Burden of knee osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019.

BACKGROUND: Knee is the most affected joint in osteoarthritis (OA) and accounts for almost four-fifths of the burden of OA globally. We aimed to explore the prevalence, incidence, trends, and burden of knee OA during 1990-2019 in the Middle East and North Africa (MENA) region, using the Global Burden of Disease (GBD) study data. METHODS: This is an epidemiological study based on the GBD data from 1990 to 2019 on knee OA in MENA countries. The prevalence, incidence, and years lived with disability (YLD) numbers of knee OA were obtained for both genders. Similarly, age-standardized rates of these indexes per 100,000 people and the proportion of total YLD caused by knee OA in each country and for the MENA region were evaluated. RESULTS: The prevalence of knee osteoarthritis in the MENA region increased 2.88-fold, from 6.16 million cases to 17.75 million, between 1990 and 2019. Furthermore, in 2019, knee osteoarthritis accounted for approximately 1.69 million (95% UI 1.46-1.95) incident cases in MENA. The age-standardized prevalence was higher in women between 1990 (3.94% [95% UI 3.39-4.55] in women and 3.24% [95% UI 2.79-3.72] in men) and 2019 (4.44% [95% UI 3.83-5.10] in women and 3.66% [3.14-4.21] in men). Total YLDs due to knee osteoarthritis increased by more than 2.88-fold, rising from 196.29 thousand [95% UI 97.17-399.29] in 1990 to 564.66 thousand [95% UI 275.06-1,150.68] in 2019. In the year 2019, Kuwait, Turkey, and Oman had the highest age-standardized prevalence (4.42% [95% UI 3.79-5.08]), YLD (132.41 [95% UI 65.79-267.56] per 100 000), and increase (21.17%) in YLD compared with 1990 in MENA region, respectively. CONCLUSION: The prevalence of and YLDs due to knee OA in MENA has escalated over the last three decades. Considering the expanding burden of knee OA in MENA, policymakers should be more concerned to implement preventive strategies.

Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the role of diffusion-weighted imaging (DWI) in the initial diagnosis, staging, and assessment of treatment response in patients with multiple myeloma (MM). MATERIALS AND METHODS: A systematic literature review was conducted in PubMed, the Cochrane Library, EMBASE, Scopus, and Web of Science databases. The primary endpoints were defined as the diagnostic performance of DWI for disease detection, staging of MM, and assessing response to treatment in these patients. RESULTS: Of 5881 initially reviewed publications, 33 were included in the final qualitative and quantitative meta-analysis. The diagnostic performance of DWI in the detection of patients with MM revealed pooled sensitivity and specificity of 86% (95% CI: 84-89) and 63% (95% CI: 56-70), respectively, with a diagnostic odds ratio (OR) of 14.98 (95% CI: 4.24-52.91). The pooled risk difference of 0.19 (95% CI: - 0.04-0.42) was reported in favor of upstaging with DWI compared to conventional MRI (P value = 0.1). Treatment response evaluation and ADCmean value changes across different studies showed sensitivity and specificity of approximately 78% (95% CI: 72-83) and 73% (95% CI: 61-83), respectively, with a diagnostic OR of 7.21 in distinguishing responders from non-responders. CONCLUSIONS: DWI is not only a promising tool for the diagnosis of MM, but it is also useful in the initial staging and re-staging of the disease and treatment response assessment. This can aid clinicians with earlier initiation or change in treatment strategy, which could have prognostic significance for patients.

The Unequal Effect of Income on Risk of Overweight/Obesity of Whites and Blacks with Knee Osteoarthritis: the Osteoarthritis Initiative.

BACKGROUND: Although the protective effect of socioeconomic status (SES) against risk of overweight/obesity is well established, such effects may not be equal across diverse racial and ethnic groups, as suggested by the marginalization-related diminished returns (MDR) theory. AIMS: Built on the MDR theory, this study explored racial variation in the protective effect of income against overweight/obesity of Whites and Blacks with knee osteoarthritis (OA). METHODS: This cross-sectional study used baseline data of the OA Initiative, a national study of knee OA in the USA. This analysis included 4664 adults with knee OA, which was composed of 3790 White and 874 Black individuals. Annual income was the independent variable. Overweight/obesity status (body mass index more than 25 kg/m2) was the dependent variable. Race was the moderator. Logistic regressions were used for data analysis. RESULTS: Overall, higher income was associated with lower odds of being overweight/obese. Race and income showed a statistically significant interaction on overweight/obesity status, indicating smaller protective effect of income for Blacks compared with Whites with knee OA. Race-stratified regression models revealed an inverse association between income and overweight/obesity for White but not Black patients. CONCLUSIONS: While higher income protects Whites with knee OA against overweight/obesity, this effect is absent for Blacks with knee OA. Clinicians should not assume that the needs of high-income Whites and Blacks with knee OA are similar, as high-income Blacks may have greater unmet needs than high-income Whites. Racially tailored programs may help reduce the health disparities between Whites and Blacks with knee OA. The results are important given that elimination of racial disparities in obesity is a step toward eliminating racial gap in the burden of knee OA. This is particularly important given that overweight/obesity is not only a prognostic factor for OA but also a risk factor for cardiometabolic diseases and premature mortality.

Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences.

PURPOSE: To determine the added value of quantitative diffusion-weighted and dynamic contrast material-enhanced imaging to conventional magnetic resonance (MR) imaging for assessment of the response of soft-tissue sarcomas to neoadjuvant therapy. MATERIALS AND METHODS: MR imaging examinations in 23 patients with soft-tissue sarcomas who had undergone neoadjuvant therapy were reviewed by two readers during three sessions: conventional imaging (T1-weighted, fluid-sensitive, static postcontrast T1-weighted), conventional with diffusion-weighted imaging, and conventional with diffusion-weighted and dynamic contrast-enhanced imaging. For each session, readers recorded imaging features and determined treatment response. Interobserver agreement was assessed and receiver operating characteristic analysis was performed to evaluate the accuracy of each session for determining response by using results of the histologic analysis as the reference standard. Good response was defined as less than or equal to 5% residual viable tumor. RESULTS: Of the 23 sarcomas, four (17.4%) showed good histologic response (three of four with >95% granulation tissue and <5% necrosis, one of four with 95% necrosis and <5% viable tumor) and 19 (82.6%) showed poor response (viable tumor range, 10%-100%). Interobserver agreement was substantial or excellent for imaging features in all sequences (k = 0.789-1.000). Receiver operating characteristic analysis showed an increase in diagnostic performance with the addition of diffusion-weighted and dynamic contrast-enhanced MR imaging for prediction of response compared with that for conventional imaging alone (areas under the curve, 0.500, 0.676, 0.821 [reader 1] and 0.506, 0.704, 0.833 [reader 2], respectively). CONCLUSION: Adding functional sequences to the conventional MR imaging protocol increases the sensitivity of MR imaging for determining treatment response in soft-tissue sarcomas.