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

骨关节炎(OA)尚无结构修改治疗方法，部分原因是结构修改的证据需要大规模的长期研究，以证明治疗对软骨形态或其他关节结构的影响。此外，软骨形态的改变可能是不可逆的。如果治疗反应的生物标志物可用，有希望的治疗方法可以进行有效的测试，并可能在疾病可逆时进行评估。如果没有检测治疗效果的方法，骨性关节炎治疗的发展可能会继续被推迟。为了开发治疗反应的生物标记物，需要使用有效的治疗方法来测试生物标记物。 减肥手术(BSX)能显著改善骨性关节炎的症状，并有可能导致软骨基质的稳定甚至改善。随着一年内平均减掉100磅，许多但不是所有患者的S膝盖疼痛都得到了缓解。这项计划工作背后的假设是，BSX伴随的体重减轻构成了有效的膝盖骨关节炎治疗的人体模型，该治疗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这种结构改进，这可能是结构修改的例证，并可能允许在短期基础上评估其他治疗方法。反映异常软骨的软骨结构变化现在可以使用几种不同的方法进行成像，包括T1、RHO和T2映射。骨髓损害在组织学上显示骨损伤，发生在负荷增加的区域，随着体重的减轻而改善，也可能是一个生物标记物。这个项目的总体目标是研究BSX的大规模减肥及其对膝盖疼痛和膝盖结构病理的影响。具体目标是：1)确定BSX后体重减轻的人膝关节疼痛改善的可能性是否低于那些有特定结构发现的人。2)研究减重前、减重后一年及未接受BSX治疗的肥胖者的MRI改变。我们将使用T1RHO、T2图和骨髓病变体积来检查软骨成像结构的变化。

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.