Evaluating the role of fascia structure and innervation in chronic knee OA pain

评估筋膜结构和神经支配在慢性膝关节骨关节炎疼痛中的作用

• 批准号: 10858190
• 负责人: Kyle D Allen
• 金额: $ 51.04万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10858190
• 关键词: Age; Arthralgia; Award; Biopsy; Cartilage; Chronic; Data; Degenerative polyarthritis; Development; Fascia; Fascia lata structure; Fibrocartilages; Goals; Individual; Joints; Knee; Knee Osteoarthritis; Measures; Muscle; Musculoskeletal Diseases; Pain; Pain Research; Parents; Pathologic; Pathology; Patients; Pattern; Persons; Physiological; Pre-Clinical Model; Replacement Arthroplasty; Rheumatism; Role; Sensory; Severities; Structure; Synovial Membrane; Testing; Thick; Time; Tissues; Ultrasonography; Variant; Work; bone; chronic musculoskeletal pain; clinically relevant; cohort; disability; elastography; improved; joint injury; knee replacement arthroplasty; nerve supply; osteoarthritis pain; recruit; response; skin disorder

Summary To improve our understanding and treatment of chronic musculoskeletal pain, NOT-AR-23-015 calls for an expansion of rheumatic, skin, and musculoskeletal disease pain research. In response to this NOSI, we propose to expand our parent award to evaluate myofascial contributions to chronic OA pain and disability. The parent award - UC2AR082196 - is part of the RE-JOIN Consortium, which has the over-arching goal of defining the sensory innervation of different articular and peri-articular tissues. Within this Consortium-wide goal, the central objective of our parent award is to define shifts in joint innervation patterns and evaluate how these innervation shifts relate to the development of symptomatic joint pain and disability in both preclinical models and patients. In addition to the innervation of joint structures (bone, synovium, cartilage, fibrocartilage), chronic OA pain may be driven by physiologic shifts occurring beyond the joint, including changes in the fascia that lines the extra- articular muscle. Fascia is richly innervated, and pathological changes in the fascia innervation or structure could disrupt sensory information and contribute to OA pain. Our preliminary data using ultrasound imaging support these findings, as variations in fascial thickness, muscle echogenicity and fascia stiffness are associated with greater overall joint pain and worse function in persons with symptomatic knee OA. As such, this supplement application seeks to expand the aims of the parent award by adding new studies on the role of fascia on the development of chronic knee OA. The parent UC2 study provides an extraordinary and time-sensitive opportunity to understand how fascia structure and innervation are related and how pathologic shifts in fascia contribute to OA-related pain and disability in the knee. We propose to test the following hypotheses in data collected from a cohort of knee OA patients, recruited via the parent award: 1) Fascia structure (thickness, composition, stiffness) will vary between individuals with knee OA and OA-free controls and be associated with pain and function; 2) Fascia innervation patterns (sensory) will vary between individuals with knee OA and OA-free controls, and be associated with pain and function; and 3) Fascia structure and innervation patterns will vary across age. These hypotheses will be evaluated using ultrasound imaging of fascia lata (b-mode, shear wave elastography) and analyses of fascia lata biopsies collected at the time of total knee arthroplasty. Patient pain and function will be assessed prior to arthroplasty, as described in the parent award. Combined, these data will allow us to compare clinically-relevant ultrasound images to microstructure changes in the fascia, while relating all of these measures of fascia pathology to quantitative metrics of pain and disability in OA patients.

概括 为了提高我们对慢性肌肉骨骼疼痛的理解和治疗，不是AR-23-015要求 风湿性，皮肤和肌肉骨骼疾病疼痛研究的扩展。为了回应这种NOSI，我们提出了 扩大我们的父母奖，以评估对慢性OA疼痛和残疾的肌筋膜贡献。父母 奖项-UC2AR082196-是重新加入财团的一部分，该联盟的目标是定义 不同关节和关节周围组织的感觉神经。在这个整个联盟的目标中，中央 我们父母奖的目的是定义关节神经支配模式的转变，并评估这些神经如何 临床前模型和患者的症状关节疼痛和残疾的发展有关。 除了关节结构的神经（骨骼，滑膜，软骨，纤维球科）外，慢性OA疼痛可能 受到关节以外的生理转移的驱动，包括筋膜的变化 关节肌肉。筋膜很丰富，筋膜神经或结构的病理变化可能 破坏感官信息并导致OA疼痛。我们使用超声成像支持的初步数据 这些发现，随着筋膜厚度的变化，肌肉回声和筋膜刚度与 在有症状的膝盖OA的患者中，整体关节疼痛和功能较差。因此，这种补充 申请旨在通过添加有关筋膜作用的新研究来扩大父母奖的目标 慢性膝盖OA的发展。家长UC2研究提供了一个非凡且时间敏感的机会 了解筋膜结构和神经如何相关，以及筋膜的病理转变如何促进 膝盖中与OA相关的疼痛和残疾。我们建议测试从A收集的数据中的以下假设 膝盖OA患者队列，通过父级奖招募：1）筋膜结构（厚度，成分，刚度） 具有膝盖OA和无OA对照的个体之间会有所不同，并且与疼痛和功能有关； 2） 筋膜神经支配模式（感觉）在膝盖OA和无OA对照的个体之间会有所不同，并且 与疼痛和功能相关； 3）筋膜结构和神经支配模式在随着年龄的增长而变化。这些 假设将使用fastia lata（B模式，剪切波弹性图）的超声成像进行评估 在全膝关节置换术时收集的筋膜Lata活检的分析。病人的疼痛和功能将是 如父母奖所述，在关节置换术之前进行评估。这些数据结合在一起，将使我们能够比较 与筋膜中的微观结构变化，临床上与临床相关的超声图像，同时将所有这些措施 OA患者的疼痛和残疾定量指标的筋膜病理学。