Low bone mineral density in young individuals is associated with greater gingival inflammation and recession

Most patients with osteoporosis are postmenopausal women or senile people who are deemed to have primary osteoporosis. However, young women, males, and atypical cases need further work up to evaluate the risk factors for secondary osteoporosis. A growing body of literature has accumulated regarding the role of osteoporosis in the onset and progression of periodontal disease and tooth loss. We hypothesized that secondary/idiopathic osteoporosis in young patients will be associated with worse periodontal status. Patients and controls who were seen in the general internal medicine outpatient clinic and who were less than 47 years of age were recruited between December 2005 and June 2011. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Blood samples were obtained for bone turnover markers and secondary causes of low BMD. Periodontal variables were assessed. Forty-five women whose mean age was 33.9 ± 7.7 years were enrolled. The osteoporotic group consisted of 12 patients, the osteopenic group 17 patients, and the control group 16 subjects. Significantly higher gingival recession (GR), gingival bleeding time index, and hence gingival inflammation were noted in patients with secondary osteoporosis compared to healthy subjects. In logistic regression analysis, having osteoporosis was determined as the single risk factor for increased bleeding time (b = 0.871, p = 0.008), while having osteoporosis (b = 0.181, p = 0.001) and age (b = 0.010, p < 0.001) were significant parameters with regard to GR. In conclusion, low BMD in young individuals was associated with greater gingival inflammation and recession when compared to those individuals with normal BMD values.     

The association between patellar alignment and patellofemoral joint osteoarthritis features--an MRI study

OBJECTIVE: The aim of our study was to evaluate the association between patellar alignment (using standard MRI images of extended knees) and MRI indices of patellofemoral (PF) osteoarthritis (OA) features. METHODS: In this cross-sectional observational study, subjects were recruited to participate in the Boston Osteoarthritis of the Knee Study (BOKS). The association of patellar alignment [patellar length ratio (PLR), sulcus angle (SA), lateral patellar tilt angle (LPTA) and bisect offset (BO)] with measures of PF OA [cartilage morphology and bone marrow lesion (BML) in the medial and lateral PF compartment] were examined using a logistic regression model while adjusting for age, sex and BMI. RESULTS: Study sample comprised 126 males (mean age 68.0, BMI 31.2) and 87 females (mean age 64.7, BMI 31.6). All measurements of patellar alignment were statistically significantly associated with cartilage morphology and BML in the lateral compartment of PF joint. PLR and SA were significantly associated with medial cartilage loss. With increasing PLR there was an increased prevalence of lateral and medial cartilage loss as well as of lateral BML. Increasing SA was positively associated with increased lateral and medial cartilage loss and lateral BML. LPTA range was negatively associated with lateral cartilage loss and BML. More laterally displaced patella (higher BO) was associated with increased lateral cartilage loss and BML. CONCLUSIONS: The results of our study clearly indicated that patellar alignment is associated with manifestations of PF OA such as cartilage thickness loss and BML.     

Nocturnal hypoxemic burden is associated with epicardial fat volume in patients with acute myocardial infarction

Background

Increased epicardial fat volume (EFV) is a common feature of patients with sleep-disordered breathing (SDB), is considered as an established marker of cardiovascular risk, and is associated with adverse cardiovascular events after myocardial infarction (MI).

Methods

To investigate the association between different measures of SDB severity and EFV after acute MI, we enrolled 105 patients with acute MI in this study. Unattended in-hospital polysomnography was performed to determine the number of apneas and hypopneas per hour during sleep (apnea-hypopnea index, AHI). To determine nocturnal hypoxemic burden, we used pulse oximetry and applied a novel parameter, the hypoxia load representing the integrated area of desaturation divided by total sleep time (HL_TST). Of 105 patients, 56 underwent cardiovascular magnetic resonance to define EFV.

