Washington: A review of the existing scientific evidence has found that diet is unlikely to make any difference in the progression of osteoarthritis and rheumatoid arthritis.The study was published in the open-access journal RMD Open. While a healthy diet brings other health benefits, any impact on rheumatoid and musculoskeletal diseases is small and not clinically meaningful, but they just aren’t enough high-quality dietary studies, the review concludes. Diet is known to influence cardiovascular and mental health outcomes, but it’s not clear whether it might also influence the symptoms and progression of rheumatic and musculoskeletal diseases.In a bid to find out, the European League Against Rheumatism (EULAR) convened an international task force in 2018 to look at the potential impact of diet, exercise, weight, alcohol, smoking and paid work on disease progression, and develop appropriate recommendations for clinicians and patients for each of these behaviours. For the dietary recommendations, the task force searched for relevant systematic reviews of randomised controlled trials or observational studies and pooled data analyses looking at the impact of dietary components/supplements on pain, joint damage, and physical function for seven common rheumatoid and musculoskeletal conditions. These were: osteoarthritis; rheumatoid arthritis; systemic lupus erythematosus; axial spondyloarthritis; psoriatic arthritis; systemic sclerosis; and gout.In all, 24 systematic reviews, published between 2013 and 2018, and 150 original research articles with no restriction on publication date, were included in the pooled data analysis Most of the studies concerned osteoarthritis and rheumatoid arthritis and featured a wide range of dietary compounds/supplements: animal products; experimental diets; food components; fruit and veg plus other plant-based interventions; minerals and supplements; and vitamins. There were relatively few dietary studies for osteoarthritis, meaning that the evidence for these was graded as poor or very poor. The pooled data analyses showed that for dietary interventions with moderate evidence (fish oil, chondroitin, glucosamine, vitamin D, avocado and soybean), the magnitude of the impact on disease progression was generally small and not clinically meaningful.The evidence for most dietary interventions in rheumatoid arthritis was graded as poor or very poor, primarily because of the small number of studies and participants. There was moderate-quality evidence for probiotics, vitamin D, and fish oil/omega-3 but the impact was either negligible or too small to make much difference. The evidence for fish oil/omega-3 for systemic lupus erythematosus was rated as moderate but showed no effect on outcomes. The evidence for all other studies on this condition was rated as poor or very poor, as it was for axial spondyloarthritis. Similarly, the evidence for fish oil/omega-3 for psoriatic arthritis was rated as moderate and showed no effect on outcomes. The evidence for other dietary interventions was rated as poor. The evidence for systemic sclerosis and gout was also rated as poor. “Therefore, based on the current evidence, there is no single dietary intervention which has substantial benefits on the outcomes of people with [osteoarthritis and rheumatoid arthritis],” conclude the authors.“While there have been far fewer research studies published for the other included [rheumatic and musculoskeletal diseases], again, there is no consistent evidence that any dietary exposure significantly improves outcomes in these conditions,” they add. While diet might not make much difference to disease progression in these conditions, those who live with them should nevertheless make sure they eat healthily and don’t put on too much weight, they emphasise. “Health professionals can advise people with [these conditions] that consuming specific dietary components is unlikely to influence the progression of their [disease], but that it is important to maintain a healthy diet and healthy weight for general health reasons,” they wrote.—ANI

A review of the existing scientific evidence has found that diet is unlikely to make any difference in the progression of osteoarthritis and rheumatoid arthritis.

