Osteoarthritis

In 2013, enough controlled substances were prescribed in Louisiana – 2006.2 prescriptions per 1,000 population – that each and every person in the state could have received two, according to a report from the Centers for Disease Control and Prevention.

The combined prescribing rate for opioids, benzodiazepines, and stimulants in Louisiana topped the eight states included in the CDC report, with West Virginia in second at 1,695.7 prescriptions per 1,000. At the low end, California was the only one of the eight states where the average controlled substance prescription rate was less than one per person, but just barely at 994.8 per 1,000 people, followed by Idaho at 1,292.3 per 1,000, according to the CDC investigators in a Morbidity and Mortality Weekly Report Surveillance Summary (2015 Oct;64[SS09]:1-14).

Of the three categories of controlled substances, opioids were by far the most commonly prescribed. At 1,021.7 prescriptions per 1,000 people, the opioid prescription rate in Louisiana was greater than the total controlled substance prescription rate in California. West Virginia had the second highest rate at 929.3, and California had the lowest at 596.3.

Prescription rates for stimulants and benzodiazepines were highest in Louisiana at 403.9 and 580.6 per 1,000 people, respectively. Maine had the next-highest stimulant prescription rate at 293.9, and West Virginia had the second-highest benzodiazepine prescription rate at 572.1. California had the lowest rate in both categories at 87.7 and 310.8, respectively.

Women received opioids and benzodiazepines at much higher rates than did men in every state, but stimulant-prescribing rates were higher for men in five states.

Opioid use was highest in people aged 55-64 years, though use spiked dramatically past the age of 25. People in Louisiana aged 55-64 receiving opioids had the highest controlled substance prescription rate of any measured age group, at 1,715.7 per 1,000 people. Benzodiazepine use was most common in people over 65 years, and stimulant prescriptions were highest in people younger than 18, likely because of the prevalence of childhood attention-deficit/hyperactivity disorder, the CDC investigators said.

The MMWR report used data collected by the Prescription Behavior Surveillance System. The eight states were included because they submitted data to the Prescription Behavior Surveillance System in time for the report, and they represent about one-quarter of the U.S. population.

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In 2013, enough controlled substances were prescribed in Louisiana – 2006.2 prescriptions per 1,000 population – that each and every person in the state could have received two, according to a report from the Centers for Disease Control and Prevention.

The combined prescribing rate for opioids, benzodiazepines, and stimulants in Louisiana topped the eight states included in the CDC report, with West Virginia in second at 1,695.7 prescriptions per 1,000. At the low end, California was the only one of the eight states where the average controlled substance prescription rate was less than one per person, but just barely at 994.8 per 1,000 people, followed by Idaho at 1,292.3 per 1,000, according to the CDC investigators in a Morbidity and Mortality Weekly Report Surveillance Summary (2015 Oct;64[SS09]:1-14).

Of the three categories of controlled substances, opioids were by far the most commonly prescribed. At 1,021.7 prescriptions per 1,000 people, the opioid prescription rate in Louisiana was greater than the total controlled substance prescription rate in California. West Virginia had the second highest rate at 929.3, and California had the lowest at 596.3.

Prescription rates for stimulants and benzodiazepines were highest in Louisiana at 403.9 and 580.6 per 1,000 people, respectively. Maine had the next-highest stimulant prescription rate at 293.9, and West Virginia had the second-highest benzodiazepine prescription rate at 572.1. California had the lowest rate in both categories at 87.7 and 310.8, respectively.

Women received opioids and benzodiazepines at much higher rates than did men in every state, but stimulant-prescribing rates were higher for men in five states.

Opioid use was highest in people aged 55-64 years, though use spiked dramatically past the age of 25. People in Louisiana aged 55-64 receiving opioids had the highest controlled substance prescription rate of any measured age group, at 1,715.7 per 1,000 people. Benzodiazepine use was most common in people over 65 years, and stimulant prescriptions were highest in people younger than 18, likely because of the prevalence of childhood attention-deficit/hyperactivity disorder, the CDC investigators said.

The MMWR report used data collected by the Prescription Behavior Surveillance System. The eight states were included because they submitted data to the Prescription Behavior Surveillance System in time for the report, and they represent about one-quarter of the U.S. population.

[email protected]

In 2013, enough controlled substances were prescribed in Louisiana – 2006.2 prescriptions per 1,000 population – that each and every person in the state could have received two, according to a report from the Centers for Disease Control and Prevention.

The combined prescribing rate for opioids, benzodiazepines, and stimulants in Louisiana topped the eight states included in the CDC report, with West Virginia in second at 1,695.7 prescriptions per 1,000. At the low end, California was the only one of the eight states where the average controlled substance prescription rate was less than one per person, but just barely at 994.8 per 1,000 people, followed by Idaho at 1,292.3 per 1,000, according to the CDC investigators in a Morbidity and Mortality Weekly Report Surveillance Summary (2015 Oct;64[SS09]:1-14).

Of the three categories of controlled substances, opioids were by far the most commonly prescribed. At 1,021.7 prescriptions per 1,000 people, the opioid prescription rate in Louisiana was greater than the total controlled substance prescription rate in California. West Virginia had the second highest rate at 929.3, and California had the lowest at 596.3.

Prescription rates for stimulants and benzodiazepines were highest in Louisiana at 403.9 and 580.6 per 1,000 people, respectively. Maine had the next-highest stimulant prescription rate at 293.9, and West Virginia had the second-highest benzodiazepine prescription rate at 572.1. California had the lowest rate in both categories at 87.7 and 310.8, respectively.

Women received opioids and benzodiazepines at much higher rates than did men in every state, but stimulant-prescribing rates were higher for men in five states.

