Divya Sanghi

Is radiology a determinant of pain, stiffness, and functional disability in knee osteoarthritis? A cross-sectional study

Background and purposesDiscordance between clinical and radiological profiles in knee osteoarthritis has been reported. We hypothesized that the discordance could be due to limited radiological variables studied. This study essentially analyzed many more radiological features than previous studies in order to seek an association between clinical and radiographic features.MethodsOne hundred and eighty patients with knee osteoarthritis were enrolled as per the American College of Rheumatology (ACR) guidelines. Visual analog scale (VAS) for knee pain and the knee-specific Western Ontario Mac University (WOMAC) index for pain, stiffness, and disability were recorded. Five additional radiological features apart from those in the Kellgren-Lawrence (KL) classification grading system were recorded by two authors who were blinded to the clinical diagnosis. The variables significantly associated were analyzed by linear regression model.ResultsPain was significantly associated with increasing KL grades; physical function was nearly significant and stiffness was not. On analysis of individual radiological features, WOMAC pain was significant with subchondral sclerosis, joint space width, and tibiofemoral alignment although the correlation was week. VAS pain was significant with the latter two and with articular incongruity. Functional disability was associated with medial joint-space narrowing, tibiofemoral alignment, loose bodies, and juxta-articular osteopenia. However, in the linear regression model, pain and stiffness were significantly associated with articular incongruity and functional disability and total clinical scores with juxta-articular osteopenia.ConclusionWhen the radiological features were extended beyond those included in KL grades, pain, stiffness, and disability correlated well with radiography; articular incongruity with pain and stiffness; and juxta-articular osteopenia with physical disability and clinical severity.

Elucidation of Dietary Risk Factors in Osteoarthritis Knee—A Case-Control Study

Background and Objective: Nutritional imbalance, combined with endocrine abnormalities, may be involved in the pathogenesis of osteoarthritis (OA). This study was conducted to determine the association of OA with dietary factors, such as quantity and quality of nutrient intake. Methods: This case-control study enrolled 180 knee osteoarthritis (KOA) subjects who met the American College of Rheumatology definition of KOA, with an equal number of matched controls. Outcome measures, such as dietary nutrient intake and its frequency, were recorded using a food frequency questionnaire. Results: Compared to controls, cases were older individuals with a higher body mass index (BMI). Physical activity scores were lower in female cases compared to male cases and controls. A significantly higher intake of phosphorus and fat was observed in overall cases (fat in females only). A significantly lower intake of vitamin C and vitamin D was observed in overall cases and the significance of vitamin D persisted on gender-wise bifurcation. On multiple logistic regression analysis, the intake of vitamin D (odds ratio [OR] = 0.79) and vitamin C (OR = 0.97) was inversely associated with the presence of KOA in the observation group, especially in females. Generally, the intake of food servings/day, green leafy vegetables (GLVs), and fats/oils was higher, whereas the intake of fruits, milk/milk products, and meat/poultry was lower in cases compared to controls. Conclusion: Low intake of vitamin D and vitamin C is a possible risk factor for KOA. Certain food groups, such as fruits, milk/milk products, and meat/poultry are beneficial for KOA. Further studies are needed to elucidate the associations between diet and KOA.

The association of anthropometric measures and osteoarthritis knee in non-obese subjects: a cross sectional study

OBJECTIVE: Body mass index (BMI) and knee osteoarthritis have a strong association, but other anthropometric measures lack such associations. To date, no study has evaluated non‐obese knee osteoarthritis to negate the systemic and metabolic effects of obesity. This study examines the validity of the contention that BMI and other anthropometric measures have a significant relationship with knee osteoarthritis. METHODS: In total, 180 subjects with a diagnosis of knee osteoarthritis were recruited and classified according to Kellgren‐Lawrence (KL) grades. Body mass index, mid‐upper arm circumference, waist‐hip ratio and triceps‐skinfold thickness were recorded by standard procedures. Osteoarthritis outcome scores (WOMAC) were evaluated. RESULTS: (1) In both genders, the BMI was significantly higher for KL grade 4 than for grade 2; triceps‐skinfold thickness was positively correlated with the joint space width of the tibial medial compartment. (2) In males, triceps‐skinfold thickness significantly increased as the KL grades moved from 2 to 4; the significantly higher BMI found in varus aligned knees was positively correlated with WOMAC scores. (3) In females, the waist‐hip ratio was significantly higher for KL grade 4 than for grade 2; a significant correlation was found between BMI and WOMAC scores. The waist‐hip ratio was significantly associated with varus aligned knees and it positively correlated with WOMAC scores and with the joint space width of the tibial medial compartment. The mid‐upper arm circumference demonstrated no correlation with knee osteoarthritis. CONCLUSION: This study validates the contention that BMI and other anthropometric measures have a significant association with knee osteoarthritis. Contrary to common belief, the triceps‐skinfold thickness (peripheral fat) in males and the waist‐hip ratio (central fat) in females were more strongly associated with knee osteoarthritis than BMI.

Vitamin D receptor gene polymorphisms modulate the clinico-radiological response to vitamin D supplementation in knee osteoarthritis

Materials and methods This randomized placebo-controlled trial recruited 103 KOA cases as per American College of Rheumatology (ACR) guideline having vitamin D insufficiency (25(OH) D≤50 nmol/L). Enrolled cases were randomly allocated in two groups to receive placebo (51) and vitamin D (52). Primary outcome measures: pain and functional disability which were recorded by knee specific WOMAC index and secondary outcome measure were radiological features (joint space width and osteophytes). The serum levels of vitamin D were assessed by ELISA method using IDS, UK kit. Detection of VDR polymorphisms (Taq1 & Apa I) were done by PCR-RFLP technique. 25(OH)D levels, clinical and radiological features were recorded at baseline and at one year follow up.