Diet unlikely to ease rheumatoid arthritis progression: Research

Washington: Scientists at the Wake Forest Institute for Regenerative Medicine (WFIRM) have developed a promising injectable cell treatment for osteoarthritis that both decreases inflammation and regenerates articular cartilage. Recently identified by the Food and Drug Administration as a public health crisis, osteoarthritis affects more than 520 million people worldwide who deal with pain and inflammation. Osteoarthritis is typically induced by mechanical or traumatic stress in the joint, leading to damaged cartilage that cannot be repaired naturally. "Without better understanding of what drives the initiation and progression of osteoarthritis, effective treatment has been limited," said lead author Johanna Bolander of WFIRM. "Initially, we studied what goes wrong in osteoarthritic joints, compared these processes to functional environments, and used this information to develop an immunotherapy cell treatment." Osteoarthritis is a disease of the joint system. The joint includes a synovial membrane - a connective tissue that lines the inner surface of the joint. The membrane functions to protect the joint and secretes a lubricating fluid filled with cell elements needed to maintain a healthy environment and to provide friction free movement. In healthy joints when an injury occurs, the body recruits an army of inflammatory cells and sends them to the injury site to contribute to cleaning of the damaged tissues. In the osteoarthritic joint, however, a traumatic injury leads to inflammation of the synovial membrane and cartilage damage. "With time, the inflammation worsens, leading to degradation of the cartilage lining the joint bones and chronic inflammation in the surrounding tissues. For patients, this causes severe pain, swelling and often limits daily activities," said co-author Gary Poehling, MD, an orthopedic surgeon at Atrium Health Wake Forest Baptist. For this study, published in Science Advances, the journal of the American Association for the Advancement of Science, the research team set out to investigate what is taking place in the osteoarthritic joint environment that keeps the healing process from happening. "We evaluated whether the cell population present in the joint fluid environment lacked the capability to contribute to functional tissue repair, or if there is something in the environment that impairs their ability to do so," said Gustavo Moviglia, PhD, a WFIRM researcher. The team isolated cells from the joint fluid of osteoarthritic patients, separated the cells from the fluid and investigated them alone, but also in the presence of the autologous fluid. Separated from the fluid, they saw that the cells had the ability to undergo processes required for functional tissue repair. When they added a small percentage of the fluid back into the cell culture assay, the cells' abilities were impaired - they couldn't do their job - suggesting that the specific osteoarthritic environment stops them. Based on these findings and what is known about functional tissue repair, a cell therapy was designed that can overcome the inflammatory environment and also regenerate cartilage. "Cartilage activated immune cells that target inflammation, combined with progenitor cells aid tissue regeneration," said Anthony Atala, MD, senior author and director of WFIRM. "It's really a dynamic communication between these two cell populations that are crucial for the efficacy of the treatment." The combination of cells leads to simultaneous treatment of several of the aspects involved in osteoarthritis: synovial inflammation, cartilage degradation, subchondral bone sclerosis and innervation of pain sensory neurons. The therapy was tested in a pre-clinical model and was found to have the ability to reverse cartilage damage in the synovial membrane and diminish the inflammation as well. To evaluate clinical efficacy, a compassionate use study was conducted in nine patients with confirmed osteoarthritis who each received one or two injections. Efficacy was evaluated through scoring of pain and functional living, MRI scans pre- and post-treatment and a biopsy from one patient was obtained. Once treated, the patients experienced improved quality of life, ability to participate in recreational activities, and reduced pain. Additionally, MRI studies confirmed cartilage regeneration. Additional clinical studies are required to evaluate the outcome in a larger patient population as well as to evaluate potential differences in patients in specific subgroups. —ANI

 Scientists at the Wake Forest Institute for Regenerative Medicine (WFIRM) have developed a promising injectable cell treatment

