Downloaded from http://ard.bmj.com/ on January 18, 2015 - Published by group.bmj.com
ARD Online First, published on January 16, 2015 as 10.1136/annrheumdis-2014-206376 Clinical and epidemiological research
EXTENDED REPORT
A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions Michael J Callaghan,1,2 Matthew J Parkes,1,2 Charles E Hutchinson,3,4 Andrew D Gait,3 Laura M Forsythe,1,2 Elizabeth J Marjanovic,3 Mark Lunt,1,2 David T Felson1,2,5,6 Handling editor Tore K Kvien 1
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK 2 Manchester Academic Health Science Centre, Manchester, UK 3 Department of Imaging Sciences, University of Manchester, Manchester, UK 4 Department of Health Sciences, University of Warwick, UK 5 NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Manchester, UK 6 Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA Correspondence to Dr David Felson, Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA 02118, USA; [email protected] Received 29 July 2014 Revised 9 December 2014 Accepted 15 December 2014
To cite: Callaghan MJ, Parkes MJ, Hutchinson CE, et al. Ann Rheum Dis Published Online First: [please include Day Month Year] doi:10.1136/ annrheumdis-2014-206376
ABSTRACT Objective Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs). Methods Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression. Results We randomised 126 subjects aged 40–70 years (mean age 55.5 years; 72 females (57.1%)). Mean nominated visual analogue scale (0–10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/ day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups −1.3 cm, 95% CI −2.0 to −0.7; p
ARD Online First, published on January 16, 2015 as 10.1136/annrheumdis-2014-206376 Clinical and epidemiological research
EXTENDED REPORT
A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions Michael J Callaghan,1,2 Matthew J Parkes,1,2 Charles E Hutchinson,3,4 Andrew D Gait,3 Laura M Forsythe,1,2 Elizabeth J Marjanovic,3 Mark Lunt,1,2 David T Felson1,2,5,6 Handling editor Tore K Kvien 1
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK 2 Manchester Academic Health Science Centre, Manchester, UK 3 Department of Imaging Sciences, University of Manchester, Manchester, UK 4 Department of Health Sciences, University of Warwick, UK 5 NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Manchester, UK 6 Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA Correspondence to Dr David Felson, Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA 02118, USA; [email protected] Received 29 July 2014 Revised 9 December 2014 Accepted 15 December 2014
To cite: Callaghan MJ, Parkes MJ, Hutchinson CE, et al. Ann Rheum Dis Published Online First: [please include Day Month Year] doi:10.1136/ annrheumdis-2014-206376
ABSTRACT Objective Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs). Methods Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression. Results We randomised 126 subjects aged 40–70 years (mean age 55.5 years; 72 females (57.1%)). Mean nominated visual analogue scale (0–10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/ day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups −1.3 cm, 95% CI −2.0 to −0.7; p
