<?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="0.012"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18379?impressionId=1265793430694"
                     
      &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_305"
                     title="Polymorphism Predicts OA Severity (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18167?impressionId=1265793430694"
                     
      &lt;p&gt;Researchers say they have identified a genetic marker that can help predict the severity of knee osteoarthritis.&lt;/p&gt;
&lt;p&gt;Polymorphisms in the interleukin-1 receptor antagonist may be critical in determining which will have stable disease and which face progression and structural damage, investigators reported online in the &lt;em&gt;Annals of the Rheumatic Diseases.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;One interleukin-1 receptor antagonist haplotype was associated with lower odds of radiographically severe disease (OR 0.16, 95% CI 0.06 to 0.40), according to Mukundan Attur, PhD, of New York University, and colleagues.&lt;/p&gt;
&lt;p&gt;Carriers of this CTA haplotype also maintained greater joint space width (3.99 mm versus 3.14 mm, &lt;em&gt;P&lt;/em&gt;=0.0008), the researchers reported.&lt;/p&gt;
&lt;p&gt;The lack of biomarkers for severe osteoarthritis is a clinical challenge and an obstacle in the development of disease-modifying drugs for this common cause of disability, the authors noted.&lt;/p&gt;
&lt;p&gt;Attur and colleagues previously demonstrated that an imbalance in interleukin-1 and its antagonists contributes to inflammation and cartilage destruction in osteoarthritis.&lt;/p&gt;
&lt;p&gt;It also has been shown that variations in certain genes for proteins that regulate inflammation also are associated with differential expression of inflammatory mediators and susceptibility to osteoarthritis.&lt;/p&gt;
&lt;p&gt;So the investigators decided to find out whether these polymorphisms could be used to stratify patients into high- and low-risk groups in two independent patient cohorts.&lt;/p&gt;
&lt;p&gt;They recruited 80 patients (mean age was 65.6) from New York University&apos;s Hospital for Joint Diseases, and another group of 50 from the Prediction of Osteoarthritis Progression (POP) study at Duke University.&lt;/p&gt;
&lt;p&gt;All were white, met radiographic criteria for osteoarthritis (Kellgren-Lawrence grade &amp;gt;1) in at least one knee, and were 38 or older. They were stratified for severity as Kellgren-Lawrence grades 1, 2 or 3, 4.&lt;/p&gt;
&lt;p&gt;In both cohorts, 15 single-nucleotide polymorphisms in six inflammatory response genes were genotyped and assessed for association with radiographic severity.&lt;/p&gt;
&lt;p&gt;All significant polymorphisms identified were in one gene, so nine possible haplotypes from three IL-1 receptor antagonist polymorphisms were evaluated.&lt;/p&gt;
&lt;p&gt;Four of these polymorphisms had a frequency greater than 1%, and the CTA haplotype was found to be associated with reduced risk for severe radiographic disease in both patient cohorts.&lt;/p&gt;
&lt;p&gt;Further analysis revealed that CTA haplotype effects were seen not only in the subject knee, but also in the contralateral knee (OR 0.065, 95% CI 0.0076 to 0.55, &lt;em&gt;P&lt;/em&gt;&lt;em&gt;&lt;/em&gt;=0.0024).&lt;/p&gt;
&lt;p&gt;The protective effects of the IL-1 receptor antagonist polymorphism were found only in the medial compartment, where the joint space width in carriers of the CTA haplotype was 3.37 mm, compared with reference haplotype widths of 2.29 mm (&lt;em&gt;P&lt;/em&gt;=0.0054).&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that the genetic influence on osteoarthritis primarily affects medial cartilage, sparing the lateral compartment.&lt;/p&gt;
&lt;p&gt;&quot;The differential compartment effects observed for genetic influence can presumably be attributed to the combination of genetic susceptibility and weight-bearing load (70% concentrated in the medial compartment) that together are necessary and sufficient to cause [osteoarthritis] preferentially in the medial compartment,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;The authors noted several limitations to the study, such as the moderate sample size and the unavailability of longitudinal data that could confirm disease progression.&lt;/p&gt;
&lt;p&gt;They also noted that the haplotype associated with protection in later stages of osteoarthritis may have different effects in earlier disease.&lt;/p&gt;
&lt;p&gt;Currently there are no drugs on the market that can alter the progression of osteoarthritis, but the identification of biomarkers such as the interleukin-1 receptor antagonist CTA haplotype should help expedite the development of disease modifying drugs  --  and thus improve the overall management of osteoarthritis, the investigators concluded.&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 grants from Interleukin Genetics and the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Several of the co-authors were employees of Interleukin Genetics.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_275"
                     title="Spa Therapy Reduces Arthritic Knee Pain (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Geriatrics/Arthritis/tb/18132?impressionId=1265793430694"
                     