New Injectable Cell Therapy May Resolve Osteoarthritis: Research

Pennsylvania (US): According to a study, next-generation DNA sequencing (NGS) methods reveal the presence of bacterial DNA in surgical specimens of hip and knee arthritis from patients having first-time total joint arthroplasty. The findings of the study were published in the Journal of Bone &amp; Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer. The findings "add to an increasing body of evidence indicating that native joints harbor microbes, as part of a microbiome, although the clinical relevance of these findings and the mechanism of microbial colonization are still unknown," according to the new research by Javad Parvizi, MD, FRCS, of Rothman Orthopaedic Institute at Thomas Jefferson University and colleagues. Extensive study has been conducted in recent years to investigate the impact of microbiomes (the kinds and variety of bacteria found in various bodily regions) on human health and illness. Researchers can use powerful NGS methods to identify evidence of bacterial DNA that would otherwise go unnoticed. Even when no particular bacterial cause is established, infection is a primary cause of joint failure in individuals having total joint arthroplasty. In the past, it was thought that the native hip and knee joints, as well as other body areas unaffected by surgery or other potential causes of contamination, were sterile. However, recent microbiome studies have found bacterial DNA in many "body sites previously assumed to be sterile," for example, in a developing fetus, the breast, and the shoulder joint.  In the new study, Dr. Parvizi and colleagues obtained intraoperative samples of synovial fluid, deep-tissue specimens, and intramedullary swabs from the operative hip or knee from 117 patients undergoing first-time hip or knee arthroplasty. Samples were collected with strict attention to sterile technique in order to minimize the risk of bacterial contamination. The researchers then utilized a commercial NGS platform to analyze the types and diversity of the microbial DNA in each specimen. Analysis of more than 800,000 DNA "reads" led to the identification of 361 different species of bacteria. Overall, bacterial DNA was found in specimens from 113 of 117 patients with hip or knee osteoarthritis. The five most frequent types of bacteria were Escherichia, Cutibacterium, Staphylococcus, Acinetobacter, and Pseudomonas - all common infection-causing microbes. The findings were generally similar for the three sample types, although the intramedullary swabs showed slightly higher bacterial diversity than synovial fluid or deep-tissue specimens. Microbiome findings were found to be unrelated to a wide range of patient-related factors, including age, sex, race, and comorbidity. However, the hospital at which the arthroplasty was performed was shown to be a significant factor, explaining 18.5% of the variation in one measure of bacterial diversity. This finding might reflect differences in the types of bacteria found in hospital environments or possible intraoperative contamination. The only other significant factor was history of corticosteroid injections, a common treatment for hip and knee osteoarthritis. The results showed "differential abundances" of bacteria in patients with corticosteroid injections in the past six months, again raising the possibility of contamination. However, the researchers note, "the most common species observed in this study were not among the most common in previous skin microbiome studies, suggesting that the microbial profiles detected are not likely explained solely by skin contamination." The study adds to a growing body of evidence that native joints, traditionally assumed to be sterile and bacteria-free, are somehow exposed to microbes. The researchers emphasize the need for further studies to assess the relationship between the hospital where patients are treated and the bacteria detected in "closed microbiome environments," such as the knee and hip joints. Dr. Parvizi and coauthors conclude: "These findings contribute to establishing the baseline microbial signal and identifying contributing variables in the osteoarthritic joint, which will be valuable as a comparator in the contexts of infection and long-term arthroplasty success." (ANI)

According to a study, next-generation DNA sequencing (NGS) methods reveal the presence of bacterial DNA

Study gives more insight into microbiome of hip, knee osteoarthritis

Zurich (Switzerland): This study examined the relationship between individual and combination healthy lifestyle characteristics and the risk of all-cause and cause-specific death among 104,142 osteoarthritis patients using data from the UK Biobank. The researchers gave each person a score for their lifestyle, based on their body mass index (BMI) and self-reported diet, sleep duration, physical activity, sedentary time, social connection, smoking, and alcohol drinking - all factors thought to be associated with health. Overall, there were 9,915 deaths recorded after the first 2 years' follow-up. Models showed a variety of associations between people's lifestyle and mortality. Sleep duration had a U-shaped relationship, whilst moderate physical activity was L-shaped, and BMI and vigorous activity were J-shaped - a trend that starts with a sharp drop and is followed by a dramatic rise. For sleep, the ideal seems to be 7 hours a night, whilst the turning point for moderate physical activity was 550 minutes per week, and 240 minutes per week for vigorous physical activity. The J-shaped turning point for BMI was 28 kg/m2. In multivariable models, each lifestyle factor was significantly associated with all-cause mortality, as well as mortality associated with cancer, cardiovascular, digestive, and respiratory diseases. This study could be important in helping to identify a healthy lifestyle pattern that could significantly reduce the risk of mortality in people with osteoarthritis. Indeed, EULAR has recently published recommendations on lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases, including osteoarthritis.1 The overarching principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments.1 It seems now this could possibly benefit mortality as well as disease outcomes. —ANI

