The progression of radiological hand osteoarthritis over ten years: a clinical follow-up study

The natural history of hand osteoarthritis (OA) is poorly understood. The aim of the study was to ascertain the extent and pattern of radiological progression of hand OA over a 10-year period. A follow-up study was carried out on 169 consecutive patients who initially presented with OA of the hands or knees between 1975-1977. Fifty-nine subjects (45 women and 14 men) were recontacted who had paired hand radiographs, a mean of 10 years apart, and were a mean 69 (range 53-86) years old at follow-up. X-rays were scored blind, in three joint areas--distal and proximal interphalangeal joints (DIP and PIP) and first carpo-metacarpal (CMC) joints--using the method of Kellgren and Lawrence (K&L) (0-4), and for osteophytes and narrowing (0-3). Using the highest score for right and left hands (N = 118), K&L changes at the three areas were similar with 47-50% deteriorating, 45-46% unchanged, and 6-8% improving. Similar deterioration was seen when scoring the three joint areas for osteophytes (38-39%) and narrowing (39-48%). New osteophytes appeared in 48% of DIP joints during the 10 years. There was a weak correlation between progression at the DIP and PIP joints, but no relationship between DIP and CMC, or CMC and PIP. Virtually all subjects (97%) deteriorated when the total scores of all joints were calculated. No significant differences were seen between 'severe progressors' and 'minor' in terms of age or body mass index (BMI). A nonsignificant increase in the proportion of knee progressors in the severe progressor hand group was seen and there was a higher rate of baseline DIP OA in knee progressors. These results suggest that the majority of patients with OA of the hands attending a rheumatology outpatients clinic deteriorate radiologically over a 10-year period, about half developing new changes in DIP joints. There were no obvious features distinguishing those with rapid deterioration, although DIP OA appears to be a risk factor for knee progression.     

The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review

Objective

To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints.

Method

A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified.

Results

Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn’t allow us to make any comparison according to joint site or OA definition.

Conclusions

Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions.     

Statin use and knee osteoarthritis progression: Results from a post-hoc analysis of the SEKOIA trial

Objective

Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA.

Complication incidence of EUS-guided pancreas biopsy: A systematic review and meta-analysis of 11 thousand population from 78 cohort studies

A systematic review and meta-analysis were performed to estimate the incidence of possible complications following EUS-guided pancreas biopsy. Pancreatic cancer has a very poor prognosis with a high fatality rate. Early diagnosis is important to improve the prognosis of pancreatic cancer. We searched Pubmed, Embase, Web of Science, and Scopus databases for studies published from inception to Augest, 2018. Meta-analysis were conducted with random-effect models and heterogeneity was calculated with the Q, I² and τ² statistics. We enrolled 78 studies from 71 articles in the meta-analysis, comprising 11,652 patients. Pooled data showed that the whole complication incidences were low 0.210 × 10⁻⁴(95%CI -0.648 × 10⁻⁴, 1.068 × 10⁻⁴). And they were in bleeding 0.002 × 10⁻⁴ (95%CI -0.092 × 10⁻⁴, 0.097 × 10⁻⁴), pancreatitis 0.002 (95%CI -0.082 × 10⁻⁴, 0.086 × 10⁻⁴), abdominal pain 0 (95%CI -0.037 × 10⁻⁴, 0.038 × 10⁻⁴), fever 0 (95%CI -0.032 × 10⁻⁴, 0. 032 × 10⁻⁴), infection 0 (95%CI -0.030 × 10⁻⁴, 0.031 × 10⁻⁴), duodenal perforation 0 (95%CI -0.033 × 10⁻⁴, 0.034 × 10⁻⁴), pancreatic fistula 0 (95%CI -0.029 × 10⁻⁴, 0.029 × 10⁻⁴), abscess 0 (95%CI -0.029 × 10⁻⁴, 0.029 × 10⁻⁴) and sepsis 0 (95%CI -0.029 × 10⁻⁴, 0.030 × 10⁻⁴). Subgroup analysis based on the tumor size, site, needle type and tumor style also showed robust results. The pooled data showed EUS-guided pancreas biopsy could be a safe approach for the diagnosis of pancreatic lesions. More large-scale studies will be necessary to confirm the findings across different population.     

Association between benzodiazepines use and risk of hip fracture in the elderly people: A meta-analysis of observational studies

ObjectiveHip fracture is one of the leading causes of disability, cost, morbidity, and mortality. Several studies reported that benzodiazepines (BDZs) have been associated with an increased risk of hip fracture in older individuals. The aim of this study was to evaluate the magnitude of hip fracture risk with BDZs.MethodsA systematic literature search on EMBASE, PubMed, Google Scholar, Scopus was performed between January 1, 1980, and March 31, 2019. The search strategy was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline, and an observational study design was mandatory for articles inclusion. Data were extracted by two authors independently and a random effect model was used to evaluate effect size. The random-effects model (DerSimonian-Laird) was utilized to obtain the overall risk ratio (RR) and its 95% CI for all studies. The Newcastle Ottawa Scale (NOS) was also used to assess the quality of each study.ResultsOf 2315 studies screened, 33 (20 cohorts and 13 case-control) with 169,660 hip fracture cases were included in our analysis. In BDZs users, compared with non-users, the RR for hip fracture was 1.34 (95%CI: 1.26–1.44). The RR for long- and short-short acting BDZs and hip fracture risk were 1.31 (95%CI: 1.18–1.45, P < 0.0001), and 1.15 (95%CI: 1.08–1.22, P < 0.0001), respectively. When stratified by type of users, the current and recent users of BDZs had higher risk of hip fracture (RR: 1.83, 95% CI: 1.46–2.28, P < 0.0001 and RR: 1.61, 95% 1.30–1.99, P < 0.0001) whereas there was no increased risk of hip fracture in past BDZs users (RR: 1.18, 95%CI: 1.07–1.29, P < 0.0001).ConclusionOur meta-analysis showed an increased risk of hip fracture in patients with BDZs compared with non-users. Physicians should be aware of the unwanted consequence of BDZs when they will prescribe BDZs for their patients, especially elderly patients because hip fractures are highly prevalent in the elderly population.     

History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies

Objectives

Although knee injury has been implicated as a risk factor for the development of knee osteoarthritis (OA), there is great disparity in the magnitude of quantifiable risk. Our aim was to systematically review the relationship between history of knee injuries and knee OA.

Methods

Six electronic databases were searched between August and October 2010. Relative risk estimates or odds ratio (OR) and 95% confidence intervals (95% CI) were extracted or calculated from observational studies meeting the inclusion criteria. Publication bias was determined using funnel plot and the Egger’s test. Heterogeneity was examined using Cochran Q test and I² statistic. Random effects model was used to pool the heterogeneous results and OR was used to present the results. Subgroup analyses were performed to examine potential causes of heterogeneity.

Results

Twenty-four observational studies (20,997 subjects) were included in the meta-analysis of which there were seven cohort, five cross-sectional and 12 case-control studies. The overall pooled OR was 4.20 (95% CI 3.11–5.66, I² = 81.0%). Association between history of knee injuries and knee OA was significantly different for specified injuries such as ligament or tendon injuries; meniscus damage or meniscectomy; and fracture of femur, knee or lower part of the leg (OR = 5.95, 95% 4.57–7.75), compared to unspecified injuries (OR = 3.12, 95% 2.17–4.50).

Conclusion

History of knee injury is a major risk factor for the development of knee OA irrespective of study design and definition of knee injury. As one of the few modifiable/preventable risk factors, knee injury should be part of the future prevention programme in reducing the risk of knee OA.