Results

HL_TST was significantly associated with EFV (r²?=?0.316, p?=?0.025). Multivariate linear regression analysis accounting for age, sex, body mass index, smoking, and left ventricular mass demonstrated that the HL_TST was an independent modulator of EFV (B-coefficient 0.435 (95% CI 0.021–0.591); p?=?0.015). In contrast, AHI or established measures of hypoxemia did not correlate with EFV.

Conclusions

HL_TST, a novel parameter to determine nocturnal hypoxemic burden, and not AHI as an event-based measure of SDB, was associated with EFV in patients with acute MI. Further studies are warranted to confirm the link between nocturnal hypoxemia and EFV and to determine the prognostic value of a more detailed characterization of nocturnal hypoxemic burden in patients with high cardiovascular risk.

     

Minocycline-induced hyperpigmentation masquerading as alkaptonuria in individuals with joint pain

Alkaptonuria, a rare autosomal-recessive disorder caused by mutations in the HGD gene and a deficiency of homogentisate 1,2-dioxygenase, is characterized by accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue resulting in joint disease. Certain medications have been reported to cause cutaneous hyperpigmentation resembling that of alkaptonuria. We present 5 such cases. Eighty-eight patients with a possible diagnosis of alkaptonuria were examined at the National Institutes of Health Clinical Center between June 2000 and March 2004. The diagnosis of alkaptonuria was confirmed or ruled out by measurement of HGA in the urine. Five patients with findings consistent with ochronosis, including pigmentary changes of the ear and mild degenerative disease of the spine and large joints, were diagnosed clinically as having alkaptonuria, but the diagnosis was withdrawn based on normal urine HGA levels. All 5 patients were women who had taken minocycline for dermatologic or rheumatologic disorders for extended periods. Minocycline-induced hyperpigmentation should be considered in the differential diagnosis of ochronosis. This could be of increased significance now that minocycline and other tetracyclines have been proposed as therapeutic options for rheumatoid arthritis, bringing a new population of patients with ochronosis and arthritis to medical attention with the potential, but incorrect, diagnosis of alkaptonuria.     

A comparative assessment of cartilage and joint fat pad as a potential source of cells for autologous therapy development in knee osteoarthritis

Objectives. The utility of autologous chondrocytes for cartilagerepair strategies in older subjects with osteoarthritis (OA)may be limited by both age-related and disease-associated declinein chondrogenesis. The aim of this work was to assess OA Hoffa'sfat pad as an alternative source of autologous chondroprogenitorcells and to compare it with OA chondrocytes derived from differentareas of cartilage. Methods. Cartilage and fat pad tissue digests were obtainedfrom 26 subjects with knee OA and compared with normal bonemarrow (BM) mesenchymal stem cells (MSCs) with respect to theirin vitro colony-forming potential, growth kinetics, multipotentialityand clonogenicity. Flow cytometry was used to investigate theirMSC marker phenotype. Results. Expanded cultures derived from eroded areas of cartilagewere slightly more chondrogenic than those derived from macroscopicallynormal cartilage or chondro-osteophytes; however, all cartilage-derivedcultures failed to maintain their chondrogenic potency followingextended expansion. In contrast, OA fat pads contained highlyclonogenic and multipotential cells with stable chondrogenicpotency in vitro, even after 16 population doublings. Standardcolony-forming assays failed to reflect the observed functionaldifferences between the studied tissues whereas flow cytometryrevealed higher levels of a putative MSC marker low-affinitygrowth factor receptor (LNGFR) on culture expanded fat pad-derived,but not cartilage-derived, MSCs. Conclusions. In contrast to OA cartilage from three differentsites, OA Hoffa's fat pad contains clonogenic cells that meetthe criteria for MSCs and produce multipotential cultures thatmaintain their chondrogenesis long term. These findings havebroad implications for future strategies aimed at cartilagerepair in OA. KEY WORDS: Mesenchymal Stem Cells, Osteoarthritis, Cartilage Submitted 7 February 2007; revised version accepted 17 July 2007.     

