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Johns Hopkins Arthritis Center

Arthritis Research

Did you know:

Arthritis is not one disease, but rather a broad term that encompasses more than 100 very different disorders. All involve the joints and are characterized by chronic pain, limited mobility and decreased range of motion.

• Nationwide, some 70 million Americans suffer from some form of arthritis – that’s one out of three – making arthritis one of the most pervasive diseases in the U.S. as well as the leading cause of disability.
• Arthritis is not just a consequence of aging.  While most people’s joints do show some degeneration over time, many forms of arthritis are driven by immune system-mediated damage that can strike at any time.
• There is no known cure for arthritis, but advances in science are helping us to identify ways to improve diagnosis and its treatment.

Addressing the Challenge

The Johns Hopkins Arthritis Center has assembled a team of some of the world’s leading experts and specializes in the care of inflammatory arthritis. This includes forms of arthritis driven by the immune system  such as rheumatoid arthritis, psoriatic arthritis, and  ankyosing spondylitis, as well as other conditions including osteoarthritis and gout.

Rheumatoid Arthritis Rheumatoid arthritis (RA, rheumatoid disease) is an autoimmune disorder and can affect many joints, other organs, and the whole body. RA is often marked by flares and remissions or times when symptoms are more pronounced, then dissipate. Common complaints are joint pain and generalized stiffness throughout the day, joints that may feel warm and/or tender, and a general feeling of sickness and fatigue. The disease can makes it difficult to perform even routine activities, and impact the ability to fulfill social roles and obligations. Advances in understanding the disease process have led to considerable improvments for people living with RA.  Early diagnosis and more aggressive treatment pathways make it possible for many more people to achieve “remission” of their disease, but we do not have a cure.  And current treatments can be associated with significant side effects. The future however is bright as we understand more and more, and partner with patients in research toward a goal of personalized care. This requires us to recognizes both the unique biology of each person’s disease, along with the unique goals, preferences, and needs of each individual patient. Our research programs in the lab focus on biomarker identification to better define disease risk factors and subtypes.  We work with colleagues in radiology to develop and test novel methods of imaging the joints with new MRI, CT, and molecular imaging modalities. Our clinical research programs are broad ranging, including studies on exercise and lifestyle interventions, understanding individual patient preferences, how pain is perceived and moderated, oral health conditions, lung disease in arthritis, improving how we evaluate disease activity with patient-reported outcomes, and clinical trials of investigational agents, including stem cell therapy.  All of our studies are linked with our robust patient databases. Psoriatic Arthritis Psoriatic Arthritis is seen in people who have the inflammatory skin condition psoriasis.  Like RA, this is an autoimmune disease which can attack and damage joints, with similar consequences on quality of life.  As in RA, outcomes are improving for those with psoriatic arthritis with newer therapies and treatment approaches.  Unfortunately  psoriatic arthritis is not well recognized in the general medical community, resulting in irreversible joint damage occuring in many patients before they are diagnosed. Our research programs in psoriatic arthritis center on a database of patients with this condition.  Studies are ongoing to look at blood markers that may help to define disease subsets, to better understand the patient-relevant symptoms of the condition, and clinical trials of novel therapies that have great promise in improving outcomes. Ankylosing Spondylitis and Spondyloarthropathies Ankylosing spondylitis (AS) and other related spondyloarthropathies are also immune mediated conditions.  In contrast to rheumatoid arthritis, these conditions can affect the spine and lead to limitation of motion of the back, pelvis, and hips, as well as other joints in the body.  It unfortunately often takes a long time before people with this condition are diagnosed when joint damage and fusions have occured. New developments have identified promising pathways that are opening up new treatment possibilities for this condition. Our active research programs are  identifying novel biomarkers in this condition, evaluating novel imaging techniques, and better understanding patient experiences. Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, affecting nearly 30 million nationwide. OA is a degenerative joint disease often described as “wear and tear” arthritis. A common complaint from patients is pain in the weight-bearing joints such as the hips, knees and spine as well as involvement in the finger joints. Osteoarthritis increases with age. Repetitive movement and prior injuries also contribute to the disease, and younger people are increasingly affected. There is currently less understanding of what causes OA.  Our research programs have focused on identifying risk factors for rapid progression, clinical trials of new therapies, evaluating new ways of imaging the condition, and working with laboratory scientists on designing and testing new treatments that may help to repair injured joints.

What Hopkins Is Doing

The Johns Hopkins Arthritis Center treats patients, conducts cutting-edge research and trains physicians.

• Its mission is to provide excellent clinical care while seeking to better understand the causes, treatments, and best treatment approaches for arthritis and other autoimmune diseases.
• Team members include clinical nurses, medical assistants and research and patient care coordinators who assist in patient care, as well as clinical psychologists studying pain, exercise and health concerns of arthritis patients.
• These dedicated teams are committed to ensuring the highest quality, state-of-the-art care for arthritis patients as well as basic, translational, and clinical research that paves the way for new and better treatment options, slower disease progression, decreased symptoms and impacts, and potential cures.

World Renowned & Nationally Ranked

The Johns Hopkins Arthritis Center falls under the umbrella of the Johns Hopkins Division of Rheumatology.

• Hopkins has for 21 of the last 23 years years been voted #1 in the country by U.S. News & World Report as America’s Best Hospital and its Division of Rheumatology has been ranked #1 for the last 12.
• The Division of Rheumatology operates a number of specialty clinics. The Arthritis Center was the first and is looked upon as a model for disease-focused care.
• All Arthritis Center doctors are attending physicians and full-time faculty members at the Johns Hopkins University School of Medicine, and all are board-certified in Rheumatology.
• Our patients come from Baltimore and surrounding states,  and from across the country and around the world. In addition to receiving excellent medical care, patients may be eligible to participate in Hopkins research and benefit from novel treatment options while helping to advance the field for others with arthritis.
• Arthritis Center investigators publish regularly in leading Rheumatology Journals, and present their research findings at national and international conferences.

A Collaborative Effort & A Long-Term Approach

The research in the Johns Hopkins Arthritis Center encompasses many different rheumatic diseases. Most of our studies are multidisciplinary and highly collaborative efforts with faculty in our Division, in other specialties within Hopkins, and with investigators across the globe. Conducting basic science, clinical, and translational research, our experts are exploring new ways to diagnose disease, design clinical trials, measure outcomes, and deliver treatment. Our experienced research teams effectively integrate many studies with clinical care.

Areas of current research include:

• Clinical, biochemical, genetic, and imaging characterization of arthritis patients
•  Autoantibody discovery and characterization
•  Improving patient-reported outcomes in rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis
•  Advanced and molecular imaging of arthritis
•  Predictors of progression in osteoarthritis
•  Periodontal disease in rheumatoid arthritis
•  Exercise and nutrition in arthritis
•  Inflammatory arthritis in the elderly
•  Investigational medication trials

The Johns Hopkins Arthritis Center

We invite you to learn more about the exciting work underway on our campus in Baltimore, MD. The Johns Hopkins Arthritis Center was founded in 1998 and continues to expand its integrated clinical and scientific research programs. It’s here that

• Physicians Turn for Cutting-Edge Expertise
• Patients Receive State-of-the-Art Care
• Innovative Research Translates to Scientific Advances and Improved Outcomes

How You Can Get Involved

• Research Studies at the Arthritis Center
• Support Arthritis Research Financially

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All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

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Strange & offbeat.

Effects of exercise on knee osteoarthritis: A systematic review

Affiliations.

• 1 Health Sciences Department, University of Aveiro (ESSUA), Aveiro, Portugal.
• 2 University Hospital of Coimbra, Coimbra, Portugal.
• PMID: 33666347
• DOI: 10.1002/msc.1538

Background: Knee osteoarthritis is the most common joint disease and a major cause of functional limitation and pain in adults. The aim of this literature review is to review the existing evidence regarding the impact of exercise in people with knee osteoarthritis concerning physical and functional outcomes. The secondary aim is to provide both healthcare professionals and patients with updated and high-quality recommendations for the management of this condition.

Methods: A systematic search was performed at Pubmed, Scopus and Web of Science databases, limiting the studies to English, French and Portuguese language, from 2010 to May 2020. Eligible studies were randomized control trials or clinical control trials that compared an intervention consisting of an exercise programme in adult participants with knee osteoarthritis against no intervention.

Results: A total of 4499 studies were retrieved and 19 articles met the inclusion criteria. Beneficial effects of exercise were found on pain and strength. Regarding function, functional performance and quality of life, evidence is controversial. Both strengthening and aerobic exercise showed positive effects and both aquatic and land-based programmes presented improvement of pain, physical function and quality of life. Relatively to stretching, plyometric and proprioception training, no concrete conclusions can be taken.

Conclusion: Exercise programmes appear to be safe and effective in knee osteoarthritis patients, mainly regarding pain and strength improvement. Pilates, aerobic and strengthening exercise programmes performed for 8-12 weeks, 3-5 sessions per week; each session lasting 1 h appear to be effective. Both aquatic and land-based programmes show comparable and positive effects.

Keywords: aerobic exercise; exercise; hydrotherapy; knee osteoarthritis; strength training.

© 2021 John Wiley & Sons Ltd.

Publication types

• Systematic Review
• Exercise Therapy
• Osteoarthritis, Knee* / therapy
• Quality of Life
• Randomized Controlled Trials as Topic

Clinical Trials and Resources

Search for arthritis-specific clinical trials based on arthritis type and location.

