Update on osteoarthritis part 1: current concepts and the relation to exercise

There appears to be an increased risk of lower limb osteoarthritis in participants of repetitive, high impact sports, and this is strongly associated with joint injury. There seems to be little risk associated with recreational running. Assessment of risk for osteoarthritis should take into account the nature of the sport, intensity of training, presence of previous injury, body mass index, and occupation

True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin α?

Background: The combination of methotrexate and the anti-tumour necrosis factor (TNF) antibody infliximab is a very effective treatment for rheumatoid arthritis (RA). However, a proportion of patients are not responsive to this treatment. Inefficacy may represent a TNF independent disease or insufficient drug at the site of action. Case report: A patient with RA resistant to repeated high dose infliximab infusions and intra-articular infliximab into an inflamed knee is described. No beneficial clinical effect was observed. Pre-injection arthroscopic biopsy of the study knee demonstrated TNF staining but also confirmed the presence of lymphotoxin (LT or TNFß) on immunohistochemistry. Subsequent treatment with etanercept (which blocks LT as well as TNF) resulted in clinical remission of disease. Conclusion: This case suggests that resistance to TNF blockade may occur when TNF is not the dominant inflammatory cytokine and suggests that LT may have a pathogenic role in RA

Evaluation of Lolium perenne L. cv. AberDart and AberDove for silage production

peer-reviewedThe objective of this study was to assess the value, for silage production, of intermediateheading Lolium perenne L. cultivars, AberDart and AberDove (diploid), bred for increased water-soluble carbohydrate (WSC) concentrations, relative to four control cultivars (Fennema, AberElan and Spelga (diploid), and Greengold (tetraploid)). Cultivars were evaluated for forage dry matter (DM) yield, ground cover and indirect laboratory measures of nutritional value and ensilability over 3 harvest years within intensive silage-production systems. AberDove was the most desirable diploid for silage production producing on average 316 kg/ha higher (2%) DM yield per annum, having a 10 g/kg higher (1%) dry matter digestibility (DMD) and, based primarily on a 6 g/L higher (19%) concentration of WSC expressed in the aqueous extract (WSCAE), offered the greatest potential to produce well preserved silage. Ensiling AberDart compared to the diploid controls offered a slightly greater probability of producing well preserved silage based on a modest increase of 2 g/L (6%) in WSCAE concentration. The dilemma for silage production is that AberDart, on average produced 558 kg/ha less (4%) DM yield per annum but had a greater (1%) DMD of 6 g/kg than the diploid controls. The tetraploid control had, on average, 13 and 8 g/kg higher (2% and 1%, respectively) DMD than AberDart and AberDove, but at a cost of lower ensilability with lower (6% and 21%, respectively) WSCAE values of 2 and 6 g/L. In its favour, the tetraploid control outyielded AberDart by, on average, 917 kg/ha DM per annum (7%) and produced comparable yields to AberDove. Final ground cover ratings were high (≥ 95%) for all cultivars. Evaluation of nutritional value and ensilability offers further grounds to differentiate and select cultivars for animal production potential.A Teagasc Walsh Fellowship, awarded to P. Conaghan and H. Howard, and the European Commission under the Fifth Framework Programme (QLK5-CT-2001-0498) supported this research

The EULAR–OMERACT rheumatoid arthritis MRI reference image atlas: the metacarpophalangeal joints

This paper presents the metacarpophalangeal (MCP) joint magnetic resonance images of the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas. The illustrations include synovitis in the MCP joints (OMERACT RA magnetic resonance imaging scoring system (RAMRIS), grades 0–3), bone oedema in the metacarpal head and the phalangeal base (grades 0–3), and bone erosion in the metacarpal head and the phalangeal base (grades 0–3, and examples of higher grades). The presented reference images can be used to guide scoring of MCP joints according to the OMERACT RA MRI scoring system

Satisfaction, adherence and health-related quality of life with transdermal buprenorphine compared with oral opioid medications in the usual care of osteoarthritis pain

Background Osteoarthritis (OA) causes substantial pain and reduced health-related quality of life (HRQL). Although opioid analgesics are commonly used, the relative benefits of different opioids are poorly studied. Transdermal buprenorphine (TDB) offers an alternative to oral opioids for the treatment of moderate-to-severe chronic pain. This observational study of people with OA pain assessed satisfaction, HRQL and medication adherence. Methods Patients in the UK with self-reported knee and/or hip OA who had been receiving one or more of TDB, co-codamol (an oral paracetamol/codeine combination) and tramadol for at least 1 month completed an online or telephone questionnaire. Medication satisfaction scores, HRQL scores (Short-Form 36 [SF-36]), medication adherence (Morisky Medication Adherence Scale [MMAS™]), adverse events and treatment discontinuations were recorded. Linear and logistic regression models were used to compare the treatment effect of TDB with co-codamol or tramadol. Results Overall, 966 patients met the inclusion criteria; 701 were taking only one of the target medications (TDB: 85; co-codamol: 373; tramadol: 243). The largest age group was 50–59 years and 76.0 % of patients were female. The TDB group was younger, with more male patients, therefore the statistical models were adjusted for age and sex. Medication satisfaction scores were significantly higher in the TDB group than the other two groups (TDB vs. co-codamol: 3.56, 95 % confidence interval [CI] 1.90–6.68, p < 0.0001; TDB vs. tramadol: 3.22, 95 % CI 1.67–6.20, p = 0.0005). Physical Component Summary scores for HRQL and mean adherence were also higher in the TDB group, while Mental Component Summary HRQL scores were similar across the three groups. Conclusions Patients with knee and/or hip OA pain treated with TDB were more satisfied and more adherent with their medication, and reported higher Physical Component Summary HRQL scores than those treated with co-codamol or tramadol, although demographic differences were observed between groups

