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Can a biomechanically-designed yoga exercise program yield superior clinical improvements than traditional exercise in women with knee osteoarthritis?
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Methods: This is a secondary data analysis from a community-based study of changes in regional and widespread pain (WSP) among women with chronic pain in Arizona, USA. Eligibility requirements for this analysis included: 1) female; 2) physician-confirmed diagnosis of osteoarthritis of the hip, knee or spine; and 3) onset of symptoms within the last 5 years or a current pain rating of >40 on a 0e100 scale in the past month. Exclusion criteria were: 1) autoimmune or other comorbid disorders causing widespread pain, inflammation, and fatigue (e.g., fibromyalgia, ankylosing spondylitis;) 2) pending litigation regarding the pain condition; and 3) use of daily corticosteroids. Participants (n ¼ 31) completed daily diaries and collected three saliva samples daily (10 AM, 4 PM, and 8 PM) for 7 days. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale assessed severity of OA-related pain. Multilevel regression analyses estimated associations between OA pain and diurnal cortisol levels, controlling for body mass index, medication use, time and day. To assess the diurnal pattern of cortisol, a model with an interaction term of time x WOMAC pain subscale score was fitted as a function of time. Then the association of cortisol levels with OA pain was assessed without the interaction term. A t-test using the median split of the WOMAC pain subscale (¼9) was conducted to assess the affect of severity of OA pain. Mediation analyses using the product of the co-efficient approach, examined daily pain intensity, positive and negative affect, fatigue, ratings of stressfulness and enjoyment of daily events as potential mediators of the association between OA pain and cortisol. Results: The mean age was 57 years and average BMI 31kg/m2. Mean WOMAC pain subscale score was 8.8. A non-significant time x WOMAC interaction indicated that WOMAC pain scores did not alter the trajectory of cortisol levels throughout the day [Unstandardized ß 0.009 (0.04, 0.06) p ¼ 0.724]. However, analyses revealed that there was a significant main effect of WOMAC pain subscale scores on cortisol levels [Unstandardized ß 0.083 (0.02, 0.15) p ¼0.009] representing a 0.083 ng/dl increase in cortisol per one unit increase in WOMAC pain score. Women with WOMAC pain scores > 9 had higher cortisol levels than those with scores <9 [mean (sd) 4.20 (0.94) versus 3.83 (0.91) p < 0.001 respectively]. No significant mediated effects were found (Table). Conclusions: In women with OA, disease-related pain is associated with elevated cortisol production, particularly when pain severity is greater. These results are the first to demonstrate that women with OA have altered HPA axis function secondary to disease-related pain. The absence of mediated effects questions the negative affective consequences of pain as a mechanism between pain and ill health. As there are several factors common to OA and cortisol dysfunction including links with obesity, metabolic syndrome and inflammation, future studies should explore alternative variables (e.g., inflammatory cytokines) in the causal pathway between OA pain and cortisol.
Effects of daily experience variables on cortisol levels in relation to WOMAC pain scores Variable
Unstandardized ß Co-efficient
P value
Pain WOMAC pain Stress WOMAC pain Fatigue WOMAC pain Pain catastrophizing WOMAC pain Joy WOMAC pain Negative mood WOMAC pain Positive mood WOMAC pain
0.004 0.080 e0.067 0.084 0.002 0.081 0.090 0.079 e0.067 0.081 e0.009 0.083 e0.036 0.085
0.177 0.016 0.515 0.009 0.397 0.015 0.328 0.011 0.455 0.004 0.939 0.010 0.662 0.009
S445
