Evaluation of a circumferential femoral head osteophyte as an early indicator of osteoarthritis characteristic of canine hip dysplasia in dogs.

OBJECTIVE: To determine the relationship between a circumferential femoral head osteophyte (CFHO) and osteoarthritis characteristic of canine hip dysplasia, and to ascertain whether CFHO, like osteoarthritis, varies between diet-restricted and control-fed dogs. DESIGN: Longitudinal cohort study. ANIMALS: 48 Labrador Retrievers. PROCEDURES: Dogs were paired by size, sex, and litter and assigned to 1 of 2 equal groups at 2 months of age. The control-fed group was fed ad libitum, and the diet-restricted group was fed 25% less on a pairwise basis of the same diet for life. The dogs' hip joints were radiographed yearly for life. Each radiograph was evaluated for radiographic signs of osteoarthritis characteristic of hip dysplasia and for the presence and severity of a CFHO. RESULTS: 41 of the 48 (85.4%) dogs had a CFHO, which was detected at a median age of 5.4 years, and 33 of those 41 (80.5%) developed radiographic evidence of osteoarthritis. Nineteen (79.2%) dogs in the diet-restricted group and 22 (91.7%) in the control-fed group had a CFHO at a median age of 9 and 3 years, respectively. Of the dogs with a CFHO, 12 (63.2%) in the diet-restricted group and 20 (90.0%) in the control-fed group developed radiographic evidence of osteoarthritis characteristic of hip dysplasia at a median age of 11 and 6.5 years, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated a relationship between the CFHO and subsequent development of radiographic signs of osteoarthritis. If a CFHO is present in Labrador Retrievers, it might be considered an early indicator of osteoarthritis.

Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis.

OBJECTIVES: To investigate the effects of a Mediterranean type diet on patients with osteoarthritis (OA). PARTICIPANTS: Ninety-nine volunteers with OA (aged 31 - 90 years) completed the study (83% female). SETTING: Southeast of England, UK. DESIGN: Participants were randomly allocated to the dietary intervention (DIET, n = 50) or control (CON, n = 49). The DIET group were asked to follow a Mediterranean type diet for 16 weeks whereas the CON group were asked to follow their normal diet. MEASUREMENTS: All participants completed an Arthritis Impact Measurement Scale (AIMS2) pre-, mid- and post- study period. A subset of participants attended a clinic at the start and end of the study for assessment of joint range of motion, ROM (DIET = 33, CON = 28), and to provide blood samples (DIET = 29, CON = 25) for biomarker analysis (including serum cartilage oligomeric matrix protein (sCOMP) (a marker of cartilage degradation) and a panel of other relevant biomarkers including pro- and anti-inflammatory cytokines). RESULTS: There were no differences between groups in the response of any AIMS2 components and most biomarkers (p > 0.05), except the pro-inflammatory cytokine IL-1α, which decreased in the DIET group (~47%, p = 0.010). sCOMP decreased in the DIET group by 1 U/L (~8%, p = 0.014). There was a significant improvement in knee flexion and hip rotation ROM in the DIET group (p < 0.05). CONCLUSIONS: The average reduction in sCOMP in the DIET group (1 U/L) represents a meaningful change, but the longer term effects require further study.

Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs.