About Clinical Trials

What is a clinical trial, what happens during the phases of trials.

Phase 1 tests the safety of the intervention and is performed in a very small number of subjects to find the highest dose of the new treatment that can be given without causing severe side effects. For the treatment to enter Phase 1 testing, it has already been tested in lab and animal studies. Because of the small number of people in Phase 1 studies, rare side effects may not be seen until later phases of trials. 

Phase 2 tests a larger group of patients (between 20 to 150) with the same disease, administering the experimental treatment as everyone gets in the Phase 1 study. Some Phase 2 studies randomly assign people to different treatment groups. These groups may get different doses or get the treatment in different ways to see which provides the best balance of safety and response. These studies may be done at major hospital centers, community hospitals or even at doctor’s offices. 

Phase 3 clinical trials compare the safety and effectiveness of the new experimental treatment against the current standard treatment. Because health providers do not yet know which treatment is better, participants are often picked at random (called randomized) to get either the standard treatment or the new experimental treatment. 

When possible, neither the doctor nor the patient knows which of the treatments the patient is getting. This type of study is called a double-blind study. Phase 3 studies are conducted in multiple sites and might even be done in different countries. They are often very large, involve hundreds of patients and take a long time for results. As with other trials, patients in phase 3 clinical trials are watched closely for side effects, and treatment is stopped if they’re too hard to manage. 

Phase 4 studies look at drugs already approved by the FDA. These drugs are available for doctors to prescribe for patients. But phase 4 studies might still be needed to answer important questions. They usually involve thousands of people and look at safety over time, as well as examine other aspects of the treatment, such as quality of life or cost effectiveness. You can get the drugs used in a Phase 4 trial without being in a study.  

What Role Does the FDA Play in Approvals?

What considerations should i keep in mind.

When considering a clinical trial, examine all options available to you and discuss with your doctor. Make sure you understand the Consent Form you are asked to sign and all the risks and benefits of participation. After enrolling, you are always free to discontinue your participation. 

Having a diverse representation of genders, races, ethnicities, ages and other factors enables progress to happen faster and makes the results from the clinical trials better applicable to real life.  

Always consult with your doctor before enrolling in a clinical trial. More information about clinical trials for your disease or in your geographic area can be found on  clinicaltrials.gov . 

How Do I Sign Up?

Clinical trial navigator.

Use  our clinical trial navigator below to search for relevant trials.

iFrame Url: https://tools.arthritis.org/walkwithease/pages/public/register.aspx

Sign up for updates .

Stay up to date on latest developments in the world of arthritis, including new scientific and advocacy breakthroughs, progress being made and upcoming knowledge-sharing opportunities and events for the medical, scientific and patient communities.

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Joints that could heal themselves? Researchers could get there in 5 years

Stephanie Bryant, a materials scientist in the Department of Chemical and Biological Engineering and the BioFrontiers Institute at CU Boulder, works in her lab. Bryant is leading a Colorado team seeking to end osteoarthritis. (Photo by Casey Cass/CU Boulder)  

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Imagine a day when joints could heal themselves.

At the first inkling of a creaky knee, patients could get a single shot in the joint that would not only stop their cartilage and bone from eroding, but kick start its regrowth. In more advanced cases, that shot might also deliver a biomaterial repair kit to patch holes in tissue. If multiple joints ached, an annual IV infusion could ferry regenerating therapies to all of them at once.

This may seem like a dream to the 32.5 million people who suffer from osteoarthritis. This week, the Advanced Research Projects Agency for Health (ARPA-H) awarded up to $39 million to a University of Colorado Boulder-led team of scientists to work toward making it a reality. 

The Novel Innovations for Tissue Regeneration in Osteoarthritis (NITRO) program was the first created under ARPA-H, a new federal agency to support “high-impact solutions to society's most challenging health problems.” 

With the cash infusion, a dream team of engineers, medical scientists and veterinarians from CU Boulder, the CU Anschutz Medical Campus and Colorado State University can make an aggressive final push toward a goal many have spent their entire careers pursuing. 

“Within five years, our goal is to develop a suite of non-invasive therapies that can end osteoarthritis,” said project leader and Principal Investigator Stephanie Bryant, PhD, professor in the Department of Chemical and Biological Engineering, Materials Science and Engineering, and the BioFrontiers Institute at CU Boulder. “It could be an absolute game-changer for patients.”

An epidemic without a cure

Osteoarthritis is the third most common disease in the U.S. and affects roughly one in six people over age 30 worldwide.

The disease causes cartilage—the buffering tissue that keeps bones from grinding together—to decay. Over time, bone is damaged too, which reshapes the joint and results in movement becoming painful. 

Age and obesity increase risk, and rates are on the rise as the U.S. population ages and grows more sedentary. At present, patients are generally limited to two options: Treat the pain and, when that is no longer adequate, surgically replace the joint. There is no cure.

Co-Principal Investigators Michael Zuscik, PhD, professor and research vice chair in the Department of Orthopedics and Karin Payne, PhD, associate professor of orthopedics at CU Anschutz (Photo by Ryan Wuller/CU Anschutz)

Co-Principal Investigator Laurie Goodrich, DVM PhD, a veterinary clinician scientist and director of the Orthopaedic Research Center at Colorado State University’s Translational Medicine Institute (Photo courtesy of Goodrich)

“To truly address osteoarthritis, you have to get at both the biology and the structural problem,” said co-Principal Investigator Michael Zuscik, PhD, professor and research vice chair in the Department of Orthopedics at the Anschutz Medical Campus. “This unique Colorado dream team we have put together has the multidisciplinary expertise, and now the resources, to tackle both at once. We can approach curing the disease like never before.”

Zuscik spent 15 years developing and testing a drug that addresses the biology, nudging both cartilage and bone cells to produce proteins needed to rebuild. While promising, it must be injected every day.

Meantime, Bryant, a materials scientist, has worked for 26 years to develop three-dimensional gel-like biomaterials that can slip into the cracks of torn cartilage or worn bone, providing supportive scaffolding—like the joists of a new building—for the body’s own cells to migrate to.

And scientists at CSU have been working for years to perfect gene therapy techniques aimed at controlling inflammation and hastening cartilage healing.

The team now faces an engineering challenge—to devise methods to deliver these technologies to the body together, in a way that provides lasting benefit and treats multiple joints at once if needed.

A one-shot medical breakthrough

To that end, the team is developing nanoparticles that could be administered intravenously, serving as Trojan horses that migrate to inflamed sites and deliver a regenerative medicine cocktail that enables joints to heal.

The team hopes to ultimately commercialize three innovations: a healing shot, an injury-patching hydrogel, and an annual infusion for systemically treating osteoarthritis. 

When it’s time for trials, co-Principal Investigator Laurie Goodrich, DVM PhD, a veterinary clinician scientist and director of the Orthopaedic Research Center at CSU’s Translational Medicine Institute, will lead the charge in animals. 

“CSU’s expertise in veterinary medicine will play a crucial role in helping to move this science to the next step,” said Goodrich. “It’s humbling to be a part of it.”

However, it’s not enough to simply develop such treatments, said Co-Principal Investigator Karin Payne, PhD, associate professor of orthopedics at CU Anschutz.

“At the core of this, the goal is to develop a therapy that’s going to be available to all Americans, not just a privileged few,” Payne said, noting that researchers will include a demographically diverse group of study participants and minimize cost to make the treatments as affordable as possible.

Learn more about AB Nexus

Early collaborations between team members were catalyzed by AB Nexus , which provides internal funding and resources to support partnerships between CU Boulder and CU Anschutz.

The Colorado team is one of five performer teams to receive an award in the NITRO program.

“This is one of the most debilitating diseases there is and leads to people not being able to work or do the things they love,” Bryant said. “The resulting lack of exercise increases the risk of other problems like heart disease. For us to have a chance to improve people’s lives—it’s the opportunity of a lifetime.”

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Clinical Trials

Displaying 17 studies

The purpose of this study is to quantify medial meniscal extrusion with and without a medial knee unloader brace using ultrasonography in patients with isolated medial knee pain.

This study is being done to determine how well a needle can be placed into your knee joint with the use of an ultrasound machine for guidance and to find out if specific nerves can be reached with anesthetic or placebo to prevent the pain in the knee. We are interested if we can reach the specific nerve that will be anesthetized to prevent the pain.

The prevalence of chronic pain following total knee replacement has been under studied.  In recent years, the perioperative use of multimodal analgesic strategies including regional anesthetic techniques has substantially improved early postoperative pain management. However, it is not clear that these improvements in perioperative care have reduced the frequency of chronic pain post-total knee replacement.  This study will conduct a cross sectional study to determine the prevalence of chronic knee pain following total knee replacement up to 5 years postoperatively.  This study will also identify risk factors, such as smoking, depression, and pain problems elsewhere as predictors of chronic knee pain after knee ...

The purpose of this study is to determine the incremental value of a “star” from the patient perspective when choosing a provider for total joint replacement.

The study aim is to conduct a clinical research investigation to compare two alignment techniques used in contemporary total knee arthroplasty by means of a prospective non-randomized clinical trial. The two alignment techniques are Kinematic Alignment (KA) and Mechanical Alignment (MA).

The purpose of this study is to evaluate the incidence of chronic knee pain at 6 months following primary total knee arthroplasty. Secondary outcomes include incidence of knee numbness, postoperative sensory loss or change at the knee, range of motion (ROM), resting pain with Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), quality of life measurement assessed by SF-36.