The development of the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas

Based on a previously developed rheumatoid arthritis MRI scoring system (OMERACT 2002 RAMRIS), the development team agreed which joints, MRI features, MRI sequences, and image planes would best illustrate the scoring system in an atlas. After collecting representative examples for all grades for each abnormality (synovitis, bone oedema, and bone erosion), the team met for a three day period to review the images and choose by consensus the most illustrative set for each feature, site, and grade. A predefined subset of images (for example, for erosion—all coronal slices through the bone) was extracted. These images were then re-read by the group at a different time point to confirm the scores originally assigned. Finally, all selected images were photographed and formatted by one centre and distributed to all readers for final approval

The dynamics of response as measured by multiple composite outcome tools in the TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) trial

Background: We aimed to evaluate the dynamics of treatment response with different composite measures in the TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) trial. Methods: Participants with early disease-modifying antirheumatic drug-naïve psoriatic arthritis (PsA) were randomised 1:1 to either tight control (TC; 4 weekly review with therapy escalation if criteria not met) or standard care (SC; 12 weekly review). We calculated modified versions of the Psoriatic ArthritiS Disease Activity Score (PASDAS), Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Composite scorE (GRACE) and Composite Psoriatic Disease Activity Index (CPDAI) at baseline and 12 weekly to 48 weeks by blinded assessor. For missing data, we used the last observation carried forward. Comparison between groups was made by analysis of covariance and comparison of area under the curve (AUC). Results: 206 people were randomised to TC (n=101) or SC (n=105). Significant differences between treatment groups were seen (p<0.0001 for all composite measures). AUC analysis demonstrated a significant difference between groups for the PASDAS but not GRACE and CPDAI. For participants with oligoarthritis, a significant difference between groups was seen for each measure, although the significance levels were greatly diminished (PASDAS, p=0.04; GRACE p=0.01; CPDAI p=0.04). For oligoarthritis using AUC analysis, none of the measures could distinguish between groups. Conclusions: Composite measures of disease activity were able to distinguish between TICOPA treatment arms, although differences were diminished for those with oligoarthritis. Further data are needed to inform the preferred composite measure for use as the primary outcome in PsA trials

An introduction to the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas

This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist and metacarpophalangeal joints of patients with rheumatoid arthritis can be scored for synovitis, bone oedema, and bone erosion, guided by standard reference images

Grazing and ensiling of energy-rich grasses with elevated sugar contents for the sustainable production of ruminant livestock (Acronym: SweetGrass)

End of Project ReportPermanent grassland dominates the Irish landscape and for many decades perennial ryegrasses have been the main constituent in seed mixtures for grassland. The main attractions in favour of perennial ryegrass swards are that they: x produce high yields in response to fertiliser nitrogen x have a high digestibility when harvested at the appropriate growth stage x are relatively easy to preserve as silage due to their superior content of sugar x persist as permanent swards where favourable management practices prevail If the phenotype of perennial ryegrass were to be improved, one potentially desirable trait would be an elevated concentration of water-soluble carbohydrates (WSC). This could confer benefits in terms of: x further increase the probability of achieving a lactic acid dominant fermentation during ensilage. This could reduce the requirement for traditional acid- or sugar-based additives, improve the likelihood of a positive response from additives based on homofermentative lactic acid bacteria or alternatively eliminate the need for any or the currently available conventional additive. If its effect was to improve silage preservation this should positively impact on dry matter (DM) recovery, improve animal productivity and potential product quality, and reduce N loss to the environment. x improve the opportunity to produce silage with an elevated concentration of WSC. In circumstances where little or no supplementary concentrate feedstuffs were offered with silage, higher residual WSC could enhance silage intake and digestion, thereby improving animal productivity and reducing urinary loss of N. x produce a grass with higher intake characteristics during grazing, resulting in improved or more efficient animal production. x better synchronise or balance the supply of a rapidly fermentable carbon source (e.g. WSC) with soluble N compounds in the rumen of cattle or sheep. This could be important with grazing animals in spring and particularly in autumn when grass N content can be relatively high. Improved synchronisation or balance could potentially improve animal productivity and reduce urinary loss of N.European Union Fifth Framework funded project (QLK5-CT-2001-0498