756 CAN A BIOMECHANICALLY-DESIGNED YOGA EXERCISE PROGRAM YIELD SUPERIOR CLINICAL IMPROVEMENTS THAN TRADITIONAL EXERCISE IN WOMEN WITH KNEE OSTEOARTHRITIS? A.B. Kuntz y, S. Karampatos y, E. Brenneman y, J.N. Chopp-Hurley z, E. Wiebenga y, J. Adachi y, K. Madsen y, M.R. Maly y. y McMaster Univ., Hamilton, ON, Canada; z McMaster Univ., Oakville, ON, Canada Purpose: For individuals with knee osteoarthritis (OA), exercise can provide equivalent pain relief to that of medication, reduce the risk of co-morbidities, and improve physical functioning. However, the optimal type of exercise is unknown; certain forms could overload the joint and exacerbate symptoms. We have selected a series of yoga postures with a minimal knee adduction moment (KAMea mechanical loading variable associated with disease progression) yet sufficient activation of the knee musculature. In a 12-week, cohort study, 38 women with knee OA engaged in a program comprised of these yoga exercises and experienced improvements in pain, mobility, strength, and self-reported measures following the intervention. The purpose of the current study was to compare the efficacy of this biomechanicallytailored yoga program with the current “gold standard” of exercise for knee OA, and a no-exercise attention control group, in women with knee OA. Methods: A single-blind, 12-week, parallel randomized control trial was conducted. Participants included women 50 years of age or over with clinical knee OA. Participants (n ¼ 31; age 67.0 ± 8.3 years; body mass index (BMI) 30.4 ± 5.5 kg/m2) were stratified by Lower Extremity Functional Scale (LEFS) scores and randomized to 1 of 3 interventions: biomechanical yoga (BY: n ¼ 10), traditional exercise (TE: n ¼ 11), or no exercise (NE: n ¼ 10). Participants were asked to attend 3 of 4 available exercises classes each week. The BY program consisted of an instructor led series of postures that yield peak KAMs smaller than that experienced during gait. The TE regimen was comprised of supervised exercises that are currently prescribed for those with knee OA, including walking/cycling, lower body resistance training, balance exercises, and stretching. The NE group engaged in guided relaxation exercises consisting of no physical activity. The primary outcome measure was pain; secondary outcomes included self-reported physical function and mobility performance. Pain was assessed using the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) as well as the pain subscale of the Knee Osteoarthritis Outcome Score (KOOS). Self-reported physical function was evaluated using the LEFS and other symptoms, activities of daily living, sport and recreation, and quality of life subscales of the KOOS. Mobility performance measures included 6minute walk, 40-meter walk, 30-second chair stand, timed up and go, and stair climb tests. Paired t-tests (2-tailed) of primary and secondary outcome measures were computed to compare pre and post intervention time points for within group effects. A Bonferroni corrected alpha value of 0.017 was used to adjust for multiple comparisons. Results: There were no differences in age, BMI, or LEFS scores between groups at baseline (p > 0.05). One participant was lost to follow-up (TE). Mean attendance was 3.0 classes per week for the BY group, 2.7 for TE, and 2.8 for NE. Following the intervention, the BY group had reduced scores on the constant pain subscale of the ICOAP (p ¼ 0.006); while the TE and NE groups did not change. The BY and TE groups had reduced scores on the intermittent pain subscale of the ICOAP (p ¼ 0.005, 0.006); the NE group did not change. BY improved in all 5 domains of the KOOS (p < 0.017) while the TE and NE groups did not. BY was the only group to increase self-reported function (LEFS) scores following the intervention (p ¼ 0.01). Regarding mobility performance, BY improved 6-minute walk, 30-second chair stand, timed up and go, and stair climb test performance following the intervention (p < 0.017); while TE improved on the 6-minute walk, 40-meter walk, 30-second chair stand, and stair climb tests; and the NE group resulted in no change on all tests. Within group mean differences between baseline and follow-up are presented in Table 1. Conclusions: The BY group improved on all outcomes but 1 mobility performance measure; TE was less consistent. Though the generalizability of these findings are limited by the small sample size, biomechanically-tailored yoga appears to be an efficacious exercise option for improving clinical outcomes of knee OA while minimizing potentially harmful knee loads.
