Association between metabolic syndrome and knee structural change on MRI.

OBJECTIVE: To examine the association of metabolic syndrome (MetS) and its components with knee cartilage volume loss and bone marrow lesion (BML) change. METHODS: Longitudinal data on 435 participants from a population-based cohort study were analysed. Blood pressure, glucose, triglycerides and high-density lipoprotein (HDL) were collected. MetS was defined based on the National Cholesterol Education Program-Adult Treatment Panel III criteria. MRI of the right knee was performed to measure cartilage volume and BML. Radiographic knee OA was assessed by X-ray and graded using the Altman atlas for osteophytes and joint space narrowing. RESULTS: Thirty-two percent of participants had MetS and 60% had radiographic knee OA. In multivariable analysis, the following were independently associated with medial tibial cartilage volume loss: MetS, ß = -0.30%; central obesity, ß = -0.26%; and low HDL, ß = -0.25% per annum. MetS, hypertriglyceridaemia and low HDL were also associated with higher risk of BML size increase in the medial compartment (MetS: relative risk 1.72, 95% CI 1.22, 2.43; hypertriglyceridaemia: relative risk 1.43, 95% CI 1.01, 2.02; low HDL: relative risk 1.67, 95% CI 1.18, 2.36). After further adjustment for central obesity or BMI, MetS and low HDL remained statistically significant for medial tibial cartilage volume loss and BML size increase. The number of components of MetS correlated with greater cartilage volume loss and BML size increase (both P for trend <0.05). There were no statistically significant associations in the lateral compartment. CONCLUSION: MetS and low HDL are associated with medial compartment cartilage volume loss and BML size increase, suggesting that targeting these factors has the potential to prevent or slow knee structural change.

How Do MRI-Detected Subchondral Bone Marrow Lesions (BMLs) on Two Different MRI Sequences Correlate with Clinically Important Outcomes?

The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50-80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70; all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (ß = 1.12 to 1.37, respectively; p < 0.05) and worsening stiffness (ß = 0.45 to 0.52, respectively; all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63; all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (ß = - 174.77 to - 140.67; p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.

The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review.

INTRODUCTION: More than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the existing evidence on the cost of dementia in LMICs. METHODS: Six databases were searched for original research reporting on the costs associated with all-cause dementia or its subtypes in LMICs. The national-level dementia costs inflated to 2019 were expressed as percentages of each country's gross domestic product (GDP) and summarised as the total mean percentage of GDP. The risk of bias of studies was assessed using the Larg and Moss method. RESULTS: We identified 14 095 articles, of which 24 studies met the eligibility criteria. Most studies had a low risk of bias. Of the 138 LMICs, data were available from 122 countries. The total annual absolute per capita cost ranged from US$590.78 for mild dementia to US$25 510.66 for severe dementia. Costs increased with the severity of dementia and the number of comorbidities. The estimated annual total national costs of dementia ranged from US$1.04 million in Vanuatu to US$195 billion in China. The average total national expenditure on dementia estimated as a proportion of GDP in LMICs was 0.45%. Indirect costs, on average, accounted for 58% of the total cost of dementia, while direct costs contributed 42%. Lack of nationally representative samples, variation in cost components, and quantification of indirect cost were the major methodological challenges identified in the existing studies. CONCLUSION: The estimated costs of dementia in LMICs are lower than in high-income countries. Indirect costs contribute the most to the LMIC cost. Early detection of dementia and management of comorbidities is essential for reducing costs. The current costs are likely to be an underestimation due to limited dementia costing studies conducted in LMICs, especially in countries defined as low- income. PROSPERO REGISTRATION NUMBER: The protocol was registered in the International Prospective Register of Systematic Reviews database with registration number CRD42020191321.

Hand Examination, Ultrasound, and the Association With Hand Pain and Function in Community-Based Older Adults.

OBJECTIVE: To describe cross-sectional associations between features observed on ultrasound (US) or clinical joint examination and hand symptoms among community-dwelling older adults (n = 519), and to determine whether such associations are independent of age, sex, body mass index, and other imaging features. METHODS: Hand pain, function, and stiffness were assessed using a visual analog scale (VAS) and the Australian/Canadian Hand Osteoarthritis (AUSCAN) index. Standardized clinical and US examinations were performed, and grip strength was assessed using a dynamometer. Data were analyzed using hurdle and linear models and adjusted for demographic factors and other features. RESULTS: Abnormal findings on joint examination and on US imaging are common in older adults with and without hand pain. Greater numbers of tender joints were associated with greater pain (VAS: ß = 2.63 [95% confidence interval (95% CI) 1.88, 3.39]; AUSCAN pain: ß = 10.57 [95% CI 4.00, 17.13]), poorer AUSCAN function (ß = 4.07 [95% CI 1.28, 6.86]), and poorer grip strength (ß = -0.15 [95% CI -0.27, -0.03]). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS: ß = 2.61 [95% CI 1.03, 4.19]; AUSCAN pain: ß = 13.07 [95% CI 3.82, 22.32]), but not function. Joint deformity was associated with poorer function (ß = 4.51 [95% CI 1.75, 7.26]) and grip strength (ß = -0.23 [95% CI -0.40, -0.05]), but not pain. Gray-scale synovitis was associated only with poorer grip strength (ß = -0.22 [95% CI -0.41, -0.04]). Associations with function and grip strength were partially mediated by pain. CONCLUSION: Joints that are tender on palpation or have US-identified PDI synovitis are potential treatment targets for hand pain. Treating tender joints and preventing hand deformity is required to improve hand function in community-dwelling older adults.