Opioid use was highest in people aged 55-64 years, though use spiked dramatically past the age of 25. People in Louisiana aged 55-64 receiving opioids had the highest controlled substance prescription rate of any measured age group, at 1,715.7 per 1,000 people. Benzodiazepine use was most common in people over 65 years, and stimulant prescriptions were highest in people younger than 18, likely because of the prevalence of childhood attention-deficit/hyperactivity disorder, the CDC investigators said.

The MMWR report used data collected by the Prescription Behavior Surveillance System. The eight states were included because they submitted data to the Prescription Behavior Surveillance System in time for the report, and they represent about one-quarter of the U.S. population.

[email protected]

Total knee replacement was superior to nonsurgical treatment in relieving pain, restoring function, and improving quality of life for patients with moderate to severe knee osteoarthritis, according to a report published online Oct. 22 in the New England Journal of Medicine.

Even though the number of total knee replacements performed each year is large and steadily increasing – with more than 670,000 done in 2012 in the United States alone – no high-quality randomized, controlled trials have ever compared the effectiveness of the procedure against nonsurgical treatment, said Søren T. Skou, Ph.D., of the Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, and his associates.

Dr. Skou and his colleagues remedied that situation by randomly assigning 100 adults (mean age, 66 years) who were eligible for unilateral total knee replacement to either undergo the procedure and then receive a comprehensive nonsurgical intervention (50 patients) or receive the comprehensive nonsurgical intervention alone (50 patients) at two specialized university clinics in Denmark. The 12-week nonsurgical intervention comprised a twice-weekly group exercise program to restore neutral, functional realignment of the legs; two 1-hour education sessions regarding osteoarthritis characteristics, treatments, and self-help strategies; a dietary (weight-loss) program; provision of individually fitted insoles with medial arch support and a lateral wedge if patients had knee-lateral-to-foot positioning; and as-needed pain medication for pain – acetaminophen and ibuprofen – and pantoprazole, a proton-pump inhibitor.

The primary outcome measure in the trial was the between-group difference at 1 year in improvement on four subscales of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) for pain, symptoms, activities of daily living, and quality of life. The surgical group showed a significantly greater improvement (32.5 out of a possible 100 points) than the nonsurgical group (16.0 points) in this outcome. The surgical group also showed significantly greater improvements in all five individual subscales and in a timed chair-rising test, a timed 20-meter walk test, and on a quality-of-life index, the investigators said (N Engl J Med. 2015 373;17:1597-606).

However, it is important to note that patients who had only the nonsurgical intervention showed clinically relevant improvements, and only 26% of them chose to have the surgery after the conclusion of the study. As expected, the surgical group had more serious adverse events than did the nonsurgical group (24 vs. 6), including three cases of deep venous thrombosis and three cases of knee stiffness requiring brisement forcé while the patient was anesthetized, Dr. Skou and his associates said.

This study was supported by the Obel Family Foundation, the Danish Rheumatism Association, the Health Science Foundation of the North Denmark Region, Foot Science International, Spar Nord Foundation, the Bevica Foundation, the Association of Danish Physiotherapists Research Fund, the Medical Specialist Heinrich Kopp’s Grant, and the Danish Medical Association Research Fund. Dr. Skou and his associates reported having no relevant financial disclosures.

Total knee replacement was superior to nonsurgical treatment in relieving pain, restoring function, and improving quality of life for patients with moderate to severe knee osteoarthritis, according to a report published online Oct. 22 in the New England Journal of Medicine.

Even though the number of total knee replacements performed each year is large and steadily increasing – with more than 670,000 done in 2012 in the United States alone – no high-quality randomized, controlled trials have ever compared the effectiveness of the procedure against nonsurgical treatment, said Søren T. Skou, Ph.D., of the Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, and his associates.

Dr. Skou and his colleagues remedied that situation by randomly assigning 100 adults (mean age, 66 years) who were eligible for unilateral total knee replacement to either undergo the procedure and then receive a comprehensive nonsurgical intervention (50 patients) or receive the comprehensive nonsurgical intervention alone (50 patients) at two specialized university clinics in Denmark. The 12-week nonsurgical intervention comprised a twice-weekly group exercise program to restore neutral, functional realignment of the legs; two 1-hour education sessions regarding osteoarthritis characteristics, treatments, and self-help strategies; a dietary (weight-loss) program; provision of individually fitted insoles with medial arch support and a lateral wedge if patients had knee-lateral-to-foot positioning; and as-needed pain medication for pain – acetaminophen and ibuprofen – and pantoprazole, a proton-pump inhibitor.

The primary outcome measure in the trial was the between-group difference at 1 year in improvement on four subscales of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) for pain, symptoms, activities of daily living, and quality of life. The surgical group showed a significantly greater improvement (32.5 out of a possible 100 points) than the nonsurgical group (16.0 points) in this outcome. The surgical group also showed significantly greater improvements in all five individual subscales and in a timed chair-rising test, a timed 20-meter walk test, and on a quality-of-life index, the investigators said (N Engl J Med. 2015 373;17:1597-606).

However, it is important to note that patients who had only the nonsurgical intervention showed clinically relevant improvements, and only 26% of them chose to have the surgery after the conclusion of the study. As expected, the surgical group had more serious adverse events than did the nonsurgical group (24 vs. 6), including three cases of deep venous thrombosis and three cases of knee stiffness requiring brisement forcé while the patient was anesthetized, Dr. Skou and his associates said.

This study was supported by the Obel Family Foundation, the Danish Rheumatism Association, the Health Science Foundation of the North Denmark Region, Foot Science International, Spar Nord Foundation, the Bevica Foundation, the Association of Danish Physiotherapists Research Fund, the Medical Specialist Heinrich Kopp’s Grant, and the Danish Medical Association Research Fund. Dr. Skou and his associates reported having no relevant financial disclosures.