Circulating sCD36 is associated with unhealthy fat distribution and elevated circulating triglycerides in morbidly obese individuals

Background:

The recently identified circulating sCD36 has been proposed to reflect tissue CD36 expression, and is upregulated in case of obesity, insulin resistance and hepatic steatosis. The aim of this study was to explore the effect of weight loss secondary to bariatric surgery in relation to sCD36 among morbidly obese individuals. Furthermore, we investigated the levels of sCD36 in relation to obesity-related metabolic complications, low-grade inflammation and fat distribution.

Methods:

Twenty morbidly obese individuals (body mass index (BMI) 43.0±5.4 kg m⁻²) with a referral to Roux-en-Y gastric bypass were included. Anthropometric measurements and fasting blood samples were collected at a preoperative baseline visit and 3 months after surgery. sCD36 was measured by an in-house assay, whereas insulin sensitivity and the hepatic fat accumulation were estimated by the homeostasis model assessment (HOMA-%S) and liver fat percentage (LF%), respectively.

Results:

Postoperatively, BMI was reduced by 20% to 34.3±5.2 kg m⁻² (P<0.001). sCD36 was reduced by 31% (P=0.001) and improvements were observed in the amount of fat mass (P<0.001), truncal fat mass (P<0.001), circulating triglycerides (P=0.001), HOMA-%S (P=0.007), LF% (P=0.001) and the inflammatory marker high-sensitive C-reactive protein (P=0.005). sCD36 correlated with triglycerides (ρ=0.523, P=0.001) and truncal fat mass (ρ=0.357, P=0.026), and triglycerides were found to be an independent predictor of sCD36. At baseline, participants with the metabolic syndrome had a higher LF% and higher levels of the inflammatory biomarker YKL-40 (P=0.003 and P=0.014) as well as a tendency towards higher levels of sCD36.

Conclusion:

sCD36 was reduced by weight loss and associated with an unhealthy fat accumulation and circulating triglycerides, which support the proposed role of sCD36 as a biochemical marker of obesity-related metabolic complications and risks.     

Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. Insulin resistance (IR) is a key component of metabolic syndrome. The aim was to determine the dietary composition, physical activity, and histologic severity between NAFLD patients with and without metabolic syndrome. METHODS: Ninety-one patients with NAFLD completed the Block Food Frequency Questionnaire and the Paffenbarger Physical Activity Questionnaire. IR was assessed by the homeostasis model assessment (HOMA) index. Metabolic syndrome was defined by the ATP III clinical definition. Nonalcoholic steatohepatitis (NASH) Clinical Network Scoring System was used to determine the histologic severity of NAFLD. RESULTS: Thirty-one patients (34%) had metabolic syndrome. Patients with metabolic syndrome had a higher HOMA index (7.66 vs 4.45, p = 0.04), and consumed more carbohydrates (51%vs 45%, p = 0.03) and less fat (34%vs 40%, p = 0.01) compared with those without metabolic syndrome; total daily calorie, protein consumption, and physical activity were similar between the two groups. Patients with metabolic syndrome had higher scores for steatosis (2.0 +/- 0.8 vs 1.37 +/- 1, p = 0.02), NASH activity (4.13 +/- 1.4 vs 3.13 +/- 1.7, p = 0.004), and global NASH score (5.9 +/- 1.7 vs 4.4 +/- 2.3, p = 0.0006) compared with those without metabolic syndrome. When controlled for other factors including dietary composition and physical activity, the presence of metabolic syndrome was a significant risk factor for global NASH severity in addition to HOMA index and female gender. CONCLUSION: Metabolic syndrome in patients with NAFLD is associated with a diet containing more carbohydrate and less fat and greater histologic severity. The role of a carbohydrate-restricted diet in decreasing the risk for metabolic syndrome and histologic severity should be assessed in patients with NAFLD.     

Increase in vastus medialis cross‐sectional area is associated with reduced pain,cartilage loss,and joint replacement risk in knee osteoarthritis

Objective

Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross‐sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA).

Methods

One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs).

Results

After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = −0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient −10.9 [95% CI −19.5, −2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient −16.8 [95% CI −28.9, −4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]).

