Improving the management of lower limb osteoarthritis
Overview:
Osteoarthritis (OA) is a disease of the joints which causes damage to bone and soft tissue (e.g. cartilage - the protective tissue that covers the ends of bones), and causes inflammation. OA is a leading cause of global disability often causing pain, reduced function and quality of life. OA commonly affects the knee, with up to 1 in 3 adults showing joint structural change(s) on x-ray.
Currently there is no cure for OA. The primary focus of my work is to identify factors which are likely to contribute to knee OA. Specifically, my research explores the role of joint structure, physical activity, occupational activity and use of medication in the development and progression of knee OA. By identifying modifiable risk factors, it is hoped to alter the path of the disease and therefore ease the disease burden.
Aims and Objectives:
- To identify modifiable risk factors which are likely to contribute to the development and progression of knee osteoarthritis (OA).
- To reduce the impact of knee OA on patients and to better understand the disease mechanisms.
- To examine the epidemiology of ankle OA and to assess the global occurrence of ankle joint replacements.
Key Findings:
Identifying Early Risk Factors for the Occurrence and Progression of Knee Osteoarthritis (OA).
Study 1: Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study
Ankle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.
Study 2: Effect of Heeled Shoes on Joint Symptoms and Knee Osteoarthritis in Older Adults: A 5-Year Follow-Up Study
Compared with the non-use of heeled shoes, ever-use of heels (≥2 inches) was not associated with incident radiographic knee OA (RKOA) and incident joint symptoms. Further, increasing cumulative time spent wearing heels was not associated with any of our outcomes.
Study 3: Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative
In current users of NSAIDs, medial joint space width (mJSW) loss was increased compared with current non-users in participants with radiographic knee OA (RKOA). Clinical trials are required to assess the potential disease-modifying effects of these medications.
Physical Activity and Risk of Incident Knee Osteoarthritis.
Recreational Physical Activity and Risk of Incident Knee Osteoarthritis: an international meta‐analysis of individual participant‐level data
Our findings suggest that whole-body, physiological energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes.
Epidemiology of Ankle OA and Total Ankle Replacement. Relationship between MRI-assessed Joint Structure and Knee Symptoms in Symptomatic Knee OA.
Trends in the Utilisation of Ankle Replacements: Data from Worldwide National Joint Registries
In 6 countries, we found marked differences in the utilisation of ankle replacements. Registry-related factors including data completeness and the number of hospitals/surgeons performing ankle replacements are likely to contribute to the observed between-country differences and need to be carefully considered when interpreting comparisons for this less common site for joint replacement surgery.
Relationship between MRI-assessed Joint Structure and Knee Symptoms in Symptomatic Knee OA.
Association between Markers of Synovial Inflammation, Matrix Turnover and Symptoms in Knee Osteoarthritis: A Cross-Sectional Study.
Whole joint and site-specific infrapatellar synovial tissue volume (STV) measures on CE-MRI were associated with knee pain respectively. Volumes relative to the size of the femoral condyle may be promising outcome measures in knee OA (KOA) trials.
Outputs:
- Perry T, Arden N, Yang X, Kluzek S. Quantitative and Semi-Quantitative Assessment of Synovitis on MRI and the Relationship with Symptoms in Symptomatic Knee Osteoarthritis. Rheumatology. 2020 September DOI RHE-20-0981.R2
- Perry T.A, Segal N.A, Bowen C, Gates L, Arden N, NevittM.C. Foot and Ankle Pain and Risk of Incident Knee Osteoarthritis and Knee Pain: data from the Multicentre Osteoarthritis Study. Osteoarthritis and Cartilage. 27 August 2021. https://doi.org/10.1016/j.ocarto.2021.100210
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Perry, T., Wang, X., Nevitt, M., Abdelshaheed, C., Arden, N. and Hunter, D. Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Rheumatology, 60(10), pp.4624-4632. October 2021. https://doi.org/10.1093/rheumatology/keab059
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Perry, T., Dando, C., Spector, T., Hart, D., Bowen, C. and Arden, N., 2021. Effect of Heeled Shoes on Joint Symptoms and Knee Osteoarthritis in Older Adults: A 5‐Year Follow‐Up Study. ACR Open Rheumatology, 3(9), pp.614-621.2021. DOI: 10.1002/acr2.11298 June 2021
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Perry, T., Silman, A., Culliford, D., Gates, L., Arden, N. and Bowen, C., 2021. Trends in the Utilization of Ankle Replacements: Data from Worldwide National Joint Registries. Foot & Ankle International, 42(10),pp.1319-1329.2021Jun17:10711007211012947. doi: 10.1177/10711007211012947. Epub ahead of print. PMID: 34137278.
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Gates, L., Perry, T., Golightly, Y., Nelson, A., Callahan, L., Felson, D., Nevitt, M., Jones, G., Cooper, C., Batt, M., Sanchez‐Santos, M. and Arden, N., 2021. Recreational Physical Activity and Risk of Incident Knee Osteoarthritis: an international meta‐analysis of individual participant‐level data. Arthritis & Rheumatology. November 2021. https://doi.org/10.1002/art.42001