Benny Antony

Thank you, (Asia Pacific League of Associations for Rheumatology), for inviting me to present at the conference in Chiang Mai. I had a great time delivering three talks on Hand Osteoarthritis, Treatment/Placebo Response and the Yoga trial. Thank you for the award

Thank you, APLAR (Asia Pacific League of Associations for Rheumatology), for inviting me to present at the Conference in Chiang Mai. I look forward to delivering three talks on Hand Osteoarthritis, Treatment/Placebo Response, and the Yoga trial. Additionally, I am honoured to chair the Abstract session with Prof Kanon on Osteoarthritis/Osteoporosis/Crystal arthropathies.

Our latest Clinical trial published in the Lancet explored drug repurposing for hand osteoarthritis. Once-weekly dose of Methotrexate might have a role in reducing pain and stiffness in hand osteoarthritis patients with synovitis. We found a moderate but potentially clinically relevant effect of the treatment.

Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial Treatment of hand osteoarthritis and synovitis with 20 mg methotrexate for 6 months had a moderate but potentially clinically meaningful effect on reducing pain, providing proof of concept that methotrexate might have a role in the management of hand osteoarthritis with an inflammatory phenotype.

Thank you to the organizers of the (Society for Osteoarthritis Research) Conference ( ) 2023, particularly Prof. Siddharth K Das, for inviting me to deliver a session on "Mind-Body Therapies in Osteoarthritis: Yoga vs. Strengthening Exercise." I couldn't attend in person to present, but I appreciate the online presentation opportunity. It was an excellent session, and I still cherish the warm welcome I received at the 2019 SOARCON in-person conference.

Latest paper on Vitamin D from VIDEO-5 year trial. Serum vitamin D levels regressed to the mean value after 3 years of the cessation of the supplementation. However, this was significantly higher than the mean baseline vitamin D levels before starting the trial.
Among participants without knee surgery, maintaining sufficient vitamin D was associated with a reduction in knee symptoms over 5 years.

Long-term effects of vitamin D supplementation and maintaining sufficient vitamin D on knee osteoarthritis over 5 years - Arthritis Research & Therapy Objectives This study aimed to investigate the long-term effect of vitamin D supplementation compared to placebo over 5 years in participants with knee osteoarthritis (OA). We also aimed to describe the effect of maintaining sufficient serum vitamin D levels over five years in knee OA. Methods Parti...

Our latest book chapter published by Elsevier https://shop.elsevier.com/books/cartilage-tissue-and-knee-joint-biomechanics/nochehdehi/978-0-323-90597-8

https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.14822
Our latest paper is on the use of (CAMs) in the older adult population. There remains an evidence-practice gap in use, and the safety and efficacy of CAM use alone and in combination with other medications remains to be determined. We found that CAMs (medications) were commonly used among Tasmanian older adults, with 35% of the population using them alone or combined with conventional for . CAM users were more likely to be female, better educated, have more joints with , and have healthier lifestyles, including lower BMI and higher steps per day.

Prevalence and correlates of the use of complementary and alternative medicines among older adults with joint pain Background There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional medicines in osteoarthritis (OA) patients. Objectives This stud...

Our recent research on the association between knee markers and knee symptoms in young adults. Exploring quantitative and semi-quantitative MRI markers as a marker of the clinical progression of is an important step in conducting early intervention trials in early osteoarthritis.

Association between knee magnetic resonance imaging markers and knee symptoms over 6–9 years in young adults AbstractObjectives. Describe associations between MRI markers with knee symptoms in young adults.Methods. Knee symptoms assessed using WOMAC scale during Childh

I want to thank the and the organisers of for inviting me to speak on the topic of "Harnessing the Contextual (Placebo) Effects for the Treatment of Osteoarthritis." It was an honour to share my insights and research with such an esteemed audience.
I thoroughly enjoyed the panel discussion that highlighted that the placebo response is embedded in the clinical effects, and we should focus on boosting the placebo component along with identifying better treatments with bigger physiological treatment effects. https://www.araconference.com/invited-speakers

BBC Radio interviewing Dr Benny Antony on Dr 's show on the use of Turmeric extracts for the treatment of arthritis (from 6 min).

