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  • 1
    Language: English
    In: Arthritis & Rheumatism, November 2009, Vol.60(11), pp.3514-3515
    Keywords: Chondroitin Sulfates -- Therapeutic Use ; Glucosamine -- Therapeutic Use ; Osteoarthritis, Knee -- Drug Therapy;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 2
    Language: English
    In: Arthritis & Rheumatism, May 2002, Vol.46(5), pp.1223-1227
    Description: OBJECTIVE: A suspected, but heretofore undemonstrated, limitation of the conventional weight-bearing anteroposterior (AP) knee radiograph, in which the joint is imaged in extension, for studies of progression of osteoarthritis (OA) is that changes in knee pain may affect extension, thereby altering the apparent thickness of the articular cartilage. The present study was undertaken to examine the effect of changes in knee pain of varying magnitudes on radiographic joint space width (JSW) in the weight-bearing extended and the semiflexed AP views, in which radioanatomic positioning of the knee was carefully standardized by fluoroscopy.METHODS: Fifteen patients with knee OA underwent a washout of their analgesic/nonsteroidal antiinflammatory drug (NSAID) agents (duration 5 half-lives), after which standing AP and semiflexed AP knee radiographs of both knees were obtained. Examinations were repeated 1-12 weeks later (median 4.5 weeks, mean 6.0 weeks), after resumption of analgesic/NSAID therapy. Knee pain was measured with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index (Likert scale). JSW was measured with a pair of calipers and a magnifying lens. Mixed model analyses of variance were used to test the significance of changes in pain and JSW within and between 2 groups of knees with mild-to-moderate radiographic severity of OA: (a) "flaring knees," in which the patient rated standing knee pain as severe or extreme after the washout and in which pain decreased to any degree after resumption of analgesics and/or NSAIDs (n = 12) and (b) "nonflaring knees," in which standing knee pain was absent, mild, or moderate after the washout or did not decrease after resumption of treatment (n = 15).RESULTS: After reinstitution of treatment, WOMAC pain scores decreased significantly in both flaring and nonflaring knees (-44%; P 〈 0.0001 and -18%; P 〈 0.01, respectively). After adjustment for the within-subject correlation between knees, mean JSW (+/-SEM) in the extended view of the flaring OA knee increased significantly from the first to second examination (0.20 +/- 0.06 mm; P = 0.005). In contrast, the change in adjusted mean JSW in the extended view of the nonflaring OA knee was negligible (-0.04 +/- 0.04 mm) and significantly smaller than that observed in flaring knees (P 〈 0.01). Mean JSW in the semiflexed AP view was unaffected by the severity or responsiveness of standing knee pain in flaring and nonflaring OA knees.CONCLUSION: JSW in weight-bearing extended-view radiographs of highly symptomatic OA knees can be altered significantly by changes in joint pain. In clinical trials and in epidemiologic studies of OA progression that use this radiographic technique, longitudinal variations in pain may confound changes in the apparent thickness of the articular cartilage.
    Keywords: Medicine;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 3
    Language: English
    In: Arthritis & Rheumatism, October 2005, Vol.52(10), pp.3160-3167
    Description: To determine whether baseline or serial plasma concentrations of stromelysin (matrix metalloproteinase 3 [MMP-3]) protein might distinguish subjects with progressive radiographic knee osteoarthritis (OA) from those with stable disease. Subjects were 120 women with unilateral knee OA who participated in a 30-month randomized, placebo-controlled trial of structure modification with doxycycline. Anteroposterior views of both knees in a semiflexed position were obtained at baseline, 16 months, and 30 months. Subjects were selected to obtain comparisons of plasma MMP-3 levels between 60 progressors (21 taking doxycycline, 39 taking placebo) and 60 nonprogressors (30 taking doxycycline, 30 taking placebo) with respect to medial joint space narrowing (JSN) in the index knee. Each group consisted of 30 subjects who exhibited significant increases in knee pain. Blood samples were obtained semiannually for MMP-3 assay. Subjects in the placebo group whose MMP-3 concentration was in the upper tertile of the baseline distribution showed a 4-fold increase in the odds of progression of JSN as compared with the lower tertile (odds ratio 4.12, P = 0.037). Baseline MMP-3 levels were unrelated to knee pain. The within-subject mean of serial MMP-3 concentrations was associated with concurrent JSN in the placebo group over the 0-16-month interval (b = 0.18 mm/SD increase in the mean MMP-3, P 〈 0.01) and over the 16-30-month interval (b = 0.15, P 〈 0.05). Similar evidence of concurrent validity was found in the placebo group for the maximum of intercurrent MMP-3 values. The baseline MMP-3 level was a significant predictor of JSN in this pilot study. Moreover, serial plasma MMP-3 levels reflected concurrent JSN in the placebo group over the 30-month period of observation.
