The association between morbidity and radiographic hand osteoarthritis: a population-based study

OBJECTIVES: Osteoarthritis is the most common form of joint disease and is considered to be a risk factor for other morbidities. We performed a population-based study to evaluate the association between morbidity and radiographic hand osteoarthritis. METHODS: Our population consisted of Chuvashians residing in peripheral villages of the Russian Federation. The investigated cohort included 434 males aged 18-86 years and 385 females aged 18-84 years. Osteoarthritis development was evaluated using the Kellgren and Lawrence grading scheme. Morbidity data was attained from their medical records and divided into 14 categories by an experienced research physician. To explore the relationship between morbidity and age-adjusted radiographic hand osteoarthritis score, one-way analysis of variance was used, with hand osteoarthritis score as a dependent variable and individuals affected vs. non-affected with the specific disease as an independent (grouping) variable. RESULTS AND CONCLUSIONS: Statistically significant evidence linking radiographic hand osteoarthritis and morbidities was found in patients with ischemic heart disease and gastrointestinal diseases. Our research indicates that individuals with ischemic heart disease have higher values of radiographic hand osteoarthritis, compared to lower values in individuals with gastrointestinal diseases. Additional research is needed to understand the biological mechanisms of the association between morbidity and osteoarthritis.     

Appendicular bone mass and knee and hand osteoarthritis in Japanese women: a cross-sectional study

Background  

It has been reported that there is an inverse association between osteoarthritis (OA) and osteoporosis. However, the relationship of bone mass to OA in a Japanese population whose rates of OA are different from Caucasians remains uncertain.     

Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females

OBJECTIVE: To describe the association between early radiographic osteoarthritis of the knee (ROA), knee cartilage volume and tibial bone surface area. METHODS: Cross-sectional convenience sample of 372 male and female subjects (mean age 45 years, range 26-61). Articular cartilage volume, bone area and volume were determined at the patella, medial tibial and lateral tibial compartments by processing images acquired in the sagittal plane using T1-weighted fat saturation MRI. ROA was assessed with a standing semiflexed radiograph and the OARSI atlas for joint space narrowing and osteophytosis. Both radiographs and MRIs were performed in the right knee and read by different observers. RESULTS: ROA (predominantly grade 1) was present in 17% of subjects of which medial joint space narrowing was most common (14%) followed by medial osteophytes (6%). Grade one medial joint space narrowing was associated with substantial reductions in cartilage volume at both the medial and lateral tibial and patellar sites within the knee (adjusted mean difference 11-13%, all P<0.001) while grade one osteophytosis was associated with substantial increases in both lateral and medial tibial joint surface area (adjusted mean difference 10-16%, all P<0.001). In contrast, osteophytosis was not associated with a significant change in cartilage volume and joint space narrowing was not associated with a significant change in tibial bone area (all P>0.05). CONCLUSIONS: Early medial compartment ROA is associated with substantial reductions in cartilage volume and increases in bone area. These large changes, when combined with similar measurement error for MRI and radiographs, suggest that MRI may be superior at detecting and hence understanding early osteoarthritis of the knee in humans.     

Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian Older Adult Cohort study

OBJECTIVE: To describe the association between knee and hip radiographic osteoarthritis (ROA), a measure of knee pain, stiffness and functional ability and objectively measured physiological falls risk predictors. METHODS: Cross-sectional, population-based study of 850 randomly selected men and women aged 50-80 years (mean 62.5, SD 7.4). Falls risk (Z score) was determined objectively with the short form Physiological Profile Assessment (PPA). Two observers assessed knee and hip ROA using the Altman atlas. Pain, stiffness and functional ability were assessed using the Western Ontario McMasters Osteoarthritis index (WOMAC). RESULTS: Overall, the study population was at a mild risk of falling. In multivariable analysis, the WOMAC function and pain score were significantly associated with reaction time, balance, proprioception, knee extension strength, and edge contrast sensitivity. Stiffness was associated with knee extension strength and edge contrast sensitivity. Males had a dose response association between the global WOMAC score and falls risk (r=0.17, P<0.001). Those who reported a global WOMAC score of 50 and above had a higher risk of falling compared to those with a score below 50 (Z score: 0.53 vs 0.14, P<0.001). Hip joint space narrowing (JSN) was significantly associated with knee extension strength (r=-0.10, P=0.003), however, no other significant associations were observed between ROA and falls risk predictors. CONCLUSION: Self-reported functional ability and pain, and to a lesser extent, stiffness (but not knee and hip ROA), have a modest but independent association with physiological predictors of falls risk.     

