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Curation log — osteoarthritis

2026-08-28 — Seed

  • Created: four seed files, 18 canonical pages, overview with 25 PMIDs, and 7 seed questions.
  • Searches run (live PubMed E-utilities esearch/esummary): OA definition, GBD and hip prevalence; whole-joint biology, genetics and pain/inflammation; ACR/AF and OARSI guidelines; exercise, IDEA and semaglutide; NSAIDs, acetaminophen and SPACE opioids; triamcinolone, PRP and hyaluronate; arthroplasty; DMOADs, lorecivivint, tanezumab and biomarkers.
  • Verification: every cited PMID was returned live from PubMed in this session.
  • Next: full build queued per CONDITIONS-ROADMAP.md.

2026-08-28 — Full build

  • Built: all 18 canonical wiki pages as draft; expanded overview; 464-record master bibliography; 6 landmark paper notes; worldwide guideline registry; 100+ row statistics layer; patient-voice method, organizations, themes and annotated sources; 22 tiered open questions; and 12 “Dots not yet connected” junctions.
  • Live PubMed search: 125 topic-specific E-utilities searches across overview, diagnosis, epidemiology, cartilage/bone/synovium, pain and sensitization, genetics/risk, knee, hip, exercise/weight/self-management, pharmacology, injections/orthobiologics, surgery, DMOADs, guidelines, biomarkers, trials, patient experience and safety. The search ledger contained 1,047 unique fetched records. Four seeded IDs not captured by broad relevance search were separately fetched exactly: PMID 26488691, 29509867, 33096010 and 37460782.
  • Live ClinicalTrials.gov search: v2 condition query returned 100 studies; a second v2 query restricted to recruiting, not-yet-recruiting, active-not-recruiting and enrolling-by-invitation returned 100 active records. The trials page records 20 relevance-filtered registrations with point-in-time status and intervention.
  • Official web verification: NICE NG226, AAOS knee OA and CPG catalog, RACGP second edition, OARSI guideline portal, Arthritis Foundation, Versus Arthritis, Arthritis Australia and Arthritis Society Canada were retrieved live on 2026-08-28.
  • Quantitative extraction: effect sizes and confidence/credible/uncertainty intervals were transcribed from fetched PubMed abstracts for GBD, hip prevalence, pain discordance, sensitization, BMI, occupation, ACL injury, exercise, IDEA, STEP 9, NSAIDs, tramadol, duloxetine, viscosupplementation, RESTORE, repeated triamcinolone, sham meniscectomy, TKR, UKA/TKA and OA genetics.
  • Statuses: pages remain draft; roadmap advanced from seeded to built as required after full build. No page was promoted to curated because the playbook requires a separate-session audit.
  • Could not verify fully: current official replacement status for older Italian, Turkish, Dutch and Mexican national documents; these are explicitly marked uncertain/watch-list items. ClinicalTrials.gov returned several registry entries with implausibly high NCT sequence numbers for the calendar date; they resolved live in the v2 API and are reported only as registrations, not as validated trial quality or efficacy. No claim of absence was strengthened beyond the dated search boundary.
  • Next: run the mandated separate-session audit: refetch every page PMID/NCT, check author/year/journal and claim/number alignment, fix mismatches, re-run absence claims and promote only fully checked pages to curated.

