Preoperative synovitis in knee osteoarthritis is predictive for pain 1 year after total knee arthroplasty

Preoperative synovitis in knee osteoarthritis is predictive for pain 1 year after total knee... 184Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188AQP4 expression in trigeminal neurons and SGCs under normal andinflammatory conditions relevant to craniofacial pain conditions.Methods: Rat trigeminal ganglia (TG) were isolated from adultmale Sprague-Dawley rats subjected to a model of trigeminalinflammation evoked by unilateral complete Freund’s adjuvant(CFA) injection in temporomandibular joint. Immunohistochemistry was performed on TG sections of CFA-treated animals. NeuNand GS markers were used for identification of neurons and SGCs,respectively. AQP4 expression was investigated in both ipsilateraland contralateral TG sections. The study protocol was approved bythe local ethics committee.Results: Co-localization of NeuN-AQP4 and GS-AQP4 wereidentified in both ipsi and contralateral trigeminal ganglia ofthe CFA-treated rats. However, we did not detect any differencebetween the ipsi- and contralateral side in terms of alteration inAQP4 receptor expression.Conclusions: AQP4 was expressed both on trigeminal neuronsand SGCs and CFA did not cause a remarkable change in AQP4expression, when ipsilateral and contralateral TG of the test animalswas compared. Previously, it has been shown that in a neuropathic pain model no difference is detectable between wild typeand AQP4-deficient mice, for mechanical and thermal perception;however, in formalin pain model AQP4-deficient mice have higherthermal pain thresholds. Further investigation is required to clarifyrole of AQP4 in pain.http://dx.doi.org/10.1016/j.sjpain.2017.04.055Preoperative synovitis in knee osteoarthritis ispredictive for pain 1 year after total kneearthroplastyJonathan Vela a,b,c,d,∗ , Kristian KjærPetersen a,b,c,d , Lars Arendt-Nielsen a,b,c,d , MikkelMeyer Andersen a,b,c,d , Ole Simonsen a,b,c,daDepartment of Rheumatology, Aalborg, DenmarkCentre for Sensory-Motor Interaction, Aalborg,Denmarkc Department of Mathematical Sciences, Aalborg,Denmarkd Department of Orthopaedic Surgery, Aalborg,DenmarkE-mail address: j.vela@rn.dk (J. Vela).Background: Knee osteoarthritis (KOA) was previously considered a degenerative joint disease due to wear and tear. Aftertotal Knee replacement (TKR) 13–38% of patients develop persistent post-operative pain. Emerging evidence has shown that theetiology of pain in KOA is multifaceted and may involve differentstructures including the synovial membrane, musculotendinousstructures and neuronal tissue. Current preoperative assessmentdoes not take these into account, thus the current study examinesthe role of preoperative synovitis on patient reported outcomesone-year post surgery.Material and methods: 40 patients with end-stage KOAanswered the KOOS questionnaire prior to receiving total kneereplacement surgery. During the procedure synovitis was scoredsystematically at six sites where synovial excision biopsies wereobtained. Macro scoring was based on three parameters (hypertrophy, vascularity and synovitis) on a 0–4 point scale. Micro biopsieswhere also graded based on three parameters (synovial hyperplasia, inflammatory infiltration and activation of synovial stroma) buton a 0–3 point scale. Patients received a follow up KOOS questionnaire one-year post surgery.Results: 33 patients completed the KOOS questionnaire atfollow-up. A high correlation between the micro mean, micro