Mild-to-moderate renal impairment is associated with platelet activation: a cross-sectional study

The high incidence of cardiovascular disease in patients with moderate renal impairment is not fully explained by traditional atherothrombotic risk factors. Independently from these factors, blood platelet activation may increase the cardiovascular disease risk of patients with mild-to-moderate renal impairment. Blood platelet activation has not been studied in nondiabetic patients with mild-to-moderate renal impairment. Therefore, we measured the extent of platelet activation by means of fluorescence cytometry in 93 nondiabetic patients with MDRD-estimated creatinine clearance ranging from 13 - 63 ml/min/1.73 m2. As platelet activation parameters we used the expression of CD62P (P-selectin), CD 63 (glycoprotein 53), PAC-1 (activated fibrinogen receptor), CD42b (von Willebrand factor receptor) and CD41 (fibrinogen receptor) on the platelet surface membrane. The expression of CD62p, CD63 and PAC-1 was statistically significantly inversely related to the estimated glomerular filtration rate in these patients (standardized b -0.28, -0.32 and -0.39, respectively). We conclude that nondiabetic mild-to-moderate renal impairment is associated with blood platelet activation. Whether this contributes to the increased cardiovascular risk in these patients needs further study.     

The predictive role of scintigraphy in radiographic osteoarthritis of the hand

Sixty-seven patients with symptomatic knee osteoarthritis (OA) (26 male, 42 female, mean age 62.7 years) have been followed prospectively for a mean of 67.3 months (range 60-72 months). Hand radiographs were obtained at entry and at follow-up. Scintigraphic images of the hands were obtained at entry, and the predictive value of scan abnormalities for subsequent radiographic change was examined. Forty-six of 203 scan-positive joints at entry showed radiographic change, compared with 41 of 2075 scan-negative joints (P < 0.0001). The thumb base was more often involved than other joints and scintigraphy was a better predictor of change at this site than at other joints in the hand. This study confirms the predictive value of scintigraphy in hand OA and suggests that thumb base and interphalangeal joint OA behave differently.     

Serum phosphate level at initiation of dialysis is associated with all-cause mortality: a multicenter prospective cohort study

Introduction: As glomerular filtration rate (GFR) decreases, serum phosphate level increases. Previous reports indicated that serum phosphate level was associated with mortality in patients on dialysis. However, few reports have examined the association using dialysis initiation as the baseline period.

Methods: This was a multicenter prospective cohort analysis including 1492 patients. Patients were classified into four quartiles based on the serum phosphate level at dialysis initiation, with Q1 being the lowest and Q4 the highest. All-cause mortality after dialysis initiation was compared using the log-rank test. The propensity score represented the probability of being assigned to group Q1 or Q2–4. All-cause mortality was compared in propensity score-matched patients by using the log-rank test for Kaplan–Meier curves. All-cause mortality of Q1 was compared with that for Q2–4 using multivariate Cox proportional hazard regression analysis. All-cause mortality was also determined among stratified groups with or without use of phosphate binders.

Results: Significant differences in cumulative survival rates were observed between the four groups (p?p?=?.046). All-cause mortality was significantly higher in the Q1 group after adjustment for history of CAD (hazard ratio [HR]?=?0.76, 95% confidence interval [CI]: 0.58???1.00, p?=?.048). However, there was no significant difference between the two groups after adjustment for estimated GFR.

Conclusion: The serum phosphate level at the time of dialysis initiation was associated with all-cause mortality. However, the serum phosphate level was dependent on the renal function.     