      &lt;p&gt;French spa therapy reduces pain and improves function in patients suffering from osteoarthritis of the knee, but it fails to improve their general quality of life, a new study found.&lt;/p&gt;
&lt;p&gt;Of the patients with knee osteoarthritis who exercised at home and received mineral water and mud therapy at France&apos;s largest spas, 51% reported minimally clinically important improvements in pain and function after six months, compared with only 36% of patients who only exercised (&lt;em&gt;P&lt;/em&gt;=0.005), according to an online report in the Sept. 3 &lt;em&gt;Annals of the Rheumatic Diseases.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;However, spa therapy was not associated with improved quality of life or improvements significant enough that patients considered themselves well.&lt;/p&gt;
&lt;p&gt;&quot;This study demonstrates that an intensive course of spa therapy with [a home exercise program] and usual treatment provides medium-term benefit over a home exercise program and usual treatment alone in the management of knee osteoarthritis,&quot; Jean-Luc Bosson, of CHU de Grenoble, in Grenoble, France, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;To our knowledge this is the first multicenter, randomized controlled trial of spa therapy for knee osteoarthritis.&quot;&lt;/p&gt;
&lt;p&gt;Spa therapy is often prescribed for patients with knee osteoarthritis in Europe and is covered by social security in France and many other European countries.&lt;/p&gt;
&lt;p&gt;In 2007, roughly 200,000 French patients received spa treatment for knee arthritis, which includes activities such as soaking in mineral pools and mud baths and receiving massages. Despite the popularity of the therapy, little high-quality scientific evidence existed to support its effectiveness.&lt;/p&gt;
&lt;p&gt;To bring rigor to the question, Bosson and colleagues enrolled 382 patients with knee osteoarthritis in a randomized controlled trial between June 2006 and April 2007.&lt;/p&gt;
&lt;p&gt;Of the participants, 195 conducted home exercises and received treatment at one of the three largest spa therapy resorts in France  --  Aix-les-Bains, Balaruc, or Dax. Another 187 served as controls, only participating in the home exercise portion of the therapy.&lt;/p&gt;
&lt;p&gt;The participants lived close enough to the spas that they could drive to each visit, avoiding the possibility that effects of the treatment could be attributable to the improved well-being of going on vacation.&lt;/p&gt;
&lt;p&gt;The exercise program consisted of knee strengthening exercises conducted three times a day. Participants in the spa treatment group also received 18 days of spa therapy over three weeks.&lt;/p&gt;
&lt;p&gt;The therapy, designed by experienced physicians, included mineral hydrojet sessions, manual massages of the knee and thigh under heated mineral water by a physiotherapist, applications of mineral-matured mud to the knees, and supervised group general mobilization sessions in a mineral water pool.&lt;/p&gt;
&lt;p&gt;Participants attended follow-up visits with a physician at one, three and six months, during which the patients filled out self-assessment forms to gauge their average level of pain, the severity of their osteoarthritis and their quality of life.&lt;/p&gt;
&lt;p&gt;Therapy was considered a success if patients required no knee surgery and showed minimal clinically important improvement at six months (defined as &amp;#8805;19.9 mm on the visual analogue pain scale and/or &amp;#8805;9.1 points in a normalized WOMAC function score).&lt;/p&gt;
&lt;p&gt;Of the participants, 55 dropped out before the study was complete, and 14 patients failed to return their six-month questionnaires.&lt;/p&gt;
&lt;p&gt;The authors argued that spa therapy seems to offer some improvement over arthroscopic surgery and acupuncture, which have shown little efficacy in recent studies.&lt;/p&gt;
&lt;p&gt;&quot;A physical exercise regimen has been shown to be effective for knee osteoarthritis,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Nevertheless, it is well known that unsupervised home exercise programs often have limited efficacy over time due to progressive lack of compliance, even in the context of therapeutic trials with consecutive visits and that are motivating for the patients. Thus a course of spa therapy may enhance patient compliance to home exercise program.&quot;&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 French Society for Spa Research, the Rhone-Alpes regional council, and the County Council of Savoie.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&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="0.001"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18126?impressionId=1265793430694"
                     
      &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;
    </recommendedItem>
    <recommendedItem id="20090101_9_933"
                     title="Arthritic Knee Procedures May Lead to Future Deterioration"
                     score="-0.005"
                     href="