Total knee replacement was superior to nonsurgical treatment in relieving pain, restoring function, and improving quality of life for patients with moderate to severe knee osteoarthritis, according to a report published online Oct. 22 in the New England Journal of Medicine.

Even though the number of total knee replacements performed each year is large and steadily increasing – with more than 670,000 done in 2012 in the United States alone – no high-quality randomized, controlled trials have ever compared the effectiveness of the procedure against nonsurgical treatment, said Søren T. Skou, Ph.D., of the Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, and his associates.

Dr. Skou and his colleagues remedied that situation by randomly assigning 100 adults (mean age, 66 years) who were eligible for unilateral total knee replacement to either undergo the procedure and then receive a comprehensive nonsurgical intervention (50 patients) or receive the comprehensive nonsurgical intervention alone (50 patients) at two specialized university clinics in Denmark. The 12-week nonsurgical intervention comprised a twice-weekly group exercise program to restore neutral, functional realignment of the legs; two 1-hour education sessions regarding osteoarthritis characteristics, treatments, and self-help strategies; a dietary (weight-loss) program; provision of individually fitted insoles with medial arch support and a lateral wedge if patients had knee-lateral-to-foot positioning; and as-needed pain medication for pain – acetaminophen and ibuprofen – and pantoprazole, a proton-pump inhibitor.

The primary outcome measure in the trial was the between-group difference at 1 year in improvement on four subscales of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) for pain, symptoms, activities of daily living, and quality of life. The surgical group showed a significantly greater improvement (32.5 out of a possible 100 points) than the nonsurgical group (16.0 points) in this outcome. The surgical group also showed significantly greater improvements in all five individual subscales and in a timed chair-rising test, a timed 20-meter walk test, and on a quality-of-life index, the investigators said (N Engl J Med. 2015 373;17:1597-606).

However, it is important to note that patients who had only the nonsurgical intervention showed clinically relevant improvements, and only 26% of them chose to have the surgery after the conclusion of the study. As expected, the surgical group had more serious adverse events than did the nonsurgical group (24 vs. 6), including three cases of deep venous thrombosis and three cases of knee stiffness requiring brisement forcé while the patient was anesthetized, Dr. Skou and his associates said.

This study was supported by the Obel Family Foundation, the Danish Rheumatism Association, the Health Science Foundation of the North Denmark Region, Foot Science International, Spar Nord Foundation, the Bevica Foundation, the Association of Danish Physiotherapists Research Fund, the Medical Specialist Heinrich Kopp’s Grant, and the Danish Medical Association Research Fund. Dr. Skou and his associates reported having no relevant financial disclosures.

People without x-ray evidence of osteoarthritis in their knees but with MRI-identified lesions that worsen over time are significantly likelier to develop knee OA, compared with people whose lesions remain stable, according to results from a prospective cohort study.

For their research, published Oct. 14 in Annals of the Rheumatic Diseases, Dr. Leena Sharma of Northwestern University in Chicago and her colleagues recruited more than 1,000 patients at elevated risk of knee OA but with no radiographic evidence yet of disease (Kellgren/Lawrence measures of 0 [KL0] in both knees) to test their hypothesis that lesions seen worsening over time on MRI were predictive of knee OA within 4 years and of persistent symptoms between 4 and 7 years. Patients in the cohort (56% women, mean age 59.6 years) were assessed for cartilage damage, meniscal tears, meniscal extrusions, and bone marrow lesions at 12 and 48 months. Study inclusion required that patients remain at KL0 in both knees at 12 months to continue, and 849 patients had complete data at 12 and 48 months.

©KatarzynaBialasiewicz/Thinkstock

Patients with lesions that had worsened on MRI between 12 and 48 months had significantly higher risk of incident radiographic KL1 and KL2 by 48 months, compared with patients whose lesions had not worsened. For example, 6.3% of patients with tibiofemoral cartilage damage that was stable at 48 months developed mild (KL1) disease at 48 months, compared with 9.5% of patients whose damage had worsened in that interval (odds ratio, 2.69; 95% confidence interval, 1.50-4.84). Half of patients with worsening meniscal extrusion developed mild knee OA by the endpoint, compared with 13.6% of patients with a stable lesion (OR, 5.73; 95% CI, 2.94-11.16). Higher risk of KL1 or KL2 at 48 months was significant for all the lesion types studied except bone marrow lesions. Worsening of these lesions between 12 and 48 months was also significantly associated with having persistent symptoms between 4 and 7 years. Having more lesion types that worsened was significantly associated with worse outcomes.

The findings, Dr. Sharma and her colleagues wrote, support the idea of stable and progressive disease phases with early indicators of each and that worsening lesions represent early osteoarthritis. “Given the absence of disease-modifying therapy for OA, widespread clinical application of MRI is difficult to justify,” the investigators wrote in their analysis (Ann Rheum Dis. 2015 Oct 14. doi: 10.1136/annrheumdis-2015-208129).

Nevertheless, they concluded, “prevention or delay of worsening of early-stage lesions should be considered as a target for emerging pharmacological and nonpharmacological treatments in an effort to prevent or delay full-blown disease. Candidate interventions should be studied at this stage, when they are more likely to be effective.” Investigators acknowledged that one limitation of the study was that its findings may not apply in populations not already at higher risk for knee OA.

The study was funded by the Osteoarthritis Initiative, a public-private partnership of the National Institutes of Health and Merck, Novartis, GlaxoSmithKline, and Pfizer, with industry funding administered by NIH.