Serum uric acid level is associated with cardiac hypertrophy in renal transplant recipients

Caliskan Y, Gorgulu N, Yelken B, Akturk F, Yazici H, Turkmen A, Sever MS. Serum uric acid level is associated with cardiac hypertrophy in renal transplant recipients.
Clin Transplant 2011: 25: 368–374. © 2010 John Wiley & Sons A/S. Abstract: Background: Serum uric acid (UA) level as a significant and independent risk factor for cardiovascular disease, and the link between this marker and left ventricular hypertrophy (LVH) in renal transplant recipients remains to be clarified. Methods: A total of 141 renal transplant recipients (83 men), between ages of 18 and 69 (mean age 37 ± 11), were included in this single center study. In addition to demographic, clinical, and laboratory parameters, serum UA concentrations were evaluated. LVH was determined by two‐dimensional and M‐mode echocardiography. Results: Serum UA levels were significantly higher (6.14 ± 1.15 mg/dL) in patients with LVH (n = 54) when compared to patients (n = 87) who did not have this abnormality (5.29 ± 1.43 mg/dL) (p = 0.006). Serum UA levels were significantly correlated with septal wall thickness, LV posterior wall thickness, LV mass index (LVMI), and pulmonary arterial pressure. Multiple linear regression analysis revealed that UA predicted LVMI (r² = 0.150, β = 0.369, p = 0.001). However, serum creatinine (β = 0.060, p = 0.593) and age (β = 0.146, p = 0.175) were not predictors of LVMI. Conclusion: High serum UA levels are associated with LVH in renal transplant recipients, which underlines the importance of treating hyperuricemia.     

Serum aluminium level in the veneto chronic haemodialysis population: cross-sectional study on 1,026 patients

A total of 1,026 patients undergoing haemodialysis as the only chronic treatment were studied in all the dialysis units of the Veneto region, Italy. Aluminium was determined in water, dialysis fluids, and patients' serum. Aluminium mean concentration was 9.1 micrograms/l in tap water and 13.3 and 15.7 micrograms/l in bicarbonate and acetate haemodialysis fluids, respectively. Patients' serum aluminium mean level was 52.0 micrograms/l with the following frequency distribution: 59.2% below 60 micrograms/l, 25.5% between 60 and 100 micrograms, and 15.3% above 100 micrograms/l. The mean serum aluminium level was higher in patients undergoing haemodialysis with aluminium concentration in fluids over 10 micrograms/l. This was true also in patients not receiving aluminium hydroxide. Furthermore, we found higher average serum aluminium in those treated with aluminium hydroxide more than 3 g/day. No relationship was found between serum aluminium and sex, age, dialytic age, parathyroid hormone, and vitamin D treatment. Moreover, the patients with serum aluminium above 100 micrograms/l had higher serum alkaline phosphatase and lower mean cell volume values. Thus, in our haemodialysis population aluminium overloading occurred in spite of low concentration in water and fluid, and it was a result more of fluid pollution (over 10 micrograms/l) than aluminium hydroxide ingestion (over 3 g/day).     

Biomarkers associated with clinical phenotypes of hand osteoarthritis in a large multigenerational family: the CARRIAGE family study

OBJECTIVE: To evaluate biological markers as potential quantitative traits of clinical osteoarthritis (OA) in a large multigenerational family in the Carolinas of the USA known as the CARRIAGE (CARolinas Region Interaction of Aging, Genes and Environment) family. METHODS: During a series of three family reunions over 6 years, we ascertained 365 family members. We performed clinical hand examinations (n=287), and obtained sera (n=278) for seven OA-related biomarkers [type IIA collagen N-propeptide (PIIANP), type II procollagen carboxy-propeptide (CPII), neoepitope from cleavage of CII (C(2)C), cartilage oligomeric matrix protein (COMP), hyaluronan (HA), high-sensitive C-reactive protein (hs-CRP), and glycated serum protein (GSP)]. Three hand OA definitions were evaluated - clinical ACR (American College of Rheumatology) and GOGO (Genetics of Generalized OA) criteria, and any single hand joint involvement. Non-hand OA was defined as a negative hand examination for OA but varying prevalence of joint symptoms; the control group was defined as having neither symptoms nor evidence for clinical hand OA. RESULTS: Mean lnHA, lnCOMP, and lnhs-CRP were significantly higher in the hand OA group, compared with the non-hand OA or control group. Adjusted for age and sex, mean lnPIIANP (a collagen II synthesis marker) was significantly lower in the hand OA group compared with the other groups. Among those without clinical hand OA, GSP was associated with hand joint symptoms. CONCLUSIONS: This is the first report, to our knowledge, showing an association of OA biomarkers and hand OA based on physical examination alone. Analyses using these biomarkers as quantitative traits could reveal novel genetic loci and facilitate exploration of the genetic susceptibility to OA.