Plasma fatty acids reflect pain, disability, and psychological well-being in knee osteoarthritis in a longitudinal study with joint replacement surgery Anne-Mari Mustonen, Laura Säisänen, Lauri Karttunen, Amir Esrafilian, Petro Julkunen, et al. Scientific Reports, 2026 We investigated the associations of pro- and anti-inflammatory fatty acids (FAs) with cartilage degradation, functional limitations, pain, and psychological well-being in knee osteoarthritis (KOA). Fasting plasma samples were obtained from controls ( n = 12) and from end-stage KOA patients at baseline ( n = 13), and 3 months ( n = 11) and 12 months ( n = 9) after knee replacement surgery. FA composition in total lipids was analyzed with gas chromatography and mass spectrometry. Cartilage loss was determined by magnetic resonance imaging, and knee pain and disability by physical performance and quantitative sensory testing, neuromuscular examination, and several questionnaires. The associations between variables were tested with the univariate analysis of variance adjusted for age and body mass index. KOA was characterized with elevated baseline 16:1n-7 percentages, while the proportions of 24:0 decreased 12 months after surgery and those of 24:1n-9 decreased 3 and 12 months after surgery. Several FA variables, such as 20:3n-6, 20:4n-6, long-chain saturated FAs, and 24:1n-9, were associated with pain, stiffness, disability, pain self-efficacy, or mental health. Circulating FAs can predict KOA symptoms, independent of age and body adiposity, and provide promising targets to design novel pain treatments.
External clinical audits in clinical radiology in Finland Petro Julkunen, Nina Heinola, Taina Autti, Ritva Bly Radiation Protection Dosimetry, 2026 Clinical audits have been implemented in Finland to healthcare organizations over 20 years. We introduce the outcomes of fourth round external clinical audits on medical radiological procedures following the implementation of the EU Directive (Basic Safety Standards). We analyzed 31 external clinical audits on radiological practices in 2018–2022. The summarized strengths and recommendations from the audits were collected from the main auditing organization’s database. 306 recommendations were given, 18% related to definitions of responsibilities, 16% to internal procedural guidelines, 16% to personnel education, and 25% to quality assurance and utilization of self-assessments of radiological procedures. Private and small organizations received less recommendations than large and public operators. Moreover, 215 strengths were reported, focusing on the clarity of responsibilities (21%) and excellence in quality assurance (15%). Reaching and maintaining feasible radiological diagnostic accuracy by consideration of radiation safety requires continuous quality assurance and development facilitated, and monitored by clinical audits.
Proteomics Analysis Reveals Serum Biomarkers Reflecting Joint Pain and Physical Limitations in Knee Osteoarthritis Before and After Joint Replacement Surgery Anne-Mari Mustonen, Janne Tampio, Kristiina M. Huttunen, Petro Julkunen, Laura Säisänen, et al. Cartilage, 2026 Objective Osteoarthritis (OA) is an age-related musculoskeletal disorder lacking effective disease-modifying therapies and early diagnostic biomarkers. This study aimed to identify serum proteins that could indicate the occurrence of knee OA (KOA) and correlate with patients’ pain and functional impairment. Design/Methods Fasting serum samples were collected from controls (n = 8) and patients with end-stage KOA at baseline (n = 8) and 12 months after total knee arthroplasty (n = 8). Proteomics analysis was conducted with liquid chromatography–mass spectrometry, followed by univariate and multivariate statistics and pathway analyses by MetaboAnalyst and STRING. Partial correlations were calculated with R, adjusted for sex, age, and body mass index, using a linear regression model. Results 151 proteins were upregulated and 5 proteins downregulated in baseline KOA compared to control. These proteins were linked to the complement system, immune response, coagulation, inflammatory response, calcium homeostasis, and extracellular matrix remodeling. Of these, complement factor I showed strong biomarker potential. Several proteins emerged as statistically significant predictors of cartilage loss, pain sensitivity, physical function, and corticospinal excitability. Systemic alterations persisted 12 months after surgery. Conclusion Serum proteins may serve as biomarkers of KOA, reflecting disease-related immune, inflammatory, and tissue-remodeling processes that persist after joint replacement.
Hyaluronic Acid and Large Extracellular Vesicles (EVs) in Synovial Fluid and Plasma of Patients With End-Stage Arthritis: Positive Association of EVs to Joint Pain Anne-Mari Mustonen, Janne Capra, Sanna Oikari, Laura Säisänen, Lauri Karttunen, et al. Cartilage, 2025 Objective Hyaluronic acid (HA) in synovial fluid (SF) contributes to boundary lubrication with altered levels in osteoarthritis (OA) and rheumatoid arthritis (RA). SF extracellular vesicles (EVs) may participate in arthritis by affecting inflammation and cartilage degradation. It remains unknown whether HA and EVs display joint-specific alterations in arthritic SFs. Design We investigated the numbers and characteristics of HA-particles and large EVs in SF from knees and shoulders of 8 OA and 8 RA patients and 8 trauma controls, and in plasma from 10 healthy controls and 11 knee OA patients. The plasma and SF HA concentrations were determined with a sandwich-type enzyme-linked sorbent assay, and EVs and HA-particles were characterized from plasma and unprocessed and centrifuged SFs with confocal microscopy. The data were compared according to diagnosis, location, and preanalytical processing. Results The main findings were: (1) OA and RA SFs can be distinguished from trauma joints based on the distinctive profiles of HA-particles and large EVs, (2) there are differences in the SF HA and EV characteristics between shoulder and knee joints that could reflect their dissimilar mobility, weight-bearing, and shock absorption properties, (3) EV counts in SF and plasma can positively associate with pain parameters independent of age and body adiposity, and (4) low-speed centrifugation causes alterations in the features of HA-particles and EVs, complicating their examination in the original state. Conclusions Arthritis and anatomical location can affect the characteristics of HA-particles and large EVs that may have potential as biomarkers and effectors in joint degradation and pain.
X-ray scatter in projection radiography Satu Ylimaula, Lasse Räsänen, Miia Hurskainen, Arttu Peuna, Petro Julkunen, et al. Radiation Protection Dosimetry, 2024