The purpose of this study is to test the feasibility of a Digital Home-Exercise Therapy Application (DETP) by conducting a randomized, controlled, non-inferiority study to compare the DETP to conventional physical therapy (PT).

The purpose of this study is to evaluate whether ultrasound can detect medial meniscal extrusion more frequently than MRI.

The overall goal of this study is to develop regenerative cell therapy for use in patients with osteoarthritis (OA). The primary objective of this proposal is to conduct a pilot study that assesses the safety and feasibility of using concentrated bone marrow aspirate containing MSC to treat patients with painful knee OA.

The purpose of this study is to compare two methods of postoperative pain management for patients who have undergone total knee replacement surgery.

The purpose of this study is to compare the use of ultrasound guidance and nerve stimulator guidance with a popliteal (knee) nerve block for postoperative pain control.

This confirmatory study is a prospective randomized trial comparing the efficacy and safety of an autologous chondrocyte tissue implant (NeoCart) to the surgical intervention microfracture in the treatment of cartilage defects in the knee.

The purposes of this study are to determine:  the risk of cardiomyopathy and heart failure, and cardiac structure and function in patients with THA and TKA. This study will also determine the association between serum and/or synovial fluid metal ion levels with cardiac structure and function in 100 prospectively-recruited THA and TJA patients.

The goals of this continuation of MeTeOR are to determine: a) whether the greater structural damage observed at five years in subjects treated with APM persists over 12 years; and b) whether structural changes observed in the first five years are associated with worse pain and function and greater TKR utilization at 12 years. We propose the following aims:

• Conduct a 12-year follow-up visit of MeTeOR subjects to characterize the extent of cartilage damage over 12 years and identify factors associated with OA progression . MeTeOR participants will complete questionnaires and performance tests and undergo MRI and radiographs 12 years ...

This is a prospective, randomized, multicenter comparison study examining the outcomes of subjects with osteoarthritis and knee pain undergoing a procedure to create a radiofrequency lesion of the genicular nerves with the Cooled Radiofrequency Ablation (CRFA) system compared to subjects receiving Hyaluronic Acid (HA). Approximately 168 subjects will be enrolled into this study, with subjects undergoing either CRFA or HA injection in a 1:1 randomization scheme. Follow-up will be conducted for 12 months post-CRFA, with the primary endpoint being completed at month 6. Subjects randomized to the comparison (HA) group will have the option to cross-over to the neurotomy group ...

The purpose of this study is to conduct a comprehensive clinical and biomechanical screening of high school, collegiate-level, recreational, and Olympic/professional-level athletes with the goal of identifying individual functional and performance deficits that lead to future injury.

This study aims to compare postoperative pain levels between three (3) treatment groups, using the Numerical Rating Scale (NRS).

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Biking over your lifetime is associated with less knee pain or arthritis, study suggests

Bicycling, whether outdoors or in a spinning class, may help prevent knee arthritis and pain.

People who biked at any point in their lives were 17% less likely to develop knee pain and 21% less likely to develop arthritis with pain in the knee joint, according to an analysis of data from more than 2,600 people in their 60s. The report was published earlier this month in Medicine & Science in Sports & Exercise .

“Based on our observational study, bicycling over a lifetime is associated with better knee health, including less knee pain and less damage to the joint,” said the study’s lead author, Dr. Grace Lo, chief of rheumatology at the Michael E. DeBakey VA Medical Center in Houston. “The more periods of time in life a person spent bicycling, the less likely she or he had knee pain and signs of osteoarthritis.”

From a more personal perspective, Lo said, “the findings from the study make me feel pretty good that I make my kids ride their bikes on a regular basis and I will continue to encourage that activity. I also am happy that I have a bike and I ride when I have a chance as well.” Lo is also associate professor of medicine at Baylor College of Medicine.

Biking builds muscles around the knees

People with knee arthritis are often told by their doctors to keep their joints moving, but until now it wasn’t clear what activity might be best for that. The new study suggests that biking may build muscles around the knees without the downside of jarring to the joints that might result from activities such as running.

Lo and her colleagues focused on a subset of volunteers from a larger study, the Osteoarthritis Initiative , a multicenter observational investigation that recruited people ages 45 to 79, some of whom had knee arthritis while some did not.

As part of the new research, eight years into the original study participants filled out a questionnaire that asked about leisure physical activity during four periods of their lives:

• Ages 12 to 18.
• Age 50 and older.

For each time period, the participants were asked how often they cycled. More than half of them had cycled consistently at some point in their lives. 

The data from the study can’t explain why biking might be protective. But Lo suspects that people who biked between 12 and 18, when most did it, built up their quadriceps and that development stayed with them even though they may not have continued to ride.

Biking may be so protective because it doesn’t jar the joints.

“We do know that activities that are non-weight bearing are less likely to cause pain,” Lo said. “That’s probably a reason why people have less pain when bicycling as compared to other activities.”

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When it comes to outside versus inside pedaling, Lo says there’s no research to determine whether one is better than the other. It’s just a matter of personal preference and convenience.

“This is a pretty cool study,” said Dr. Andrew Gregory, an associate professor of orthopedics neurosurgery and pediatrics at the Vanderbilt University Medical Center in Nashville. “It’s advice we give out a lot but it’s good to be able to support that advice with evidence.”

Activities that involve moving the knee help maintain the health of cartilage.

"Movement of the joint is really important because it drives nutrients into the cartilage,” Gregory said, adding that this part of the knee has no blood supply of its own.

Which helps knees more — biking or running?

The big advantage biking has over running is it saves the knees from being jarred, Gregory said. In fact, people with knee arthritis probably shouldn’t be running, he added.

Moreover, biking strengthens an important group of muscles that isn’t built up by running.

“Running works the muscles that are in a straight line: the hamstrings, the quads and the calves,” Gregory explained. “Biking strengthens the glutes, which keep the hips and knees strong and that helps because they affect side to side motion.”

Without strong muscles on the sides of the legs, the knees are more vulnerable to injury.

The new study doesn’t suggest how often people should bicycle. But for that, you might want to fall back on general recommendations on how much activity is healthy, said Dr. Christine Peoples, a clinical associate professor of medicine in the division of rheumatology at the University of Pittsburgh.

“I would say, if you’re not active now, you should start slow and cycle two to three times a week pedaling slowly and at a low intensity," she said. “Make sure you’re on a bike with a supportive seat position. Then you can gradually increase the intensity.”

The study does have limitations. It doesn't prove that biking helped people’s knees — it can only show an association between cycling and less pain and joint damage, said Dr. Scott Barbuto, an assistant professor of rehabilitation and regenerative medicine at the Columbia University Vagelos College of Physicians and Surgeons in New York City.

When a study is retrospective, meaning the data are examined after the fact, “you can never talk about causality,” he added. “And the authors do mention this as a limitation of the study.”

Still, Barbuto said, doing a prospective trial in which participants are randomly assigned to bike or not to bike is not feasible since it takes so long for arthritis to develop.

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How to Thrive as You Age

Like to bike your knees will thank you and you may live longer, too.

Allison Aubrey

A large new study shows people who bike have less knee pain and arthritis than those who do not. PamelaJoeMcFarlane/Getty Images hide caption

A large new study shows people who bike have less knee pain and arthritis than those who do not.

We are in the middle of National Bike Month , and cycling enthusiasts love to talk up the benefits of their favorite activity.

"It's definitely my longevity drug," says Brooks Boliek, 65, an avid cyclist of many decades, who used to commute to his office on a bicycle.

A substantial body of evidence supports the health benefits of cycling, everything from strengthening the immune system to boosting the likelihood of living longer. Now, a new study finds people who are in the habit of riding a bike are significantly less likely to have osteoarthritis and experience pain in their knees by age 65, compared to people who don't bike.

The study, which was funded in part by the National Institutes of Health, and published in the American College of Sports Medicine's flagship peer-reviewed journal, included about 2,600 men and women, with an average age of 64 years old. They were surveyed about their physical activity over their lifetime. As part of the study, researchers took X-ray images to evaluate signs of arthritis in their knee joints. "Bicyclers were 21% less likely to have X-ray evidence and symptoms of osteoarthritis compared to those who did not have a history of bicycling," explains study author Dr. Grace Lo of Baylor College of Medicine.

"I was surprised to see how very strong the benefit was," Lo says given the profile of the participants. The people enrolled in the study were not competitive athletes, but rather "average" people, ranging from their mid-40's up to 80 years old. All of them had elevated risks of developing knee arthritis due to weight, family history or former injuries.

The study can not prove cause and effect, given it was an observational study that assessed osteoarthritis at one point in time. But the findings, which are published in the journal Medicine & Science in Sports & Exercise , validate the advice many health care providers give to patients about the benefits of cycling and other non weight-bearing exercises.

"Cycling is very low impact," says musculoskeletal researcher Matt Harkey , an assistant professor at Michigan State University and a co-author of the study. Cycling also helps to build strength in the muscles around the knee which can help protect the joint. In addition, the rhythmic motion of pedaling on a bicycle can move synovial fluid , the viscous, egg white -like liquid in joints that helps reduce friction and absorb shock. "What it does is help to circulate the synovial fluid throughout the joint to help to kind of lubricate [the joint] and provide nutrient delivery to the cartilage," Harkey says.

Cycling enthusiast Brooks Boliek calls biking his "longevity drug," and the research backs him up on that. Allison Aubrey/NPR hide caption

Cycling enthusiast Brooks Boliek calls biking his "longevity drug," and the research backs him up on that.

