Rozendaal, R.M.

Defining discriminative pain trajectories in hip osteoarthritis over a 2-year time period (Article)

2012-09-01T00:00:00Z

Background: Although pain due to osteoarthritis (OA) generally deteriorates over time, there is a large individual variation in the course of pain. This study examines the different longitudinal trajectories of patients with hip pain due to OA. Methods: Data from a previously performed randomised controlled trial were used to investigate the course of pain over 2 years in 222 patients with clinically and radiographically determined hip OA. Pain was measured with a visual analogue scale (0-100). Latent class growth analysis was used to determine the number of trajectories of patients with hip pain due to OA. Results: Analyses yielded five trajectories of pain due to hip OA. Trajectory 1 ('mild pain'; n=69) consists of patients with stable mild pain. Patients in trajectory 2 ('moderate pain'; n=31) fluctuated slightly between moderate and severe pain levels. Trajectory 3 ('always pain'; n=32) consists of patients with severe pain. Patients in trajectory 4 ('regularly progressing'; n=48) started with mild pain and progressed slowly to moderate pain. Trajectory 5 ('highly progressing'; n=42) patients also started with mild pain but quickly progressed to severe pain over 2 years. Compared with the 'mild pain' group, patients in the 'always pain' group had more severe radiographic hip OA, morning stiffness and decreased range of motion. The 'highly progressing'group had more severe radiographic hip OA and morning stiffness. Conclusions: Latent class growth analysis applied to longitudinal data of patients with hip OA identified five distinct trajectories of pain. More studies are needed to externally validate these findings.

A statistical model of shape and density of the proximal femur in relation to radiological and clinical OA of the hip (Article)

2010-06-01T00:00:00Z

Objective: Common radiological measures of osteoarthritis (OA) relate poorly to symptoms as experienced by patients. We created a statistical model of shape and density to see if Dual Energy X-ray (DXA) images of the hip contain symptom-related information that is not captured by common radiological measures. Methods: DXA images of the hip were made in a prospective study of patients that met the American College of Rheumatology (ACR) criteria for hip OA. From the DXA scans, we constructed a statistical model of the appearance (shape combined with density) of the proximal femur of left and right side. The model yields a number of independent descriptors of the appearance (modes) which we related to various measures of radiological and clinical OA. These outcome measures were defined using Joint Space Width (JSW), Kellgren and Lawrence (KeL) scores, Visual Analogue Scale (VAS) and Western Ontario MacMaster Universities (WOMAC) pain scores and a self-reported global assessment score. Results: Various modes showed significant relations with measures of OA. Interestingly, the modes that related well with radiological OA did not relate to clinical OA and vice-versa. Moreover, the modes were predictors of status and progression of clinical OA, independent from JSW and KeL. Conclusion: Statistical modeling of the appearance captures the patterns of variation in projected femoral morphology as visible on DXA images. We showed that these descriptors of subtle aspects of shape and density of the hip contain information about clinical status which common radiological measures do not. The presented results warrant further careful study of the method as a monitoring tool in clinical trials.

Dual energy x-ray absorptiometry analysis contributes to the prediction of hip osteoarthritis progression (Article)

2009-11-02T00:00:00Z

Introduction: To determine if structural bone parameters obtained from dual energy X-ray absorptiometry (DXA) contribute to the prediction of progression of hip osteoarthritis (OA) and to test if the difference between the most affected (OA) hip and the contralateral hip adds to this prediction.Methods: The study group involves a prospective cohort of 189 patients that met the American College of Rheumatology (ARC) classification criteria for hip osteoarthritis. Progression was defined as 20% joint space narrowing or total hip replacement within a two years follow up. Software was developed to calculate geometrical aspects and bone mineral density (BMD) in different regions of interest of the proximal femur. Logistic regression was used to test if Kellgren and Lawrence (K-L) scores and DXA parameters can predict progression of OA. Models were compared using -2log likelihood tests, R2Nagelkerke and areas under the Receiver Operator Characteristic curves, assessed using 10-fold cross validation.Results: The model that included the DXA variables was significantly better in predicting hip OA progression than the model with K-L score of the affected side alone (P < 0.01). The addition of the differences in DXA parameters between the most affected and contralateral hip in the superior part of the femoral head, trochanteric and intertrochanteric area further improved the prediction of progression (P < 0.05). K-L score of the affected side was still the most significant single variable in the models.Conclusions: DXA parameters can significantly contribute to the prediction of progression in patients with hip osteoarthritis. The analysis of the DXA differences between the hips of the patient represents a small but significant contribution to this prediction. These analyses show the importance of bone density changes in the etiology of OA.

Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial (Article)

2009-04-01T00:00:00Z

Objective: Recently we reported that glucosamine sulphate (GS) did not have an effect on the symptoms and progression of primary care patients with hip osteoarthritis (OA). The aim of this present study was to investigate whether there are subgroups of patients with hip OA for whom GS might be an effective therapy. Method: We randomized 222 patients with hip OA that met one of the American College of Rheumatology criteria to either 1500 mg of oral GS or placebo once daily for 2 years. Subgroup analyses were predefined for radiographic severity (Kellgren & Lawrence (KL) = 1 vs ≥2) and for type of OA (localised vs generalised). Additional exploratory subgroup analyses focused on groups based on pain level, pain medication use, baseline joint space width (JSW), and concomitant knee OA at baseline. Primary outcome measures were Western Ontario MacMaster Universities (WOMAC) pain and function scores over 24 months, and joint space narrowing (JSN) after 24 months. Results: In the predefined subgroups based on radiographic severity and type of OA, the outcomes WOMAC pain, function and JSN were similar for the GS and placebo group. Conclusion: GS was not significantly better than placebo in reducing symptoms and progression of hip OA in subgroups of patients.

Hip Osteoarthritis in General Practice: Course and Therapies (Doctoral Thesis)

2009-03-11T00:00:00Z

Osteoarthritis of the hip is a common problem in todayâ?Ts aging society. The disease is characterised by joint pain and functional limitations. The treatment of osteoarthritis has been focused on relief of symptoms, since there are as yet no therapies available that can alter progression of the disease. In the last decade the search for a disease modifying treatment has been intensified. One of the most promising agents is glucosamine sulphate. Results on pain were conflicting, when tested in patients with knee osteoarthritis. Our randomised controlled trial (GOAL) was the first trial to assess the effect of glucosamine on symptoms and structural progression of primary care patients with hip osteoarthritis. We found that there was no difference in effect between glucosamine and placebo on pain (-1.54 [-5.43, 2.36]), function (-2.01[-5.38, 1.36]), or joint space narrowing (-0.029 [-0.122, 0.064]). Also, no significant differences were found in any of the predefined subgroups based on radiographic severity or type of osteoarthritis. We also looked at the course of complaints of patients with hip osteoarthritis over two years. We assessed pain and function every three months and found that while complaints on average stayed relatively stable over 2 years, the intraindividual pain level was highly fluctuating. Seventy percent of all patients with hip osteoarthritis had consulted one or more care givers for their complaints. The costs for medical consumption is estimated to be â,¬639 per patient per year, which is comparable to costs for knee osteoarthritis. The majority of these costs were attributable to total hip replacement by an orthopedist.

Het effect van glucosaminesulfaat op de progressie van heupartrose (Article)

2008-10-01T00:00:00Z

Introduction: Het effect van glucosaminesulfaat bij de behandeling van artrose is omstreden. Een systematische review uit 2005 met twintig onderzoeken kon geen definitieve conclusie trekken.1 Van de vijftien onderzoeken die glucosamine vergeleken met een placebo was het algehele effect op pijn gemiddeld weliswaar in het voordeel van glucosamine, maar meer dan de helft van deze onderzoeken vond geen verschil tussen glucosamine en een placebo. Ook recente onderzoeken gaven geen duidelijkheid.2-4 Uit eerdere onderzoeken kon men concluderen dat patiënten met milde radiologische artrose meer baat zouden hebben bij glucosamine dan patiënten met een ernstiger ziektebeeld.5,6 We vonden slechts twee onderzoeken over het effect van glucosaminesulfaat op radiologische progressie,10,11 waarbij bovendien discussie ontstond over het radiologisch protocol.12-14 Daarom is verder onderzoek nodig. Tot nu toe is vooral het effect van glucosamine op knieartrose onderzocht, slechts drie onderzoeken includeerden ook patiënten met andere aangedane gewrichten.7-9 Wij vonden geen onderzoeken bij patiënten met heupartrose. En hoewel knieartrose meer voorkomt, komt heupartrose voldoende voor om het effect van glucosamine bij deze groep te testen. Al met al genoeg aanleiding voor een tweejarig, geblindeerd, gerandomiseerd, placebo-gecontroleerd onderzoek naar het effect van glucosaminesulfaat op de symptomatische en radiologische progressie van eerstelijns patiënten met heupartrose.

The effect of glucosamine sulphate on osteoarthritis: design of a long- term randomised clinical trial [ISRCTN54513166]. (Article)

2005-04-26T00:00:00Z

BACKGROUND: Pharmacological treatment for osteoarthritis (OA) can be divided into two groups: symptom-modifying drugs and disease-modifying drugs. Symptom-modifying drugs are currently the prescription of choice for patients with OA, as disease-modifying drugs are not yet available in usual care. However, there has recently been a lot of debate about glucosamine sulphate (GS), a biological agent that is thought to have both symptom-modifying and disease-modifying properties. This assumption has yet to be proved. The objective of this article is to present the design of a blind randomised clinical trial that examines the long-term symptom-modifying and disease-modifying effectiveness of GS in patients with hip OA. This trial is ongoing and will finish in March 2006. METHODS/DESIGN: Patients with hip OA meeting the ACR-criteria are randomly allocated to either 1500 mg of oral GS or placebo for the duration of two years. The primary outcome measures, which are joint space narrowing (JSN), and change in the pain and function score of the Western Ontario McMaster Universities Osteoarthritis index (WOMAC), are determined at baseline and after two years of follow-up during the final assessment. Intermediate measures at three-month intervals throughout the trial are used to study secondary outcome measures. Secondary outcome measures are changes in WOMAC stiffness score, quality of life, medical consumption, side effects and differences in biomarker CTX-II.