Pain

Less Severe Synovitis in Patients with Knee Osteoarthritis is Associated with Higher Self-Reported Pain Intensity 12 Months After Total Knee Arthroplasty- An Exploratory Cohort Study.

Copyright © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ
Annals of the Rheumatic Diseases. 2019 June;78(2)_suppl. doi: 10.1136/annrheumdis-2019-eular.5695

Abstract

BACKGROUND:
Synovitis is a pain generator in patients with osteoarthritis and associated with upregulation of pro-inflammatory cytokines, which have been found to lead to pain sensitivity and worse self-reported pain(1).

OBJECTIVES:
This study aimed to investigate the association between pre- and perioperative synovitis from imaging and histology and self-reported pain 12 months after total knee arthroplasty (TKA).

METHODS:
Preoperative synovitis was assessed from MRI data of the knee by 11 point synovitis score a.m Guermazi (2) using contrast enhanced MRI (CE-synovitis) and heuristic time intensity curve analysis of the dynamic contrast enhanced MRI (DCE-MRI) data using the DYNAMIKA® software (Image Analysis group, London) providing Dynamic Enhanced MR Quantification (DEMRIQ) Indices (3). Perioperative synovitis was also assessed from biopsies of the synovium in 6 predefined places graded histologically a.m Krenn (4). Worst pain within the last 24-hours (visual analog scale, VAS, 0-100) was assessed before and 12 months after TKA. Patients were divided into a low-pain (VAS≤30) and a high-pain (VAS>30) group based on 12-months postoperative VAS.

RESULTS:
Twenty-six patients had full pre- and postoperative data and were analysed. The high-pain group had significantly lower CE-synovitis (P=0.03), DCE-MRI inflammation indices (DEMRIQ-inflammation) (P<0.03) and a trend towards lower histologically assessed synovitis grades (P=0.077) compared to the low-pain group at baseline. Preoperative synovitis scores were also inversely correlated with pain 12-months after TKA, CE-synovitis (R = – 0.455, P = 0.022) and DCE-MRI inflammation (R = -0.528, P = 0.007), indicating that more severe preoperative synovitis is associated with less severe pain at 12-months.

CONCLUSION:
Higher preoperative synovitis scores are associated with less postoperative pain 12-months after TKA. Further, correlation analysis revealed that less severe preoperative synovitis was associated with worse pain 12-months after TKA, suggesting that CE and DCE-MRI synovitis quantification could be used as imaging markers for prediction of good surgical outcomes.

Effect of Liraglutide on Body Weight and Pain in Patients with Overweight and Knee Osteoarthritis: Protocol for a Randomised, Double-Blind, Placebo-Controlled, Parallel-Group, Single-Centre Trial

Copyright © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ
BMJ Open. 2019 May;9(5) doi: 10.1136/bmjopen-2018-024065

Abstract

INTRODUCTION:
With an increasing prevalence of citizens of older age and with overweight, the health issues related to knee osteoarthritis (OA) will intensify. Weight loss is considered a primary management strategy in patients with concomitant overweight and knee OA. However, there are no widely available and feasible methods to sustain weight loss in patients with overweight and knee OA. The present protocol describes a randomised controlled trial evaluating the efficacy and safety of the glucagon-like peptide-1 receptor agonist liraglutide in a 3 mg/day dosing in patients with overweight and knee OA.

METHODS AND ANALYSIS:
150 volunteer adult patients with overweight or obesity and knee OA will participate in a randomised, double-blind, placebo-controlled, parallel-group and single-centre trial. The participants will partake in a run-in diet intervention phase (week −8 to 0) including a low calorie diet and dietetic counselling. At week 0, patients will be randomised to either liraglutide 3 mg/day or liraglutide placebo 3 mg/day for 52 weeks as an add-on to dietetic guidance on re-introducing regular foods and a focus on continued motivation to engage in a healthy lifestyle. The co-primary outcomes are changes in body weight and the Knee Injury and Osteoarthritis Outcome Score pain subscale from week 0 to week 52.

ETHICS AND DISSEMINATION:
The trial has been approved by the regional ethics committee in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. An external monitoring committee (The Good Clinical Practice Unit at Copenhagen University Hospitals) will oversee the trial. The results will be presented at international scientific meetings and through publications in peer-reviewed journals.