Of course, there are many types of exercise that are good for health, though cycling seems to have a leg up when it comes to protecting joints. Oftentimes, people give up contact sports such as basketball, as they age, given the risk of injury.

"It can be expected that physical activity in which there is little weight-bearing on joints will be more beneficial than those that need constant stamping," such as running, says Norman Lazarus, a professor emeritus at King's College London, who is in his late 80's and is still cycling. (NPR profiled his cycling research in 2018.)

Lazarus says the results of the new study – pointing to a benefit – are not surprising, though he points out that biking does bring risk of injury . He says it's important for cyclists to understand the risk of overuse injuries as well as the importance of technique and getting a proper fitting bike. Each year, thousands of bicyclists are injured in motor vehicle crashes, and older adults are at higher risk of serious injury. Research shows it's safer to bike on trails or paths separated from traffic.

Risks, aside, research shows biking is good for longevity. "There's good data to support that people live longer when they bicycle," says Lo. She points to a study that found people who cycled one hour per week were about 22% less likely to die prematurely. This was a study of people with diabetes, so it's possible that the benefits are greater for people without the disease.

"This is an exercise [people] can participate in over a lifetime," Lo says, and it can also be done indoors on a stationary bike. "I think that it is a great preventative strategy for many things, including arthritis," she says.

Biking enthusiast Brooks Boliek says cycling brings him joy and a sense of accomplishment. "I'm very goal oriented," he says, and a daily ride gives him something to focus on. "It gives me something to live for."

A sense of purpose that keeps his heart pumping and his muscles strong. He says he'd love to keep riding until the day he dies.

Find Allison Aubrey on Instagram at @allison.aubrey and on X @AubreyNPR .

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Nasa’s heliophysics experiment to study sun on european mission.

Tiernan P. Doyle

Nasa headquarters.

NASA announced Tuesday it selected a new instrument to study the Sun and how it creates massive solar eruptions. The agency’s Joint EUV coronal Diagnostic Investigation, or JEDI, will capture images of the Sun in extreme ultraviolet light, a type of light invisible to our eyes but reveals many of the underlying mechanisms of the Sun’s activity.

Once integrated aboard the ESA’s (European Space Agency’s) Vigil space weather mission , JEDI’s two telescopes will focus on the middle layer of the solar corona, a region of the Sun’s atmosphere that plays a key role in creating the solar wind and the solar eruptions that cause space weather.

The Vigil space mission, planned to launch in 2031, is expected to provide around-the-clock space weather data from a unique position at Sun-Earth Lagrange point 5 – a gravitationally stable point about 60 degrees behind Earth in its orbit. This vantage point will give space weather researchers and forecasters a new angle to study the Sun and its eruptions. NASA’s JEDI will be the first instrument to provide a constant view of the Sun from this perspective in extreme ultraviolet light – giving scientists a trove of new data for research, while simultaneously supporting Vigil’s ability to monitor space weather. 

“JEDI’s observations will help us link the features we see on the Sun’s surface with what we measure in the solar atmosphere, the corona,” said Nicola Fox, associate administrator, Science Mission Directorate at NASA Headquarters in Washington. “Combined with Vigil’s first-of-its-kind, eagle eye view of the Sun, this will change the way we understand the Sun’s drivers of space weather – which in turn can lead to improved warnings to mitigate space weather effects on satellites and humans in space as well as on Earth.”

The project is led by Don Hassler at the Southwest Research Institute in Boulder, Colorado. The instrument is funded by the NASA Heliophysics Space Weather Program with a total cost not to exceed $45 million. Management oversight will be provided by the Living With a Star Program of the Explorers & Heliophysics Projects Division at NASA’s Goddard Space Flight Center in Greenbelt, Maryland.

For more information on NASA heliophysics missions, visit:

https://science.nasa.gov/heliophysics

Karen Fox Headquarters, Washington 202-358-1600 [email protected]

Sarah Frazier NASA’s Goddard Space Flight Center 202-853-7191 [email protected]

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Collagen is the most abundant protein in the body. Its fiber-like structure is used to make connective tissue. Like the name implies, this type of tissue connects other tissues and is a major component of bone, skin, muscles, tendons, and cartilage. It helps to make tissues strong and resilient, able to withstand stretching.

In food, collagen is naturally found only in animal flesh like meat and fish that contain connective tissue. However, a variety of both animal and plant foods contain materials for collagen production in our own bodies.

Our bodies gradually make less collagen as we age, but collagen production drops most quickly due to excess sun exposure, smoking, excess alcohol, and lack of sleep and exercise . With aging, collagen in the deep skin layers changes from a tightly organized network of fibers to an unorganized maze. [1] Environmental exposures can damage collagen fibers reducing their thickness and strength, leading to wrinkles on the skin’s surface.

Collagen Supplementation

Despite its abundance in our bodies, collagen has become a top-selling supplement purported to improve hair, skin, and nails—key components of the fountain of youth. The idea of popping a pill that doesn’t have side effects and may reverse the signs of aging is attractive to many. According to Google Trends, online searches for collagen have steadily increased since 2014.

Collagen first appeared as an ingredient in skin creams and serums. However, its effectiveness as a topical application was doubted even by dermatologists, as collagen is not naturally found on the skin’s surface but in the deeper layers. Collagen fibers are too large to permeate the skin’s outer layers, and research has not supported that shorter chains of collagen, called peptides, are more successful at this feat.

Oral collagen supplements in the form of pills, powders, and certain foods are believed to be more effectively absorbed by the body and have skyrocketed in popularity among consumers. They may be sold as collagen peptides or hydrolyzed collagen, which are broken down forms of collagen that are more easily absorbed. Collagen supplements contain amino acids, the building blocks of protein , and some may also contain additional nutrients related to healthy skin and hair like vitamin C , biotin , or zinc .

What does the research say on collagen supplements?

Most research on collagen supplements is related to joint and skin health. Human studies are lacking but some randomized controlled trials have found that collagen supplements improve skin elasticity. [3,4] Other trials have found that the supplements can improve joint mobility and decrease joint pain such as with osteoarthritis or in athletes. [5] Collagen comprises about 60% of cartilage, a very firm tissue that surrounds bones and cushions them from the shock of high-impact movements; so a breakdown in collagen could lead to a loss of cartilage and joint problems.

However, potential conflicts of interest exist in this area because most if not all of the research on collagen supplements are funded or partially funded by related industries that could benefit from a positive study result, or one or more of the study authors have ties to those industries. This makes it difficult to determine how effective collagen supplements truly are and if they are worth their often hefty price.

A downside of collagen supplements is the unknown of what exactly it contains or if the supplement will do what the label promotes. There are also concerns of collagen supplements containing heavy metals. In the U.S., the Food and Drug Administration does not review supplements for safety or effectiveness before they are sold to consumers.

Another potential downside is that taking a collagen supplement can become an excuse to not practice healthy behaviors that can protect against collagen decline, such as getting enough sleep and stopping smoking.

That said, the available research has not shown negative side effects in people given collagen supplements. [3,4]

Can You Eat Collagen?

Food containing collagen

• There are foods rich in collagen, specifically tough cuts of meat full of connective tissue like pot roast, brisket, and chuck steak. However, a high intake of red meat is not recommended as part of a long-term healthy and environmentally sustainable diet . Collagen is also found in the bones and skin of fresh and saltwater fish. [2]
• Bone broth, a trending food featured prominently in soup aisles, is promoted as a health food rich in collagen. The process involves simmering animal bones in water and a small amount of vinegar (to help dissolve the bone and release collagen and minerals) anywhere from 4 to 24 hours. However, the amount of amino acids will vary among batches depending on the types of bones used, how long they are cooked, and the amount of processing (e.g., if it is a packaged/canned version).
• Gelatin is a form of collagen made by boiling animal bones, cartilage, and skin for several hours and then allowing the liquid to cool and set. The breakdown of these connective tissues produces gelatin. Collagen and its derivative, gelatin, are promoted on certain eating plans such as the paleo diet .

Foods to boost collagen production

• Several high-protein foods are believed to nurture collagen production because they contain the amino acids that make collagen—glycine, proline, and hydroxyproline. [6] These include fish, poultry, meat, eggs , dairy , legumes , and soy .
• Collagen production also requires nutrients like zinc that is found in shellfish, legumes, meats, nuts , seeds, and whole grains ; and vitamin C from citrus fruits, berries, leafy greens, bell peppers, and tomatoes.

Is bone broth healthy?

In reality, bone broth contains only small amounts of minerals naturally found in bone including calcium , magnesium , potassium , iron , phosphorus , sodium , and copper. The amount of protein , obtained from the gelatin, varies from 5-10 grams per cup.

There is some concern that bone broth contains toxic metals like lead. One small study found that bone broth made from chicken bones contained three times the lead as chicken broth made with the meat only. [7] However the amount of lead in the bone broth per serving was still less than half the amount permitted by the Environmental Protection Agency in drinking water. A different study found that bone broth, both homemade and commercially produced, contained low levels (<5% RDA) of calcium and magnesium as well as heavy metals like lead and cadmium. [9] The study noted that various factors can affect the amount of protein and minerals extracted in bone broth: the amount of acidity, cooking time, cooking temperature, and type of animal bone used. Therefore it is likely that the nutritional value of bone broths will vary widely.