S446
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Table 1. Mean difference scores (follow-up minus baseline) and 95% confidence intervals (CI) of differences are presented. Significant within-group changes compared using 2-tailed paired t-tests are denoted with an asterisk (*). A Bonferroni corrected alpha value of 0.017 was used to adjust for multiple comparisons. Outcomes included Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), Knee Osteoarthritis Outcome Score (KOOS), Lower Extremity Functional Scale (LEFS), and mobility performance measures. Lower scores on KOOS and LEFS indicate more troublesome values. Outcome measure
ICOAP Constant pain subscale score (/100) ICOAP Intermittent pain subscale score (/100) KOOS - Pain (/100) KOOS - Other symptoms (/100) KOOS - Activities of daily living (/100) KOOS - Sport and recreation (/100) KOOS - Quality of life (/100) LEFS (/80) Six-minute walk test (m) 40-Meter walk test (s) 30-Second chair stand test (repetitions) Timed up and go test (s) Stair climb test (s)
Biomechanical yoga
Traditional exercise
No exercise
Mean difference [95% CI]
Mean difference [95% CI]
Mean difference [95% CI]
24.5* [40.0, 9.0] 23.7* [30.9, 16.5] 21.5* [15.1. 27.9] 20.2* [8.7, 31.7] 17.9* [8.7, 27.2] 21.3* [9.7, 32.9] 13.9* [5.7, 22.1] 10.6* [3.3, 17.9] 59.3* [22.5, 96.0] 3.9 [7.4, 0.3] 3.4* [2.0, 4.8] 1.3* [2.3, 0.3] 1.7* [2.8, 0.7]
15.0 [29.5, 0.5] 14.3* [23.4, 5.2] 8.3 [4.1,20.7] 10.9 [0.8, 21.0] 8.7 [0.2, 17.2] 29.2 [2.9, 55.5] 10.7 [4.9, 26.3] 7.6 [0.63, 15.8] 54.0* [28.5, 79.5] 2.9* [5.0, 0.8] 2.5* [0.9, 4.1] 0.3 [1.0, 0.4] 0.7* [1.3, 0.2]
10.5 [34.1, 13.1] 4.2 [16.7, 8.3] 2.1 [12.6, 8.4] 0.1 [10.5, 10.7] 0.0 [8.6, 8.6] 2.7 [14.5, 9.1] 1.8 [9.8, 6.2] 6.4 [13.2, 0.4] 19.1 [16.8, 54.9] 4.01 [9.9, 17.9] 1.8 [0.3, 3.3] 0.2 [1.2, 1.6] 1.9 [2.8, 6.5]
757 CORRELATES OF PATELLAR TENDON ENTHESIS ABNORMALITIES IN OLDER ADULTS S. Mattap y, P. Otahal y, A. Halliday z, G. Jones y, L. Laslett y. y Univ. of Tasmania, Hobart, Australia; z Royal Hobart Hosp., Tasmania, Hobart, Australia Purpose: The patellar tendon works together with the quadriceps tendon to enable straightening and bending of knee joints; its’ attachment site (enthesis) is at risk of micro damage and degeneration. Recent studies suggest that enthesis abnormalities (enthesopathy) are associated with the development of osteoarthritis at the synovio-entheseal complex and subchondral bone marrow. However, no studies have assessed presence of patellar tendon enthesis (PTE) abnormalities in
WOMAC score (refer Table 1). While the effect size was similar, the association with knee pain became of borderline statistical significance after further adjustment for patellar cartilage defects (p-value ¼ 0. 052). Weight-bearing knee bending and straightening activities; going up and down stairs (Relative risk (RR) 2.13 (95% confidence interval; 1.15, 3.94)) and standing upright (RR 3.22 (1.08, 9.62)) had the strongest associations amongst the pain subscales (Table 1). Conclusions: Presence of PTE abnormalities is associated with greater knee pain (predominantly involving weight-bearing knee bending and straightening activities), poorer knee physical function and worse total WOMAC score. This suggests that the patellar tendon enthesis abnormalities may be important factors in the development of osteoarthritis in older adults.
Table 1. Associations between PTE abnormalities and knee pain, physical function, stiffness, total
Knee pain subscales Walking on a flat surface Going up and down stairs At night while in bed Sitting or lying Standing upright Knee pain scale Physical function scale Stiffness scale Total WOMAC score
Univariate RR (95% CI)
p-value
Adjusted for age, sex, BMI, & knee extension strength RR (95% CI)
p-value
Further adjusted for patellar cartilage defects RR (95% CI)
p-value
2.15 2.20 0.75 0.89 3.16 1.26 1.25 1.23 1.28
0.147 0.012 0.635 0.849 0.025 0.022 0.015 0.086 0.020
2.01 2.23 0.84 1.11 3.17 1.26 1.33 1.20 1.29
0.185 0.010 0.766 0.855 0.033 0.019 0.008 0.120 0.018
1.94 2.13 0.84 1.12 3.22 1.21 1.28 1.18 1.24
0.203 0.016 0.767 0.846 0.036 0.052 0.021 0.175 0.045
(0.76e6.04) (1.19e4.09) (0.23e2.48) (0.26e2.99) (1.15e8.67) (1.03e1.53) (1.04e1.50) (0.97e1.55) (1.04e1.58)
(0.72e5.63) (1.22e4.10) (0.26e2.73) (0.36e3.43) (1.10e9.15) (1.04e1.54) (1.08e1.65) (0.95e1.51) (1.04e1.59)
older adults. This studies aims to describe cross-sectional associations between patellar tendon enthesis (PTE) abnormalities and knee pain and physical function in older adults. Methods: Population-based study of randomly selected older Tasmanian adults (n ¼ 528; aged 50e80 years, 50% female). Predictor: Presence of abnormal bone signal or erosion at the PTE region was scored using T2-weighted fat saturated magnetic resonance imaging (MRI), proximally and distally. Presence of any abnormalities was scored as 1 and absence of abnormality as 0. Outcomes: Knee pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical analyses: Associations between PTE abnormalities and WOMAC scales were assessed using log binomial regression. Knee pain subscales were dichotomised at 4 and other data was dichotomised at the median. Associations were adjusted for age, sex, BMI, knee extension strength; data was then further adjusted for patellar cartilage defects. Results: 20% of our study population had the PTE abnormalities (bone signal and/or erosion). Presence of PTE abnormalities was associated with greater knee pain, poorer physical function, and worse total
