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

骨关节炎（OA）中没有结构修饰治疗，部分原因是结构修饰的证据需要大规模的长期研究，以证明对软骨形态或其他关节结构的治疗效果。此外，软骨形态的变化可能是不可逆的。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，并且可以在疾病可逆时进行评估。如果没有检测治疗效果的方法，OA治疗的开发可能会继续推迟。为了开发治疗反应的生物标志物，需要使用有效的治疗来测试生物标志物。 减肥手术（BSX）可显著改善OA症状，并可能导致软骨基质稳定甚至改善。平均一年减掉100磅，许多但不是所有患者的膝关节疼痛都会解决。计划工作背后的假设是，伴随BSX的体重减轻构成了有效膝关节OA治疗的人体模型，该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这种结构上的改善，这可能会导致结构修饰，并可能允许在短期内评估其他治疗方法。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T1rho和T2映射。在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，并且也可以是生物标志物。该项目的总体目标是研究BSX的大量体重减轻及其对膝关节疼痛和膝关节结构病理学的影响。具体目标是：1）确定BSX后体重减轻的患者膝关节疼痛的改善是否不太可能发生在具有特定结构发现的患者中。2)描述未接受BSX的过度肥胖者在大量体重减轻之前和之后一年的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。

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.