Yuelong Cao

Association between serum levels of 25-hydroxyvitamin D and osteoarthritis: a systematic review

OBJECTIVE To systematically review the evidence for association between serum 25-hydroxyvitamin D (25-(OH)D) and OA and the effect of vitamin D therapy on OA. METHODS An English Medline, EMBASE and Cochrane Library search for vitamin D and OA from January 1980 to June 2012 was performed. Randomized controlled trials (RCTs), cohort, case-control and cross-sectional studies in adults were included. The methodological quality of the selected studies was assessed and a best-evidence synthesis was used to summarize the results due to the heterogeneity of the studies. RESULTS Of the 86 evaluated articles, 2 RCTs and 13 observational studies were included in the final analyses. The number of participants ranged from 64 to 1644 (0-100% women). The RCTs were only reported in abstract form and showed inconsistent results, most likely due to variations in their study design. There was insufficient or limited evidence for associations between 25-(OH)D and hand or hip OA. For knee radiographic OA as assessed by the Kellgren and Lawrence (KL) score, there was moderate evidence showing that low levels of 25-(OH)D were associated with increased progression of radiographic OA. Strong evidence for an association between 25-(OH)D and cartilage loss was apparent when joint space narrowing and changes in cartilage volume were considered collectively as cartilage loss. CONCLUSION 25-(OH)D appears to be implicated in structural changes of knee OA rather than symptoms, and further well-designed RCTs are required to determine whether vitamin D supplementation can slow disease progression. There is insufficient evidence for other sites.

Cross-sectional and longitudinal associations between circulating leptin and knee cartilage thickness in older adults

OBJECTIVE To investigate cross-sectional and longitudinal associations between serum leptin levels and knee cartilage thickness in older adults. METHODS A prospective cohort of 163 randomly selected subjects (mean 63 years, range 52-78, 46% women) was studied. Knee cartilage thickness at medial tibial, lateral tibial, femoral and patellar sites was determined using T1-weighted fat-suppressed MRI. Serum leptin levels were measured by radioimmunoassay. Radiographic osteoarthritis, body fat (%), trunk fat (%), weight and height were measured, and body mass index (BMI) was calculated. RESULTS Cross-sectionally, serum levels of leptin were negatively associated with femoral (β: -0.013, 95% CI -0.022 to -0.003), medial tibial (β: -0.009, 95% CI -0.018 to -0.001), lateral tibial (β: -0.012, 95% CI -0.021 to -0.003) and patellar (β: -0.014, 95% CI -0.026 to -0.002) cartilage thickness after adjustment for covariates. Moreover, BMI, trunk fat and total body fat were negatively associated with cartilage thickness, and the significant associations disappeared after further adjustment for leptin. Longitudinally, both baseline leptin and change in leptin were associated with greater changes in medial tibial cartilage thickness (β: -0.004, 95% CI -0.007 to -0.001 and β: -0.009, 95% CI -0.018 to -0.001, respectively) in multivariable analyses. CONCLUSIONS Serum levels of leptin are independently and consistently associated with reduced cartilage thickness cross-sectionally and longitudinally. In addition, the associations between adiposity measures and cartilage thickness are mediated by leptin, suggesting leptin may play a key role in cartilage thinning.

Cross-sectional and longitudinal associations between systemic, subchondral bone mineral density and knee cartilage thickness in older adults with or without radiographic osteoarthritis.

Objectives To investigate cross-sectional and longitudinal associations between systemic bone mineral density (BMD), subchondral BMD (sBMD) and knee cartilage thickness in older adults with or without radiographic osteoarthritis (ROA). Methods A prospective cohort of 158 randomly selected subjects (mean 63 years, 48% women) including 69 non-ROA and 89 ROA subjects were studied at baseline and 2.7 years later. Knee cartilage thickness was semi-automatically determined from T1-weighted fat-suppressed MRI. Knee cartilage volume was measured from MRI. Systemic BMD and sBMD were measured by dual-energy X-ray absorptiometry (DXA). Results Cross-sectionally, total body, total hip, spine BMD and/or lateral tibial sBMD were significantly and positively associated with femoral, lateral tibial and/or patellar cartilage thickness in subjects with ROA after adjustment for potential confounders. Longitudinally, a high total body BMD was associated with an increase in femoral cartilage thickness (β: 0.33 mm/g/cm2, 95% CI 0.13 to 0.53); a high spine BMD was associated with increases in femoral and lateral tibial cartilage thickness (β: 0.25 mm/g/cm2, 95% CI 0.10 to 0.41; and β: 0.18 mm/g/cm2, 95% CI: 0.01 to 0.34, respectively) and a high medial tibial sBMD was associated with an increase in medial tibial cartilage thickness (β: 0.45 mm/g/cm2, 95% CI 0.02 to 0.89) in subjects with ROA. In contrast, there were no significant associations between baseline systemic BMD, sBMD and cartilage volume loss, nor were there associations between BMD and cartilage thickness in subjects without ROA. Conclusions Both systemic and subchondral BMD are positively associated with increased cartilage thickness in subjects with ROA, suggesting BMD may play a protective role against cartilage loss in knee OA.

Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundOsteoarthritis (OA) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss, implying that vitamin D supplementation may prevent the progression of knee OA. The aim of the VItamin D Effects on OA (VIDEO) study is to compare, over a 2- year period, the effects of vitamin D supplementation versus placebo on knee structural changes, knee pain, and lower limb muscle strength in patients with symptomatic knee OA.Methods/designRandomised, placebo-controlled, and double-blind clinical trial aiming to recruit 400 subjects (200 from Tasmania and 200 from Victoria) with both symptomatic knee OA and vitamin D deficiency (serum [25-(OH)D] level of >12.5 nmol/liter and <60 nmol/liter). Participants will be randomly allocated to vitamin D supplementation (50,000 IU compounded vitamin D3 capsule monthly) or identical inert placebo group for 2 years. The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging (MRI) and Western Ontario and McMaster Universities Index of OA (WOMAC) knee pain score. The secondary endpoints will be other knee structural changes, and lower limb muscle strength. Several other outcome measures including core muscle images and central blood pressure will be recorded. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses. Both intention to treat and per protocol analyses will be utilized.DiscussionThe trial is designed to test if vitamin D supplementation will reduce loss of knee cartilage volume, prevent the progression of other knee structural abnormalities, reduce knee pain and strengthen lower limb muscle strength, thus modify disease progression in knee OA.Trial registrationClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials Registry: ACTRN12610000495022

Cross-sectional and Longitudinal Associations between Knee Joint Effusion Synovitis and Knee Pain in Older Adults

Objective. To describe the cross-sectional and longitudinal associations between knee regional effusion synovitis and knee pain in older adults. Methods. Data from a population-based random sample (n = 880, mean age 62 yrs, 50% women) were used. Baseline knee joint effusion synovitis was graded (0–3) using T2-weighted magnetic resonance imaging (MRI) in the suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess. Effusion synovitis of the whole joint was defined as a score of ≥ 2 in any subregion. Other knee structural (including cartilage, bone marrow, and menisci) lesions were assessed by MRI at baseline. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire at baseline and 2.6 years later. Multivariable analyses were performed after adjustment for age, sex, body mass index, and other structural lesions. Results. The prevalence of effusion synovitis was 67%. Suprapatellar pouch effusion synovitis was significantly and independently associated with increased total and nonweight-bearing knee pain in both cross-sectional and longitudinal analyses (for an increase in total knee pain of ≥ 5, RR 1.26 per grade, 95% CI 1.04–1.52), and increased weight-bearing knee pain in longitudinal analysis only. Effusion synovitis in posterior femoral recess and central portion were independently associated with increases in nonweight-bearing pain (RR 1.63 per grade, 95% CI 1.32–2.01 and RR 1.29 per grade, 95% CI 1.01–1.65, respectively) in longitudinal analyses only. Conclusion. Knee joint effusion synovitis has independent associations with knee pain in older adults. Suprapatellar pouch effusion synovitis is associated with nonweight-bearing and weight-bearing knee pain, while posterior femoral recess and central portion effusion synovitis are only associated with nonweight-bearing pain.