    Keywords: Knee Joint -- Pathology ; Matrix Metalloproteinase 3 -- Blood ; Osteoarthritis, Knee -- Blood;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 4
    Language: English
    In: Arthritis & Rheumatism, December 1989, Vol.32(12), pp.1577-1583
    Description: After we assessed the functional status of 439 patients with osteoarthritis, we randomly assigned them to 1 of 3 intervention groups or to a control group. The interventions consisted of providing information, and differed only in the method of delivery: by phone, in person at the clinic, or both. Physical health improved ( = 0.02), pain was reduced ( = 0.02), and psychological health improved marginally ( = 0.10) in patients contacted by phone compared with those not contacted by phone. In those contacted only at the clinic, physical health worsened ( = 0.02), but neither pain ( = 0.80) nor psychological health ( = 0.90) differed from the values in patients not contacted at the clinic. We conclude that telephone contact is a useful intervention that can enhance the functional status of patients with osteoarthritis.
    Keywords: Medical Social Work -- Evaluation ; Osteoarthritis -- Care And Treatment ; Patients ; Information Services;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 5
    Language: English
    In: Arthritis and rheumatism, January 2002, Vol.46(1), pp.109-13
    Description: To estimate the reproducibility of the semiflexed metatarsophalangeal (MTP) view in repeat radiographic examinations of the knee of subjects with osteoarthritis (OA) with respect to radioanatomic alignment of the medial tibial plateau and the central x-ray beam and the precision of measurements of minimum medial tibiofemoral joint space width (JSW). Thirty-eight subjects with definite knee OA underwent 2 semiflexed MTP examinations on the same day. Radioanatomic alignment of the medial tibial plateau and the x-ray beam (distance between anterior and posterior margins of the plateau) was measured manually (Lequesne method). Manual measurements of the JSW in repeat radiographs also were obtained. The reproducibility of JSW measurements was estimated by the method of Bland and Altman. Only 29% of the initial semiflexed MTP radiographs exhibited satisfactory radioanatomic alignment (intermargin distance 〈 or =1 mm). However, intermargin distances in initial and repeat radiographs were highly correlated (r = 0.86, P 〈 0.01). In 89% of knees, the intermargin distance in the first examination was reproduced (+/- 1 mm) in the second examination. The standard error of measurement (mean of within-knee standard deviations of repeat JSW values) was 0.30 mm. The magnitude of discrepancy between repeat measurements of JSW was related positively to overall radiographic severity of knee OA (P 〈 0.05). The semiflexed MTP protocol affords highly reproducible radioanatomic positioning of the knee, although misalignment of the medial tibial plateau and the x-ray beam occurs in 〉70% of cases. Precision of measurement of JSW in the semiflexed MTP view approaches that associated with fluoroscopically assisted positioning protocols. However, the consequences of poor, albeit reproducible, alignment of the knee in serial semiflexed MTP radiographs in longitudinal studies of OA progression are currently unknown.
    Keywords: Arthrography -- Standards ; Knee Joint -- Diagnostic Imaging ; Metatarsophalangeal Joint -- Diagnostic Imaging ; Osteoarthritis, Knee -- Diagnostic Imaging
    ISSN: 0004-3591
    E-ISSN: 15290131
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    Language: English
    In: Arthritis & Rheumatism, January 2002, Vol.46(1), pp.109-113
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 7
    Language: English
    In: Arthritis & Rheumatism, January 2002, Vol.46(1), pp.100-108
    Description: OBJECTIVETo evaluate the effectiveness of tidal irrigation (TI) in comparison with a well-matched sham irrigation (SI) procedure as a treatment for knee osteoarthritis (OA). METHODSOne hundred eighty subjects with knee OA were randomized to receive TI or SI, with clinical followup over the ensuing 12 months. The primary outcomes of interest were change in pain and function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Subjects and the nurse assessor were blinded, and success of blinding was assessed. RESULTSAlthough the study groups were otherwise comparable, the baseline WOMAC pain and physical functioning scores were higher (worse) in the SI group. After adjustment for baseline, there were no differences between the effects of
    Keywords: Aged–Administration & Dosage ; Anti-Inflammatory Agents, Non-Steroidal–Adverse Effects ; Debridement–Methods ; Double-Blind Method–Diagnosis ; Female–Therapy ; Follow-Up Studies–Adverse Effects ; Gout–Methods ; Humans–Methods ; Male–Methods ; Middle Aged–Methods ; Osteoarthritis, Knee–Methods ; Pain Measurement–Methods ; Therapeutic Irrigation–Methods ; Treatment Failure–Methods ; Abridged ; Anti-Inflammatory Agents, Non-Steroidal;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 8
    Language: English
    In: Arthritis & Rheumatism, August 2001, Vol.44(8), pp.1786-1794