max,bmacro mean, and macro max was found. The micro mean waschosen as a proxy for the amount of synovitis. A multiple linear regression analysis, correcting for baseline values of BMI, age,smoking, point pressure thresholds (PPTs) and KOOS pain, showedthat the synovitis measurement at baseline was significant for thechange in KOOS pain with an effect of 22.22 (p = 0.0498). Hence, themore synovitis at baseline, the higher the follow-up KOOS Pain wascompared to baseline KOOS Pain (an improvement). The standarddeviation (SD) of the synovitis measure was 0.42, hence a changeof 1 SD in synovitis gave an increase of 9 in KOOS Pain at follow-upcompared to at baseline.Conclusions: These preliminary results indicate that the synovitis score attained during operation is positively correlated withimprovement in KOOS-pain post operatively.http://dx.doi.org/10.1016/j.sjpain.2017.04.056Biomarkers alterations in trapezius muscleafter an acute tissue trauma: A humanmicrodialysis studyL.B. Sørensen a,∗ , P. Gazerani a , K. Wåhlén b , N.Ghafouri b , B. Gerdle b , B. Ghafouri baCenter for Neuroplasticity and Pain (CNAP), SMI,Department of Health Science and Technology,Aalborg University, Aalborg, Denmarkb Pain and Rehabilitation Centre, and Department ofMedical and Health Sciences, Linköping University,Linköping, SwedenE-mail address: lbs@hst.aau.dk (L.B. Sørensen).Aims: Alteration in muscle milieu has been proposed as oneof the main contributors underlying chronic musculoskeletal pain(CMP). Microdialysis (MD) provides real-time information onrelease of pain and metabolic biomarkers in muscle. However,insertion of MD probe causes a local tissue trauma, which mayaffect the tissue milieu. Whether an acute tissue trauma alter painand metabolite biomarkers in trapezius muscle of patients withCMP is not known. Hence, this study investigated changes in muscle metabolites following MD probe insertion in patients with CMPin comparison with healthy controls.Methods: Nineteen patients (11 women and 8 men; 41.4 years)with CMP and 20 pain-free volunteers (10 women and 10 men;36.5 years) were recruited (project approval number: 2013/15131). Baseline pressure pain thresholds (PPT) at trapezius musclewere obtained bilaterally with a reference point at the tibialis muscle. Pain questionnaires were used for determining levels of anxietyand depression and catastrophizing impact. Interstitial sampleswere collected from trapezius muscles by aid of MD (20 kDa cut-off)during a period of 40 min. Collected dialysates at 2 time-points of20 and 40 min were stored at −70 ◦ C until analysis. Concentrationsof glucose, lactate, pyruvate, glycerol, and glutamate were analyzedby ISCUSSflex . P ≤ 0.05 was considered significant.Results: No potential case with respect to anxiety, depression orcatastrophizing impact was found. Lower PPTs were found in CMPgroup (P ≤ 0.05). Significantly lower levels of pyruvate were foundin CMP group at both 20 min (P = 0.003) and 40 min (P = 0.006).Gender-based analysis indicated higher concentrations of glutamate in female patients with CMP.Conclusions: This study was first to demonstrate metabolitealterations during trauma phase of MD in trapezius muscles of CPMcompared with healthy controls. This model proved beneficial forinvestigating pain and metabolic biomarkers during acute phase ofMD.http://dx.doi.org/10.1016/j.sjpain.2017.04.057 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Preoperative synovitis in knee osteoarthritis is predictive for pain 1 year after total knee arthroplasty