BBC Radio 4 - Just One Thing - with Michael Mosley, Try Some Turmeric Can turmeric boost your mood and memory, reduce inflammation and act as a painkiller?

Pain reduction in clinical trials is a complex phenomenon that traditional outcome measures may not fully explain. We need to take a multidimensional approach and consider a wide range of factors that can influence pain reduction, including the placebo effect, to evaluate the effectiveness of pain treatments. Objective measures are important because they provide a more reliable and standardized way to assess the impact of individual differences. Our recent paper tried to explore if serum inflammatory markers and synovitis assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of the knee can explain the pain reduction we observed in our CurKOA clinical trial (Published in Ann Intern Med 2020 Dec 1;173(11):861-869).

Effect of Curcuma longa extract on serum inflammatory markers and MRI-based synovitis in knee osteoarthritis: secondary analyses from the CurKOA randomised trial Curcuma longa (CL) extract is modestly effective for relieving knee symptoms in knee osteoarthritis (OA) patients; however, its mechanism of action is…

It was great to catch up with collaborators and friends at the Orthopaedic Research Society meeting Dallas, Texas. It was a great opportunity to present our research and get feedback on our clinical research studies.

Thanks to for inviting me for talks on “predictors of treatment response in osteoarthritis”. I had a a great time at the congress discussing osteoarthritis research with great experts.

Bone remodelling drugs were always trialled in (OA) based on the role of subchondral bone in mediating cartilage and other joint structures. We conducted a clinical trial on the effect of zoledronic acid in knee OA in a subgroup of OA patients with MRI-evidence of subchondral bone marrow lesions (BMLs) and did not find a significant effect of the treatment on knee OA symptoms or cartilage damage progression.

This latest clinical trial from Belgium reports a promising effect of on structural progression in patients with and showed signs of reversing the damage. Patients receiving the drug during this 48-week placebo-controlled trial had a mean increase of 10.1 points under the radiographic Ghent University Scoring System (GUSS) for joint erosion, indicating a healthy remodelling. The mean scores declined 7.9 points in the placebo group.

Effect of Denosumab on Structure Modification in Erosive Hand Osteoarthritis: Results of a 48-Week, Monocentric, Randomized, Placebo-controlled, Double-blind Phase 2 Study and Open Label Extension Phase - ACR Meeting Abstracts Background/Purpose: Erosive hand osteoarthritis (OA) is a disabling disease with limited therapeutic options. Denosumab, a Receptor Activator of Nuclear Factor kappa-b Ligand inhibitor, affects bone resorption and osteoclast activity. The purpose of this clinical trial was to study the structure mod...

has become an integral part of , especially in diseases with limited pharmacological treatment options such as . Our latest -analyses concluded that the current evidence does not suggest a benefit of in reducing pain and improving physical function in the overall cohort of hand/knee OA patients. However, we still believe that future trials should focus on the subgroups of OA patients with local or systemic inflammation and/or mineralization who might benefit from colchicine. We are currently planning an RCT in this area.

Efficacy and safety of colchicine for the treatment of osteoarthritis: a systematic review and meta-analysis of intervention trials - Clinical Rheumatology Objective Colchicine, an approved treatment for gout, has been trialed in many diseases including osteoarthritis (OA) due to its anti-inflammatory effects. However, its efficacy and safety remain unclear in OA. This systematic review and meta-analysis evaluated the efficacy and safety of colchicine....

effect (including effect) is an important component (contributing upto70%) in symptom reduction in . In this trial, we have tried to minimise this issue by comparing yoga to a similar active intervention (exercise therapy). We just published the of our ongoing clinical trial.

A Randomised Controlled Trial of YOGa and Strengthening Exercise for Knee OsteoArthritis: Protocol for a Comparative Effectiveness Trial (YOGA Trial) Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, ba...

A retrospective study using electronic records retrieved in Hong Kong public primary care among patients with aged ≥ 45 reported that use was associated with a 19% lower risk of with a dose-response relationship compared to patients who did not use (why some patients were not prescribed metformin is not clear in the study). Findings suggest a potential protective effect of metformin on knee progression.

Recent evidence suggests that meta-inflammation has an important role in pathogenesis. We are currently doing a study on the association between and -based markers of knee .

