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In this 24-week trial, glucosamine and chondroitin sulfate were not more effective, alone or in combination, than placebo in controlling pain in patients with osteoarthritis of the knee. In secondary analyses, however, in the subgroup of patients with moderate-to-severe osteoarthritis, those given both glucosamine and chondroitin sulfate were more likely than those given placebo to have a decrease in pain (79 percent vs. 54 percent). In this trial, glucosamine and chondroitin sulfate were not more effective, alone or in combination, than placebo in controlling pain in patients with osteoarthritis of the knee. Osteoarthritis is the most common of the arthritides, affecting at least 20 million Americans, a number that is expected to double over the next two decades. 1 , 2 Currently available medical therapies primarily address the treatment of joint pain in patients with osteoarthritis. 3 Analgesics as well as traditional and cyclooxygenase-2–selective nonsteroidal antiinflammatory drugs (NSAIDs) have suboptimal effectiveness, 4 , 5 and there is some question about their safety, especially in the light of recent reports of increased cardiovascular risk. 6 – 8 The dietary supplements glucosamine and chondroitin sulfate have been advocated, especially in the lay media, as safe and effective options for the management . . .

Several industry-sponsored trials have shown benefit with glucosamine for pain and function in osteoarthritis, and a Cochrane review concluded that at least one of the available preparations was effective.13 However, a subsequent large pivotal trial funded by the US National Institutes of Health showed that after 24 weeks of treatment neither glucosamine or chondroitin sulfate, nor a combination of the two, was more efficacious than was placebo for treatment of osteoarthritic knee pain.14 The side-effects of glucosamine and chondroitin sulfate were similar to those of placebo. Some evidence suggests that braces, insoles, and assistive devices decrease osteoarthritic pain and improve function.2-6,18 Weight loss results in decreased pain and improved function in overweight or obese patients with osteoarthritis of the knee.19 Because exercise combined with diet results in a greater weight reduction than does diet alone, both components should be included in self-management programmes.

ObjectiveTo compare the performance of different knee osteoarthritis (OA) classification criteria in a subsample of subjects of ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK) in comparison with the clinical-radiographic evaluation of an experienced rheumatologist.MethodA cross-sectional study of the diagnostic accuracy of different knee OA classification criteria: radiographic OA, symptomatic OA, clinical and clinical-radiographic criteria of the American College of Rheumatology (ACR), and the definition proposed by the National Institute for Health and Care Excellence (NICE), UK. The study also evaluated some alternative definitions of OA including a combination of criteria. In total, 250 subjects participated. Only one knee per subject was included. When both or none of the knees were affected, one knee was randomly selected for analysis. OA prevalence, sensitivity, specificity, positive and negative predictive values, and accuracy were presented (CI 95%; α = 5%).ResultsThe mean age was 56.1 years (SD = 8.7), 48.8% female, and 39.2% presented knee OA according to the rheumatologist. The sensitivity and the specificity of radiographic OA were 51% and 96.7%, respectively, while the NICE definition showed 57.0% and 76.3%, respectively. The other OA criteria showed good levels of specificity, but the levels of sensitivity were below 30%. Considering NICE and/or X-ray result in combination, the sensitivity increased (73.4%), while the specificity reduced slightly (73.0%) in relation to the original NICE definition.ConclusionsRadiographic OA showed the best performance, followed by NICE definition, especially in combination with X-ray results.

Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.