People without x-ray evidence of osteoarthritis in their knees but with MRI-identified lesions that worsen over time are significantly likelier to develop knee OA, compared with people whose lesions remain stable, according to results from a prospective cohort study.

For their research, published Oct. 14 in Annals of the Rheumatic Diseases, Dr. Leena Sharma of Northwestern University in Chicago and her colleagues recruited more than 1,000 patients at elevated risk of knee OA but with no radiographic evidence yet of disease (Kellgren/Lawrence measures of 0 [KL0] in both knees) to test their hypothesis that lesions seen worsening over time on MRI were predictive of knee OA within 4 years and of persistent symptoms between 4 and 7 years. Patients in the cohort (56% women, mean age 59.6 years) were assessed for cartilage damage, meniscal tears, meniscal extrusions, and bone marrow lesions at 12 and 48 months. Study inclusion required that patients remain at KL0 in both knees at 12 months to continue, and 849 patients had complete data at 12 and 48 months.

©KatarzynaBialasiewicz/Thinkstock

Patients with lesions that had worsened on MRI between 12 and 48 months had significantly higher risk of incident radiographic KL1 and KL2 by 48 months, compared with patients whose lesions had not worsened. For example, 6.3% of patients with tibiofemoral cartilage damage that was stable at 48 months developed mild (KL1) disease at 48 months, compared with 9.5% of patients whose damage had worsened in that interval (odds ratio, 2.69; 95% confidence interval, 1.50-4.84). Half of patients with worsening meniscal extrusion developed mild knee OA by the endpoint, compared with 13.6% of patients with a stable lesion (OR, 5.73; 95% CI, 2.94-11.16). Higher risk of KL1 or KL2 at 48 months was significant for all the lesion types studied except bone marrow lesions. Worsening of these lesions between 12 and 48 months was also significantly associated with having persistent symptoms between 4 and 7 years. Having more lesion types that worsened was significantly associated with worse outcomes.

The findings, Dr. Sharma and her colleagues wrote, support the idea of stable and progressive disease phases with early indicators of each and that worsening lesions represent early osteoarthritis. “Given the absence of disease-modifying therapy for OA, widespread clinical application of MRI is difficult to justify,” the investigators wrote in their analysis (Ann Rheum Dis. 2015 Oct 14. doi: 10.1136/annrheumdis-2015-208129).

Nevertheless, they concluded, “prevention or delay of worsening of early-stage lesions should be considered as a target for emerging pharmacological and nonpharmacological treatments in an effort to prevent or delay full-blown disease. Candidate interventions should be studied at this stage, when they are more likely to be effective.” Investigators acknowledged that one limitation of the study was that its findings may not apply in populations not already at higher risk for knee OA.

The study was funded by the Osteoarthritis Initiative, a public-private partnership of the National Institutes of Health and Merck, Novartis, GlaxoSmithKline, and Pfizer, with industry funding administered by NIH.

People without x-ray evidence of osteoarthritis in their knees but with MRI-identified lesions that worsen over time are significantly likelier to develop knee OA, compared with people whose lesions remain stable, according to results from a prospective cohort study.

For their research, published Oct. 14 in Annals of the Rheumatic Diseases, Dr. Leena Sharma of Northwestern University in Chicago and her colleagues recruited more than 1,000 patients at elevated risk of knee OA but with no radiographic evidence yet of disease (Kellgren/Lawrence measures of 0 [KL0] in both knees) to test their hypothesis that lesions seen worsening over time on MRI were predictive of knee OA within 4 years and of persistent symptoms between 4 and 7 years. Patients in the cohort (56% women, mean age 59.6 years) were assessed for cartilage damage, meniscal tears, meniscal extrusions, and bone marrow lesions at 12 and 48 months. Study inclusion required that patients remain at KL0 in both knees at 12 months to continue, and 849 patients had complete data at 12 and 48 months.

©KatarzynaBialasiewicz/Thinkstock

Patients with lesions that had worsened on MRI between 12 and 48 months had significantly higher risk of incident radiographic KL1 and KL2 by 48 months, compared with patients whose lesions had not worsened. For example, 6.3% of patients with tibiofemoral cartilage damage that was stable at 48 months developed mild (KL1) disease at 48 months, compared with 9.5% of patients whose damage had worsened in that interval (odds ratio, 2.69; 95% confidence interval, 1.50-4.84). Half of patients with worsening meniscal extrusion developed mild knee OA by the endpoint, compared with 13.6% of patients with a stable lesion (OR, 5.73; 95% CI, 2.94-11.16). Higher risk of KL1 or KL2 at 48 months was significant for all the lesion types studied except bone marrow lesions. Worsening of these lesions between 12 and 48 months was also significantly associated with having persistent symptoms between 4 and 7 years. Having more lesion types that worsened was significantly associated with worse outcomes.

The findings, Dr. Sharma and her colleagues wrote, support the idea of stable and progressive disease phases with early indicators of each and that worsening lesions represent early osteoarthritis. “Given the absence of disease-modifying therapy for OA, widespread clinical application of MRI is difficult to justify,” the investigators wrote in their analysis (Ann Rheum Dis. 2015 Oct 14. doi: 10.1136/annrheumdis-2015-208129).

Nevertheless, they concluded, “prevention or delay of worsening of early-stage lesions should be considered as a target for emerging pharmacological and nonpharmacological treatments in an effort to prevent or delay full-blown disease. Candidate interventions should be studied at this stage, when they are more likely to be effective.” Investigators acknowledged that one limitation of the study was that its findings may not apply in populations not already at higher risk for knee OA.

The study was funded by the Osteoarthritis Initiative, a public-private partnership of the National Institutes of Health and Merck, Novartis, GlaxoSmithKline, and Pfizer, with industry funding administered by NIH.

