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Obesity is well documented as a prominent risk factor of osteoarthritis (OA). When osteoarthritis extensively affects the joints, it becomes a major cause of mobility impairment creating definite psychosocial impact. The effect of obesity on the severity of the disease in terms of physical and psychosocial impact is less studied. This study tried to find the association of the severity of physical symptoms of OA with obesity and its effect on psychosocial problems associated with osteoarthritis. Patients with osteoarthritis attending the Orthopaedics outpatient department at Government Medical College, Thiruvananthapuram, Kerala, were interviewed using a structured questionnaire that included physical, emotional and social parameters. They were asked to rate the physical parameters on a scale of 1 to 5 based on severity and mention which among the psychosocial parameters were present. Their height and weight were also recorded. The scores of obese and non-obese individuals were compared using Mann-Whitney U test. The psychosocial parameters were compared using Chi-Square test with Yates'correction and Fischer's Exact test A total of 40 patients were studied. Obese patients with osteoarthritis had a significantly higher total severity score (p=0.019) and stiffness sub score (p=0.019). The social functions affected were mainly participation in leisure activities and the emotional problems were predominantly anxiety and stress. Obese participants with osteoarthritis had 10 times more chance of restricting leisure activities when compared to non-obese participants. Anxiety was also more prevalent among the obese participants and they were 15 times more stressed than their non-obese counterparts. Keywords: Obesity, Osteoarthritis, Stress, Joint Stiffness, Anxiety

A wonder therapy for knee osteoarthritis
Professor Shaw-Ruey Lyu from the Dalin Tzu-Chi Hospital discusses the benefits of arthroscopic cartilage regeneration facilitating procedure (ACRFP) as an alternative to traditional methods of treating knee OA. I have always been a conscientious orthopedic surgeon. I was trained in mainstream orthopedic medicine and had treated many patients suffering from knee osteoarthritis (knee OA) with all the available tools in the 'mainstream medicine' repertoire (Table 1). Traditional treatment often led patients to eventual knee replacement. That is proof that mainstream medicine cannot stop knee OA from deteriorating, and even lead to patients needing a knee replacement.

Background There is a pressing need to enhance osteoarthritis (OA) research to find ways of alleviating its enormous individual and societal impact due to the high prevalence, associated disability, and extensive costs. Methods Potential research priorities and initial rankings were pre-identified via surveys and the 1000Minds process by OA consumers and the research community. The OA Summit was held to decide key research priorities that match the strengths and expertise of the Australian OA research community and align with the needs of consumers. Facilitated breakout sessions were conducted to identify initiatives and strategies to advance OA research into agreed priority areas, and foster collaboration in OA research by forming research networks. Results From the pre-Summit activities, the three research priority areas identified were: treatment adherence and behaviour change, disease modification, and prevention of OA. Eighty-five Australian and international leading OA experts participated in the Summit, including specialists, allied health practitioners, researchers from all states of Australia representing both universities and medical research institutes; representatives from Arthritis Australia, health insurers; and persons living with OA. Through the presentations and discussions during the Summit, there was a broad consensus on the OA research priorities across stakeholders and how these can be supported across government, industry, service providers and consumers. Conclusion The Australian OA Summit brought consumers, experts and opinion leaders together to identify OA research priorities, to enhance current research efforts by fostering collaboration that offer the greatest potential for alleviating the disease burden.

Background: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project. Methods: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates. Results: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints. Conclusions: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management ; The study was supported by a non-commercial private funder. The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) was supported by the European Union (No.: 2005121) and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (project numbers FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143). The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study is funded by the Medical Research Council of Great Britain, Arthritis Research UK, the British Heart Foundation and the International Osteoporosis Foundation.

The Egyptian Empire conquered and colonized Nubia, what is today northern Sudan, on multiple occasions. The colonization strategy employed was highly variable through time, ranging from the construction of militarized fortresses (Middle Kingdom 2,050-1,650 BCE) to an amicable co-existence approach (New Kingdom 1,550-1,050 BCE). Egyptian tactics also varied spatially, depending on several factors including a colonized community's utility to the empire and the potential for revolt. Using a large dataset (n=540), this paper compares osteoarthritis between seven Nubian communities to (1) evaluate whether imperial strategy impacted physical activity, and (2) assess whether levels of activity differed between cotemporary colonized communities. Age-controlled ANCOVA analysis suggests there was significant variation in the frequency and severity of osteoarthritis throughout the empire. The Middle Kingdom C-Group, an indigenous Nubian population that lived outside the Egyptian built and occupied fortresses, displayed the highest rates of osteoarthritis for nearly all joint systems. Osteoarthritis then decreases during the post-colonial Second Intermediate Period (1,650-1,550 BCE) and again increases during the recolonization of the New Kingdom. However, there is significant variation of osteoarthritis at three New Kingdom sites, each of which experienced a differing colonization approach. This study suggests that the varying imperial strategies utilized by the Egyptian Empire may have impacted the physical activities and daily lives of Nubians and that these approaches were not equal throughout Nubia, but were tailored to communities. It is therefore difficult to discuss a singular outcome of colonization. Rather, these interpretations need to be nuanced with community-level archaeological context.