2026-08-30 — Separate citation and claim audit

  • Scope checked: all 18 canonical wiki pages; INDEX.md; OPEN-QUESTIONS.md; the master bibliography; all 6 landmark notes; guideline registry; statistics tables; and all 4 patient-voice artifacts.
  • Live identifier verification: extracted 486 unique PMIDs present at audit start (2,304 mentions across condition artifacts) and re-fetched all 486 through PubMed E-utilities efetch in seven batches. All 486 resolved. Re-fetched all 20 cited NCT identifiers individually through ClinicalTrials.gov v2; all 20 resolved and their displayed status, title, intervention and phase fields matched the live records.
  • Metadata and structure checks: matched author, year, journal and title against live PubMed XML; no unresolved identifier or bibliography-metadata mismatch remained. Checked and normalized the design label on 508 wiki evidence-map rows against live PubMed publication types. Confirmed every wiki body PMID appears in that page's References section and every listed reference is used; confirmed all relative wiki links resolve to canonical pages. The bibliography now has 492 unique, nonduplicated PMID entries: the former 464 count described wiki-only records and understated the 486 condition-wide records present at audit start.
  • Claim-pair errors: the audit found a systematic templating defect in the non-overview pages: 132 distinct topic-adjacent claim-to-citation pairings, duplicated across 264 table occurrences, were not directly supported by the cited paper. Examples included radiographic OARSI scoring cited to a glucosamine review and thromboembolism warnings cited to a septic-arthritis case report. The unsupported clinical statement was removed from each occurrence and the row was explicitly downgraded to Scope-only record, which now states only the live record's actual studied question. These are integrity repairs, not completed replacement syntheses.
  • Numerical correction: corrected the overview's transposed GBD 2020–2050 projections from the incorrect knee/hand/hip/other sequence to knee +74.9%, hand +48.6%, hip +78.6% and other OA +95.1% (PMID 37675071). Rechecked the statistics layer and six landmark notes against fetched abstracts; no other quoted effect estimate or confidence/uncertainty interval required correction.
  • Absence and junction searches: re-ran seven targeted searches covering DMOAD approval, diagnostic biomarkers, surrogate endpoints, pain-mechanism treatment selection, polygenic-score clinical utility, placebo-controlled PRP and recent DMOAD trials. Separately re-ran all 12 “Dots not yet connected” junctions. Five build-time absences were stale and were rewritten as narrower residual questions: exercise adherence with sensitization (PMID 36397008), bone-marrow-lesion change after high tibial osteotomy (PMID 42004451), post-GWAS/single-cell target prioritization (PMID 42519341), exercise and education while awaiting arthroplasty (PMID 27233479), and a preoperative blood marker associated with postoperative hip pain (PMID 37238223). A qualitative intra-articular-therapy expectation study (PMID 33166060) also narrowed the injection preference/context junction. All six records were live-fetched and added to the bibliography.
  • ClinicalTrials.gov refresh: the live status-filtered osteoarthritis query returned 1,252 records on 2026-08-30; the prior page had described its 100-record first API page as if it were the returned total. The trials page now distinguishes total count from first-page size. All 20 displayed registrations remained status-matched.
  • Official-source refresh: live-opened 11 cited official URLs covering NICE, AAOS, OARSI, RACGP and the patient organizations/resources. All resolved. The former Versus Arthritis pages redirected to the renamed Arthritis UK site, so the organization name and final official URLs were updated. Access dates were advanced to 2026-08-30.
  • Formatting and page checks: corrected repeated et al.. punctuation, refreshed audit dates, and added a per-page audit-disposition table. All 18 wiki pages retain required frontmatter, TL;DR, Open questions, Related pages and References sections and are 152–187 lines. No [unverified] flag remains.
  • Disposition: 0/18 pages passed the promotion threshold. All remain status: draft because the 132 downgraded claim pairings still need topic-appropriate replacement synthesis; the overview also retains uncited decision-table statements. CONDITIONS-ROADMAP.md therefore remains built, not audited. The unresolved older Italian, Turkish, Dutch and Mexican guideline replacement chains remain explicitly uncertain/watch-listed.
  • Next audit: replace every Scope-only record row with a claim supported by a directly matched abstract/full report or delete the row entirely; add direct sources to the overview's uncited decision statements; then repeat claim-level review before any page or roadmap promotion.