This study examined the relationship between individual and combination healthy lifestyle characteristics and the risk 

Study Examines Connection Between Healthy Living And Osteoarthritis Mortality

Illinois: The most prevalent degenerative joint condition, osteoarthritis, affects 22 per cent of persons over 40 worldwide. The molecular alterations connected to osteoarthritis are still unknown, despite the ailment having received substantial medical study. In a recent study, scientists used several tools to monitor the disease's development and the alterations it causes. The smooth surface of the cartilage in the joints, along with a lubricant called synovial fluid, helps them resist weight-bearing movements. Several chemicals, including phospholipids and hyaluronan (HA), are present in the fluid. Researchers have sought to identify the early stages of joint illness by monitoring the molecular weight and concentration of HA since the cartilage environment cannot be easily mended or regenerated. "Although we know that in healthy joints there is very low friction, it is unclear which other molecules are involved and how they change during osteoarthritis," said Rosa Espinosa-Marzal (EIRH), Donald Biggar Willett Faculty Scholar and a professor of environmental engineering &amp; science, and materials science &amp; engineering. "During the early stages of osteoarthritis, the cartilage starts degrading, and previous research has shown that the molecular composition of the synovial fluid changes. We wanted to see if the two changes are related to each other." In a healthy joint, the molecular weight of HA varies between 2-20 MDa with a concentration ranging from 1-4 mg/ml. However, in diseased joints, HA is broken down resulting in a lower molecular weight. Additionally, its concentration is also reduced by ten times. Based on these observations, made by other researchers, the study looked at how the concentration and molecular weight of HA influences the structure of healthy and diseased joints. To do so, the researchers combined vesicles with high and low molecular weight HA. Using neutron scattering and light scattering, they discovered that the molecular weight of HA can vastly change the structure of the vesicles. Lower molecular weight HA, which mimics osteoarthritis-diseased joints, results in larger vesicle size. They also observed that the molecular weight of HA changes the thickness of the phospholipid layers in the joints. The researchers also studied how these differences can influence the formation of a protective film; in joints, this film is responsible for the very low friction we need for unhindered motion. Once again, they used a combination of techniques, quartz crystal microbalance and atomic force microscopy, to examine how these molecules assemble on gold surfaces. "The formation of a film is possible only when there is an optimal concentration of HA and phospholipids. Even though the gold surfaces have very little in common with cartilage, our studies indicate that there could also be an optimum concentration under biological conditions," Espinosa-Marzal said. "This is an important observation because we can use the concentration changes as a diagnostic tool." "We are at a point where you need to use multiple techniques on a complex system like this," said Mark Rutland, a professor of surface science at the KTH Royal Institute of Technology. "None of these techniques alone would have given us any insight. The key was to look at all the different effects and put the pieces together to show that the molecular weight of HA has a huge effect on the characteristics of the layer that is formed with phospholipids." The researchers are now working on using cartilage to understand whether their observations with gold surfaces also hold true in a biologically relevant system. They are also interested in studying the other molecular components that are found in joints to build a more comprehensive model of the changes that are associated with osteoarthritis. —ANI

The most prevalent degenerative joint condition, osteoarthritis, affects 22 per cent of persons over 40 worldwide

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Diet unlikely to ease rheumatoid arthritis progression: Research

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Diet unlikely to ease rheumatoid arthritis progression: Research

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