Serum concentration of hyaluronic acid correlated with the severity of knee osteoarthritis in a longitudinal population-based cohort, with concentrations above 51.9 ng/mL significantly associated with progression in people with moderate disease.

While previous studies have suggested cutoff values for serum hyaluronic acid (HA) as biomarkers for progression of knee osteoarthritis, this study, conducted by Dr. Eiji Sasaki of Hirosaki (Japan) University and his colleagues, is the first to report a serum HA cutoff value from a longitudinal study.

©decade3d/Thinkstock.com

The investigators prospectively enrolled 720 volunteers into a community-based preventive medicine program with intent to follow them for 5 years. They excluded patients with renal failure, liver failure, rheumatoid arthritis, or cancer, as all of these can increase serum HA. HA concentrations and knee radiography were taken at baseline and at 5-year follow-up, with complete data from 444 patients (mean age 55, 64% female) entered into analysis. Dr. Sasaki and his colleagues measured severity of knee osteoarthritis using Kellgren-Lawrence grades. Higher serum HA at baseline correlated with KL grade progression in the cohort as a whole (P = .004), and HA concentration was linked to joint space narrowing in knees with no disease or mild disease (KL grades 0-1) and moderate disease (KL grades 2 or 3) at baseline (P = .021 and P = .008, respectively).

Serum HA of 51.9 ng/mL was predictive of knee osteoarthritis progression in subjects (n = 119) with KL grades 2 or 3 disease (area under curve [AUC], 0.707), and associated with a fivefold increase (odds ratio, 4.89) in risk of joint space narrowing over 5 years. For people with mild or no disease at baseline (n = 323), Dr. Sasaki and his colleagues identified a cutoff of 35.1 ng/mL for the development of OA, but it was not a robust indicator with an AUC of 0.603 (Arthritis Res Ther. 2015;17:283. doi: 10.1186/s13075-015-0793-0).

“Further clinical studies are needed to determine whether serum HA can predict the incidence of OA, which was not determined in the present study,” Dr. Sasaki and his colleagues wrote in their analysis. They noted that the cutoff value of 51.9 ng/mL “should be useful during screening for abnormal knee conditions or as an additional evaluation for the risk of OA progression when used in combination with conventional imaging tools.”

The study was funded by grants from the Japanese government, the Japanese Society for the Promotion of Science, and the Japanese Orthopedic Association. Dr. Sasaki and colleagues declared no conflicts of interest.

Serum concentration of hyaluronic acid correlated with the severity of knee osteoarthritis in a longitudinal population-based cohort, with concentrations above 51.9 ng/mL significantly associated with progression in people with moderate disease.

While previous studies have suggested cutoff values for serum hyaluronic acid (HA) as biomarkers for progression of knee osteoarthritis, this study, conducted by Dr. Eiji Sasaki of Hirosaki (Japan) University and his colleagues, is the first to report a serum HA cutoff value from a longitudinal study.

©decade3d/Thinkstock.com

The investigators prospectively enrolled 720 volunteers into a community-based preventive medicine program with intent to follow them for 5 years. They excluded patients with renal failure, liver failure, rheumatoid arthritis, or cancer, as all of these can increase serum HA. HA concentrations and knee radiography were taken at baseline and at 5-year follow-up, with complete data from 444 patients (mean age 55, 64% female) entered into analysis. Dr. Sasaki and his colleagues measured severity of knee osteoarthritis using Kellgren-Lawrence grades. Higher serum HA at baseline correlated with KL grade progression in the cohort as a whole (P = .004), and HA concentration was linked to joint space narrowing in knees with no disease or mild disease (KL grades 0-1) and moderate disease (KL grades 2 or 3) at baseline (P = .021 and P = .008, respectively).

Serum HA of 51.9 ng/mL was predictive of knee osteoarthritis progression in subjects (n = 119) with KL grades 2 or 3 disease (area under curve [AUC], 0.707), and associated with a fivefold increase (odds ratio, 4.89) in risk of joint space narrowing over 5 years. For people with mild or no disease at baseline (n = 323), Dr. Sasaki and his colleagues identified a cutoff of 35.1 ng/mL for the development of OA, but it was not a robust indicator with an AUC of 0.603 (Arthritis Res Ther. 2015;17:283. doi: 10.1186/s13075-015-0793-0).

“Further clinical studies are needed to determine whether serum HA can predict the incidence of OA, which was not determined in the present study,” Dr. Sasaki and his colleagues wrote in their analysis. They noted that the cutoff value of 51.9 ng/mL “should be useful during screening for abnormal knee conditions or as an additional evaluation for the risk of OA progression when used in combination with conventional imaging tools.”

The study was funded by grants from the Japanese government, the Japanese Society for the Promotion of Science, and the Japanese Orthopedic Association. Dr. Sasaki and colleagues declared no conflicts of interest.

Serum concentration of hyaluronic acid correlated with the severity of knee osteoarthritis in a longitudinal population-based cohort, with concentrations above 51.9 ng/mL significantly associated with progression in people with moderate disease.

While previous studies have suggested cutoff values for serum hyaluronic acid (HA) as biomarkers for progression of knee osteoarthritis, this study, conducted by Dr. Eiji Sasaki of Hirosaki (Japan) University and his colleagues, is the first to report a serum HA cutoff value from a longitudinal study.

