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，NOT-AR-23-015 呼吁 扩大风湿病、皮肤病和肌肉骨骼疾病的疼痛研究。针对这一 NOSI，我们建议 扩大我们的家长奖，以评估肌筋膜对慢性骨关节炎疼痛和残疾的影响。家长 奖项 - UC2AR082196 - 是 RE-JOIN 联盟的一部分，该联盟的总体目标是定义 不同关节和关节周围组织的感觉神经支配。在这个联盟范围内的目标中，中央 我们家长奖的目标是定义关节神经支配模式的变化并评估这些神经支配如何 这种转变与临床前模型和患者中症状性关节疼痛和残疾的发展有关。 除了关节结构（骨、滑膜、软骨、纤维软骨）的神经支配外，慢性 OA 疼痛还可能与关节结构（骨、滑膜、软骨、纤维软骨）的神经支配有关。 是由关节以外发生的生理变化驱动的，包括排列在关节外的筋膜的变化 关节肌。筋膜神经支配丰富，筋膜神经支配或结构的病理变化可能会导致 扰乱感觉信息并导致 OA 疼痛。我们使用超声成像支持的初步数据 这些发现表明，筋膜厚度、肌肉回声性和筋膜硬度的变化与 有症状的膝骨关节炎患者的整体关节疼痛更严重，功能更差。因此，本补充 该申请旨在通过增加关于筋膜对孩子的影响的新研究来扩大家长奖的目标。 慢性膝关节骨关节炎的发展。 UC2 母公司研究提供了一个非同寻常且时间敏感的机会 了解筋膜结构和神经支配之间的关系以及筋膜的病理变化如何导致 与 OA 相关的膝关节疼痛和残疾。我们建议通过收集的数据来检验以下假设 通过家长奖招募的膝骨关节炎患者队列：1) 筋膜结构（厚度、成分、硬度） 患有膝骨关节炎和无膝关节骨关节炎的个体之间会有所不同，并且与疼痛和功能相关； 2） 膝关节 OA 患者和无 OA 对照者的筋膜神经支配模式（感觉）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会因年龄而异。这些 将使用阔筋膜超声成像（b 模式、剪切波弹性成像）来评估假设 对全膝关节置换术时收集的阔筋膜活检进行分析。患者的疼痛和功能将受到影响 如家长奖励中所述，在关节置换术前进行评估。综合起来，这些数据将使我们能够比较 与筋膜微观结构变化相关的临床相关超声图像，同时关联所有这些措施 筋膜病理学对 OA 患者疼痛和残疾的定量指标的影响。