(0.70e5.35) (1.15e3.94) (0.25e2.75) (0.36e3.15) (1.08e9.62) (1.00e1.48) (1.04e1.59) (0.93e1.48) (1.01e1.53)
758 COMORBIDITY IN HAND OSTEOARTHRITIS: ITS IMPACT ON HAND PAIN AND FUNCTION W. Damman, R. Liu, M. Kloppenburg. Leiden Univ. Med. Ctr. (LUMC), Leiden, Netherlands Purpose: Hand pain and function are important complaints in patients with hand osteoarthritis (OA). Therefore, it is important to know which factors influence hand pain and function. In patients with knee and hip OA, comorbidities result in a higher burden of disease. However, the role of comorbidities in association with hand complaints in patients with hand OA is unclear. Therefore, we aimed to study the association of comorbidities and hand pain and function in a hand OA population in secondary care. Methods: Baseline data were used of the ongoing HOSTAS (Hand osteoarthritis in Secondary care) study, which included consecutive patients diagnosed by their treating rheumatologist with primary hand OA between June 2009 and October 2015. Demographic data were collected using standardized questionnaires. Self-reported comorbidity was assessed by a 17-item list (derived from Charlson comorbidity index). Additionally, presence of knee and/or hip OA (poly OA) was
Methods: This is a secondary data analysis from a community-based study of changes in regional and widespread pain (WSP) among women with chronic pain in Arizona, USA. Eligibility requirements for this analysis included: 1) female; 2) physician-confirmed diagnosis of osteoarthritis of the hip, knee or spine; and 3) onset of symptoms within the last 5 years or a current pain rating of >40 on a 0e100 scale in the past month. Exclusion criteria were: 1) autoimmune or other comorbid disorders causing widespread pain, inflammation, and fatigue (e.g., fibromyalgia, ankylosing spondylitis;) 2) pending litigation regarding the pain condition; and 3) use of daily corticosteroids. Participants (n ¼ 31) completed daily diaries and collected three saliva samples daily (10 AM, 4 PM, and 8 PM) for 7 days. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale assessed severity of OA-related pain. Multilevel regression analyses estimated associations between OA pain and diurnal cortisol levels, controlling for body mass index, medication use, time and day. To assess the diurnal pattern of cortisol, a model with an interaction term of time x WOMAC pain subscale score was fitted as a function of time. Then the association of cortisol levels with OA pain was assessed without the interaction term. A t-test using the median split of the WOMAC pain subscale (¼9) was conducted to assess the affect of severity of OA pain. Mediation analyses using the product of the co-efficient approach, examined daily pain intensity, positive and negative affect, fatigue, ratings of stressfulness and enjoyment of daily events as potential mediators of the association between OA pain and cortisol. Results: The mean age was 57 years and average BMI 31kg/m2. Mean WOMAC pain subscale score was 8.8. A non-significant time x WOMAC interaction indicated that WOMAC pain scores did not alter the trajectory of cortisol levels throughout the day [Unstandardized ß 0.009 (0.04, 0.06) p ¼ 0.724]. However, analyses revealed that there was a significant main effect of WOMAC pain subscale scores on cortisol levels [Unstandardized ß 0.083 (0.02, 0.15) p ¼0.009] representing a 0.083 ng/dl increase in cortisol per one unit increase in WOMAC pain score. Women with WOMAC pain scores > 9 had higher cortisol levels than those with scores <9 [mean (sd) 4.20 (0.94) versus 3.83 (0.91) p < 0.001 respectively]. No significant mediated effects were found (Table). Conclusions: In women with OA, disease-related pain is associated with elevated cortisol production, particularly when pain severity is greater. These results are the first to demonstrate that women with OA have altered HPA axis function secondary to disease-related pain. The absence of mediated effects questions the negative affective consequences of pain as a mechanism between pain and ill health. As there are several factors common to OA and cortisol dysfunction including links with obesity, metabolic syndrome and inflammation, future studies should explore alternative variables (e.g., inflammatory cytokines) in the causal pathway between OA pain and cortisol.