©decade3d/Thinkstock.com

The investigators prospectively enrolled 720 volunteers into a community-based preventive medicine program with intent to follow them for 5 years. They excluded patients with renal failure, liver failure, rheumatoid arthritis, or cancer, as all of these can increase serum HA. HA concentrations and knee radiography were taken at baseline and at 5-year follow-up, with complete data from 444 patients (mean age 55, 64% female) entered into analysis. Dr. Sasaki and his colleagues measured severity of knee osteoarthritis using Kellgren-Lawrence grades. Higher serum HA at baseline correlated with KL grade progression in the cohort as a whole (P = .004), and HA concentration was linked to joint space narrowing in knees with no disease or mild disease (KL grades 0-1) and moderate disease (KL grades 2 or 3) at baseline (P = .021 and P = .008, respectively).

Serum HA of 51.9 ng/mL was predictive of knee osteoarthritis progression in subjects (n = 119) with KL grades 2 or 3 disease (area under curve [AUC], 0.707), and associated with a fivefold increase (odds ratio, 4.89) in risk of joint space narrowing over 5 years. For people with mild or no disease at baseline (n = 323), Dr. Sasaki and his colleagues identified a cutoff of 35.1 ng/mL for the development of OA, but it was not a robust indicator with an AUC of 0.603 (Arthritis Res Ther. 2015;17:283. doi: 10.1186/s13075-015-0793-0).

“Further clinical studies are needed to determine whether serum HA can predict the incidence of OA, which was not determined in the present study,” Dr. Sasaki and his colleagues wrote in their analysis. They noted that the cutoff value of 51.9 ng/mL “should be useful during screening for abnormal knee conditions or as an additional evaluation for the risk of OA progression when used in combination with conventional imaging tools.”

The study was funded by grants from the Japanese government, the Japanese Society for the Promotion of Science, and the Japanese Orthopedic Association. Dr. Sasaki and colleagues declared no conflicts of interest.

Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.

“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.

Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).

Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.

For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.

Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.

The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.

Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.

“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.

Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).

Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.

For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.

Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.

The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.

Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.

“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.

Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).

Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.

For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.

Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.

The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.

Among adults with hand osteoarthritis, ultrasonographic evidence of persistent joint-level inflammation increased the odds of subsequent erosions by as much as 11 times, said authors of a 2-year prospective study.

“These observations implicate a role for inflammation in the pathogenesis of erosive osteoarthritis and might render new therapeutic options that can halt erosive development,” said Dr. Marion C. Kortekaas and her associates at Leiden (the Netherlands) University Medical Center. The findings appeared online in Arthritis & Rheumatology.

©Astrid Gast/thinkstockphotos.com

The pathogenesis of erosive hand OA remains poorly understood, despite its high clinical burden, the researchers noted. To assess potential risk factors for erosive development, they used standard ultrasonographic methods to examine the interphalangeal joints of 56 consecutive patients who presented to a rheumatology outpatient clinic with hand OA based on American College of Rheumatology criteria. They also scored radiographs for osteophytes or joint-space narrowing with the OARSI method and used the Verbruggen-Veys method to identify and exclude joints that were already eroded (E phase) or remodeled (R phase) at baseline (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.39438). At baseline, 18 patients had ultrasonographic evidence of erosions in a total of 51 interphalangeal joints, the investigators said. At the 2.3-year follow-up, a total of 38 interphalangeal joints from 26 patients showed erosive development.

After accounting for age, gender, body mass index, and baseline cartilage and bone abnormalities, all ultrasonographic features of inflammation that were at least grade 1 at baseline and follow-up predicted erosive development. Persistent power Doppler signal was the strongest risk factor, yielding an odds ratio of 11.4 in the adjusted model (95% confidence interval, 2.7-49.1). Other significant risk factors included moderate to severe baseline synovial thickening (OR, 8.8; 95% CI, 2.4-32.3) and power Doppler signal (OR, 7.1; 95% CI, 1.9-26.9).

“The present study confirms that inflammatory US features found at baseline are associated with erosive development on the joint level in hand OA,” the investigators wrote. “These associations are already found after 2 years of follow-up, which is important for future prospective trials.”

The researchers reported having no funding sources or conflicts of interest.

Among adults with hand osteoarthritis, ultrasonographic evidence of persistent joint-level inflammation increased the odds of subsequent erosions by as much as 11 times, said authors of a 2-year prospective study.

“These observations implicate a role for inflammation in the pathogenesis of erosive osteoarthritis and might render new therapeutic options that can halt erosive development,” said Dr. Marion C. Kortekaas and her associates at Leiden (the Netherlands) University Medical Center. The findings appeared online in Arthritis & Rheumatology.

©Astrid Gast/thinkstockphotos.com

The pathogenesis of erosive hand OA remains poorly understood, despite its high clinical burden, the researchers noted. To assess potential risk factors for erosive development, they used standard ultrasonographic methods to examine the interphalangeal joints of 56 consecutive patients who presented to a rheumatology outpatient clinic with hand OA based on American College of Rheumatology criteria. They also scored radiographs for osteophytes or joint-space narrowing with the OARSI method and used the Verbruggen-Veys method to identify and exclude joints that were already eroded (E phase) or remodeled (R phase) at baseline (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.39438). At baseline, 18 patients had ultrasonographic evidence of erosions in a total of 51 interphalangeal joints, the investigators said. At the 2.3-year follow-up, a total of 38 interphalangeal joints from 26 patients showed erosive development.

After accounting for age, gender, body mass index, and baseline cartilage and bone abnormalities, all ultrasonographic features of inflammation that were at least grade 1 at baseline and follow-up predicted erosive development. Persistent power Doppler signal was the strongest risk factor, yielding an odds ratio of 11.4 in the adjusted model (95% confidence interval, 2.7-49.1). Other significant risk factors included moderate to severe baseline synovial thickening (OR, 8.8; 95% CI, 2.4-32.3) and power Doppler signal (OR, 7.1; 95% CI, 1.9-26.9).