2026-08-31 — Scope repair and passing audit

  • Placeholder repair: deleted all 264 remaining Scope-only record occurrences across the 17 non-overview pages. These rows repeated record titles after the 2026-08-30 audit had already removed the unsupported clinical assertion; retaining them added no supported synthesis. Empty tables and sections created by those deletions were removed.
  • Additional claim repair: the new claim-level pass found and removed further overbroad pairings, including arthroscopy cited to an arthroplasty review, degenerative-meniscus coexistence cited to a trial that excluded OA, hip differential/walking-aid/complication assertions broader than the cited abstract, and organ-specific NSAID or opioid harms not enumerated by the cited network meta-analysis. Remaining claims were narrowed to the live abstract's actual population, comparator, outcome and limitation. Examples include the 13,459-participant classification-criteria comparison, sprifermin cartilage/WOMAC result, IDEA's distinct diet-versus-exercise and diet-plus-exercise findings, semaglutide's unconfirmed structural role, questionnaire-defined neuropathic-like pain prevalence, TKA dissatisfaction, and prehabilitation evidence strength.
  • Overview and summaries: sourced all seven rows in overview.md's decision architecture and all four joint-specific rows. Replaced uncited or overbroad statements in the overview and rewrote every wiki TL;DR as an abstract-supported summary. Deleted duplicate bold decision rows so each supported claim appears once in a valid Markdown table.
  • Live PubMed searches: E-utilities esearch queries were run for hip/knee OA diagnosis and treatment; pain–structure discordance; NSAID/opioid network evidence; placebo-controlled PRP; randomized knee replacement; OA biomarkers; generalized OA definitions; GBD OA projections; and MRI abnormalities with knee pain. Each selected PMID was returned by its topical query. All 464 unique PMIDs remaining across the 18 wiki pages were then fetched through live E-utilities efetch in four batches; all 464 resolved.
  • Bibliography: no globally new paper was needed because all replacement sources already existed in literature/BIBLIOGRAPHY.md. Added or corrected cited by mappings for PMID 25748615 and 24461078 (wiki/overview), PMID 20829200 (wiki/biomarkers-and-imaging-markers), and PMID 37675071 (wiki/epidemiology-and-burden); added the corresponding full page-reference entries.
  • ClinicalTrials.gov: individually fetched all 20 displayed NCT registrations through the live v2 API; title, status, phase and intervention fields matched after expanding NCT05986292 to include all six currently listed interventions. A live active-status condition count query again returned 1,252 OA registrations on 2026-08-31.
  • Final audit checks: 18/18 pages have required frontmatter, TL;DR, Open questions, Related pages and References; every body PMID is listed in that page's References and every listed reference is used; every wiki PMID occurs in the master bibliography; author/year labels match live PubMed metadata; all relative links resolve; and no Scope-only record, scope-only, [unverified], uncited decision-table row or unresolved substantive citation issue remains.
Page Final status
overview.md curated
diagnosis-and-classification.md curated
epidemiology-and-burden.md curated
cartilage-bone-and-synovium.md curated
pain-mechanisms-and-sensitization.md curated
genetics-and-risk-factors.md curated
knee-osteoarthritis.md curated
hip-osteoarthritis.md curated
exercise-weight-and-self-management.md curated
pharmacologic-treatment.md curated
injections-and-orthobiologics.md curated
surgery-and-joint-replacement.md curated
disease-modifying-therapies.md curated
guidelines.md curated
biomarkers-and-imaging-markers.md curated
clinical-trials-landscape.md curated
patient-experience-and-advocacy.md curated
red-flags-and-safety-concerns.md curated
  • Disposition: 18/18 pages passed and were promoted to status: curated; INDEX.md and CONDITIONS-ROADMAP.md were advanced to audited.

2026-08-31 — Deepening pass (substance, not structure)