Effects of daily experience variables on cortisol levels in relation to WOMAC pain scores Variable
Unstandardized ß Co-efficient
P value
Pain WOMAC pain Stress WOMAC pain Fatigue WOMAC pain Pain catastrophizing WOMAC pain Joy WOMAC pain Negative mood WOMAC pain Positive mood WOMAC pain
0.004 0.080 e0.067 0.084 0.002 0.081 0.090 0.079 e0.067 0.081 e0.009 0.083 e0.036 0.085
0.177 0.016 0.515 0.009 0.397 0.015 0.328 0.011 0.455 0.004 0.939 0.010 0.662 0.009
S445
756 CAN A BIOMECHANICALLY-DESIGNED YOGA EXERCISE PROGRAM YIELD SUPERIOR CLINICAL IMPROVEMENTS THAN TRADITIONAL EXERCISE IN WOMEN WITH KNEE OSTEOARTHRITIS? A.B. Kuntz y, S. Karampatos y, E. Brenneman y, J.N. Chopp-Hurley z, E. Wiebenga y, J. Adachi y, K. Madsen y, M.R. Maly y. y McMaster Univ., Hamilton, ON, Canada; z McMaster Univ., Oakville, ON, Canada Purpose: For individuals with knee osteoarthritis (OA), exercise can provide equivalent pain relief to that of medication, reduce the risk of co-morbidities, and improve physical functioning. However, the optimal type of exercise is unknown; certain forms could overload the joint and exacerbate symptoms. We have selected a series of yoga postures with a minimal knee adduction moment (KAMea mechanical loading variable associated with disease progression) yet sufficient activation of the knee musculature. In a 12-week, cohort study, 38 women with knee OA engaged in a program comprised of these yoga exercises and experienced improvements in pain, mobility, strength, and self-reported measures following the intervention. The purpose of the current study was to compare the efficacy of this biomechanicallytailored yoga program with the current “gold standard” of exercise for knee OA, and a no-exercise attention control group, in women with knee OA. Methods: A single-blind, 12-week, parallel randomized control trial was conducted. Participants included women 50 years of age or over with clinical knee OA. Participants (n ¼ 31; age 67.0 ± 8.3 years; body mass index (BMI) 30.4 ± 5.5 kg/m2) were stratified by Lower Extremity Functional Scale (LEFS) scores and randomized to 1 of 3 interventions: biomechanical yoga (BY: n ¼ 10), traditional exercise (TE: n ¼ 11), or no exercise (NE: n ¼ 10). Participants were asked to attend 3 of 4 available exercises classes each week. The BY program consisted of an instructor led series of postures that yield peak KAMs smaller than that experienced during gait. The TE regimen was comprised of supervised exercises that are currently prescribed for those with knee OA, including walking/cycling, lower body resistance training, balance exercises, and stretching. The NE group engaged in guided relaxation exercises consisting of no physical activity. The primary outcome measure was pain; secondary outcomes included self-reported physical function and mobility performance. Pain was assessed using the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) as well as the pain subscale of the Knee Osteoarthritis Outcome Score (KOOS). Self-reported physical function was evaluated using the LEFS and other symptoms, activities of daily living, sport and recreation, and quality of life subscales of the KOOS. Mobility performance measures included 6minute walk, 40-meter walk, 30-second chair stand, timed up and go, and stair climb tests. Paired t-tests (2-tailed) of primary and secondary outcome measures were computed to compare pre and post intervention time points for within group effects. A Bonferroni corrected alpha value of 0.017 was used to adjust for multiple comparisons. Results: There were no differences in age, BMI, or LEFS scores between groups at baseline (p > 0.05). One participant was lost to follow-up (TE). Mean attendance was 3.0 classes per week for the BY group, 2.7 for TE, and 2.8 for NE. Following the intervention, the BY group had reduced scores on the constant pain subscale of the ICOAP (p ¼ 0.006); while the TE and NE groups did not change. The BY and TE groups had reduced scores on the intermittent pain subscale of the ICOAP (p ¼ 0.005, 0.006); the NE group did not change. BY improved in all 5 domains of the KOOS (p < 0.017) while the TE and NE groups did not. BY was the only group to increase self-reported function (LEFS) scores following the intervention (p ¼ 0.01). Regarding mobility performance, BY improved 6-minute walk, 30-second chair stand, timed up and go, and stair climb test performance following the intervention (p < 0.017); while TE improved on the 6-minute walk, 40-meter walk, 30-second chair stand, and stair climb tests; and the NE group resulted in no change on all tests. Within group mean differences between baseline and follow-up are presented in Table 1. Conclusions: The BY group improved on all outcomes but 1 mobility performance measure; TE was less consistent. Though the generalizability of these findings are limited by the small sample size, biomechanically-tailored yoga appears to be an efficacious exercise option for improving clinical outcomes of knee OA while minimizing potentially harmful knee loads.
