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      Efficacy and safety of pentosan polysulfate sodium in people with symptomatic knee osteoarthritis and dyslipidaemia: protocol of the MaRVeL trial

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          Abstract

          Introduction

          Knee osteoarthritis (OA) is the most prevalent arthritis type and a leading cause of chronic mobility disability. While pain medications provide only symptomatic pain relief; growing evidence suggests pentosan polysulfate sodium (PPS) is chondroprotective and could have anti-inflammatory effects in knee OA. This study aims to explore the efficacy and safety of oral PPS in symptomatic knee OA with dyslipidaemia.

          Methods and analysis

          MaRVeL is a phase II, single-centre, parallel, superiority trial which will be conducted at Royal North Shore Hospital, Sydney, Australia. 92 participants (46 per arm) aged 40 and over with painful knee OA and mild to moderate structural change on X-ray (Kellgren and Lawrence grade 2 or 3) will be recruited from the community and randomly allocated to receive two cycles of either oral PPS or placebo for 5 weeks starting at baseline and week 11. Primary outcome will be the 16-week change in overall average knee pain severity measured using an 11-point Numeric Rating Scale. Main secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life and other structural changes. A biostatistician blinded to allocation groups will perform the statistical analysis according to the intention-to-treat principle.

          Ethics and dissemination

          The protocol has been approved by the NSLHD Human Research Ethics Committee (HREC) (2021/ETH00315). All participants will provide written informed consent online. Study results will be disseminated through conferences, social media and academic publications.

          Trial registration numbers

          Australian New Zealand Clinical Trial Registry (ACTRN12621000654853); U1111-1265-3750.

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          Most cited references46

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          Interrater reliability: the kappa statistic

          The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.
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            Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.

            There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.
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              The fate and lifespan of human monocyte subsets in steady state and systemic inflammation

              Using stable isotope labeling, Patel et al. establish the lifespan of all three human monocyte subsets that circulate in dynamic equilibrium; in steady state, classical monocytes are short-lived precursors with the potential to become intermediate and nonclassical monocytes. They highlight that systemic inflammation induces an emergency release of classical monocytes into the circulation.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2024
                22 May 2024
                : 14
                : 5
                : e083046
                Affiliations
                [1 ] departmentDepartment of Rheumatology, Royal North Shore Hospital, Northern Clinical School , Ringgold_522555The University of Sydney Faculty of Medicine and Health , Sydney, New South Wales, Australia
                [2 ] departmentSydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia , Ringgold_141015Kolling Institute of Medical Research , St Leonards, New South Wales, Australia
                [3 ] Ringgold_522555The University of Sydney Faculty of Medicine and Health , Sydney, New South Wales, Australia
                [4 ] departmentMusculoskeletal Health, Arabanoo Precinct, Kolling Institute , Ringgold_522555The University of Sydney Faculty of Medicine and Health , Sydney, New South Wales, Australia
                [5 ] departmentRheumatology Department , Ringgold_60086Royal North Shore Hospital , St Leonards, New South Wales, Australia
                [6 ] departmentRheumatology , Ringgold_141015Kolling Institute of Medical Research , St Leonards, New South Wales, Australia
                [7 ] University of Medicine , Mandalay, Mandalay, Myanmar
                [8 ] Castlereagh Imaging, St Leonard, NSW , St Leonard, New South Wales, Australia
                [9 ] Arthropharm Pty Ltd , St Leonard, New South Wales, Australia
                Author notes
                [Correspondence to ] Dr Md Abu Bakar Siddiq; msid8426@ 123456uni.sydney.edu.au
                Author information
                http://orcid.org/0000-0001-9964-599X
                http://orcid.org/0000-0003-3197-752X
                Article
                bmjopen-2023-083046
                10.1136/bmjopen-2023-083046
                11116866
                38777590
                cc117998-a3cd-422d-88f2-2ecf6426b7ab
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 11 December 2023
                : 03 May 2024
                Funding
                Funded by: Arthropharm PTY LTD;
                Award ID: NA
                Categories
                Rheumatology
                1506
                1732
                Protocol
                Custom metadata
                unlocked

                Medicine
                clinical trial,knee,osteoarthritis,pain management,phase ii as topic
                Medicine
                clinical trial, knee, osteoarthritis, pain management, phase ii as topic

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