<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_455"
                     title="Low Vitamin D Linked to Hip OA (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18379?impressionId=1265802610953"
                     
      &lt;p&gt;Elderly men with low serum levels of vitamin D are at increased risk for developing hip osteoarthritis, a prospective cohort study found.&lt;/p&gt;
&lt;p&gt;Men whose levels of 25-hydroxyvitamin (OH)D were between 15.1 to 30 ng/mL had twice the likelihood of prevalent radiographic hip osteoarthritis than those whose levels were normal (OR 2.19, 95% CI 1.21 to 3.97), according to R. Krishna Chaganti, MD, of the University of California at San Francisco, and colleagues.&lt;/p&gt;
&lt;p&gt;Conversely, after adjusting for age, season at blood draw, and clinic site, higher vitamin D levels were associated with a lower prevalence of hip osteoarthritis (OR 1.39 per 1 SD decrease in 25(OH)D level, 95% CI 1.11 to 1.74), the researchers reported in the February issue of &lt;em&gt;Arthritis &amp;amp; Rheumatism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Because the role vitamin D may play in the pathogenesis and progression of osteoarthritis is unclear, Chaganti and colleagues analyzed data from the Osteoporotic Fractures in Men Study, which enrolled a large cohort of elderly men between 2000 and 2002 from six centers across the U.S.&lt;/p&gt;
&lt;p&gt;A total of 1,104 men whose mean age was 77.2 years had baseline measurements of serum vitamin D, and about 4.5 years later pelvic radiographs were obtained.&lt;/p&gt;
&lt;p&gt;Radiographs were scored to reflect joint space narrowing, osteophyte formation, cysts, subchondral sclerosis, and femoral head deformity.&lt;/p&gt;
&lt;p&gt;Vitamin D levels were categorized as deficiency (&amp;#8804;15 ng/mL), insufficiency (15.1 to 30 ng/mL), and sufficiency (&amp;gt;30 ng/mL).&lt;/p&gt;
&lt;p&gt;Mean vitamin D level was 23.38 ng/mL in men who had radiographic hip osteoarthritis, compared with 26.04 ng/mL in men without radiographic abnormalities (&lt;em&gt;P&lt;/em&gt;=0.0002).&lt;/p&gt;
&lt;p&gt;Men with hip osteoarthritis had a higher prevalence of both vitamin D insufficiency (77% versus 65%, &lt;em&gt;P&lt;/em&gt;=0.002) and deficiency (10.2% versus 7.5%, &lt;em&gt;P&lt;/em&gt;=0.012).&lt;/p&gt;
&lt;p&gt;Moreover, they had slower six-meter walking speed (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) and reported more hip pain (&lt;em&gt;P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;Men who were vitamin D deficient also tended to have an increased likelihood of hip osteoarthritis (OR 1.99, 95% CI 0.83 to 4.74), but after adjustment in multivariate models, statistical significance was lost with this level of the vitamin.&lt;/p&gt;
&lt;p&gt;&quot;The association of low 25(OH)D levels with prevalent radiographic hip [osteoarthritis] underscores the potentially important role of vitamin D in the pathogenesis of [osteoarthritis]. Vitamin D metabolites have been found to be associated with the regulation of the Wnt pathway, products of which play important roles in the development and maintenance of bone and cartilage,&quot; the investigators explained.&lt;/p&gt;
&lt;p&gt;Furthermore, in vitro studies have suggested that serum levels of 25-hydroxyvitamin D&lt;sub&gt;3&lt;/sub&gt; can affect the ratio of RANKL to osteoprotegerin and thereby influence bone deterioration and repair.&lt;/p&gt;
&lt;p&gt;Previous investigations have yielded conflicting results. One study found that low levels of vitamin D were not associated with worsening of knee osteoarthritis, as reflected in loss of articular cartilage on MRI.&lt;/p&gt;
&lt;p&gt;Another study, however, linked knee osteoarthritis with low vitamin D levels, particularly in patients who also had decreased bone mineral density in the lumbar spine.&lt;/p&gt;
&lt;p&gt;&quot;Vitamin D influences the mineralization of bone matrix, and low serum levels of vitamin D may result in poorly mineralized bone that might alter forces across the joint and reduce joint deterioration,&quot; the authors suggested.&lt;/p&gt;
&lt;p&gt;On the other hand, low levels may interfere with chondrocyte metabolism and thereby increase degeneration.&lt;/p&gt;
&lt;p&gt;Further studies will be needed to more fully clarify the effects of the vitamin on the development and progression of osteoarthritis, the investigators cautioned.&lt;/p&gt;
&lt;p&gt;Strengths of the study include the large cohort of participants, careful classification of radiographic osteoarthritis, and reliance on the gold standard of vitamin D measurement, the 25(OH)D level.&lt;/p&gt;