Conclusion

In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

     

Magnetic resonance imaging of patellofemoral osteoarthritis: intertester reliability and associations with knee pain and function

Clinical Rheumatology - We examined the intertester reliability of patellofemoral compartment (PFC) osteoarthritis (OA) severity using magnetic resonance images (MRI) and a modified Kellgren and...     

Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: Data from the osteoarthritis initiative

Objective

To examine the association of concurrent low back pain (LBP), and other musculoskeletal pain comorbidity, with knee pain severity in symptomatic knee osteoarthritis (OA).

Methods

Individuals from the Progression Cohort of the Osteoarthritis Initiative (n = 1,389, ages 45–79 years) with symptomatic tibiofemoral knee OA were studied. Participants identified pain in the low back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle, or foot. The primary outcome was the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) applied to the more symptomatic knee. We examined WOMAC pain score in persons with and without LBP, before and after adjusting for other musculoskeletal symptoms.

Results

Of the participants, 57.4% reported LBP. The mean ± SD WOMAC pain score (possible range 0–20) was 6.5 ± 4.1 in participants with and 5.2 ± 3.4 in participants without LBP (P < 0.0001). In multivariate analyses, LBP was significantly associated with increased WOMAC knee pain score (β [SE] = 1.00 [0.21], P < 0.0001). However, pain in all other individual musculoskeletal locations demonstrated similar associations with knee pain score. In models including all pain locations simultaneously, only LBP (β [SE] = 0.65 [0.21], P = 0.002), ipsilateral elbow pain (β [SE] = 0.98 [0.40], P = 0.02), and ipsilateral foot pain (β [SE] = 1.03 [0.45], P = 0.02) were significantly associated with knee pain score. Having >1 pain location was associated with greater WOMAC knee pain; this relationship was strongest for individuals having 4 (β [SE] = 1.83 [0.42], P < 0.0001) or ≥5 pain locations (β [SE] = 1.86 [0.36], P < 0.0001).

Conclusion

LBP, foot pain, and elbow pain are significantly associated with WOMAC knee pain score, as are a higher total number of pain locations. This may have implications for clinical trial planning.     

Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis

OBJECTIVE: To compare the knee joint loading patterns in individuals with differing radiographic grades of knee osteoarthritis (OA) for characterization of the mechanical implications of different structural states, and to compare the knee adduction angular impulse, a measure of gait complementary to the commonly used peak knee adduction moment. METHODS: Asymptomatic subjects (those without knee OA) having a Kellgren/Lawrence (K/L) radiographic severity grade of 0 or 1 (n = 28) and subjects with symptomatic knee OA having K/L grades of 2 (n = 66) or 3 (n = 23) were recruited. Gait analysis was used to calculate the peak external knee adduction moment and the external knee adduction angular impulse for the whole stance and for the 4 subdivisions of stance. RESULTS: Both the peak knee adduction moment and the knee adduction angular impulse increased with K/L radiographic grade (P < 0.05). However, only the knee adduction angular impulse differed between subjects with moderate (grade 3) and those with mild (grade 2) radiographic knee OA (P < 0.05). CONCLUSION: The differences between mild and moderate symptomatic radiographic knee OA are not only structural but also functional, based on the magnitude of load in the medial knee joint. Moreover, knee adduction angular impulse provides additional information beyond that available from the peak knee adduction moment, and may therefore be an important gait parameter to include in OA research. These findings are important for our understanding of the pathophysiologic mechanisms of OA.     