Knee pain and osteoarthritis (Knee OA) treatment research
Professor Shaw-Ruey Lyu from the School of Medicine, Tzu-Chi University, discusses Knee Pain and Osteoarthritis (Knee OA) Treatment Research, in particular Knee Health Promotion Option (KHPO). Starting from 2002, I conducted a series of studies(1-3,5,6,8,9) to investigate medial abrasion phenomenon (MAP) as a cause of knee OA. I found a high correlation between medial plica-related MAP and knee OA. MAP would elicit lifelong interplay between a pathologic medial plica and the facing medial femoral condyle, and therefore plays a role in the pathogenesis of knee OA both physically and chemically.(10,11,13) Consequently, I have developed the procedures of arthroscopic medial release (AMR)(4) and the concept of arthroscopic cartilage regeneration facilitating procedure (ACRFP)(7,15) for the treatment of knee OA.

Sports participation and the risk of osteoarthritis (OA) have been a concern for decades. Few research efforts have been dedicated to clarify this issue for females, although they are considered at greater risk of developing OA than males. In contrast, several reviews have established an association between sports participation and OA for males. The aim of the systematic review was to assess the association between OA and participation in popular sports for females. PubMed, Embase, and Google Scholar were searched and yielded 578 articles. Nine eligible studies were included and covered ballet (age range: 19–54 years), running or tennis (age range: 40–65 years), Olympic sports (age range: not specified), volleyball (age range: 16.0 ± 0.8 to 46.8 ± 5.1 years), and cross-country skiing (age range: 15 to ≥60 years). For females, participating in sports at an elite level was associated with a higher risk of OA and an increased need for surgical treatment. At non-elite level, it was associated with a higher risk of OA, but it did not materialize to an increased risk for surgical treatment. Few studies compared females and males, and these studies suggested that sex did not affect the risk of developing OA from participating in sports. Nevertheless, to isolate the precise effect of sports participation on the development of OA remains difficult as injuries are common among athletes and are independently associated with an increased risk of OA.

This rapid evidence assessment (REA) was conducted to explore the burden of weight-bearing joint osteoarthritis in the developing countries of Latin America. REA methodology used a standardized search strategy to identify observational studies published from 2010 to 23 April 2020 that reported outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from each included study were used to populate bespoke data extraction tables and qualitatively analyzed. Thirteen publications were identified that reported on knee and hip osteoarthritis in the Latin American region. Overall prevalence of physician-diagnosed symptomatic knee osteoarthritis in adults ranged from 1.55% in Peru to 7.4% in Ecuador. Total prevalence of grade ≥ 2 radiographic knee osteoarthritis was 22% among those ≥ 39 years of age in Brazil and 25.5% among those ≥ 40 years of age in Mexico. The prevalence of symptomatic/radiographic knee osteoarthritis was 7.1% in people ≥ 18 years of age in Mexico and 17.6% among those ≥ 40 years of age. Prevalence of hip osteoarthritis was similar to or slightly lower than knee osteoarthritis. The limited data available indicates weight-bearing osteoarthritis negatively affects quality of life and that the economic burden may vary between countries with different healthcare systems. The limited evidence found in the published literature suggests the burden of osteoarthritis in Latin America is substantial. Our analysis identified several evidence gaps, particularly for health-related quality of life and socioeconomic outcomes. Further research is of particular importance in areas where government-subsidized healthcare and resources are scarce.

Background: Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and loss of independence in older persons. The European Project on OSteoArthritis (EPOSA) is a collaborative study involving six European cohort studies on ageing. This project focuses on the personal and societal burden and its determinants of osteoarthritis. This paper describes the design of the project, and presents some descriptive analyses on selected variables across countries. Methods/design: EPOSA is an observational study including pre-harmonized data from European cohort studies (Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom) on older community-dwelling persons aged 65 to 85 years. In total, 2942 persons were included in the baseline study with a mean age of 74.2 years (SD 5.1), just over half were women (51,9%). The baseline assessment was conducted by a face-to-face interview followed by a clinical examination. Measures included physical, cognitive, psychological and social functioning, lifestyle behaviour, physical environment, wellbeing and care utilisation. The clinical examination included anthropometry, muscle strength, physical performance and OA exam. A follow-up assessment was performed 12–18 months after baseline. Discussion: The EPOSA study is the first population-based study including a clinical examination of OA, using preharmonized data across European countries. The EPOSA study provides a unique opportunity to study the determinants and consequences of OA in general populations of older persons, including both care-seeking and non care-seeking persons ; The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) is supported by the European Union (No.: 2005121) and the Ministry of Science, Baden-Württemberg. The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The ProVA study was funded by Fondazione Cassa di Risparmio di Padova e Rovigo, by the University of Padova, by Azienda Unità Locale Socio Sanitaria 15 and 18 of the Veneto Region, and by a grant from the Regione Veneto (Ricerca Sanitaria Finalizzata 156/03). The Hertfordshire Cohort Study was supported by the Medical Research Council, UK. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (project numbers FIS PI 05/1898); FIS RETICEF RD06/0013/1013 and FIS PS09/02143