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Source: Wikimedia Commons and Dr.saptarshi

Kingella kingae Tied to Pediatric Joint Infection; Delineating OA Phenotypes; New Study: ≥2x/Week Exercise Cuts LBP

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, September 12th, 2017

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Kingella kingae Tied Pediatric Joint Infection

Pediatric researchers in Canada and Switzerland have uncovered evidence that a bacteria known as Kingella kingae has a strong link to bone and joint infection with the same bacterium. Their work, “Association between oropharyngeal carriage of Kingella kingae and osteoarticular infection in young children: a case–control study,” was published in the September 5, 2017 edition of the Canadian Medical Association Journal.

Jocelyn Gravel, M.D., M.Sc., pediatric emergency physician at Sainte-Justine Hospital in Montreal, Canada and study co-author commented to OTW, “This study was initiated by Dr. Sergio Manzano, a Swiss pediatric emergency physician who did a fellowship in Montreal. When he returned to Geneva, they completed a study showing the association between oropharyngeal carriage of the K kingae and osteoarticular infection in young children in Switzerland. When they tried to publish it in North American journals, they were told that this was a ‘European’ problem and that we don't have K kingae in North America. This is why he approached us and we decided to look for this bacteria in our population using a new and more sensitive technique for K kingae.”

Dr. Gravel and her colleagues used a technique known as Polymerase Chain Reaction (PCR). “When you do a study about a disease, you have to make sure to include only confirmed cases. This is why most studies about osteoarticular infection only include patients with a proven pathogen. From experience and from some studies, we know that we couldn't find the pathogen in most osteoarticular infection in children (up to 70% in some populations). With our new PCR technique, we were able to find K kingae in most of these patients that were previously called negative. It is important to know that K kingae is very difficult to identify/grow on regular culture media.”

“Contrarily to what was previously reported, we demonstrated that K kingae is by far the most common bacteria involved in osteoarticular infection of young children. There is a strong association between osteoarticular infection by K kingae and its presence in the throat of young children.”

“Hospitals should develop PCR techniques to identify K kingae for joint aspiration for osteoarticular infection. Osteoarticular infections from K kingae are more subtle and the bacteria is more difficult to identify with regular methods.”

Injury, Pain Mechanisms Important in Delineating OA Phenotypes

Researchers from Australia are pushing personalized medicine for osteoarthritis patients forward. Their research, “Knee osteoarthritis phenotypes and their relevance for outcomes: a systematic review of the literature,” appears online in the August 25, 2017 edition of Osteoarthritis and Cartilage.

Leticia A Deveza, a rheumatology fellow at the Royal North Shore Hospital, Institute of Bone and Joint Research at Sydney Medical School in Australia, and her colleagues undertook a comprehensive review of phenotypic characteristics that may be helpful in defining the distinct subtypes of knee osteoarthritis (OA).

Dr. Deveza told OTW, “Knee osteoarthritis [OA] appears to be a collection of different diseases with similar characteristics instead of one single homogenous condition.”

“Different OA risk factors such as obesity, knee injury and genetics may have distinct mechanisms leading to joint damage that is characteristic of OA, which may be suitable for different treatments. Similarly, the mechanisms of pain are also highly variable across the OA population.”

“While some patients have symptoms predominantly arising from the damage to the joint (bone marrow lesions, inflammation, etc.), others experience pain due to the sensitization of nociceptive pathways or psychological issues. This may have important implications for the prevention and treatment of OA and may change the way we currently see this disease.”

“As yet, there is limited evidence-based recommendations on how to best personalize the care for knee OA patients.”

“We found great heterogeneity across the previous studies investigating knee OA phenotypes. Most studies focused on clinical phenotypes while others used laboratory markers and imaging features to classify patients into distinct phenotypes. There were a limited number of prospective studies assessing the association of phenotypes with longitudinal outcomes and most studies did not validate the phenotypes properly.”

“We found evidence that pain sensitization, psychological distress, radiographic severity, BMI [body mass index], muscle strength, inflammation and comorbidities play a part in distinguishing clinically distinct phenotypes. Gender, obesity and other metabolic abnormalities, the pattern of cartilage damage, and inflammation may be implicated in delineating structural knee OA phenotypes.”

