Massive weight loss and its effects on knee pain and knee structure

大量减肥及其对膝盖疼痛和膝盖结构的影响

• 批准号: 8511567
• 负责人: DAVID Tobin FELSON
• 金额: $ 35.14万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8511567
• 关键词: Australia; Biological Markers; Body Weight decreased; Bone Marrow; Cartilage; Cartilage Matrix; Clinical Research; Degenerative polyarthritis; Disease; Disease Progression; Dose; Gadolinium; Goals; Histologic; Human; Image; Injection of therapeutic agent; Joints; Knee; Knee Osteoarthritis; Knowledge; Lesion; Longitudinal Studies; Magnetic Resonance Imaging; Maps; Measures; Medical; Methods; Modeling; Modification; Morphology; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Nature; Obesity; Observational Study; Osteoarthrosis Deformans; Pathology; Patients; Scanning; Structure; Symptoms; Testing; Therapeutic Agents; Time; Weight-Bearing state; Work; bariatric surgery; base; bone; effective therapy; experience; falls; gadolinium oxide; improved; knee pain; multidisciplinary; prevent; therapy development; treatment effect; treatment response

There are no structure modifying treatments in osteoarthritis (OA) in part because the proof of structure modification requires large scale long term studies that demonstrate treatment effects on cartilage morphology or other joint structures. Also, changes in cartilage morphology may be irreversible. If biomarkers for treatment response were available, promising treatments could be tested efficiently and might be evaluated when disease is reversible. Without ways of detecting treatment effects, OA treatment development will likely continue to be delayed. To develop biomarkers for treatment response, biomarkers need to be tested using an effective treatment. Bariatric surgery (BSX) produces dramatic improvements in OA symptoms and likely results in stability of cartilage matrix or even improvement. With loss of 100 pounds over one year on average, in many but not all patient¿s knee pain resolves. The assumption behind the planned work is that the weight loss that accompanies BSX constitutes a human model of an effective knee OA treatment which either stabilizes or leads to improvement in knee structure. That model will allow us to explore how detect this improvement in structure which might exemplify structure modification and might allow other treatments to be evaluated over a short-term basis. Structural changes in cartilage that reflect abnormal cartilage can now be imaged using several different approaches including T1rho and T2 mapping. Bone marrow lesions which show bone damage histologically and occur in regions of increased loading could improve with weight loss and could be a biomarker also. The overall goals of this project are to study massive weight loss from BSX and its effects on knee pain and structural pathology in knees. The specific aims are: 1) To determine whether the improvement in knee pain in those experiencing weight loss after BSX is less likely in those with specific structural findings. 2) To characterize MRI changes before and one year after massive weight loss and in comparably obese persons not undergoing BSX. We will examine changes in imaged structure of cartilage using T1rho, T2 maps and bone marrow lesion volume.

骨关节炎 (OA) 没有结构改变治疗，部分原因是结构改变的证据需要大规模长期研究来证明治疗对软骨形态或其他关节结构的影响。此外，软骨形态的变化可能是不可逆转的。如果治疗反应的生物标志物可用，则可以有效地测试有希望的治疗方法，并在疾病可逆时进行评估。如果没有检测治疗效果的方法，骨关节炎治疗的开发可能会继续被推迟。为了开发治疗反应的生物标志物，需要使用有效的治疗方法来测试生物标志物。 减肥手术 (BSX) 可以显着改善 OA 症状，并可能导致软骨基质的稳定性甚至改善。一年内平均体重减轻 100 磅，许多但并非所有患者的膝盖疼痛都得到缓解。计划工作背后的假设是，BSX 带来的体重减轻构成了有效膝关节 OA 治疗的人体模型，可以稳定或改善膝关节结构。该模型将使我们能够探索如何检测结构的这种改进，这可能是结构修改的例证，并可能允许在短期内评估其他治疗方法。现在可以使用几种不同的方法（包括 T1rho 和 T2 映射）对反映异常软骨的软骨结构变化进行成像。组织学上显示骨损伤并发生在负荷增加区域的骨髓病变可以随着体重减轻而改善，并且也可以作为生物标志物。该项目的总体目标是研究 BSX 带来的大量体重减轻及其对膝盖疼痛和膝盖结构病理学的影响。具体目标是： 1) 确定 BSX 后体重减轻的患者的膝盖疼痛改善是否在具有特定结构发现的患者中不太可能。 2) 表征体重大幅减轻之前和之后一年以及未接受 BSX 的相对肥胖者的 MRI 变化。我们将使用 T1rho、T2 图和骨髓病变体积检查软骨成像结构的变化。