine ont été collectés. Résultats: Huit-cent-soixante-dix-huit personnes ont été incluses, 222 atteintes d’arthrose de la hanche (âge moyen 61,2±8,8ans), 607 atteintes d’arthrose du genou (âge moyen 62,0±8,5ans) et 49 atteintes d’arthrose de la hanche et du genou (âge moyen 64,9±7,9ans). L’indice de masse corporelle (IMC) moyen était de 26,9±4,5 pour les arthroses de la hanche et de 30,3±6,3 pour les arthroses du genou. Les patients souffrant d’arthrose de la hanche et du genou avaient respectivement des index de comorbidité moyens de 1,99 et 2,06. La sévérité radiographique de la maladie pour des stades 2, 3 et 4 dans la classification de KL étaient, respectivement, de 69,8 %, 26,1 % et 4,1 % pour les arthroses de la hanche, et de 44,5 %, 30,3 %, et 25,2 % pour les arthroses du genou. En comparaison avec la population générale, les scores SF-36 standardisés selon l’âge et le sexe étaient fortement diminués pour les arthroses du genou et de la hanche dans toutes ses dimensions, particulièrement dans les dimensions physiques et émotionnelles. Perspectives: Les patients vont être suivis annuellement, tour à tour par courrier et par une visite clinique. Cette cohorte, représentative de patients souffrant d’arthrose du genou et de la hanche, va être une opportunité pour de futures recherches collaboratives. [Copyright &y& Elsevier]

Abstract: Objectives: This study aimed to describe the prevalence of symptomatic knee and hip osteoarthritis (OA) and its course over time, as well as identify prognostic factors of OA course and determinants of costs and access to care in France in a patient cohort. Methods: Subjects aged 40 to 75 years, with uni- or bilateral symptomatic hip and/or knee OA (ACR criteria), Kellgren and Lawrence (KL) stage 2 or greater, were recruited from a French national prevalence survey for the multicenter KHOALA cohort study. Data collected at baseline included sociodemographic and clinical data; WOMAC, IKS and Harris scores for pain and function; MAQ score for physical activity; functional comorbidity index; GHQ28 score for psychological status; and SF-36 (generic) and OAKHQOL (specific) scores for quality of life. Blood and urine samples were collected. Results: Eight hundred and seventy-eight subjects were included, 222 with OA of the hip (mean age 61.2±8.8 years), 607 knee (mean age 62.0±8.5 years) and 49 both hip and knee (mean age 64.9±7.9 years). Mean body mass index was 26.9±4.5 for hip OA and 30.3±6.3 for knee OA. Hip and knee OA patients had 1.99 and 2.06 comorbidities, on average, respectively. Disease severity on X-rays for KL stages 2, 3 and 4 for hip OA was 69.8, 26.1 and 4.1%, respectively, and for knee OA, 44.5, 30.3, and 25.2%. As compared with population norms, age- and sex-standardized SF-36 scores were greatly decreased for both knee and hip OA in all dimensions, particularly physical and emotional dimensions. Perspectives: Patients will be followed up annually, alternately by mail and clinical visit. This cohort of representative patients with knee and hip OA will be an opportunity for future collaborative research. [Copyright &y& Elsevier]

Abstract: Objective: To determine the prevalence of generalized osteoarthritis in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were recruited for a therapeutic trial via press announcement and selected based on American College of Rheumatology radioclinical criteria for femorotibial arthritis. Patients were asked to bring all their radiographs to the study visits, which included a physical examination. Each patient had an inclusion visit and a second visit 1 month later. The study physicians used a standardized chart to indicate clinical and radiographic evidence of osteoarthritis in each patient. At the hands and feet, the presence of clinical criteria was sufficient for the diagnosis of osteoarthritis. The shoulders and elbows were not assessed. Three criteria sets for generalized osteoarthritis were evaluated: Kellgren and Moore criteria (Heberden''s nodes or interphalangeal osteoarthritis), ACR criteria (osteoarthritis of the spine and at least two other joints), and Dougados criteria (bilateral finger osteoarthritis or osteoarthritis of the spine and both knees). Results: We included 302 patients for whom the side affected with knee osteoarthritis was known. Mean symptom duration was 5.9±5.7 years, mean number of painful flares was 10.1±9.4, mean number of joints with osteoarthritis was 2.6±1.8, and mean body mass index was 29.5±5.3kg/m2. A family history of osteoarthritis was noted in 154 (51%) patients and spinal osteoarthritis in 148 (49%) patients. Kellgren-Moore criteria for interphalangeal osteoarthritis were met in 42 (13.9%) patients, ACR criteria by 124 (41%) patients, and Dougados criteria by 127 (42%) patients. In all, 156 (52%) patients met at least one of the three definitions of generalized osteoarthritis. Conclusion: More than half the patients included in a therapeutic trial in knee osteoarthritis had generalized osteoarthritis with maximum symptoms at the knee at baseline. Some patients with osteoarthritis in multiple joints met none of the three criteria sets for generalized osteoarthritis. Further studies are needed to assess the sensitivity and specificity of current criteria sets and, if needed, to identify new criteria. [Copyright &y& Elsevier]