“The first and most important [point] is that there is growing evidence supporting the notion that OA is a syndrome composed of multiple subsets rather than one single disease. Secondly, more studies assessing the implication of phenotypes for prognosis and treatment response are needed. The phenotypic characteristics that we identified can be used in future research to determine a comprehensive phenotype classification.”

“There has been a great research effort to identify distinct phenotypes of knee OA patients in the past few years. Identifying disease subtypes based on specific underlying mechanisms or based on who is most likely to respond to a given treatment is of utmost importance to achieve better treatment outcomes. Personalized medicine is already used in diverse fields such as oncology and will hopefully improve the current management of knee OA.”

Muscle Strengthening 2x/Week Helps Prevent LBP

A new study has used Department of Health and Human Services (DHHS) recommendations on muscle strengthening activity to evaluate the effect of such exercises in preventing low back pain (LBP).

The research, “Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults,” appears in the August 15, 2017 edition of Spine. A co-author on this work, Albatool Alnojeidi, M.S.H. is with the Department of Clinical and Applied Movement Sciences at the University of North Florida in Jacksonville.

Dr. Alnojeidi told OTW, “Chronic low back pain has been shown to have a significant impact on individuals, their families, professional life, and communities. It is one of the most common health problems causing suffering and disability, and it is a leading cause of physical inactivity. In addition to the physical impairments and professional detriments, chronic low back pain increases the financial burden to the healthcare system by augmenting medical treatment costs.”

“Muscle strengthening activity, on the other side, has been used clinically to treat low back pain. However, there is inconclusive data regarding the preventative effect of muscle strengthening activity on low back pain. Thus, we wanted to see if being engaged in muscle strengthening activity reduces the odds of low back pain. Not only that, but we wanted to stress on meeting the U.S. physical activity guidelines since that it has not been evaluated before with low back pain.”

“We evaluated a nationally representative sample of U.S. adults (N= 12,721) utilizing the1999-2004 NHANES [National Health and Nutrition Examination Survey]. Though, since the most recent NHANES muscle strengthening activity and chronic low back pain data were collected from 1999-2004, the analyzed data may not be reflective of the current U.S. adult population. Furthermore, we created the muscle strengthening activity variable with three categories: no muscle strengthening activity; some muscle strengthening activity, and meeting the DHHS muscle strengthening activity recommendation. Thus, the intention of evaluating meeting the U.S. physical activity guidelines was addressed.”

Dr. Alnojeidi, also with the College of Medicine at Al-Imam Myhammad Ibn Saud University in Riyadh, Saudi Arabi, commented to OTW, “First, we found that in men, the prevalence of low back pain was significantly lower only in those who met the current muscle strengthening activity recommendation, that is ≥ 2 days/week, compared to those who perform some (≥ 1 to < 2 days/week), or no muscle strengthening activity. However, in women, the prevalence of low back pain was significantly lower in those who met the current muscle strengthening activity recommendation and those who perform some muscle strengthening activity compared to those who did not perform any muscle strengthening activity. These findings suggest a potential gender difference in the response to muscle strengthening activity.”

“Second, following adjustment for smoking, the association between volumes of muscle strengthening activity meeting the recommendation and low back pain in male participants was no longer statistically significant. Interestingly, the attenuated odds of low back pain remained statistically significant in females reporting volumes of muscle-strengthening activity meeting the recommendation.”

“In order to reduce the odds of low back pain among men, one must perform muscle strengthening activity two or more days per week. In women, it would be enough to engage in muscle strengthening activity for one day per week to reduce the odds of low back pain. Yet, doing muscle-strengthening activity for more than one day per week is also effective. Furthermore, men should keep in mind that smoking might discard the benefits of muscle strengthening activity in reducing low back pain.”

“Muscle strengthening activity can be used to prevent low back pain. Thus, if the individual has one, or more, of the low back pain risk factors, it is suggested that the surgeon recommends muscle-strengthening activity for him/her. This includes activities designed to strengthen muscles such as lifting weights, push-ups or sit-ups. Attention should be given to the frequencies reported in our study; ≥ 2 days/week for men and ≥1 day/week for women.”

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