IntroductionThe Tönnis classification is widely accepted for grading hip arthritis, but its usefulness as a reference in hip-preserving surgery is yet to be demonstrated. We aimed to evaluate reproducibility of the Tönnis classification in early stages of hip osteoarthritis, and thus determine whether it is a reliable reference for hip-preserving surgery.Materials and methodsThree orthopaedic surgeons with different levels of experience examined 117 hip X-rays that were randomly mixed of two groups: a group of 31 candidates for hip-preserving surgery and a control group of 30 patients that were asymptomatic with respect to the hip joint. The surgeons were asked to rate an eventual osteoarthritis according to the Tönnis classification. After 2 months, the surgeons were asked to re-evaluate the X-rays in a random order. Intra- and interobserver reliabilities were calculated by comparing the observers’ two estimations using Kappa statistics.ResultsKappa values for interobserver reliability were slight or fair (range 0.173–0.397). Kappa values for intraobserver reproducibility were fair (range 0.364–0.397). Variance in grading no and slight osteoarthritis was the most frequent cause for intra- and interobserver disagreements (76.3 and 73.01 % of the non-concordant observations, respectively). The confidence interval analysis showed that the observers’ experience did not affect reproducibility.ConclusionsThe Tönnis classification is a poor method to assess early stages of hip osteoarthritis. These findings suggest that its routine use in therapeutic decision-making for conservative hip surgery should be reconsidered.

(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis’s true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis.

Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.In this Review, the authors assess the current understanding of symptomatic early-stage knee osteoarthritis, including its diagnosis and classification, and highlight important gaps in knowledge that will need to be addressed to enable effective management.

BackgroundLow-dose radiotherapy (LDRT) for pain reduction in osteoarthritis (OA) is a frequently used treatment in Germany and Eastern European countries. The evidence on the effects of LDRT on pain in patients with OA remains unclear. This study evaluated the effect of LDRT on pain in patients with severe OA of the hip or knee joint.MethodsThis prospective study included a total of 16 joints in 12 patients (4 hips and 12 knees). The inclusion criteria were: patients older than 50 years, severe OA (Kellgren–Lawrence grade III–IV) of the hip or knee joint, patients not responding to conservative treatment and patients who are inoperable or not willing to undergo surgery. The joint was irradiated with a total dose of 6.0 Gray. The Numeric Rating Scale for pain (NRS-pain) and patient-reported outcome measures were obtained at pre-, 6, 13, 26, 39 and 52 weeks post-radiation. A decrease of two points on the NRS-pain was defined as clinical relevant.ResultsThe median age of the included patients was 74 years (range 58–89). In 50% of the joints (n = 8, 3 hip and 5 knee joints), a clinical relevant difference in pain at 6 weeks post-radiation was observed. This clinical relevant difference decreased to 25% at 52 weeks post-radiation.ConclusionLDRT showed a clinical relevant pain relief at 6 weeks after radiotherapy. The long-term effect of LDRT, however, was limited. A randomized placebo-controlled trial is necessary to assess the effect of LDRT on pain in patients with OA of the hip or knee joint.

ObjectivesThe objective of this study is to develop classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA based on self-reported data and radiographic features.MethodsThe classification criteria sets were developed in three phases. In phase 1, we identified criteria that discriminated hand OA from controls. In phase 2, we used a consensus-based decision analysis approach to derive a clinician-based evaluation of the relative importance of the criteria. In phase 3, we refined the scoring system, determined the cut-offs for disease classification and compared the sensitivity and specificity of the European Alliance of Associations for Rheumatology (EULAR) criteria with the 1990 American College of Rheumatology (ACR) criteria.ResultsIn persons with hand symptoms and no other disease (including psoriasis) or acute injury that can explain the hand symptoms (mandatory criteria), hand OA can be classified based on age, duration of morning stiffness, number of joints with osteophytes and joint space narrowing, and concordance between symptoms and radiographic findings. Using a sum of scores based on each diagnostic element, overall hand OA can be classified if a person achieves 9 or more points on a 0–15 scale. The cut-off for interphalangeal OA and thumb base OA is 8 points. While the EULAR criteria demonstrated better sensitivity than the ACR criteria in the phase 1 data set, the performance of the two criteria sets was similar in two external cohorts.ConclusionsInternational experts developed the EULAR criteria to classify overall hand OA, interphalangeal OA and thumb base OA in clinical studies using a rigorous methodology.

Background. Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate. Objectives. To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada. Research Design. Population-based mail and telephone survey. Subjects. All adults aged ≥55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area. Measures. We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty. Results. Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively. Conclusions. Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.