  • Mandate: The 18 pages were citation-clean after the repair audit but thin (mostly ~114–153 lines with evidence-map rows that did not transfer numbers). This pass extended every wiki page; it did not delete verified claims or rewrite pages from scratch. Status on every touched page set to draft for a different-engine re-audit.
  • Live PubMed: 231 topical E-utilities esearch queries plus 16 missed-landmark retries; 650 unique records efetched with abstracts (0 batch errors). Additional landmark PMIDs from retries (Sellam 20924410, Moseley 12110735, GLA:D 28173795, Sharma 33406330, Wandel 20847017, Neogi 23973124) were fetched the same session.
  • Live ClinicalTrials.gov v2: recruiting osteoarthritis condition query returned 598 studies. Individually fetched: NCT05064735 (STEP 9, COMPLETED phase 3), NCT01919164 (FORWARD, COMPLETED phase 2), NCT00381290 (IDEA, COMPLETED), NCT02697773 (tanezumab, COMPLETED phase 3), NCT03815448 (methotrexate, COMPLETED), NCT04385303 (lorecivivint STRIDES-1, COMPLETED phase 3), NCT04931667 (lorecivivint 3-year OL, TERMINATED), NCT01352247 (TOPKAT, COMPLETED), NCT00549172 (FIDELITY, COMPLETED), NCT04070027 (THR vs resistance training, ACTIVE_NOT_RECRUITING). Lorecivivint query total 12; tanezumab+OA query total 24. NCT03491188 (RESTORE) and NCT01558727 (SPACE) did not resolve on filter.ids and were not cited as NCT IDs.
  • Official web: NICE NG226 recommendations and AAOS knee OA CPG portal opened 2026-08-31.
  • What was deepened (by page):
  • overview — lifetime risks, paracetamol WMD, Moseley/Kirkley/MeTeOR/Kise arthroscopy block, Frydendal THR increment, FORWARD/lorecivivint P3, explicit controversies table.
  • epidemiology — GBD 2010/2017/2021 not averaged; Losina 13.83% lifetime knee; Dillon NHANES 37.4%/12.1%; Murphy 25.3% lifetime hip; Wallace 2.1-fold residual increase; BMI/occupation/ACL magnitudes.
  • diagnosis — ACR 1986/1991 operating characteristics; EULAR 2010 six-feature ladder to 99%; Guermazi 89% MRI+ in KL 0; Hannan discordance; Dell'Isola six phenotypes as hypotheses.
  • cartilage/bone/synovium — ADAMTS5 knockout and IGD-resistant aggrecan knock-in; Sellam/Kapoor/Sanchez-Lopez synovitis loop; subchondral initiation vs progression still unresolved.
  • pain — Felson BML 77.5% vs 30%; Finan high-pain/low-KL sensitization; Arendt-Nielsen TS/DNIC; Previtali/Zolio instrument dependence.
  • genetics — arcOGEN → Zengini → Tachmazidou → Boer 100 variants → Hatzikotoulas 962 associations/700 genes; SMO OR 2.8; BMI causal, T2D/triglycerides not.
  • knee — five arthroscopy RCTs one direction; TOPKAT OKS 1.04 (−0.42 to 2.50); Skou TKR 15.8; dissatisfaction 10% not 20%.
  • hip — cam OR 2.11, dysplasia OR 2.19; Kjeldsen PRT vs NEMEX null; Frydendal 11.4-point THR increment; hip precautions RR 1.8 (0.6–5.2).
  • exercise/weight — Uthman sequential analysis by 2002; Lawford 8.70/100 pain with MID-relative uncertainty; Holden IPD baseline-pain moderator; Yan aerobic SUCRA; Weng exercise ≈ NSAID; Christensen 5% threshold; GLA:D n=9,825.
  • pharmacology — da Costa 2017/2021 dose MCID probabilities; Machado/Leopoldino paracetamol; SPACE 3.4 vs 3.3; GAIT vs Wandel; CNT and Bally naproxen discrepancy.
  • injections — Jüni low-quality short-term steroids; McAlindon repetition harm; Rutjes large-trial HA −0.11 vs overall −0.37; Pereira −0.08; RESTORE vs Tang; Gazendam hip saline.
  • surgery — Skou/Frydendal increments; TOPKAT/Wilson revision trade-off; Gademan 10-year revision; precautions; two different decision aids.
  • DMOADs — FORWARD 0.05 mm; lorecivivint OA-11/OA-10 misses; tanezumab analgesia vs 38.3–71.5/1000 PY joint-safety; MIV-711 structure without pain; doxycycline JSN without pain; methotrexate null.
  • guidelines — class/level table across ACR/AF, OARSI (1A–5), NICE offer/consider/do-not, AAOS, EULAR 2023, ESCEO algorithm.
  • biomarkers — BIPEDS qualification gap; WORMS; Guermazi MRI background rate; FNIH mediation not a treatment rule.
  • trials — landmark NCT table replacing over-reliance on a random recruiting first page.
  • patient experience — GLA:D implementation, work/hand/stiffness themes, two decision-aid RCTs that do not agree.
  • red flags — 0.08% septic arthritis after IA GC; 6% RPOA after hip CSI (heterogeneous); NGF RPOA rates; CNT/Bally NSAID MI.
  • Literature layer: appended deepening bibliography block; added lifetime-risk, NSAID-vascular, landmark-trial and conflict rows to STATISTICS.md; added EULAR 2023 update, Fernandes 2013 supersession and ESCEO 2019 profile to REGISTRY.md; sharpened OQ-6, OQ-8 and added OQ-23 (methotrexate inflammatory phenotype closed-negative).
  • Deliberately left alone: evidence-map tables (verified records; numbers were added in new synthesis sections rather than by deleting maps); patient-voice ethics files; landmark notes/ (already cover GBD, ACR/AF, IDEA, triamcinolone, RESTORE, TKR); no new paper-note files (none of the added trials independently outranked those six for a seventh note). Patient-experience page remains the shortest (~126 lines) because further qualitative padding would not add decision-relevant quantities.
  • Could not verify: NCT03491188 and NCT01558727 did not return on filter.ids this session; they are not cited as NCT IDs. Cui 2020 global knee-prevalence meta-analysis, Loeser 2012 Nature Reviews aging review, and Gala 2016 dysplasia review did not hit on title search and were not cited. Sharma 2021 NEJM knee seminar abstract was empty and was not used.
  • Ambiguous decisions (no one to ask): kept evidence maps rather than deleting “scope-only” rows, because the instruction was EXTEND not delete verified content; used NICE “offer/consider/do not offer” language rather than inventing GRADE classes NICE does not publish; treated lorecivivint OA-10/OA-11 as failed primaries with a KL 2 post-hoc, not as a new enrichment standard.
  • Next: different-engine claim-level re-audit of newly added PMIDs and numbers; do not promote off this session.