Association of Intronic Single Nucleotide Polymorphism (SNP) of CALM 1 gene with Osteoarthritis of the Knee in Indian Population: A Case-control Study

ABSTRACT: H1N1 influenza is an emerging threat that is life threatening to pregnant women in the third trimester. Pregnant women are a high-risk group for morbidity and mortality from influenza (H1N1). During the current pandemic of H1N1 influenza, few cases of H1N1 have been reported in pregnancy. We report a case of H1N1 influenza in a 23-year old female with 28 weeks of gestation, who developed acute respiratory distress syndrome, required mechanical ventilation and eventually recovered. KEYWORDS : H1N1; Acute Respiratory Distress Syndrome; Pregnancy; Influenza Internet Journal of Medical Update 2012 January;7(1):73-76

Poster 84 Which Radiologic Feature Is a True Predictor of Clinical Severity in Knee Osteoarthritis

with osteoarthritis of the knee. Design: Randomized, single blind, open-labeled, controlled trial. Setting: Outpatient. Participants: 113 patients randomly assigned to group A (n 55) or B (n 58). Interventions: Group A subjects received oral collagen hydrolysate, 400 mg/capsule 3 capsules once a day at bedtime. Group B underwent the conventional treatment of nonsteroidal anti-inflammatory drug for 5 days, then as needed for pain. Both groups also were prescribed with a topical analgesic to be applied twice a day as needed for pain, and physical therapy treatment thrice a week for 2 weeks. Follow-up evaluation was done every month to assess developments from the symptoms. Initial radiograph of the knee was done before the intake of the medications and was repeated after 6 months of completion of the intervention. Main Outcome Measures: Western Ontario and McMaster Universities (WOMAC) Knee Osteoarthritis Index, Likert Scale, and measurement of the radiographed medial compartment of the tibiofemoral joint by using a standard ruler in millimeters. Results: Patients in group A significantly scored lower in the average WOMAC score from baseline to the 6th month follow-up (P .04), whereas group B had no significant change in their average WOMAC score after 6 months (P .21). There was no significant difference in the medial knee joint space measured at baseline and after 6 months in both groups (group A, P .42; group B, P .32). Conclusions: The administration of 1200 mg of collagen hydrolysate daily for a period of 6 months had a beneficial impact on pain symptoms and joint function in patients with osteoarthritis.

Poster 81 Association of Vitamin D Receptor Gene Polymorphisms and Vitamin D Status in Knee Osteoarthritis

neuroprosthesis to improve gait biomechanics. Discussion: Although dystonia in HIV has been associated with opportunistic infection and encephalopathy, some have suggested that HIV and ART may accelerate neurodegeneration and the appearance of movement disorders. This is the first reported case of adult onset torsion dystonia with normal spine and brain MRI in the setting of HIV, which improved clinically after switching ART regimens. Conclusions: This case highlights accelerated torsion dystonia in an patient with HIV on ART that improved with discontinuation of TE, which suggests an association between ART and MD that may be modifiable based on selection of ART drug regimen.

Poster 82 Intronic Single Nucleotide Polymorphism of the CALM-1 Gene Is Significantly Associated With Knee Osteoarthritis: A Case Control Study

neuroprosthesis to improve gait biomechanics. Discussion: Although dystonia in HIV has been associated with opportunistic infection and encephalopathy, some have suggested that HIV and ART may accelerate neurodegeneration and the appearance of movement disorders. This is the first reported case of adult onset torsion dystonia with normal spine and brain MRI in the setting of HIV, which improved clinically after switching ART regimens. Conclusions: This case highlights accelerated torsion dystonia in an patient with HIV on ART that improved with discontinuation of TE, which suggests an association between ART and MD that may be modifiable based on selection of ART drug regimen.

Poster 86 Role of Nutrients in the Development of Knee Osteoarthritis

Disclosures: D. Sanghi, none. Objective: There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA). The present study sought to identify influence of dietary nutrients in prevalence of OA of the knee. Design: A cross-sectional study. Participants: 150 subjects were recruited from an outpatient clinic with the diagnosis of knee osteoarthritis (KOA) according to the criteria of American College of Rheumatology (ACR). Controls were age and gender matched healthy subjects who were free from disease under study. OA was radiologically graded according to Kellgren-Lawrence grades. Body mass index (BMI) was recorded by standard procedure. Dietary nutrient intakes were analyzed by self-administered questionnaire, including 3-day dietary recall and food frequency table (FFQ). Results: An average weight and BMI was significantly higher in subjects with OA knee in comparison with subjects without KOA. Among all dietary factors under study, riboflavin, -carotene, vitamin C, and vitamin D was significantly lower in subjects who have OA knee in comparison with subjects without OA knee. In unadjusted logistic regression, lower intake quartile of riboflavin, -carotene, vitamin C and vitamin D having higher risk of OA knee in comparison with higher intake quartiles. However, in adjusted analysis, the risk of OA knee for riboflavin was diminished and -carotene lose some strength, but vitamins C and D have similar strength of risk of OA knee in quartile having a lower intake. As the severity of disease was only defined by vitamin D intake. Conclusions: The present cross-sectional study revealed that a lower intake of -carotene, vitamin C and vitamin D intake is risk factor for knee OA. These nutrients might be an explanatory nutrient for the course of OA knee and might lead disease-modifying effect.