&lt;p&gt;Limitations include the cross-sectional design, precluding the inference of causality, and the gap in time between measurement of serum vitamin D and radiography.&lt;/p&gt;
&lt;p&gt;The authors concluded that therapeutic interventions to increase vitamin D serum levels in the elderly &quot;are warranted,&quot; with the goal of improving skeletal health in this vulnerable age group.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, the National Center for Research Resources, and the NIH Roadmap for Medical Research.&lt;/p&gt;&lt;p&gt;The lead author was supported by a grant from the American College of Rheumatology Research and Education Foundation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265802610953"
                     
      &lt;p&gt;SAN ANTONIO  --  A personalized, online self-management program helped patients with pain syndromes improve coping skills and reduce stress and depression in two studies reported here.&lt;/p&gt;
&lt;p&gt;Patients randomized to the self-management program demonstrated significant improvement in multiple social, emotional, and behavioral outcomes after six months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). Improvement in some parameters occurred within one month. A control group that was not exposed to the program showed no significant improvement.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to help people communicate better with providers, understand better how they can use social support, understand the comorbid conditions, like anxiety and depression, and develop cognitive skills to help get them through their pain episodes,&quot; said Emil Chiauzzi, PhD, of Inflexxion, the Newton, Mass. company that developed the program.&lt;/p&gt;
&lt;p&gt;Although the studies involved patients with migraine or low-back pain, programs are being developed for other types of pain condition, including several forms of neuropathic pain.&lt;/p&gt;
&lt;p&gt;The online program, demonstrated at &lt;a href=&quot;http://www.painACTION.com&quot; mce_href=&quot;http://www.painACTION.com&quot; target=&quot;_blank&quot;&gt;www.painACTION.com&lt;/a&gt;, employs patient-specific information to generate individualized self-management strategies.&lt;/p&gt;
&lt;p&gt;Patient responses to assessments are analyzed by a &quot;recommendation engine,&quot; which produces content recommendations designed to address each patient&apos;s informational and self-management needs.&lt;/p&gt;
&lt;p&gt;Elements on the Web site include multimedia education units, a pain inventory, interactive tools that provide information based on patient-provider communication, and medication risk management.&lt;/p&gt;
&lt;p&gt;&quot;The content on the Web site is focused on teaching people practical skills to manage the behavioral side of pain,&quot; Jonas Bromberg, PsyD, also of Inflexxion, said in an interview.&lt;/p&gt;
&lt;p&gt;Bromberg presented results of a randomized study involving 210 patients, all of whom met International Headache Society diagnostic criteria for migraine, with or without aura.&lt;/p&gt;
&lt;p&gt;Patients assigned to the online program completed at least eight 30-minute session during the first month of the study and at least five more 30-minute sessions during the five-month follow-up period. Patients in the control group continued to receive usual care without exposure to the Web site.&lt;/p&gt;
&lt;p&gt;Participants assigned to the online program had a minimum set of requirements for each session, which were provided at log-in. Follow-up assessments occurred at one, three, and six months.&lt;/p&gt;
&lt;p&gt;The two groups were balanced with respect to sex and headache frequency and severity, the researchers said.&lt;/p&gt;
&lt;p&gt;Bromberg reported that patients assigned to the self-management program demonstrated significant improvement in: &lt;ul&gt; &lt;li&gt;Headache self-efficacy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 compared with baseline)&lt;/li&gt; &lt;li&gt;Use of relaxation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Use of social support (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Pain catastrophizing (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Depression (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Chiauzzi presented results from a randomized study of 209 patients with low-back pain. The design was similar to that of the migraine study, except results were analyzed for between-group differences.&lt;/p&gt;