2026-08-31 — Independent audit of Grok deepening pass

  • Authorship and independence: Grok authored the 2026-08-31 deepening additions; Codex performed this separate claim-level audit as the independent auditor.
  • Scope: audited the new synthesis, quantitative tables, landmark-trial material and absence statements across all 18 wiki pages that Grok returned to status: draft. Previously curated evidence-map content was not re-synthesized, but every identifier now present on the draft pages was included in the resolution and structural checks.
  • Live PubMed verification: re-fetched all 527 unique PMIDs present across the 18 pages through PubMed E-utilities; all resolved. The explicitly appended deepening bibliography block contained 55 unique PMIDs and all 55 resolved to the claimed papers. Author, year and journal labels were checked against the live records, with ePub/print year offsets tolerated.
  • Live ClinicalTrials.gov verification: individually re-fetched all 31 unique NCT registrations now cited across the pages through the v2 API; all resolved. Displayed title, status, phase and intervention fields matched. The recruiting OA count remained 598; the active-status OA count refreshed from 1,252 to 1,243, and the tanezumab-plus-OA query refreshed from 24 to 22; the lorecivivint query remained 12.
  • Claim and number repairs: corrected the 2024 exercise review's pain evidence from moderate- to low-certainty; identified GLA:D as an uncontrolled registry before presenting its before-after changes; removed an unsupported diagnostic-criteria prescribing rule; removed an unverified current ADAMTS5-approval statement and an unsupported anticytokine comparison; removed the unsupported assertion that the Skou trial remained the only published randomized comparison; and narrowed molecular-endotype and semaglutide-MRI absence language to what the cited reports actually establish.
  • Padding removed or replaced: replaced the citation-only Dutch revision sentence with its 1.6%–13% stratified 10-year range; removed the uncontextualized zero-replacement sprifermin-arm observation; replaced a vague septic-arthritis citation with its 0.18% absolute risk and matched −0.07% risk difference; removed an unsupported claim about generic instruments missing hand-OA burdens; and replaced editorial “marketing”/“folklore” wording with source-bounded comparisons.
  • Guideline repair: re-opened NICE NG226 and the official AAOS knee nonarthroplasty third-edition guideline. Replaced the AAOS column's vague scope placeholders with the document's actual Strong, Moderate or Limited recommendation directions, including the AAOS positions that conflict with ACR/AF or NICE.
  • Absence searches repeated: ran live PubMed searches for approved disease-modifying OA treatment, ADAMTS5 inhibitor trials, sprifermin symptom benefit, imaging/biochemical surrogate validation, molecular-endotype treatment selection, semaglutide MRI mediation and arthroplasty-versus-nonsurgical randomized evidence. Broad current absences were either narrowed to the retrieved report's boundary or removed; no unresolved absence claim remains from the deepening pass.
  • Reference and structure repair: added three page-reference entries omitted by the deepening pass, consolidated one duplicated bibliography PMID record, and updated every page's audit-disposition identifier totals. Final checks found every body PMID represented in that page's References, no unused page reference, every wiki PMID present in the master bibliography, no duplicate bibliography PMID, all required sections present and all relative wiki links resolving.
  • Disposition: all new claims and identifiers resolved after repair. All 18 pages were promoted from status: draft to status: curated. No [unverified], Scope-only record, citation mismatch or substantive audit issue remains.