Healthy Lifestyle Habits That May Help  

Along with a healthy and balanced diet , here are some habits that may help protect your body’s natural collagen:

• Wear sunscreen or limit the amount of time spent in direct sunlight (10-20 minutes in direct midday sunlight 3-4 times a week provides adequate vitamin D for most people).
• Get adequate sleep . For the average person, this means 7-9 hours a night.
• Avoid smoking or secondhand smoke.
• Control stress . Chronically high cortisol levels can decrease collagen production.
• Although the exact connection between exercise and skin quality is unclear, some studies have found that exercise slows down cell activity involved with aging skin. [10]  

Bottom Line

At this time, non-industry funded research on collagen supplements is lacking. Natural collagen production is supported through a healthy and balanced diet by eating enough protein foods , whole grains , fruits, and vegetables and reducing lifestyle risk factors.

• Rinnerhaler M, Bischof J, Streubel MK, Trost A, Richter K. Oxidative Stress in Aging Human Skin. Biomolecules . 2015 Apr 21;5(2):545-89.
• Avila Rodríguez MI, Rodriguez Barroso LG, Sánchez ML. Collagen: A review on its sources and potential cosmetic applications. Journal of Cosmetic Dermatology . 2018 Feb;17(1):20-6.
• Proksch E, Segger D, Degwert J, Schunck M, Zague V, Oesser S. Oral supplementation of specific collagen peptides has beneficial effects on human skin physiology: a double-blind, placebo-controlled study. Skin pharmacology and physiology . 2014;27(1):47-55.
• Kim DU, Chung HC, Choi J, Sakai Y, Lee BY. Oral intake of low-molecular-weight collagen peptide improves hydration, elasticity, and wrinkling in human skin: a randomized, double-blind, placebo-controlled study. Nutrients . 2018 Jul;10(7):826.
• Bello AE, Oesser S. Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. Current medical research and opinion . 2006 Nov 1;22(11):2221-32.
• Lodish H, Berk A, Zipursky SL, et al. Molecular Cell Biology . New York: W. H. Freeman; 2000.
• Monro JA, Leon R, Puri BK. The risk of lead contamination in bone broth diets. Medical hypotheses . 2013 Apr 1;80(4):389-90.
• Global Market Insights. Worldwide Broth Market . Feb 26, 2018.
• Hsu DJ, Lee CW, Tsai WC, Chien YC. Essential and toxic metals in animal bone broths. Food & nutrition research . 2017 Jan 1;61(1):1347478.
• Crane JD, MacNeil LG, Lally JS, Ford RJ, Bujak AL, Brar IK, Kemp BE, Raha S, Steinberg GR, Tarnopolsky MA. Exercise‐stimulated interleukin‐15 is controlled by AMPK and regulates skin metabolism and aging. Aging cell . 2015 Aug;14(4):625-34.

Last reviewed May 2021

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Quantification supports amyloid-PET visual assessment of challenging cases: results from the AMYPAD-DPMS study

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Several studies have demonstrated the high agreement between routine clinical visual assessment and quantification, suggesting that quantification approaches could support the assessment of less experienced readers and/or in challenging cases. However, all studies to date have implemented a retrospective case collection and challenging cases were generally underrepresented.

Methods In this prospective study, we included all participants ( N =741) from the AMYPAD Diagnostic and Patient Management Study (DPMS) with available baseline amyloid-PET quantification. Quantification was done with the PET-only AmyPype pipeline, providing global Centiloid (CL) and regional z-scores. Visual assessment was performed by local readers for the entire cohort. From the total cohort, we selected a subsample of 85 cases 1) for which the amyloid status based on the local reader’s visual assessment and CL classification (cut-off=21) was discordant and/or 2) that were assessed with a low confidence (i.e. ≤3 on a 5-point scale) by the local reader. In addition, concordant negative ( N =8) and positive ( N =8) scans across tracers were selected. In this sample, ( N =101 cases: ([ 18 F]flutemetamol, N =48; [ 18 F]florbetaben, N =53) the visual assessments and corresponding confidence by 5 certified independent central readers were captured before and after disclosure of the quantification results.

Results For the AMYPAD-DPMS whole cohort, the overall assessment of local readers highly agreed with CL status (κ=0.85, 92.3% agreement). This was consistently observed within disease stages (SCD+: κ=0.82/92.3%; MCI: κ=0.80/89.8%; dementia: κ=0.87/94.6%). Across all central reader assessments in the challenging subsample, global CL and regional z-scores quantification were considered supportive of visual read in 70.3% and 49.3% of assessments, respectively. After disclosure of quantitative results, we observed an improvement in concordance between the 5 readers (κ baseline =0.65/65.3%; κ post-disclosure =0.74/73.3%) and a significant increase in reader confidence ( M baseline =4.0 vs. M post-disclosure =4.34, W =101056, p <0.001).

Conclusion In this prospective study enriched for challenging amyloid-PET cases, we demonstrate the value of quantification to support visual assessment. After disclosure, both inter-reader agreement and confidence showed a significant improvement. These results are important considering the arrival of anti-amyloid therapies, which utilized the Centiloid metric for trial inclusion and target-engagement. Moreover, quantification could support determining Aβ status with high certainty, an important factor for treatment initiation.

Competing Interest Statement

DISCLOSURES DA, IB, DVG, ILA, AP, and GBF report no relevant disclosures. LEC has received research support from GE Healthcare and Springer Healthcare (funded by Eli Lilly), both paid to institution. Dr. Collij s salary is supported by the MSCA postdoctoral fellowship research grant (#101108819) and the Alzheimer Association Research Fellowship (AARF) grant (#23AARF-1029663). GNB is funded by the Deutsche Forschungsgemeinschaft (DFG) Project ID 431549029 - SFB 1451 and partially by DFG, DR 445/9 1. MB is employed by GE HealthCare. RW is employed by IXICO ltd. RG is employed by Life Molecular Imaging AWS is employed by Life Molecular Imaging ZW has received research support from GE Healthcare. PS is employed by EQT Life Sciences team. AN has received consulting fee from H Lundbeck AB, AVVA pharmaceuticals and honoraria for lecture from Hoffman La Roche. JDG has received research support from GE HealthCare, Roche Diagnostics and Hoffmann La Roche, speaker/consulting fees from Roche Diagnostics, Esteve, Philips Nederlands, Biogen and Life Molecular Imaging and serves in the Molecular Neuroimaging Advisory Board of Prothena Biosciences. AD has received research support from: Siemens Healthineers, Life Molecular Imaging, GE Healthcare, AVID Radiopharmaceuticals, Sofie, Eisai, Novartis/AAA, Ariceum Therapeutics, speaker Honorary/Advisory Boards: Siemens Healthineers, Sanofi, GE Healthcare, Biogen, Novo Nordisk, Invicro, Novartis/AAA, Bayer Vital, Lilly Stock: Siemens Healthineers, Lantheus Holding, Structured therapeutics, Lilly. Patents: Patent for 18F JK PSMA 7 (Patent No.: EP3765097A1; Date of patent: Jan. 20, 2021). SM received speaker honoraria from GE Healthcare, Eli Lilly and Life Molecular Imaging. CB is employed by GE HealthCare. VG is supported by the Swiss national science foundation (project n.320030_185028 and 320030_169876), the Aetas Foundation, the Schmidheiny Foundation, the Velux Foundation, the Fondation privee des HUG. She received support for research and speakers fees from Siemens Healthineers, GE HealthCare, Janssen, Novo Nordisk, all paid to institution. GF is employed by GE HealthCare. FB is supported by the NIHR biomedical research centre at UCLH. Steering committee or Data Safety Monitoring Board member for Biogen, Merck, Eisai and Prothena. Advisory board member for Combinostics, Scottish Brain Sciences. Consultant for Roche, Celltrion, Rewind Therapeutics, Merck, Bracco. Research agreements with ADDI, Merck, Biogen, GE Healthcare, Roche. Co-founder and shareholder of Queen Square Analytics LTD.

Funding Statement

ACKNOWLEDGMENTS The project leading to this paper has also received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115952. This Joint Undertaking receives the support from the European Union s Horizon 2020 research and innovation programme and EFPIA. This communication reflects the views of the authors and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

All participants gave written informed consent. The trial was registered with EudraCT (2017-002527-21). The study was approved by the CCER (Commission Cantonale d Ethique de la Recherche) in Geneva Switzerland (#2017-01408).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Data Availability

Data is available upon request through the ADDI platform

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Research/Study Research/Study

Key Project 2025 figure Russ Vought was appointed to the RNC's platform committee. Mainstream coverage of the move was minimal.

Vought, a former Trump official who runs MAGA think tank the Center for Renewing America, has pushed Christian nationalism and wants to recruit an “army” of right-wing activists with a “biblical worldview” to serve in the next Republican administration

Written by John Knefel

Research contributions from Tyler Monroe

Published 05/21/24 11:22 AM EDT

Russ Vought, a frequent guest on right-wing media shows and key figure in Project 2025, a broad effort to staff a future Republican administration, will have a top role in drafting the platform for the GOP's convention this July, virtually ensuring the document will be a wishlist of MAGA priorities.

The Republican National Committee and the Trump campaign made the joint announcement on May 15, highlighting Vought’s new role “as the committee's policy director” for the RNC’s 2024 Committee on the Platform and noting his previous tenure as director of the Office of Management and Budget under former President Donald Trump. In that position, Vought oversaw the administration’s attempts to remove supposed “critical race theory trainings” from federal programs and sought to coordinate the White House’s directives across the executive branch more broadly. 