&lt;p&gt;The results showed significant improvement in the study group versus control group with respect to: &lt;ul&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Coping (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Social supports (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The data showed significant effects of both treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and time (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) favoring the Web site versus control. Chiauzzi said patients assigned to the Web site had greater mean improvement at posttest, three months, and six months.&lt;/p&gt;
&lt;p&gt;Qualitative analysis suggested that Web site participants had clinically meaningful improvement in depression, anxiety, and stress.&lt;/p&gt;
&lt;p&gt;Additionally, patients in the self-management program reported a 12.3% decrease in pain from baseline, versus 7% in the control group.&lt;/p&gt;
&lt;p&gt;Access to the Web site did not improve physical functioning.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Chiauzzi and Bromberg are employees of Inflexxion, developer of the online program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_397"
                     title="AAPM: Nerve Growth Factor Antibody  May Reduce Pain (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18300?impressionId=1265802610953"
                     
      &lt;p&gt;SAN ANTONIO  --  A humanized monoclonal antibody against nerve growth factor provided relief in three chronic pain syndromes, according to a summary of small studies reported as an abstract here.&lt;/p&gt;
&lt;p&gt;Treatment with tanezumab led to statistically or clinically significant reductions in pain for patients with osteoarthritis, chronic lower back pain, and interstitial cystitis. The most common adverse events were transient abnormal peripheral sensations, which generally occurred only after the first infusion.&lt;/p&gt;
&lt;p&gt;&quot;Patients with these three different pain syndromes all had significant improvement when treated with tanezumab,&quot; Leslie Tive, PhD, of Pfizer, said in an interview at the American Academy of Pain Medicine meeting. &quot;The pain relief was sustained over time, and patient acceptance was good.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Nerve growth factor is increased in many types of chronic pain and therefore represents an attractive target for therapy,&quot; she added. &quot;Tanezumab is being evaluated in some of these other conditions in ongoing studies.&quot;&lt;/p&gt;
&lt;p&gt;A small phase I study showed that the humanized monoclonal antibody resulted in significant pain improvement in patients with osteoarthritis (&lt;em&gt;Arthritis Rheum&lt;/em&gt; 2005; 52: S461). Tive presented data from a phase II trial involving 400 patients with osteoarthritis of the knee. They were randomized to placebo or to one of five tanezumab doses, administered on day one and day 56.&lt;/p&gt;
&lt;p&gt;All five doses of tanezumab resulted in significant reductions (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) versus placebo after one week and were sustained through 16 weeks. As assessed by a visual analog scale, the mean change in pain on walking from baseline to week 16 ranged from 30 to 45 points (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), a two- to threefold difference compared with placebo.&lt;/p&gt;
&lt;p&gt;The trial in chronic low back pain involved 217 adults with Quebec Task Force on Spinal Disorders category 1 or 2 pain for at least three months. The primary location of the pain was between the 12th thoracic vertebra and the lower gluteal folds.&lt;/p&gt;
&lt;p&gt;Eligibility criteria included a score of at least 4 on an 11-point pain scale on at least four occasions in the five days before randomization, as indicated by entries in an electronic pain diary.&lt;/p&gt;
&lt;p&gt;Patients were randomized 2:2:1 to a single infusion of tanezumab, to oral naproxen, or to placebo. The primary endpoint was the change in mean Lower Back Pain Index score from baseline to six weeks, averaged over the last seven days.&lt;/p&gt;
&lt;p&gt;Beginning at week one and continuing through week six, patients who were randomized to either dose of tanezumab had significantly greater improvement in pain than those who took the placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), and compared with the naproxen group beginning at week two (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;The interstitial cystitis study included 64 men and women who had a score &amp;#8805;13 on Pelvic Pain Symptom/Frequency questionnaire, &amp;#8805;7 score on the O&apos;Leary-Sant Interstitial Cystitis index, and micturition frequency &amp;#8805;8 times a day, as recorded in an electronic diary for at least five consecutive days prior to randomization.&lt;/p&gt;
