Surprise footwear findings for reducing knee pain, the risks of weight cycling and more from the Osteoarthritis Research Society International conference.
The Osteoarthritis Research Society International recently held its annual conference, featuring three days of online presentations and discussions. Here are some of the highlights.
Minimalist vs supportive shoes for knee OA
Australian researchers set out to demonstrate that flat, flexible, lightweight footwear would be better for people with knee osteoarthritis than stable supportive shoes, but instead found the complete opposite was true.
A randomised, controlled trial in 164 individuals with severe knee osteoarthritis found that stable supportive footwear was in fact associated with significantly greater reductions in walking knee pain and improvements in knee-related quality of life scores than flat flexible footwear.
In conducting the six-month study, the University of Melbourne’s Dr Kade Paterson and co-authors also discovered that many participants normally wore inappropriate footwear – such as slippers and shoes with heels – or footwear that was extremely old and worn, suggesting a need for greater attention to patients’ footwear in knee osteoarthritis.
Intramuscular as good in long-term as intra-articular glucocorticoid injections
A Dutch study has found intramuscular glucocorticoid injections for knee osteoarthritis achieve the same longer-term improvements in pain as intra-articular injections.
The 24-week randomised controlled study compared pain scores in 74 patients who received an intramuscular injection and 71 patients who received an intra-articular injection. While researchers saw significantly lower pain scores at four weeks after the injection in the intra-articular group, there were no significant differences between the two groups at eight and 24 weeks.
Presenter Dr Qiuke Wang, from Erasmus University Medical Center in Rotterdam, noted that some clinicians are uncertain about administering intra-articular injections, and there were also concerns about the risk of infection and possible adverse effects on cartilage.
oarsijournal.com/article/S1063-4584(21)00068-6/fulltext
No OA pain relief from antidepressant
Duloxetine does not appear to achieve pain relief in people with chronic pain associated with hip or knee osteoarthritis.
The serotonin and norepinephrine reuptake inhibitor is hypothesised to inhibit pain in the central nervous system, and chronic pain due to central sensitisation is known to affect nearly one quarter of people with osteoarthritis-related chronic pain.
The open-label, cluster-randomised study involved 132 patients in 66 GP practices, which were randomised 1:1 to either duloxetine plus usual care, or usual care alone, for three months.
Dr Jacoline van den Driest, from Erasmus University Medical Center, told the conference that the study did not find statistically significant differences between the two groups in pain, function or centralised pain.
Yo-yo dieting bad for knee cartilage
Significant ups and downs in weight are associated with more cartilage degeneration in people with knee osteoarthritis than maintaining a steady weight or steady weight loss.
Dr Gabby Davis, from the University of California, San Francisco, and co-authors looked at ‘weight cycling’ – people in the top 10% of weight change in either direction each year over four years – in more than 2200 individuals with knee osteoarthritis, using MRI data to examine its effects on disease progression.
Compared to non-weight-cycling individuals who either maintained a steady weight – gained or lost less than 3% weight – or those who gained more than 5% or lost more than 5%, weight cyclers showed significantly more cartilage degeneration and bone marrow oedema degeneration, as well as significantly lower walking speeds.
oarsijournal.com/article/S1063-4584(21)00079-0/fulltext
Increased falls risk in OA patients flies under the radar
Falls are a major cause of injury, hospitalisation and death in older people, and people with osteoarthritis have an increased risk of falls, yet little attention is given to preventing them in this group.
Monash University’s Associate Professor Ilana Ackerman and co-authors looked at the prevalence of falls among people with osteoarthritis, then surveyed clinicians and patients to aid in the development of falls prevention resources in this patient group.
They found that 41% of people with osteoarthritis had a history of falls, compared to 31% of people without osteoarthritis, and osteoarthritis was a significant predictor of fall risk. Their survey of 370 physiotherapists found that most didn’t use a risk screening tool for falls with their osteoarthritis patients, and relatively few assessed balance. On average, physiotherapists did not have a high degree of confidence about assessing the risk of falls in their patients, and delivering falls care.
The survey of patients also revealed that many did not consider osteoarthritis to be a risk factor for falls, but also viewed falls and falls prevention as something only relevant to older people, suggesting a need for a rethink of the language around preventing falls.