As of May 21, the announcement has been met with total silence by mainstream cable outlets and corporate broadcast Sunday shows. Vought’s appointment hasn’t been mentioned at all on CNN or MSNBC, and wasn’t discussed on the May 19 editions of ABC’s This Week ; CBS’ Face the Nation ; or NBC’s Meet the Press . As a result, Vought’s radical vision for another Trump term remains hidden in plain sight, even as he positions himself for a possible return to government should his former boss win in November.

Vought is a hardline conservative who has promoted Christian nationalism and advocated for “ideological purity tests” for civil servants

After Trump’s loss in 2020, Vought founded the Center for Renewing America, where he has consistently pushed a Christian nationalist agenda. He has called for an “army” of right-wing activists with “biblical worldview” to serve in the next Republican administration, and wrote an op-ed for Newsweek in 2021 with the headline: “Is There Anything Actually Wrong With 'Christian Nationalism?' As Politico reported , “One ​​document drafted by CRA staff and fellows includes a list of top priorities for CRA in a second Trump term. ‘Christian nationalism’ is one of the bullet points.” 

The Center for Renewing America has emerged as a key player in the MAGA-aligned think tank world. It’s one of the more than 100 conservative groups that make up Project 2025 , an effort organized by The Heritage Foundation to provide staffing and policy proposals to a future GOP presidency. Vought plays a central role in the effort, including as the author of a chapter in Project 2025’s guiding document, Mandate for Leadership: The Conservative Promise , in which he argued that the “ enormous power ” of the executive branch should be exclusively the purview of the president rather than dispersed within agencies and departments.

Though that argument may sound anodyne, Vought’s vision has radical implications. First and foremost, Vought advocates for implementing a policy known as “Schedule F,” which would reclassify tens of thousands of federal employees as political appointees — thus stripping them of union protections. If Trump is reelected in November and chooses to go forward with Schedule F, he could fire career civil servants from agencies and departments en masse and replace them hardcore MAGA foot soldiers, potentially decimating the Environmental Protection Agency, the Department of Labor, the Department of Education, and other frequent right-wing targets.

“What we’re trying to do is identify the pockets of independence and seize them,” Vought has said, according to The New York Times.

In a 2022 interview with right-wing activist Charlie Kirk, Vought and the host agreed that a future Republican president should deploy “ideological purity tests” against civil servants, with Vought calling for a purge of at least 10% of the federal workforce. In a 2023 appearance on former Trump adviser Steve Bannon’s War Room podcast, guest hosted by Rep. Matt Gaetz (R-FL), Vought endorsed readopting the Holman Rule, which would allow members of Congress to target existing funding for agencies or individual federal employees. 

“The Holman Rule makes sure that those career bureaucrats are no longer anonymous, and that they are put in the crosshairs to the same extent — in the arena — that you are. That I am,” Vought told Gaetz, who is currently under investigation by the House Ethics Committee.

Vought has sowed chaos in the GOP-led House of Representative and targeted anti-poverty programs

In service of his uncompromising, hardline stances, Vought has championed the right-most flank of the Republican House Caucus in its fights against former Speaker of the House Kevin McCarthy (R-CA) and his successor, Speaker Mike Johnson (R-LA). 

In a November 2022 appearance on Bannon’s War Room , Vought lobbied against McCarthy even before he got the job, arguing that “we need a war-time speaker that can seize confrontation and risk by the throat in order to go against their adversaries and be able to deal with the woke and weaponized government that we are all suffering from.” He later accused McCarthy of “running this House in concert with the Democrats,” during another edition of Bannon’s show. As Johnson attempted to pass a bill that would provide military aid to Ukraine, Vought returned to Bannon’s podcast and referred to Johnson as a “neocon,” who “rejects the America first perspective.”

Vought and CRA have an entire wishlist of radical domestic policies. According to The Washington Post, Vought advocates for trillions of dollars of reductions to “anti-poverty programs such as housing, health care and food assistance,” including massive cuts to Medicaid and potentially slashing Social Security and Medicare benefits in the future. Jeffrey Clark, a senior fellow at CRA and a participant in Trump’s attempts to overturn the 2020 election, has reportedly advocated for Trump to invoke the Insurrection Act to deploy the military against civilian protests if he wins in November.

Mainstream outlets do the public a disservice by failing to report Vought’s newly announced role is drafting the GOP’s 2024 platform for a potential second Trump administration.

Methodology

Media Matters searched transcripts in the Snapstream video database for all original programming on CNN and MSNBC as well as all original episodes of ABC’s This Week ; CBS’ Face the Nation ; and NBC’s Meet the Press for any of the terms “Vought” (including misspellings), “Center for Renewing America,” “OMB,” or “Office of Management and Budget” within close proximity of any of the terms “RNC,” “Platform,” “Republican National Committee,” or “Trump,” from May 15, 2024, when the Republican National Committee announced the appointment of Russ Vought to the Committee on the Platform, through May 20, 2024. 

We timed segments, which we defined as instances when Russ Vought's appointment to the RNC's Committee on the Platform was the stated topic of discussion or when we found significant discussion of the appointment. We defined significant discussion as instances when two or more speakers in a multitopic segment discussed the appointment with one another.

We also timed mentions, which we defined as, instances when a single speaker in a segment on another topic mentioned Russ Vought's appointment without another speaker in the segment engaging with the comment, and teasers, which we defined as instances when the anchor or host promoted a segment about the appointment scheduled to air later in the broadcast.

We rounded all times to the nearest minute.

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Clinical efficacy and safety of stem cell therapy for knee osteoarthritis

a Department of neurosurgery, The Second Hospital of Jilin University

b Department of pediatrics, The First Hospital of Jilin University

c Department of hand surgery, The Second Hospital of Jilin University

d College of Mathematics, Jilin University

e Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.

Background:

We performed a meta-analysis of the efficacy and safety of stem cell therapy as a clinical treatment of knee osteoarthritis. This meta-analysis is expected to provide evidence of the efficacy of stem cell therapy, which is currently controversial, as a conservative treatment for knee osteoarthritis.

An online search for relevant articles was conducted in the PubMed, EMBASE, and Cochrane Library databases. The search terms were “stem cells” and “osteoarthritis.” We conducted a quality assessment of the included articles and extracted the following indicators: Visual Analogue Scale (VAS) score, Subjective International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities (WOMAC) subscales, and adverse events. The RevMan5.3 software was used for determining effect sizes.

Nine randomized controlled trials involving 339 patients were included. VAS score and IKDC score from baseline to 24 months were improved in the stem cell therapy group compared to those in the control group. However, no significant difference was observed between the 2 groups in IKDC score changes from baseline to 6 and 12 months, as well as in WOMAC-Pain, WOMAC-Stiffness, and WOMAC-Physical Function score changes at each visit point.

Conclusion:

Stem cell therapy is certainly superior to traditional treatments in the conservative treatment of KOA; it considerably reduces pain with no obvious additional side effects.

1. Introduction

Knee osteoarthritis is a chronic degenerative bone metabolic disease that commonly occurs in middle-aged and older adults; it affects patients’ daily activities and even causes disability. [ 1 , 2 ] Its clinical features mainly include cartilage degenerative lesions, with clinical manifestations such as joint swelling, pain, and deformity. Thus, the main therapeutic purposes of knee osteoarthritis are to reduce or eliminate pain, correct joint deformities, and improve joint function through cartilage repair. [ 3 ]

In recent years, replacement of damaged articular cartilage by chondrocytes or cartilage tissue has been considered a potential approach for treating knee osteoarthritis. Studies have shown that it is feasible to induce human pluripotent stem cells to differentiate into chondrocytes; therefore, stem cell therapy has become a new method for local treatment of knee osteoarthritis. For example, mesenchymal stem cells (MSCs) have multi-directional differentiation potential and can be differentiated into osteoblasts and chondrocytes under specific induction conditions in vitro and in vivo, thereby repairing bone and articular cartilage. [ 4 , 5 ] However, there is still a dispute on the clinical effects of stem cells, [ 6 – 8 ] for which a multitude of clinical trials and meta-analyses have been conducted. [ 9 , 10 ]

We herein present a meta-analysis of the controversial efficacy and safety of stem cell therapy as a clinical treatment of knee osteoarthritis. This study is markedly distinguished from previous meta-analyses [ 9 , 10 ] because it focused on bone marrow MSCs, peripheral blood stem cells, and amniotic fluid free stem cells. In addition, we used updated data from several latest high-level randomized controlled trials (RCTs). [ 11 , 12 ] This meta-analysis is expected to provide an evidence of the efficacy of stem cell therapy as a conservative treatment of knee osteoarthritis.

All analyses were based on previous published studies; thus, no ethical approval and patient consent are required.

2.1. Study selection

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, [ 13 ] 2 researchers independently screened the literature, as well as extracted and cross-checked the relevant data. If disagreements occurred, a decision regarding data extraction was made by a third researcher.