“The present study confirms that inflammatory US features found at baseline are associated with erosive development on the joint level in hand OA,” the investigators wrote. “These associations are already found after 2 years of follow-up, which is important for future prospective trials.”

The researchers reported having no funding sources or conflicts of interest.

Among adults with hand osteoarthritis, ultrasonographic evidence of persistent joint-level inflammation increased the odds of subsequent erosions by as much as 11 times, said authors of a 2-year prospective study.

“These observations implicate a role for inflammation in the pathogenesis of erosive osteoarthritis and might render new therapeutic options that can halt erosive development,” said Dr. Marion C. Kortekaas and her associates at Leiden (the Netherlands) University Medical Center. The findings appeared online in Arthritis & Rheumatology.

©Astrid Gast/thinkstockphotos.com

The pathogenesis of erosive hand OA remains poorly understood, despite its high clinical burden, the researchers noted. To assess potential risk factors for erosive development, they used standard ultrasonographic methods to examine the interphalangeal joints of 56 consecutive patients who presented to a rheumatology outpatient clinic with hand OA based on American College of Rheumatology criteria. They also scored radiographs for osteophytes or joint-space narrowing with the OARSI method and used the Verbruggen-Veys method to identify and exclude joints that were already eroded (E phase) or remodeled (R phase) at baseline (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.39438). At baseline, 18 patients had ultrasonographic evidence of erosions in a total of 51 interphalangeal joints, the investigators said. At the 2.3-year follow-up, a total of 38 interphalangeal joints from 26 patients showed erosive development.

After accounting for age, gender, body mass index, and baseline cartilage and bone abnormalities, all ultrasonographic features of inflammation that were at least grade 1 at baseline and follow-up predicted erosive development. Persistent power Doppler signal was the strongest risk factor, yielding an odds ratio of 11.4 in the adjusted model (95% confidence interval, 2.7-49.1). Other significant risk factors included moderate to severe baseline synovial thickening (OR, 8.8; 95% CI, 2.4-32.3) and power Doppler signal (OR, 7.1; 95% CI, 1.9-26.9).

“The present study confirms that inflammatory US features found at baseline are associated with erosive development on the joint level in hand OA,” the investigators wrote. “These associations are already found after 2 years of follow-up, which is important for future prospective trials.”

The researchers reported having no funding sources or conflicts of interest.

U.S. Compounding Inc. is issuing a recall on all sterile products distributed between March 14, 2015, and Sept. 9, 2015, according to a safety alert from the Food and Drug Administration.

The product recall applies to all aseptically compounded and packaged USC sterile products distributed to hospitals, patients, providers, and clinics because of FDA concerns over lack of sterility assurance. Because of the risk to any patients using a compromised product, USC is proceeding voluntarily with the recall.

Patients or providers who received sterile compounded products from USC within the recall date and have not expired should stop using the products immediately, quarantine the product until proper disposal is possible, and contact USC as soon as possible to coordinate a plan to return the product.

Patients should also contact their physicians if they have experienced any issues relating to the recalled product, and physicians should contact patients to inform them of the recall and to advise them to stop using the product.

The USC recall does not apply to any nonsterile compounded medication produced or distributed by USC, according to the FDA alert.

Find the full safety alert on the FDA website.

[email protected]

U.S. Compounding Inc. is issuing a recall on all sterile products distributed between March 14, 2015, and Sept. 9, 2015, according to a safety alert from the Food and Drug Administration.

The product recall applies to all aseptically compounded and packaged USC sterile products distributed to hospitals, patients, providers, and clinics because of FDA concerns over lack of sterility assurance. Because of the risk to any patients using a compromised product, USC is proceeding voluntarily with the recall.

Patients or providers who received sterile compounded products from USC within the recall date and have not expired should stop using the products immediately, quarantine the product until proper disposal is possible, and contact USC as soon as possible to coordinate a plan to return the product.

Patients should also contact their physicians if they have experienced any issues relating to the recalled product, and physicians should contact patients to inform them of the recall and to advise them to stop using the product.

The USC recall does not apply to any nonsterile compounded medication produced or distributed by USC, according to the FDA alert.

Find the full safety alert on the FDA website.

[email protected]

U.S. Compounding Inc. is issuing a recall on all sterile products distributed between March 14, 2015, and Sept. 9, 2015, according to a safety alert from the Food and Drug Administration.

The product recall applies to all aseptically compounded and packaged USC sterile products distributed to hospitals, patients, providers, and clinics because of FDA concerns over lack of sterility assurance. Because of the risk to any patients using a compromised product, USC is proceeding voluntarily with the recall.

Patients or providers who received sterile compounded products from USC within the recall date and have not expired should stop using the products immediately, quarantine the product until proper disposal is possible, and contact USC as soon as possible to coordinate a plan to return the product.

Patients should also contact their physicians if they have experienced any issues relating to the recalled product, and physicians should contact patients to inform them of the recall and to advise them to stop using the product.

The USC recall does not apply to any nonsterile compounded medication produced or distributed by USC, according to the FDA alert.

Find the full safety alert on the FDA website.

[email protected]

Neither psoriatic arthritis (PsA) nor cutaneous psoriasis (PsC) is an independent predictor of poor postoperative pain or function following a total hip arthroplasty, according to the results of a case-control study by Dr. Lisa A. Mandl and her colleagues.

The study’s participants underwent surgery between May 1, 2007, and Dec. 31, 2010, in a center that performs more than 4,300 THAs annually. All subjects lived for at least 2 years after their operations. The researchers compared pre- and postoperative data from patients in the following three categories: those with PsA, those with PsC without evidence of inflammatory arthritis, and those with osteoarthritis (OA). Patients with OA comprised the control group, which excluded any patient who self-reported a history of PsA, rheumatoid arthritis, lupus erythematosus, or any other systematic rheumatic disease, or who had documentation of skin psoriasis. The researchers acquired postoperative self-report data from 47 PsA patients, 106 PsC patients, and 864 OA patients. Seventeen percent of patients submitted information on their status at 1 year, 69% at 2 years, and 14% at 3-5 years.