    Description: OBJECTIVEPrevious studies of knee osteoarthritis (OA) have yielded variable estimates of the rate of joint space narrowing (JSN) in the standing anteroposterior (AP) radiograph, due largely to longitudinal changes in the alignment of the medial tibial plateau (MTP) and x-ray beam. To characterize this bias, we examined serial radiographs of subjects with knee OA in population-based and clinical OA cohorts from 3 locations in the United States and the United Kingdom. METHODSRadiographic features of knee OA (e.g., osteophytosis, JSN) and MTP alignment in 428 OA knees were evaluated by consensus of 2 readers. Alignment was considered satisfactory if the anterior and posterior margins of the MTP were superimposed within 1 mm. Readers were blinded to subject identity, and films were read in random order. The minimum medial joint space width was also measured manually (standard error of repeated measurements 0.20 mm) in serial knee images. RESULTSOnly 14% of serial radiographs exhibited alignment of the MTP in both images. In OA knees with satisfactory alignment in both images, the mean rate of JSN over 2-3 years (0.26 mm/year) was significantly larger (P = 0.004) than that in OA knees with misalignment in 1 or both radiographs and was 86% more rapid than the mean JSN in all OA knees. Moreover, the within-group standard deviation of JSN was significantly smaller among knees with reproduced alignment of the MTP than in knees in which misalignment occurred in 1 or both images (P = 0.006). CONCLUSIONPoor standardization of knee positioning in serial standing AP radiographs in previous studies of OA progression has obscured the rate and variability of articular cartilage loss in subjects with knee OA. True JSN (i.e., JSN that is not attributable to longitudinal changes in the alignment of the MTP with the x-ray beam in serial radiographic examinations) may occur more rapidly, and with less between-subject variability, than that previously thought to be characteristic of knee OA.
    Keywords: Aged–Diagnostic Imaging ; Cohort Studies–Diagnostic Imaging ; Diagnostic Errors–Pathology ; Disease Progression–Methods ; Female–Methods ; Humans–Methods ; Male–Methods ; Menisci, Tibial–Methods ; Osteoarthritis, Knee–Methods ; Radiography–Methods ; Abridged;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 9
    Language: English
    In: Arthritis & Rheumatism, April 1991, Vol.34(4), pp.377-382
    Description: We examined the relationship between articular cartilage degeneration, as visualized arthroscopically, and joint space narrowing (JSN) in standing anteroposterior knee radiographs of 161 patients with chronic knee pain. The majority of these patients had radiographic findings of mild osteoarthritis. Twenty‐five (33%) of the 76 patients in the series whose radiographs showed tibiofemoral JSN had grossly normal articular cartilage in both tibiofemoral compartments at arthroscopy (false‐positive). The specificity of medial JSN for the presence of medial compartment articular cartilage degeneration was 0.61, i.e., only 61% of patients with normal (grade 0) medial compartment cartilage had a normal medial joint space. Of 22 patients with 〉50% medial JSN, 9 (41%) had normal articular cartilage in the medial compartment at arthroscopy. Of 6 patients with 〉50% lateral JSN, 3 (50%) had normal lateral compartment articular cartilage at arthroscopy. Among 36 patients with 〉25% JSN who had neither medial nor lateral compartemnt articular cartilage degeneration, JSN was associated with articular caartilage degeneration, JSN was associated with articular cartilage degeneration in the patellofemoral compartemnt in 8 (22%), with meniseus degeneration in 18 (50%), and with both in 8 (22%). Thus, in these patients with chronic knee pain, radiographic evidence of JSN in the tibiofemoral compartment did not permit confident prediction of the status of the articular cartilage.
    Keywords: Arthroscopy -- Usage ; Cartilage -- Physiological Aspects ; Osteoarthritis -- Physiological Aspects ; Knee;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 10
    Language: English
    In: Arthritis & Rheumatism, January 1989, Vol.32(1), pp.45-53
    Description: Fifteen patients with Wegener's granulomatosis, polyarteritis nodosa, or isolated angiitis of the central nervous system were treated with cyclophosphamide according to a widely used regimen. Seventeen clinical episodes of infection were observed over 201 patient‐months of cyclophosphamide therapy, and 2 patients died of pneumonia. Notably, neither the incidence of leukopenia nor the dosage or duration of cyclophosphamide or corticosteroid therapy correlated well with infection, which occurred most frequently in men over 60 years of age. Patients with Wegener's granulomatosis appeared to be at greater risk of infection than those with the other forms of vasculitis. These results suggest that this treatment regimen may not be as safe as was previously thought.
    Keywords: Bacterial Infections -- Etiology ; Cyclophosphamide -- Adverse Effects ; Vasculitis -- Drug Therapy ; Virus Diseases -- Etiology;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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