2.2. Search strategy

We conducted the search in PubMed (1970-May 2019), Embase (1970-May 2019), and The Cochrane Library (1970-May 2019) databases for relevant articles, with “stem cells” and “osteoarthritis” as search terms. We also manually screened relevant Chinese and English language journals and reference lists to include potential studies. The search strategy for PubMed is detailed herein as an example: (((“Stem Cells”[Mesh]) OR ((((((((((((((Cell, Stem[Title/Abstract]) OR Stem Cell[Title/Abstract]) OR Progenitor Cells[Title/Abstract]) OR Cell, Progenitor[Title/Abstract]) OR Cells, Progenitor[Title/Abstract]) OR Progenitor Cell[Title/Abstract]) OR Mother Cells[Title/Abstract]) OR Cell, Mother[Title/Abstract]) OR Cells, Mother[Title/Abstract]) OR Mother Cell[Title/Abstract]) OR Colony-Forming Unit[Title/Abstract]) OR Colony Forming Unit[Title/Abstract]) OR Colony-Forming Units[Title/Abstract]) OR Colony Forming Units[Title/Abstract]))) AND ((((((((((((((Osteoarthritides[Title/Abstract]) OR Osteoarthrosis[Title/Abstract]) OR Osteoarthroses[Title/Abstract]) OR Arthritis, Degenerative[Title/Abstract]) OR Arthritides, Degenerative[Title/Abstract]) OR Degenerative Arthritides[Title/Abstract]) OR Degenerative Arthritis[Title/Abstract]) OR Osteoarthrosis Deformans[Title/Abstract]) OR Polyarthritides[Title/Abstract]) OR Arthritides[Title/Abstract]) OR Polyarthritis[Title/Abstract]) OR Arthritis[Title/Abstract])) OR “Osteoarthritis”[Mesh]).

2.3. Eligibility criteria

The study inclusion criteria included:

• (1) studies involving patients with knee osteoarthritis;
• (2) studies including stem cell therapy as the test group, as well as placebo, hyaluronic acid, and steroid treatments as the control groups;
• (4) studies that used at least one of the following indicators: Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities (WOMAC) subscale, International Knee Documentation Committee (IKDC) score, and incidence of adverse events.

Studies were ineligible if they met any of the following conditions:

• (1) studies that used animals or cadavers as research objects;
• (2) studies that were unable to extract or convert valid data;
• (3) retrospective studies, literature reviews, or conference papers with no full text.

2.4. Data extraction

Data were extracted independently by 2 researchers using a predesigned data sheet. Valid data were converted as per the Cochrane Handbook for Systematic Reviews of Interventions, [ 14 ] in the case where standard deviation could not be acquired. If disagreements occurred, the decision regarding data extraction was done by the third reviewer. Each RCT was concurrently assessed with risk of bias.

2.5. Outcome measures

• VAS is a scoring scale that intuitively quantifies the intensity of pain in the knee. A lower score indicates milder pain.
• The WOMAC subscale is a rating scale that assesses the structure, stiffness, and function of the knee in pain A lower score indicates better knee condition.
• IKDC is a subjective scale for assessing the knee joint. A higher score indicates better symptoms, functions, and physical activities of the knee joint.
• Adverse events refer to treatment-related adverse reactions, including joint effusion, stiffness, and pain.

2.6. Statistical analysis

Statistical analysis was conducted using the RevMan 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). The chi-square test was used to assess inter-study heterogeneity. I 2  > 50% indicated heterogeneity. A random effects model was used; otherwise, a fixed effects model was used. Relative risk and standardized mean difference were used for assessing binary variables and continuous variables, respectively. The 95% confidence interval estimates and hypothesis testing results for each variable were listed in a forest plot. For each endpoint with high heterogeneity, a sensitivity analysis, in which the included studies were removed one at a time, was conducted to screen the source of heterogeneity. A publication bias assessment using a funnel plot was performed if there were no less than 10 studies included.

3.1. Literature search

We retrieved 7054 relevant articles, and ultimately included 9 RCTs [ 11 , 12 , 15 – 21 ] involving 399 patients (Fig. ​ (Fig.1). 1 ). In the studies by Kuah, [ 12 ] Lamo-Espinosa, [ 16 ] and Thomas Vangsness et al, [ 19 ] there were 2 parallel test groups, namely the high- and low-dose groups, in comparison with the control group. Therefore, for each study mentioned above, we conducted statistical analyses in 2 RCTs: high-dose vs control and low-dose vs control.

Flowchart of literature retrieval.

3.2. Study characteristics

There were 203 patients in the stem cell therapy group and 196 patients in the control group. The specific features and Jadad scores of the patients [ 22 , 23 ] are listed in Table ​ Table1. 1 . The Jadad scale is a 7-point scale that includes random sequence generation, randomized hiding, blind method, withdrawal, and dropout.

Main characteristics of all the eligible studies included in the analysis.

3.3. Clinical outcomes

From baseline to 3 months, 4 studies [ 12 , 15 , 16 , 20 ] were included, involving 6 RCTs with 87 patients in the stem cell group and 79 patients in the control group Fig. ​ Fig.2. 2 . There was no heterogeneity (I 2  = 0%) between the studies; thus, the fixed effects model was used for the analysis. According to Figure ​ Figure2, 2 , SMD (standardized mean difference) = −0.36, 95% CI (confidence interval)[−0.67, −0.05], and P  = .02. The VAS score in the stem cell group was significantly lower than that in the control group.

Forest plot of the change of VAS score. VAS = visual analogue scale score.

From baseline to 6 months, 4 studies [ 12 , 15 , 16 , 20 ] were included, involving 6 RCTs with 87 patients in the stem cell group and 79 patients in the control group. Because there was a high heterogeneity (I 2  = 86%) between the studies, the study by Bhattacharya et al [ 20 ] was removed from the sensitivity analysis, and the I 2 value was reduced to 0%. The fixed effects model was used. According to Figure ​ Figure2, 2 , SMD = −0.86, 95% CI [−1.21, −0.52], and P  < .00001. The VAS score in the stem cell group was significantly lower than that in the control group.

From baseline to 12 months, 3 studies [ 12 , 16 , 21 ] were included, involving 5 RCTs with 51 patients in the stem cell group and 43 patients in the control group. There was a low heterogeneity (I 2  = 8%) between the studies, and thus the fixed effects model was used. According to Figure ​ Figure2, 2 , SMD = −0.86, 95% CI [−1.30, −0.43], and P  = 0.0001. The VAS score in the stem cell group was significantly lower than that in the control group.

3.3.2. WOMAC-Pain

From baseline to 3 months, 2 studies [ 12 , 16 ] were included, involving four RCTs with 36 patients in the stem cell group and 28 patients in the control group Fig. ​ Fig.3. 3 . There was a low heterogeneity (I 2  = 40%) between the studies, and thus the fixed effects model was used. According to Figure ​ Figure3, 3 , SMD = −0.22, 95% CI [−0.73, 0.30], and P  = .41. There was no significant difference in WOMAC-Pain score between the groups.

Forest plot of the change of WOMAC-Pain score. WOMAC = Western Ontario and McMaster Universities subscore.

From baseline to 6 months, 2 studies [ 12 , 16 ] were included, involving four RCTs with 36 patients in the stem cell group and 28 patients in the control group. There was a low heterogeneity (I 2  = 48%) between the studies, and thus the fixed effects model was used. According to Figure ​ Figure3, 3 , SMD = −0.08, 95% CI [−0.59, 0.44], and P  = .77. There was no significant difference in WOMAC-Pain score between the groups.

From baseline to 12 months, 3 studies [ 12 , 16 ] were included, involving 4 RCTs with 43 patients in the stem cell group and 39 patients in the control group. There was no heterogeneity (I 2  = 0%) between the studies, and thus the fixed effects model was used. According to Figure ​ Figure3, 3 , SMD = −0.09, 95% CI [−0.53, 0.36], and P  = .70. There was no significant difference in WOMAC-Pain score between the groups.

3.3.3. WOMAC-Stiffness

From baseline to 3 months, 2 studies [ 12 , 16 ] were included, involving 4 RCTs with 36 patients in the stem cell group and 28 patients in the control group Fig. ​ Fig.4. 4 . There was no heterogeneity (I 2  = 0%) between the studies, and the fixed effects model was used. According to Figure ​ Figure4, 4 , SMD = −0.51, 95% CI [−1.02, 0.01], and P  = .05. There was no significant difference in WOMAC-Stiffness score between the groups.

Forest plot of the change of WOMAC-Stiffness score. WOMAC = Western Ontario and McMaster Universities subscore.

From baseline to 6 months, 2 studies [ 12 , 16 ] were included, involving four RCTs with 36 patients in the stem cell group and 28 patients in the control group. There was a low heterogeneity (I 2  = 36%) between the studies, and the fixed effects model was used. According to Figure ​ Figure4, 4 , SMD = −0.25, 95% CI [−0.76, 0.27], and P  = .35. There was no significant difference in WOMAC-Stiffness score between the groups.

From baseline to 12 months, 2 studies [ 12 , 16 ] were included, involving 4 RCTs with 36 patients in the stem cell group and 28 patients in the control group. There was a low heterogeneity (I 2  = 9%) between the studies, and the fixed effects model was used. According to Figure ​ Figure4, 4 , SMD = −0.46, 95% CI [−0.98, 0.05], and P  = .08. There was no significant difference in WOMAC-Stiffness score between the groups.

3.3.4. WOMAC-Function

From baseline to 3 months, 2 studies [ 12 , 16 ] were included, involving 4 RCTs with 36 patients in the stem cell group and 28 patients in the control group Fig. ​ Fig.5. 5 . There was no heterogeneity (I 2  = 0%) between the studies, and the fixed effects model was used. According to Figure ​ Figure5, 5 , SMD = 0.15, 95% CI [−0.35, 0.66], and P  = .55. There was no significant difference in WOMAC-Function score between the groups.