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De Gruyter
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© 2017 Scandinavian Association for the Study of Pain
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1877-8860
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1877-8879
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10.1016/j.sjpain.2017.04.056
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Abstract

184Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188AQP4 expression in trigeminal neurons and SGCs under normal andinflammatory conditions relevant to craniofacial pain conditions.Methods: Rat trigeminal ganglia (TG) were isolated from adultmale Sprague-Dawley rats subjected to a model of trigeminalinflammation evoked by unilateral complete Freund’s adjuvant(CFA) injection in temporomandibular joint. Immunohistochemistry was performed on TG sections of CFA-treated animals. NeuNand GS markers were used for identification of neurons and SGCs,respectively. AQP4 expression was investigated in both ipsilateraland contralateral TG sections. The study protocol was approved bythe local ethics committee.Results: Co-localization of NeuN-AQP4 and GS-AQP4 wereidentified in both ipsi and contralateral trigeminal ganglia ofthe CFA-treated rats. However, we did not detect any differencebetween the ipsi- and contralateral side in terms of alteration inAQP4 receptor expression.Conclusions: AQP4 was expressed both on trigeminal neuronsand SGCs and CFA did not cause a remarkable change in AQP4expression, when ipsilateral and contralateral TG of the test animalswas compared. Previously, it has been shown that in a neuropathic pain model no difference is detectable between wild typeand AQP4-deficient mice, for mechanical and thermal perception;however, in formalin pain model AQP4-deficient mice have higherthermal pain thresholds. Further investigation is required to clarifyrole of AQP4 in pain.http://dx.doi.org/10.1016/j.sjpain.2017.04.055Preoperative synovitis in knee osteoarthritis ispredictive for pain 1 year after total kneearthroplastyJonathan Vela a,b,c,d,∗ , Kristian KjærPetersen a,b,c,d , Lars Arendt-Nielsen a,b,c,d , MikkelMeyer Andersen a,b,c,d , Ole Simonsen a,b,c,daDepartment of Rheumatology, Aalborg, DenmarkCentre for Sensory-Motor Interaction, Aalborg,Denmarkc Department of Mathematical Sciences, Aalborg,Denmarkd Department of Orthopaedic Surgery, Aalborg,DenmarkE-mail address: j.vela@rn.dk (J. Vela).Background: Knee osteoarthritis (KOA) was previously considered a degenerative joint disease due to wear and tear. Aftertotal Knee replacement (TKR) 13–38% of patients develop persistent post-operative pain. Emerging evidence has shown that theetiology of pain in KOA is multifaceted and may involve differentstructures including the synovial membrane, musculotendinousstructures and neuronal tissue. Current preoperative assessmentdoes not take these into account, thus the current study examinesthe role of preoperative synovitis on patient reported outcomesone-year post surgery.Material and methods: 40 patients with end-stage KOAanswered the KOOS questionnaire prior to receiving total kneereplacement surgery. During the procedure synovitis was scoredsystematically at six sites where synovial excision biopsies wereobtained. Macro scoring was based on three parameters (hypertrophy, vascularity and synovitis) on a 0–4 point scale. Micro biopsieswhere also graded based on three parameters (synovial hyperplasia, inflammatory infiltration and activation of synovial stroma) buton a 0–3 point scale. Patients received a follow up KOOS questionnaire one-year post surgery.Results: 33 patients completed the KOOS questionnaire atfollow-up. A high correlation between the micro mean, micro max,bmacro mean, and macro max was found. The micro mean waschosen as a proxy for the amount of synovitis. A multiple linear regression analysis, correcting for baseline values of BMI, age,smoking, point pressure thresholds (PPTs) and KOOS pain, showedthat the synovitis measurement at baseline was significant for thechange in KOOS pain with an effect of 22.22 (p = 0.0498). Hence, themore synovitis at baseline, the higher the follow-up KOOS Pain wascompared to baseline KOOS Pain (an improvement). The standarddeviation (SD) of the synovitis measure was 0.42, hence a changeof 1 SD in synovitis gave an increase of 9 in KOOS Pain at follow-upcompared to at baseline.Conclusions: These preliminary results indicate that the synovitis score attained during operation is positively correlated withimprovement in KOOS-pain post operatively.http://dx.doi.org/10.1016/j.sjpain.2017.04.056Biomarkers alterations in trapezius muscleafter an acute tissue trauma: A humanmicrodialysis studyL.B. Sørensen a,∗ , P. Gazerani a , K. Wåhlén b , N.Ghafouri b , B. Gerdle b , B. Ghafouri baCenter for Neuroplasticity and Pain (CNAP), SMI,Department of Health Science and Technology,Aalborg University, Aalborg, Denmarkb Pain and Rehabilitation Centre, and Department ofMedical and Health Sciences, Linköping University,Linköping, SwedenE-mail address: lbs@hst.aau.dk (L.B. Sørensen).Aims: Alteration in muscle milieu has been proposed as oneof the main contributors underlying chronic musculoskeletal pain(CMP). Microdialysis (MD) provides real-time information onrelease of pain and metabolic biomarkers in muscle. However,insertion of MD probe causes a local tissue trauma, which mayaffect the tissue milieu. Whether an acute tissue trauma alter painand metabolite biomarkers in trapezius muscle of patients withCMP is not known. Hence, this study investigated changes in muscle metabolites following MD probe insertion in patients with CMPin comparison with healthy controls.Methods: Nineteen patients (11 women and 8 men; 41.4 years)with CMP and 20 pain-free volunteers (10 women and 10 men;36.5 years) were recruited (project approval number: 2013/15131). Baseline pressure pain thresholds (PPT) at trapezius musclewere obtained bilaterally with a reference point at the tibialis muscle. Pain questionnaires were used for determining levels of anxietyand depression and catastrophizing impact. Interstitial sampleswere collected from trapezius muscles by aid of MD (20 kDa cut-off)during a period of 40 min. Collected dialysates at 2 time-points of20 and 40 min were stored at −70 ◦ C until analysis. Concentrationsof glucose, lactate, pyruvate, glycerol, and glutamate were analyzedby ISCUSSflex . P ≤ 0.05 was considered significant.Results: No potential case with respect to anxiety, depression orcatastrophizing impact was found. Lower PPTs were found in CMPgroup (P ≤ 0.05). Significantly lower levels of pyruvate were foundin CMP group at both 20 min (P = 0.003) and 40 min (P = 0.006).Gender-based analysis indicated higher concentrations of glutamate in female patients with CMP.Conclusions: This study was first to demonstrate metabolitealterations during trauma phase of MD in trapezius muscles of CPMcompared with healthy controls. This model proved beneficial forinvestigating pain and metabolic biomarkers during acute phase ofMD.http://dx.doi.org/10.1016/j.sjpain.2017.04.057

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Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

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