&lt;p&gt;Patients were randomized to intravenous tanezumab or matching placebo. The primary efficacy endpoint was change from baseline to six weeks in the 11-point pain scale. A difference of at least one point from placebo was considered clinically significant. Statistical significance was not evaluated.&lt;/p&gt;
&lt;p&gt;The mean difference between tanezumab and placebo was -0.7 at week two, increasing to -1.1 at week four and -1.4 at week six. The advantage versus placebo was maintained at week 10 (-0.9) and week 16 (-0.5).&lt;/p&gt;
&lt;p&gt;Adverse events were evaluated for all patients combined in the three studies. Adverse events were reported by 66.3% of tanezumab patients, 61.4% of naproxen patients, and 59.3% of placebo patients. Serious and severe adverse events occurred in 1.6% to 3.4% of patients and 4.8% to 5.7%, respectively.&lt;/p&gt;
&lt;p&gt;Tive said 14.4% of tanezumab patients reported abnormal peripheral sensations, the most common being paresthesia (7.1%), hyperesthesia (4.1%), and hypoesthesia (3.9%).&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies included in the summary were funded by Pfizer.&lt;/p&gt;&lt;p&gt;Investigators included several Pfizer employees.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_337"
                     title="RA Patients Maintain Computer Skills (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18215?impressionId=1265802610953"
                     
      &lt;p&gt;The hand impairment experienced by many patients with rheumatoid arthritis did not significantly interfere with their computer use, researchers found.&lt;/p&gt;
&lt;p&gt;On average, a group of patients with longstanding rheumatoid arthritis had only mild impairments on the Keitel Hand Function Index, which assesses active range of motion, according to Nancy A. Baker, ScD, and Joan C. Rogers, PhD, from the University of Pittsburgh.&lt;/p&gt;
&lt;p&gt;Participants&apos; mean score was 21.8 on this index, which includes scores ranging from 4 to 52, with higher scores indicating greater impairment, the investigators reported in the Feb. 15 issue of&lt;em&gt; Arthritis Care &amp;amp; Research.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Many patients with rheumatoid arthritis experience impairments in hand strength and range of motion because of joint synovitis and report difficulties using computer peripherals.&lt;/p&gt;
&lt;p&gt;But to remain competitive in today&apos;s marketplace, workers must maintain computer skills, including typing and use of the mouse, both of which require coordinated hand actions.&lt;/p&gt;
&lt;p&gt;Because there&apos;s little objective data on possible loss of productivity because of hand involvement in rheumatoid arthritis, Baker and Rogers recruited 45 computer users with the disease from their university&apos;s Arthritis Network Research Registry.&lt;/p&gt;
&lt;p&gt;Their study sought to discover which variables  --  impairments in range of motion, impairments in hand function, general activity limitations, or task-specific training (training in touch typing)  --  explain the most variance in keyboard and mouse speeds in computer users with rheumatoid arthritis.&lt;/p&gt;
&lt;p&gt;Participants&apos; mean age was 56.2, and duration of disease was 16.7 years. Most were women and white and 73% had been trained in touch typing.&lt;/p&gt;
&lt;p&gt;About half were employed, and most of those reported that computer use was very important to their work.&lt;/p&gt;
&lt;p&gt;Specific keyboard tasks measured included typing the alphabet from memory, typing a series of words that contain all letters of the alphabet, and repeating key strikes.&lt;/p&gt;
&lt;p&gt;Specific mouse tasks included pointing and clicking, dragging an icon, and moving a rectangle to a target.&lt;/p&gt;
&lt;p&gt;Moderate impairments were seen on the Arthritis Hand Function Test, which measures pure and applied strength and dexterity, with a mean score of 35.5 (range 14 to 56, with higher scores representing less impairment).&lt;/p&gt;
&lt;p&gt;General activity limitations, as measured by the Health Assessment Questionnaire (HAQ), were mild, with a mean score of 1 (range 0 to 3, with higher scores indicating worse functioning).&lt;/p&gt;
&lt;p&gt;The investigators then performed regression analyses for each of the individual keyboard and mouse tasks, with predictor variables for keyboard tasks being age, training in touch typing, and the three arthritis scores. Mouse regression analyses omitted the touch-typing variable.&lt;/p&gt;
&lt;p&gt;All regression analyses of skills in keyboarding were significant and explained 27% to 45% of the variance in typing speed, the investigators found.&lt;/p&gt;
&lt;p&gt;The strongest predictor of typing speed was training in touch typing, as was shown by the large effect sizes for this association (r&lt;sup&gt;2&lt;/sup&gt;=0.40 to 0.56).&lt;/p&gt;