The primary outcomes of interest were postoperative pain and function, which were assessed via the Hip Osteoarthritis Outcome Score (HOOS), from which the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was derived.

There were no statistically significant differences in postoperative WOMAC pain or function scores between the three groups of patients (P = .78 and .96, respectively). The mean pain scores were 14.9, 6.1, and 15.8 for patients with PsA, PsC, and OA, respectively. These patients’ mean function scores were 16.3, 19.6, and 18.8 for the PsA, PsC and OA groups, respectively.

Overall levels of satisfaction with the surgery were similar among the three groups (P = .54). Ninety-three percent of the PsA patients, 79% of the PsC patients, and 84% of the OA patients were “very satisfied” with their total hip arthroplasty. Between 1% and 3% of each group reported being “very dissatisfied” with their surgery. The researchers found that extent of skin disease was not associated with worse postoperative pain or function.

“Further work needs to be done to better understand the interplay of disease activity and quality of life on the outcomes of [total hip arthroplasty] in PsA and PsC,” they wrote.

Read the report in Arthritis & Rheumatology (doi: 10.1002/art.39431).

[email protected]

Neither psoriatic arthritis (PsA) nor cutaneous psoriasis (PsC) is an independent predictor of poor postoperative pain or function following a total hip arthroplasty, according to the results of a case-control study by Dr. Lisa A. Mandl and her colleagues.

The study’s participants underwent surgery between May 1, 2007, and Dec. 31, 2010, in a center that performs more than 4,300 THAs annually. All subjects lived for at least 2 years after their operations. The researchers compared pre- and postoperative data from patients in the following three categories: those with PsA, those with PsC without evidence of inflammatory arthritis, and those with osteoarthritis (OA). Patients with OA comprised the control group, which excluded any patient who self-reported a history of PsA, rheumatoid arthritis, lupus erythematosus, or any other systematic rheumatic disease, or who had documentation of skin psoriasis. The researchers acquired postoperative self-report data from 47 PsA patients, 106 PsC patients, and 864 OA patients. Seventeen percent of patients submitted information on their status at 1 year, 69% at 2 years, and 14% at 3-5 years.

The primary outcomes of interest were postoperative pain and function, which were assessed via the Hip Osteoarthritis Outcome Score (HOOS), from which the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was derived.

There were no statistically significant differences in postoperative WOMAC pain or function scores between the three groups of patients (P = .78 and .96, respectively). The mean pain scores were 14.9, 6.1, and 15.8 for patients with PsA, PsC, and OA, respectively. These patients’ mean function scores were 16.3, 19.6, and 18.8 for the PsA, PsC and OA groups, respectively.

Overall levels of satisfaction with the surgery were similar among the three groups (P = .54). Ninety-three percent of the PsA patients, 79% of the PsC patients, and 84% of the OA patients were “very satisfied” with their total hip arthroplasty. Between 1% and 3% of each group reported being “very dissatisfied” with their surgery. The researchers found that extent of skin disease was not associated with worse postoperative pain or function.

“Further work needs to be done to better understand the interplay of disease activity and quality of life on the outcomes of [total hip arthroplasty] in PsA and PsC,” they wrote.

Read the report in Arthritis & Rheumatology (doi: 10.1002/art.39431).

[email protected]

Neither psoriatic arthritis (PsA) nor cutaneous psoriasis (PsC) is an independent predictor of poor postoperative pain or function following a total hip arthroplasty, according to the results of a case-control study by Dr. Lisa A. Mandl and her colleagues.

The study’s participants underwent surgery between May 1, 2007, and Dec. 31, 2010, in a center that performs more than 4,300 THAs annually. All subjects lived for at least 2 years after their operations. The researchers compared pre- and postoperative data from patients in the following three categories: those with PsA, those with PsC without evidence of inflammatory arthritis, and those with osteoarthritis (OA). Patients with OA comprised the control group, which excluded any patient who self-reported a history of PsA, rheumatoid arthritis, lupus erythematosus, or any other systematic rheumatic disease, or who had documentation of skin psoriasis. The researchers acquired postoperative self-report data from 47 PsA patients, 106 PsC patients, and 864 OA patients. Seventeen percent of patients submitted information on their status at 1 year, 69% at 2 years, and 14% at 3-5 years.

The primary outcomes of interest were postoperative pain and function, which were assessed via the Hip Osteoarthritis Outcome Score (HOOS), from which the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was derived.

There were no statistically significant differences in postoperative WOMAC pain or function scores between the three groups of patients (P = .78 and .96, respectively). The mean pain scores were 14.9, 6.1, and 15.8 for patients with PsA, PsC, and OA, respectively. These patients’ mean function scores were 16.3, 19.6, and 18.8 for the PsA, PsC and OA groups, respectively.

Overall levels of satisfaction with the surgery were similar among the three groups (P = .54). Ninety-three percent of the PsA patients, 79% of the PsC patients, and 84% of the OA patients were “very satisfied” with their total hip arthroplasty. Between 1% and 3% of each group reported being “very dissatisfied” with their surgery. The researchers found that extent of skin disease was not associated with worse postoperative pain or function.

“Further work needs to be done to better understand the interplay of disease activity and quality of life on the outcomes of [total hip arthroplasty] in PsA and PsC,” they wrote.

Read the report in Arthritis & Rheumatology (doi: 10.1002/art.39431).

[email protected]