S446
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Table 1. Mean difference scores (follow-up minus baseline) and 95% confidence intervals (CI) of differences are presented. Significant within-group changes compared using 2-tailed paired t-tests are denoted with an asterisk (*). A Bonferroni corrected alpha value of 0.017 was used to adjust for multiple comparisons. Outcomes included Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), Knee Osteoarthritis Outcome Score (KOOS), Lower Extremity Functional Scale (LEFS), and mobility performance measures. Lower scores on KOOS and LEFS indicate more troublesome values. Outcome measure
ICOAP Constant pain subscale score (/100) ICOAP Intermittent pain subscale score (/100) KOOS - Pain (/100) KOOS - Other symptoms (/100) KOOS - Activities of daily living (/100) KOOS - Sport and recreation (/100) KOOS - Quality of life (/100) LEFS (/80) Six-minute walk test (m) 40-Meter walk test (s) 30-Second chair stand test (repetitions) Timed up and go test (s) Stair climb test (s)
Biomechanical yoga
Traditional exercise
No exercise
Mean difference [95% CI]
Mean difference [95% CI]
Mean difference [95% CI]
24.5* [40.0, 9.0] 23.7* [30.9, 16.5] 21.5* [15.1. 27.9] 20.2* [8.7, 31.7] 17.9* [8.7, 27.2] 21.3* [9.7, 32.9] 13.9* [5.7, 22.1] 10.6* [3.3, 17.9] 59.3* [22.5, 96.0] 3.9 [7.4, 0.3] 3.4* [2.0, 4.8] 1.3* [2.3, 0.3] 1.7* [2.8, 0.7]
15.0 [29.5, 0.5] 14.3* [23.4, 5.2] 8.3 [4.1,20.7] 10.9 [0.8, 21.0] 8.7 [0.2, 17.2] 29.2 [2.9, 55.5] 10.7 [4.9, 26.3] 7.6 [0.63, 15.8] 54.0* [28.5, 79.5] 2.9* [5.0, 0.8] 2.5* [0.9, 4.1] 0.3 [1.0, 0.4] 0.7* [1.3, 0.2]
10.5 [34.1, 13.1] 4.2 [16.7, 8.3] 2.1 [12.6, 8.4] 0.1 [10.5, 10.7] 0.0 [8.6, 8.6] 2.7 [14.5, 9.1] 1.8 [9.8, 6.2] 6.4 [13.2, 0.4] 19.1 [16.8, 54.9] 4.01 [9.9, 17.9] 1.8 [0.3, 3.3] 0.2 [1.2, 1.6] 1.9 [2.8, 6.5]
757 CORRELATES OF PATELLAR TENDON ENTHESIS ABNORMALITIES IN OLDER ADULTS S. Mattap y, P. Otahal y, A. Halliday z, G. Jones y, L. Laslett y. y Univ. of Tasmania, Hobart, Australia; z Royal Hobart Hosp., Tasmania, Hobart, Australia Purpose: The patellar tendon works together with the quadriceps tendon to enable straightening and bending of knee joints; its’ attachment site (enthesis) is at risk of micro damage and degeneration. Recent studies suggest that enthesis abnormalities (enthesopathy) are associated with the development of osteoarthritis at the synovio-entheseal complex and subchondral bone marrow. However, no studies have assessed presence of patellar tendon enthesis (PTE) abnormalities in
WOMAC score (refer Table 1). While the effect size was similar, the association with knee pain became of borderline statistical significance after further adjustment for patellar cartilage defects (p-value ¼ 0. 052). Weight-bearing knee bending and straightening activities; going up and down stairs (Relative risk (RR) 2.13 (95% confidence interval; 1.15, 3.94)) and standing upright (RR 3.22 (1.08, 9.62)) had the strongest associations amongst the pain subscales (Table 1). Conclusions: Presence of PTE abnormalities is associated with greater knee pain (predominantly involving weight-bearing knee bending and straightening activities), poorer knee physical function and worse total WOMAC score. This suggests that the patellar tendon enthesis abnormalities may be important factors in the development of osteoarthritis in older adults.