Abstract: Objective: To develop recommendations regarding adherence to physical therapy programs by patients with hip or knee osteoarthritis. Methods: We used the method recommended by the French Society for Physical and Rehabilitation Therapy (SOFMER), which combines a systematic literature review, a practice survey, and validation by a multidisciplinary panel of experts. Results: When setting up exercise programs for patients with lower limb osteoarthritis, measures should be taken to increase effectiveness by optimizing adherence. Patient selection is among these measures, as exercise programs are more likely to succeed in patients with a history of being physically active, a positive view of the suggested program, and/or favorable social and material conditions. Regardless of the type of exercise, the program should be tailored to exercise capacity and pain level (professional consensus). Patient adherence can be improved by explaining the expected results to the patient, asking the patient to keep a self-evaluation diary, conducting long-term evaluations (by phone or mail), and providing follow-up visits. Conclusion: Studies of adherence according to the type of exercise are needed. The relevance of widely used incentives in patients with hip or knee osteoarthritis should be evaluated in new therapeutic trials. [Copyright &y& Elsevier]

Abstract: Objectives: To develop clinical practice guidelines about the use of taping in the management of lower limb osteoarthritis. Method: We used the methodology advocated by the SOFMER (French Society for Physical and Rehabilitation Medicine), which combines a literature review, collection of data on current practice patterns, and validation of the recommendations by a multidisciplinary panel of experts. Our evaluation focused on the effectiveness of taping in relieving symptoms of lower limb osteoarthritis. Results: Ankle taping for osteoarthritis is not recommended, given the absence of published data and very low level of use in France. Few studies are available on knee taping for osteoarthritis. Conclusions: Published studies exhibit a number of methodological weaknesses. There is no strong evidence that taping is effective in knee osteoarthritis, and this treatment modality is rarely used in France. Therefore, there is no strong basis at present for recommending taping as part of the management of knee osteoarthritis. Well-designed studies of patellar taping to modify the relationships between the patellar and the trochlea are desirable to determine whether this treatment modality benefits patients with knee osteoarthritis, most notably those with involvement of the femoropatellar compartment. [Copyright &y& Elsevier]

Résumé: Objectifs: Élaborer des recommandations sur l’intérêt de l’application d’une contention élastique adhésive (taping) dans la prise en charge thérapeutique de l’arthrose des membres inférieurs. Méthode: La méthodologie utilisée, proposée par la Société française de médecine physique et réadaptation (Sofmer), a associé une revue systématique de la littérature, un recueil des pratiques professionnelles et une validation par un panel pluridisciplinaire d’experts. Les critères d’analyse retenus ont concerné l’efficacité symptomatique du taping dans l’arthrose des membres inférieurs. Résultats: La faible utilisation en pratique courante en France et l’absence de données dans la littérature sur l’efficacité du taping dans l’arthrose de cheville, ne permettent pas de le recommander dans cette indication. L’efficacité du taping du genou dans la gonarthrose a été peu étudiée. Conclusions: La qualité méthodologique des travaux ne permettant pas d’avoir un niveau de certitude suffisant pour conclure à une possible efficacité et le faible recours au taping dans la pratique courante en France, ne permettent pas de recommander cette technique dans le traitement de la gonarthrose. La réalisation d’études de meilleure qualité méthodologique utilisant un taping rotulien modifiant les rapports entre la rotule et la trochlée est souhaitable afin de conclure à l’intérêt ou non de cette prise en charge dans la gonarthrose, en particulier fémoropatellaire. [Copyright &y& Elsevier]