Metformin use and the risk of total knee replacement among diabetic patients: a propensity-score-matched retrospective cohort study - Scientific Reports Metformin has been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). The study aimed to test the association between regular metformin use with total knee replacement (TKR) in patients with diabetes. This is a retrospective study with electronic records retr...

We often neglect the drugs based on modest effects that fail to meet (minimum clinically important difference) in . However, these drugs/interventions may be useful in a real-world setting as we do not have effective therapies in . Modelled data from shows that even small WOMAC pain score reduction by 1, 2, or 3 units (out of 20) decreased risk from 6.3% to 5.8%, 5.3% and 4.9%, respectively. Greater reductions in knee replacements were achieved when pain decreased more and when interventions were introduced at lower pain levels.
https://onlinelibrary.wiley.com/doi/abs/10.1002/art.42272 #

The relation of pain reduction with prevention of knee replacement under dynamic intervention strategies Objective Knee replacement rates are increasing exponentially in the US and straining insurance budgets. We investigated how many knee replacements (KRs) would be prevented at different levels of pa...

effectiveness and safety outcomes among second line treatments (biologic and targeted synthetic ) found similar discontinuation rates and Clinical Disease Activity Index response. However, there was increased discontinuation of JAK inhibitors for safety reasons compared with TNF inhibitors (due to real differences in safety ? or just scepticism of newer treatments? ). A wonderful study using 19 data ( -pot’ collaboration)

Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the ‘JAK-pot’ collaboration Background JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration....

(4 g/d of a commercially available oil ) had a modest but statistically significant overall effect for improvement in in patients with mild to moderate knee . Interesting to see a LARGE EFFECT in subgroup analyses by baseline levels (≥3 mg/L). These results are in line with the trial results (inhibition of IL-1β with significantly reduced rates of total and and osteoarthritis-related symptoms in post-myocardial infarction patients with ≥ 2 mg/L ), suggesting the need of phenotyping/ personalised medicine in .

We are currently analysing the results of an NHMRC-funded RCT on the efficacy of Krill oil on knee osteoarthritis in participants with MRI-defined effusion-synovitis.

Krill oil improved osteoarthritic knee pain in adults with mild to moderate knee osteoarthritis: a 6-month multicenter, randomized, double-blind, placebo-controlled trial ABSTRACTBackground. Osteoarthritis (OA) is a major cause of chronic pain and disability worldwide. Treatment generally focuses on symptom relief through nonster

The final nail in the coffin? Or due to the 'one size fits all' approach?

Vitamin D supplementation did not result in a lower risk of fractures than placebo among generally healthy midlife and older adults. Previous results from published in peer-reviewed journals have shown that vitamin D supplementation did not prevent cancer or cardiovascular disease, prevent falls, improve cognitive function, reduce atrial fibrillation, change body composition, reduce migraine frequency, improve stroke outcomes, decrease age-related macular degeneration, or reduce knee pain.

This trial and the result from the trial (Aspirin on CVD, cancer etc) highlight the importance of moving to personalised medicine. There is no 'one size fits all' pill in medicine.

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults | NEJM Original Article from The New England Journal of Medicine — Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

It’s good to be back to a physical conference after long 3 years of online only conferences. Thanks to 2022 conference for the young investigator travel award to physically present at the conference in Copenhagen, Denmark

Recruiting for YOGA trial

Do you suffer from ongoing knee pain?
The Menzies Institute for Medical Research is recruiting for a study that compares YOGA with STRENGTHENING EXERCISE
to evaluate the benefits of these physical activities for people with knee osteoarthritis.

• Are you aged 40 or over?
• Are you interested in taking part in a free supervised YOGA or EXERCISE program?

If you are interested in taking part or would like more information, please contact: Olivia Swann on 03 6226 4280 or email [email protected]

A cluster-randomized controlled with a 12-month follow-up period to determine the and of in a setting in patients with reported no clinically relevant effect of duloxetine added to usual care compared to usual care alone. The participating general practices were randomized to prescribe duloxetine in addition to usual care (intervention group) or provide usual care alone (control group). Interestingly, there was no significant difference even in the subgroup analyses (underpowered) in patients with symptoms of .