Forest plot of the change of WOMAC-Function. WOMAC = Western Ontario and McMaster Universities subscore.

From baseline to 6 months, 2 studies [ 12 , 16 ] were included, involving four RCTs with 36 patients in the stem cell group and 28 patients in the control group. There was a low heterogeneity (I 2  = 29%) between the studies, and the fixed effects model was used. According to Figure ​ Figure5, 5 , SMD = 0.43, 95% CI [−0.09, 0.95], and P  = .1. There was no significant difference in WOMAC-Function score between the groups.

From baseline to 12 months, 2 studies [ 12 , 16 ] were included, involving 4 RCTs with 36 patients in the stem cell group and 28 patients in the control group. There was no heterogeneity (I 2  = 0%) between the studies, and the fixed effects model was used. According to Figure ​ Figure5, 5 , SMD = 0.18, 95% CI [−0.33, 0.68], and P  = .49. There was no significant difference in WOMAC-Function score between the groups.

3.3.5. IKDC

From baseline to 6 months, 2 studies [ 17 , 18 ] were included, involving 2 RCTs with 53 patients in the stem cell group and 52 patients in the control group Fig. ​ Fig.6. 6 . There was a high heterogeneity (I 2  = 51%) between the studies, and the random effects model was used. According to Figure ​ Figure6, 6 , SMD = 0.16, 95% CI [−0.39,0.72], and P  = .56. There was no significant difference in IKDC score between the groups.

Forest plot of the change of IKDC score. IKDC = International Knee Documentation Committee.

From baseline to 12 months, 2 studies [ 17 , 18 ] were included, involving 2 RCTs with 53 patients in the stem cell group and 52 patients in the control group. There was a high heterogeneity (I 2  = 83%) between the studies, and the random effects model was used. According to Figure ​ Figure6, 6 , SMD = 0.36, 95% CI [−0.58, 1.31], and P  = .45. There was no significant difference in IKDC score between the groups.

From baseline to 24 months, 2 studies [ 17 , 18 ] were included, involving 2 RCTs with 53 patients in the stem cell group and 52 patients in the control group. There was a high heterogeneity (I 2  = 75%) between the studies, and the random effects model was used. According to Figure ​ Figure6, 6 , SMD = 0.53, 95% CI [−0.25, 1.32], and P  = .18. There was no significant difference in IKDC score between the groups.

3.3.6. Adverse events

There were 2 included studies, [ 11 , 12 ] involving three RCTs with 28 patients in the stem cell group and 20 patients in the control group Fig. ​ Fig.7. 7 . There was a high heterogeneity (I 2  = 73%) between the studies, and thus the random effects model was used. According to Figure ​ Figure7, 7 , SMD = 1.54, 95% CI [0.57, 4.19], and P  = .40. There was no significant difference in incidence of adverse events between the groups.

Forest plot of the change of adverse events.

4. Discussion

4.1. key findings.

Changes in VAS and IKDC scores from baseline to 24 months were superior in the stem cell group than in the control group, whereas there were no statistical differences in the changing trend of other indicators between the 2 groups, including the changes in IKDC scores at 6 months, IKDC score at 12 months, WOMAC-Pain score, WOMAC-Stiffness score, WOMAC-Function score, WOMAC-Pain score, and incidence of adverse events.

Pain relief is key to treating knee osteoarthritis, with VAS scores as an important endpoint for pain assessment. Kuah et al [ 12 ] found that relative to placebo, stem cell therapy considerably relieved pain at 3, 6, and 12 months after treatment. This conclusion has been confirmed in our meta-analysis. We found that the VAS scores in the stem cell group were significantly reduced at each visit point. Inflammatory response is known as one of the causes of pain. MSCs can release anti-inflammatory factors, thereby relieving pain. Lamo-Espinosa et al [ 16 ] believed that stem cells have a paracrine function and their anti-inflammatory properties contribute to pain relief. In addition, studies have found that in an acute renal failure model, MSCs can promote recovery of renal function by releasing anti-inflammatory factors and inhibiting production of pro-inflammatory cytokines, such as interleukin-1β, tumor necrosis factor, and interferon-γ. [ 24 ] Similar findings were observed in a pulmonary fibrosis model, in which MSCs release IL-1 receptor antagonist (IL-1RA) to inhibit interleukin-1α-producing T cells and TNF-producing macrophages, indicating that MSCs have anti-inflammatory properties. [ 25 ] WOMAC-Pain scores showed no statistical difference between the 2 groups at each visit point, but these data regarding WOMAC-Pain score were obtained only from 3 studies; [ 12 , 16 , 21 ] therefore, further studies with larger sample sizes are warranted to verify these findings.

Functional improvement of the knee joint is one of the ultimate purposes of knee osteoarthritis treatment. In this study, we used WOMAC-Stiffness, WOMAC-Function, and IKDC scores to comprehensively assess knee joint function. Statistical analysis results showed that there was no significant difference between the 2 groups in IKDC scores at 6 and 12 months, as well as in WOMAC-Stiffness and WOMAC-Function scores at each visit point. Studies have found that mesenchymal stem cell implantation achieves better outcomes in patients with grade 3 knee osteoarthritis than those in patients with grade 4 knee osteoarthritis. [ 26 ] We thus concluded that treatment with MSCs are effective in preventing or limiting the progression of knee osteoarthritis at the early stage. In the studies by Kuah [ 12 ] and Lamo-Espinosa et al, [ 16 ] patients with grade 3 osteoarthritis or higher accounted for 75% and over 80% of the total patients, respectively. Most patients developed knee osteoarthritis at the middle and late stages, for whom treatment with MSCs had no significant efficacy and was not conducive to functional recovery. Moreover, in most tissue engineering methods, MSCs are combined with cell scaffolds containing chondrogenic growth factors to form fully functional hyaline cartilage. Such a regimen is commonly used in small-animal models of surgically induced cartilage or osteochondral defects, but cannot be used for repairing large-area cartilage defects associated with knee osteoarthritis. [ 27 ] In addition, Centeno, [ 28 ] Emadedin, [ 29 ] and Vangsness et al [ 19 ] pointed out that treatment with approximately 2 × 10 7 stem cells can afford good clinical results. Kuah [ 12 ] and Lamo-Espinosa et al [ 16 ] reported that a stem cell dose of lower or higher than 2 × 10 7 may also impact the therapeutic efficacy of stem cells. In addition, the change in IKDC score at 24 months was higher in the stem cell group than in the control group; however, these data were extracted from only 2 studies. Therefore, further investigation with a larger sample size is warranted.

For adverse events, we sent an e-mail to the authors of the relevant research [ 18 , 19 , 21 ] to obtain data on the number of patients who experienced treatment-related adverse events, including arthralgia, joint effusion, and joint stiffness, in both the stem cell and control groups. Because of the lack of response from the other studies, only 2 studies [ 11 , 12 ] were included, involving 3 RCTs. There were no statistical differences in adverse events between the 2 groups, indicating that stem cell treatment has no obvious side effects. A study addressing 87 patients with lupus erythematosus [ 30 ] showed no adverse events associated with transplantation after 4 years of follow-up. Similarly, no graft-related adverse events occurred in many patients undergoing stem cell therapy for other diseases. [ 31 – 35 ] These findings indicated that the human body has good tolerance to MSCs, and that stem cell treatment has no significant side effects.

4.2. Limitations

Differences in the original RCT protocols led to insufficient representation of some outcome indicators. Thus, high-quality, large-scale RCTs are required to verify our findings. In addition, there was no uniform standard in the preparation and use of stem cells, which may cause certain heterogeneity.

5. Conclusion

Compared to traditional methods, stem cell treatment has a certain superiority as a conservative treatment of knee osteoarthritis, in terms of markedly reducing pain without inducing side effects.

Author contributions

Conceptualization: Rui Huang.

Data curation: Rui Huang, Wei Li, Ying Zhao.

Formal analysis: Rui Huang, Wei Li, Ying Zhao, Fan Yang.

Investigation: Rui Huang, Wei Li, Ying Zhao.

Methodology: Rui Huang, Wei Li, Fan Yang.

Project administration: Meng Xu.

Software: Rui Huang, Wei Li, Ying Zhao, Fan Yang.

Supervision: Rui Huang, Wei Li, Ying Zhao, Meng Xu.

Validation: Ying Zhao, Fan Yang, Meng Xu.

Visualization: Rui Huang, Wei Li, Fan Yang.

Writing – original draft: Rui Huang, Wei Li.

Writing – review & editing: Ying Zhao, Meng Xu.

Abbreviations: AD-MSCs = adipose-derived mesenchymal stem cells, BMAC = bone marrow aspirate concentrate, BM-MSCs = bone marrow mesenchymal stromal cells, Cl = confidence interval, HA = hyaluronic acid, HTO = high tibial osteotomy, IKDC = International Knee Documentation Committee, IL-1RA = IL-1 receptor antagonist, MSCs = mesenchymal stem cells, PBSC = peripheral blood stem cells, PRG = progenza, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRP = platelet-poor plasma, RCTs = randomized controlled trials, SMD = standardized mean difference, VAS = Visual Analogue Scale, WOMAC = Western Ontario and McMaster Universities.

How to cite this article: Huang R, Li W, Zhao Y, Yang F, Xu M. Clinical efficacy and safety of stem cell therapy for knee osteoarthritis: A meta-analysis. Medicine . 2020;99:11(e19434).

The authors have no conflicts of interests to disclose.