&lt;p&gt;&quot;Motor skill, such as the ability to tap fingers quickly, is not consistently associated with speed in touch typing because speed in touch typing is most strongly associated with the ability to look ahead in the text, a perceptual ability rather than a motor skill,&quot; they explained.&lt;/p&gt;
&lt;p&gt;Younger age also had moderate to large significant associations with faster typing (r&lt;sup&gt;2&lt;/sup&gt;=0.32 to 0.51).&lt;/p&gt;
&lt;p&gt;Several regression analyses of skill in use of the mouse also were significant and explained from 26% to 43% of the variance in mouse speed.&lt;/p&gt;
&lt;p&gt;Younger age once again had significant and large associations with faster mouse speed (r&lt;sup&gt;2&lt;/sup&gt;=0.43 to 0.54).&lt;/p&gt;
&lt;p&gt;In general, there were few significant associations between speed and impairments in hand function.&lt;/p&gt;
&lt;p&gt;Rather, the researchers found that general activity limitation and decreased context-specific activity ability, as measured by the HAQ disability index, was the most significant arthritis-related variable.&lt;/p&gt;
&lt;p&gt;The skills of the patients in the rheumatoid arthritis group also were compared with those of historical controls (30 who were unimpaired and 24 with various upper extremity impairments).&lt;/p&gt;
&lt;p&gt;Keyboarding speeds were found to be comparable with unimpaired workers, suggesting that most of the arthritis patients could be competitive in the job market.&lt;/p&gt;
&lt;p&gt;Mouse speed, however, was greater in the controls. Moreover, some of the arthritis patients were considerably slower than both unimpaired and impaired controls.&lt;/p&gt;
&lt;p&gt;The findings of this study suggest that if people with motor impairments can learn touch typing, it might increase their productivity.&lt;/p&gt;
&lt;p&gt;&quot;Clinicians may want to consider informing computer users with [rheumatoid arthritis] to take touch-typing training to improve performance,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;They acknowledged that the study was exploratory and had certain limitations, including small sample size, low response rate, and use of historical controls.&lt;/p&gt;
&lt;p&gt;They recommended that the study be replicated including participants both with and without rheumatoid arthritis to more closely examine personal factors such as age.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the American College of Rheumatology Research and Education Foundation.&lt;/p&gt;&lt;p&gt;No financial disclosures were provided.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_270"
                     title="Racial Differences Found in RA Radiographic Features (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18126?impressionId=1265802610953"
                     
      &lt;p&gt;African-Americans of both sexes have more features and patterns associated with progression of hip osteoarthritis than whites, a cross-sectional analysis found.&lt;/p&gt;
&lt;p&gt;Compared with white women, the adjusted odds ratio among African-American women for moderate or severe axial joint space narrowing was 2.3 (95% CI 1.1 to 5), according to Amanda E. Nelson, MD, of the University of North Carolina in Chapel Hill, and colleagues.&lt;/p&gt;
&lt;p&gt;Moreover, African-American men had twice the odds of more frequent and severe superior joint space narrowing of white men (adjusted OR 2, 95% CI 1.5 to 2.8), the researchers reported online in &lt;em&gt;Arthritis Care &amp;amp; Research&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Most comparisons of characteristics and severity of hip osteoarthritis are based on Kellgren-Lawrence grade, a global measure encompassing joint space narrowing, subchondral cysts and sclerosis, and osteophytes.&lt;/p&gt;
&lt;p&gt;This global assessment, however, does not distinguish between medial and lateral involvement, and emphasizes the presence of osteophytes over other features.&lt;/p&gt;
&lt;p&gt;Among elderly white women, both the location of osteophytes within the hip joint and the pattern of joint space narrowing have been shown to influence the likelihood of radiographic progression and the need for hip replacement surgery.&lt;/p&gt;
&lt;p&gt;Because these individual features might be more useful than the global assessment in determining the course and prognosis of osteoarthritis at the hip, the researchers recruited 2,739 participants  --  1,184 men and 1,555 women  --  from an ongoing population-based study in North Carolina.&lt;/p&gt;
&lt;p&gt;A total of 31% were African-American.&lt;/p&gt;