This trial highlights the importance of conducting clinical trials in the primary care settings before making recommendations based on randomised placebo-controlled trials alone. It is disappointing to see that we are mounting evidence against many recommended therapies in over the past 5 years, and we are yet to add a new treatment. We are losing the tools, and it's high time we add something new.

No Added Value of Duloxetine in Patients With Chronic Pain due to Hip or Knee Osteoarthritis: A Cluster‐Randomized Trial Objective To assess the effectiveness of duloxetine in addition to usual care in patients with chronic osteoarthritis (OA) pain. The cost-effectiveness and whether the presence of symptoms of centra...

A low-sodium diet was not associated with a significant reduction in the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visits, or all-cause death within 12 months among ambulatory patients with heart failure. This is the largest and longest trial to look at this question of reducing dietary sodium in heart failure patients.

Please note that the study was underpowered due to fewer events than expected and Covid related issues. There was a signal in the reduction in events indicating the need for further studies.

Maybe we need to think about the substitution of edible salt with salt containing a higher concentration of potassium and other minerals??? We are currently doing a Cochrane review focusing on sodium salt substitution.

Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events.

Opioid consumption/prescription in Australia has increased steadily over the past three decades (please note the below report doesn't include QLD statistics). A recent observational study on the usefulness of reported a reduction in Opioid Prescriptions in patients with , indicating the need for more research in this area.

New AIHW releases: National Opioid Pharmacotherapy Statistics Annual Data collection – update New AIHW releases: National Opioid Pharmacotherapy Statistics Annual Data collection – update

Proud to be a winner of the ESCEO-IOF YOUNG INVESTIGATOR award at the (World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases). Glad to see that our abstracts on MR Imaging biomarkers and the Burden of Osteoarthritis are recognised by the IOF (INTERNATIONAL OSTEOPOROSIS FOUNDATION) and (EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS, OSTEOARTHRITIS AND MUSCULOSKELETAL DISEASES).

Long-term follow-up of a trial comparing partial with therapy for knee osteoarthritis ( trial) reported that the participants in the partial meniscectomy group had a progression in abnormalities only over 18 months, but not at 60 months (except osteophytes).

Does this indicate that the structural changes in the knee are a normal physiological adaptation to changed biomechanical circumstances (due to surgery and/or tear)? (Disclosure: A previous study from the same trial reported a higher prevalence of total knee replacement in the partial meniscectomy group compared to the physical therapy group)

We are conducting a similar Long-term follow-up (5-year) of our Vitamin D for Knee Osteoarthritis (VIDEO) trial and the preliminary results suggest that there is no difference between the vitamin D and placebo groups on Total Knee Replacement over 5 years.

Five‐Year Structural Changes in Patients with Meniscal Tear and Osteoarthritis: Data from an RCT of Arthroscopic Partial Meniscectomy vs. Physical Therapy Objective Data from long-term follow-up of several randomized controlled trials (RCTs) of arthroscopic partial meniscectomy (APM) vs. non-operative therapy or sham have suggested that APM may be ass...

This meta-analysis highlight the importance of interpreting the absolute risk reduction compared to relative risk reduction (most often reported in clinical trials) for a clinically meaningful or real-world effect size. The authors reported that the absolute risk reduction of statins appears to be modest compared with the relative risk reduction for all-cause mortality, myocardial infarction and stroke. Interestingly, there was no conclusive association between absolute reductions in LDL Cholesterol levels and outcomes, suggesting that the modest efficacy of statins was not through a reduction in LDL Cholesterol.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2790055

Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment This systematic review and meta-analysis examines the association between absolute reductions in low-density lipoprotein cholesterol levels with treatment with statin therapy and all-cause mortality, myocardial infarction, and stroke.

Do you suffer from ongoing knee pain?
The Menzies Institute for Medical Research is recruiting for a study that compares YOGA with STRENGTHENING EXERCISE
to evaluate the benefits of these physical activities for people with knee osteoarthritis.

• Are you aged 40 or over?
• Are you interested in taking part in a free supervised YOGA or EXERCISE program?

If you are interested in taking part or would like more information, please contact: Olivia Swann on 03 6226 4280 or email [email protected]