Comparison between patella cartilage volume and radiological assessment of the patellofemoral joint

OBJECTIVES: There is no information on how patella cartilage relates to the radiological grade of individual features of patellofemoral osteoarthritis (osteophytes or joint space narrowing) which have been used in most epidemiological and clinical studies. In this study we compared patella cartilage volume as measured by magnetic resonance imaging (MRI) with radiological assessment of the patellofemoral joint. METHODS: 157 subjects with specific features of patellofemoral osteoarthritis (osteophytes and joint space narrowing) ranging from grade 0-3 were examined (age 62 +/- 10 years, 62% female). Each subject had skyline and lateral patellofemoral radiographs performed. Patella cartilage volume was determined by processing images acquired in the sagittal plane using T1-weighted fat saturated MRI at an independent work station. RESULTS: Grade of joint space narrowing (JSN) as measured on skyline and lateral patellofemoral radiographs was inversely associated with patella cartilage volume. After adjusting for age, gender and body mass index, for every increase in grade of skyline JSN (0-3), the patella cartilage volume was reduced by 411 mm3. For every increase in lateral patellofemoral JSN grade (0-3), the adjusted patella cartilage volume was reduced by 125 mm3. The relationship was stronger for patella cartilage volume and skyline JSN (r = -0.54, p < 0.001) than for lateral patellofemoral JSN (r = -0.16, p = 0.015). There was no significant association between patella cartilage volume and osteophytes measured on skyline or lateral radiographs. CONCLUSIONS: There is a significant negative association between patella cartilage volume and JSN, but not osteophytes. This association was strongest for the skyline rather than lateral radiographs. Longitudinal studies will be needed to determine the role of patella cartilage measurement in assessing progression of patellofemoral osteoarthritis.     

Longitudinal changes in intermuscular fat volume and quadriceps muscle volume in the thighs of women with knee osteoarthritis

Objective

To quantify rates of change in quadriceps muscle (QM) and intermuscular fat (IMF) volumes over 2 years in women in the Osteoarthritis Initiative (OAI) study and examine group differences between those with radiographic osteoarthritis (ROA) and those without ROA.

Methods

The OAI database was queried for women ≥50 years of age in the incident and progression cohorts with and without ROA at baseline. Midthigh magnetic resonance imaging scans (15 contiguous slices, 5 mm slice thickness) of eligible women were randomly selected and anonymized. Image pairs were registered. QM and IMF were segmented in the 12 most proximal matching slices with the segmenter blinded to image time point. Age‐adjusted differences in QM and IMF volume changes between groups were tested using analysis of covariance.

Results

Forty‐one women without ROA (mean ± SD age 60.7 ± 7.6 years) and 45 women with ROA (mean ± SD age 64.5 ± 6.7 years) were included. Mean ± SD QM and IMF volume changes in the non‐ROA group were ?4.1 ± 11.1 cm³ and 3.4 ± 7.1 cm³, respectively, and ?5.4 ± 13.5 cm³ and 3.1 ± 7.4 cm³ in the ROA group, respectively. Age‐adjusted between‐group differences in QM and IMF changes were not significant (P > 0.05).

Conclusion

Two‐year changes in QM and IMF volumes appear consistent with aging and do not seem to be related to OA status. Direct comparison with a control cohort without OA risk factors could confirm this. Since group assignment was based on baseline data, there may have been women in the non‐ROA group who developed ROA over followup, resulting in some overlap between groups.

     

Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis

OBJECTIVES: To evaluate the effects of two knee taping techniques, therapeutic tape and neutral tape, on pain and observed disability in symptomatic generalized knee osteoarthritis (OA). METHODS: Using a within-subjects study design, 18 participants were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing neutral knee tape. Outcome measures included assessment of pain during each of four activities (using a visual analogue scale) and assessment of observed disability (walking speed, timed up and go test, and the step test). RESULTS: Therapeutic tape significantly reduced pain on three of the four activities assessed, when compared with the neutral and untaped conditions (P<0.017). The only statistically significant change in observed disability was detected in the step test (P<0.001), in favour of the therapeutic tape. CONCLUSIONS: Therapeutic knee tape is a simple, inexpensive strategy that increases the treatment options for therapists and patients in the conservative management of knee OA. Whilst effective in immediately reducing pain, it does not appear to have a significant immediate impact on observed disability associated with the disease. Therapeutic tape may be used as an adjunct to drug and exercise therapies, potentially augmenting the individual benefits of each.     

The association of obesity with joint pain and osteoarthritis in the HANES data

Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.