&lt;p&gt;Investigators assessed radiographic features that included joint space narrowing (superior, axial, or medial), subchondral cysts (femoral or acetabular), sclerosis (femoral or acetabular), and osteophytes (medial and lateral, acetabular and/or femoral).&lt;/p&gt;
&lt;p&gt;In unadjusted analyses, white women had more mild axial joint space narrowing than African-American women (26% versus 20%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), while African-American women had more of the following features: &lt;ul&gt; &lt;li&gt;Mild superior joint space narrowing, 9% versus 6%, &lt;em&gt;P&lt;/em&gt;=0.004&lt;/li&gt; &lt;li&gt;Subchondral cysts, 5% versus 4%, &lt;em&gt;P&lt;/em&gt;=0.02&lt;/li&gt; &lt;li&gt;Medial osteophytes on the femoral side, 5% versus 2%, &lt;em&gt;P&lt;/em&gt;=0.006&lt;/li&gt; &lt;li&gt;Lateral osteophytes on the acetabular side, 47% versus 43%, &lt;em&gt;P&lt;/em&gt;=0.001&lt;/li&gt; &lt;li&gt;Osteophytes in any site (acetabular 47.1% versus 42.5%, femoral 5.1% versus 3.6%, or both, 16% versus 13.2%) &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;After adjustment for age, body mass index, education, and previous hip injury, African-American women were 70% more likely than white women to have superior joint space narrowing (OR 1.7, 95% CI 1.2 to 2.3), and for this reason to have severe conditions.&lt;/p&gt;
&lt;p&gt;In the adjusted model, the odds of having subchondral cysts were 50% higher for African-American women (OR 1.5, 95% CI 1 to 2.3), while the odds for having severe medial osteophytes were 40% higher (OR 1.4, 95% CI 1 to 2).&lt;/p&gt;
&lt;p&gt;For men, unadjusted analyses found that African-Americans had more frequent mild superior joint space narrowing (15% versus 7%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;African-American men also had these features more frequently in unadjusted analyses: &lt;ul&gt; &lt;li&gt;Sclerosis, 24% versus 20%, &lt;em&gt;P&lt;/em&gt;=0.03&lt;/li&gt; &lt;li&gt;Lateral osteophytes on the acetabular side, 39% versus 34%, &lt;em&gt;P&lt;/em&gt;=0.001&lt;/li&gt; &lt;li&gt;Osteophytes in both medial and lateral compartments (acetabular only, 36.6% versus 33.4%; both acetabular and femoral, 19.1% versus 13%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In the adjusted model for men, there were no differences according to race in sclerosis, subchondral cysts, or medial osteophytes.&lt;/p&gt;
&lt;p&gt;However, African-American men were 40% more likely to have lateral osteophytes (adjusted OR 1.4, 95% CI 1.1 to 1.8) and 80% more likely to have both acetabular and femoral osteophytes (adjusted OR 1.8, 95% CI 1.3 to 2.7).&lt;/p&gt;
&lt;p&gt;Investigators said the observations suggest anatomic or complex biomechanical differences between the races in weight-bearing and loading of joints that lead to different radiographic pattern.&lt;/p&gt;
&lt;p&gt;Local or systemic differences in bone mineral density, which were not measured in this study, could increase osteophyte formation in African-Americans, who have higher overall bone density than whites, they wrote.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that the presence of acetabular and femoral osteophytes and joint space narrowing are associated with a greater likelihood of progression.&lt;/p&gt;
&lt;p&gt;In this study, African-American women had increased odds of having these prognostic features and therefore may be at higher risk of progression and of needing total hip replacement.&lt;/p&gt;
&lt;p&gt;Yet the rates of total hip replacement currently are far lower among African-Americans, which researchers attributed to a lower prevalence of hip osteoarthritis.&lt;/p&gt;
&lt;p&gt;In this sample the prevalence of osteoarthritis among African-American and white women was 23% and 22%, respectively, and the prevalence among African-American and white men was 21% and 17%, respectively.&lt;/p&gt;
&lt;p&gt;This suggests that there is a potentially large, unmet need for total hip replacement among African-Americans, the investigators said.&lt;/p&gt;
&lt;p&gt;Limitations of the study included small numbers of patients with more moderate and severe features, and the absence of data on symptoms, while a strength was the large sample size.&lt;/p&gt;
&lt;p&gt;The investigators noted that they are further evaluating a subset of the X-ray films looking for racial differences in femoral and pelvic anatomy that might contribute to the differences.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Association of Schools of Public Health, the Centers for Disease Control and Prevention, the National Institute of Arthritis, Musculoskeletal and Skin Diseases, and by a John A. Hartford Foundation grant.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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