Table 1. Associations between PTE abnormalities and knee pain, physical function, stiffness, total
Knee pain subscales Walking on a flat surface Going up and down stairs At night while in bed Sitting or lying Standing upright Knee pain scale Physical function scale Stiffness scale Total WOMAC score
Univariate RR (95% CI)
p-value
Adjusted for age, sex, BMI, & knee extension strength RR (95% CI)
p-value
Further adjusted for patellar cartilage defects RR (95% CI)
p-value
2.15 2.20 0.75 0.89 3.16 1.26 1.25 1.23 1.28
0.147 0.012 0.635 0.849 0.025 0.022 0.015 0.086 0.020
2.01 2.23 0.84 1.11 3.17 1.26 1.33 1.20 1.29
0.185 0.010 0.766 0.855 0.033 0.019 0.008 0.120 0.018
1.94 2.13 0.84 1.12 3.22 1.21 1.28 1.18 1.24
0.203 0.016 0.767 0.846 0.036 0.052 0.021 0.175 0.045
(0.76e6.04) (1.19e4.09) (0.23e2.48) (0.26e2.99) (1.15e8.67) (1.03e1.53) (1.04e1.50) (0.97e1.55) (1.04e1.58)
(0.72e5.63) (1.22e4.10) (0.26e2.73) (0.36e3.43) (1.10e9.15) (1.04e1.54) (1.08e1.65) (0.95e1.51) (1.04e1.59)
older adults. This studies aims to describe cross-sectional associations between patellar tendon enthesis (PTE) abnormalities and knee pain and physical function in older adults. Methods: Population-based study of randomly selected older Tasmanian adults (n ¼ 528; aged 50e80 years, 50% female). Predictor: Presence of abnormal bone signal or erosion at the PTE region was scored using T2-weighted fat saturated magnetic resonance imaging (MRI), proximally and distally. Presence of any abnormalities was scored as 1 and absence of abnormality as 0. Outcomes: Knee pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical analyses: Associations between PTE abnormalities and WOMAC scales were assessed using log binomial regression. Knee pain subscales were dichotomised at 4 and other data was dichotomised at the median. Associations were adjusted for age, sex, BMI, knee extension strength; data was then further adjusted for patellar cartilage defects. Results: 20% of our study population had the PTE abnormalities (bone signal and/or erosion). Presence of PTE abnormalities was associated with greater knee pain, poorer physical function, and worse total
(0.70e5.35) (1.15e3.94) (0.25e2.75) (0.36e3.15) (1.08e9.62) (1.00e1.48) (1.04e1.59) (0.93e1.48) (1.01e1.53)
758 COMORBIDITY IN HAND OSTEOARTHRITIS: ITS IMPACT ON HAND PAIN AND FUNCTION W. Damman, R. Liu, M. Kloppenburg. Leiden Univ. Med. Ctr. (LUMC), Leiden, Netherlands Purpose: Hand pain and function are important complaints in patients with hand osteoarthritis (OA). Therefore, it is important to know which factors influence hand pain and function. In patients with knee and hip OA, comorbidities result in a higher burden of disease. However, the role of comorbidities in association with hand complaints in patients with hand OA is unclear. Therefore, we aimed to study the association of comorbidities and hand pain and function in a hand OA population in secondary care. Methods: Baseline data were used of the ongoing HOSTAS (Hand osteoarthritis in Secondary care) study, which included consecutive patients diagnosed by their treating rheumatologist with primary hand OA between June 2009 and October 2015. Demographic data were collected using standardized questionnaires. Self-reported comorbidity was assessed by a 17-item list (derived from Charlson comorbidity index). Additionally, presence of knee and/or hip OA (poly OA) was