OBJECTIVE: To evaluate the effects of diet restriction on development of radiographic evidence of hip joint osteoarthritis in dogs. DESIGN: Longitudinal cohort study. ANIMALS: 48 Labrador Retrievers from 7 litters. PROCEDURES: Forty-eight 6-week-old puppies from 7 litters were paired with littermates by sex and weight, and each pairmate was randomly assigned to 1 of 2 groups of 24 dogs each. Starting at 8 weeks of age, 1 group was fed ad libitum (control fed) and the other was fed 25% less (restricted fed) of the same diet for life on a pairwise basis. The dogs' hip joints were radiographed in the standard ventrodorsal hip-extended view at multiple intervals prior to 1 year of age and at annual intervals thereafter on the basis of birth anniversary. A board-certified radiologist unaware of group assignment scored the radiographs for evidence of osteoarthritis. RESULTS: Prevalence of radiographic evidence of hip joint osteoarthritis in all dogs increased linearly throughout the study, from an overall prevalence of 15% at 2 years to 67% by 14 years. Restricted-fed dogs had lower prevalence and later onset of hip joint osteoarthritis. Median age at first identification of radiographic evidence of hip joint osteoarthritis was significantly lower in the control-fed group (6 years), compared with the restricted-fed group (12 years). CONCLUSIONS AND CLINICAL RELEVANCE: Restricted feeding delayed or prevented development of radiographic signs of hip joint osteoarthritis in this cohort of Labrador Retrievers. Lifetime maintenance of 25% diet restriction delayed onset and reduced severity of hip joint osteoarthritis, thus favorably affecting both duration and quality of life. In addition, the data indicated that development of hip joint osteoarthritis was not bimodal in these dogs but occurred as a continuum throughout life.

Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.

INTRODUCTION: International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. MATERIALS AND METHODS: We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. RESULTS: Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. CONCLUSIONS: Strategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient's environment in OA treatment.

Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis.

OBJECTIVE: To determine the effect of weight reduction on clinical signs of lameness among overweight dogs with clinical and radiographic signs of hip osteoarthritis. DESIGN: Nonblinded prospective clinical trial. ANIMALS: 9 client-owned dogs with radiographic signs of hip osteoarthritis that weighed 11 to 12% greater than their ideal body weight and were examined because of hind limb lameness. PROCEDURE: Dogs were weighed, and baseline body condition, hind limb lameness, and hip function scores were assigned. Severity of lameness was scored using a numerical rating scale and a visual analogue scale. Dogs were fed a restricted-calorie diet, with amount of diet fed calculated to provide 60% of the calories needed to maintain the dogs' current weights. Evaluations were repeated midway through and at the end of the weight-loss period. RESULTS: Dogs lost between 11 and 18% of initial body weight. Body weight, body condition score, and severity of hind limb lameness were all significantly decreased at the end of the weight-loss period. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in overweight dogs with hind limb lameness secondary to hip osteoarthritis, weight reduction alone may result in a substantial improvement in clinical lameness.

[Uncontrolled clinical study of the efficacy of ambulant fasting in patients with osteoarthritis]. / Unkontrollierte klinische Studie zur Wirksamkeit ambulanten Heilfastens bei Patienten mit Arthrose.

OBJECTIVE: To study the efficacy of fasting therapy according to Buchinger on pain, state of health, and articular function in patients with osteoarthritis. PATIENTS AND METHODS: Uncontrolled pilot study in which 30 patients (22 women, 8 men) with osteoarthritis (Kellgren stages I-III) of the hand (N = 10), hip (N = 8) and knee (N = 12) underwent ambulant fasting therapy according to Buchinger for 2 weeks with 3 pre-fast days, 8 fast days (300 kcal) and 4 re-feed days as well as follow-up 4 and 12 weeks afterwards. ASSESSMENT CRITERIA: Global intensity of pain (visual analogue scale, VAS); joint pain with activity, with start of walking, at rest (VAS); pressure pain threshold; articular function; health-related quality of life (SF-36 including Physical Component Score and Mental Component Score); Western Ontario and McMasters Universities Arthrose Index (WOMAC); painDETECT-questionnaire (Pfizer); analgesics; weight; body mass index (BMI); waist circumference; blood pressure; pulse and a variety of serological parameters. RESULTS: Pain, state of health, and articular function improved significantly; significant reduction in weight, BMI, and waist circumference during fasting and over the complete course of the study; analgesics could be reduced. No abnormalities in autonomous, metabolic, or blood parameters were observed. CONCLUSION: Medically supervised fasting can have a positive impact on the symptoms of patients with moderate osteoarthritis. This finding must be consolidated by controlled studies that include higher numbers of patients.