OP0064 Cross Sectional and Longitudinal Associations between Knee Joint Effusion and Osteoarthritic Structural Changes in Older Adults

Background Multiple joint pathological changes such as synovial effusion, cartilage and subchondral bone lesions are involved in osteoarthritis (OA). The causal relationship between joint effusion and other knee structural changes was not clear. Objectives This study aimed to determine the cross-sectional and longitudinal associations between knee joint effusion at different compartments and knee osteoarthritic changes in older adults. Methods A cohort of 976 randomly selected subjects from local community (mean 62 years, 50% female) was studied at baseline and 416 followed up 2.7 years later. Radiographic knee osteophyte and joint space narrowing (JSN) were assessed using the OARSI atlas. T2-weighted fat saturated magnetic resonance imaging (MRI) was utilized to assess knee effusion at 4 compartments: suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess. Cartilage volume, cartilage defects, and bone marrow lesions (BMLs) were measured using MRI at baseline and 2.7 years later. Multivariable generalized linear models with Poisson regression analyses or linear regression were used to estimate prevalence ratios (PR) relative risks (RR) or regression coefficient (β). Results Cross-sectionally, knee effusion at suprapatellar pouch was associated with total cartilage volume (β=-0.23, p=0.05), cartilage defect presence at any compartment (PR: 1.17, p<0.01), BML presence at any compartment (PR: 1.23, p<0.01), any moderate to severe JSN (PR: 1.44, p<0.01) and any osteophyte (PR: 1.54, p<0.001). Effusion at central portion was associated with cartilage defect presence at any compartment (PR: 1.08, p=0.05), BML presence at any compartment (PR: 1.19, p<0.01). Effusion at posterior femoral recess was associated with cartilage defect presence at any compartment (PR: 1.12, p<0.01). Lastly, effusion at subpopliteal recess was associated with cartilage defect presence at any compartment (PR: 1.10, p<0.01), BML presence at any compartment (PR: 1.12, p=0.02), moderate to severe JSN (PR: 1.28, p<0.01) and osteophyte (PR: 1.27, p=0.03). Longitudinally, suprapatellar pouch effusion was associated with change in cartilage volume (β=-0.33%, p=0.05), increases in cartilage defects (RR: 1.24, p<0.01), and an increase in BML (RR: 1.24, p=0.04). Effusion at posterior femoral recess was associated with change in cartilage volume (β=-0.48%, p<0.01) increases in cartilage defects (RR: 1.11, p=0.03). Effusion at subpopliteal recess was associated with change in cartilage volume (β=-0.36%, p=0.01), increases in cartilage defects (RR: 1.15, p<0.01). In contrast, effusion at central portion was not significantly associated with any of the above structural changes. All these analyses were performed after adjustment for age, gender, BMI, rheumatoid arthritis, and/or radiographic osteoarthritis (ROA). Conclusions Knee joint effusions are associated with knee osteoarthritic structural changes suggesting a potential causal relationship. While suprapatellar pouch effusion is most consistently associated with knee structural changes, central portion effusion is not associated with changes in knee structures over time. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3882

AB0679 Comparison of Two Different Ethnic Groups of as Patients

Background Ankylosing spondylitis (AS) represents a world-wide diffused disease with a strong genetic factor. How subjects cope with their disease may depend on many different causes, such as education, general life-style, physical activity, etc. Few studies have reported a comparison between different parameters in two different ethnic populations. Objectives To investigate the possible differences regarding the main findings between two groups of AS patients native to Italy and China. Methods We examined patients affected by AS in two different areas: Italy (Pisa and Florence) and China (Guangzhou). All of them were asked to complete questionnaires on disease activity (BASDAI), function (BASFI), global assessment (BASGI), quality of life (SpA-HAQ), fatigue (FACIT and BASDAI fatigue item), pain (VAS-pain), and probability of anxiety and depression (HADS-A and HADS-D). Therapy was registered for all of the patients. The Student t-test was used to analyse the differences between the two groups. Results Sixty patients were examined. The two populations were slightly different in the M/F ratio (18/10 in Italy and 25/7 in China) and mostly in the mean age (53±13.68 and 29±9.27 years in the two groups, respectively). No differences were found between the two groups regarding all of the questionnaires studied (Table 1). A trend to significance was found for HADS-A (higher in Italian patients). While a difference was shown in the NSAIDs intake (higher in China), no significant difference was found for anti-TNF-a therapy in the two groups. Table 1. Parameters mean value in the two study groups BASDAI BASFI BASGI SpA-HAQ FACIT BASDAI 1 PAIN HADS-A HADS-D Italy (N=28) 4.19 2.42 4.46 0.925 17.24 4.51 4.79 7.37 6.07 China (N=32) 3.93 2.82 5.66 1.04 19.34 3.82 3.90 5.52 6.34 Conclusions Even if the two group are not completely comparable given the different mean age and sex ratio, the expression of the disease seems to be similar, as well as all the parameters studied. A trend toward significance was found for anxiety, showing a slightly higher probability in Italian patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3657