2026-10-15 — Periodic literature sweep (author: Claude; independent audit pending)

  • Window and searches. PubMed E-utilities, publication dates 2026-08-28 to 2026-10-15. I ran 21 topic queries: guidelines, burden, diagnosis, biology, pain mechanisms, genetics, exercise/weight, incretins, drugs, injections, surgery, DMOADs, biomarkers/imaging, phase 3 RCTs, hand, hip, patient experience, safety, all RCTs, all SR/MA, and all records. The all-records query returned 1,779; the topic queries returned 463 distinct records, all triaged by title and publication type. The maintenance rule requires a direct search for each Tier 1 open question, so I ran 12 more (OQ-1 to OQ-12). I also ran targeted searches for methotrexate RCTs, retatrutide, incretin RCTs and new society guidelines (ACR, OARSI, EULAR, NICE, ESCEO). Exact strings, translations and IDs are in the sweep manifest.
  • Cochrane. "Cochrane Database Syst Rev"[jour] AND osteoarthritis returned 0 records by publication date and 0 by entry date. The equivalent Europe PMC query also returned 0. That is zero in PubMed and Europe PMC. It says nothing about CENTRAL, which could not be searched (HTTP 403).
  • Beyond PubMed.
  • Europe PMC: 498 title-OA records in the window, 89 of them not from MEDLINE, plus 75 preprints. These were mostly basic science, conference abstracts or small pilot studies. None was promoted to a citation, so no DOI-only record needed Crossref resolution.
  • ClinicalTrials.gov v2: re-fetched all 33 NCT IDs in condition files and added three (NCT05929066, NCT05931367, NCT03913442). The recruiting count is now 595 and the four-status active count 1,234.
  • Other registries: ISRCTN pages for RACER-Knee and PROMOTE resolved but could not be machine-read. I did not query CTRI or WHO ICTRP; the tofacitinib CTRI number comes from its abstract.
  • Official sites: re-opened the ACR, NICE NG226, OARSI (now HTTP 404), AAOS, Arthritis UK and Arthritis Foundation pages.
  • Not searched: SciELO/LILACS and Cochrane Library/CENTRAL (HTTP 403). Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset; Crossref was queried without mailto.
  • Retraction checks. All 29 added PubMed records were checked: no PubMed Retracted Publication or Expression of Concern type, and empty Crossref updated-by lists. The two AAOS guideline summaries (PMIDs 35383651 and 38781351) now carry Crossref correction updates dated 2026-10-15. Their errata are PMIDs 42825585 and 42825586. The correction text could not be retrieved.
  • What survived triage, by weight.
  • ACR 2026 update summary (posted 2026-09-14; Board-approved 2026-09-08). It has no PMID, and the full manuscript is still to be submitted. It adds a new conditional recommendation for GLP-1 RA in knee OA with obesity, and flags three changes of direction since 2019: massage (now for), methotrexate in erosive hand OA (now for), and glucosamine/chondroitin (strong against). It also lists methotrexate as conditionally against for knee/hip OA and colchicine as conditionally against. This is the most consequential item of the sweep. Everything I wrote about it comes from the 4-page summary table; no effect sizes are available.
  • TRIUMPH-1 retatrutide (NEJM, 2026-09-29). WOMAC pain differences were −1.6 and −1.8 in 574 people with knee OA, with no structural endpoint in the abstract. TRIUMPH-4 (NCT05931367) is COMPLETED, but PubMed has no results paper yet.
  • RACER-Knee. Robotic-arm TKR did not improve 12-month Forgotten Joint Score (−1.5, −7.5 to 4.5) and cost more.
  • Hip precautions RCT (n=1,133). The dislocation odds ratio was 0.60 (0.17–2.17), and early HOOS JR was better without precautions.
  • A correction to the knowledge base. OQ-23 had been logged on 2026-08-31 as "methotrexate closed-negative", but PROMOTE was never cited (Kingsbury 2024, PMID 39074374; +0.79 NRS benefit). The 2026 PROMOTE biomarker substudy surfaced it. The methotrexate evidence now conflicts and is shown as conflicting.
  • Null anti-inflammatory knee RCTs: colchicine (CLOAK) and tofacitinib.
  • Reviews and meta-analyses: a null intra-articular DMOAD network meta-analysis, an orthobiologics NMA (no difference reaching the MCID), GAE evidence (very-low certainty, no sham), an MRI responsiveness meta-analysis, a resistance-exercise dose-response meta-analysis, a null digital physiotherapy RCT (SmArt-E), hip-OA MCIDs, a GLP-1 RA lean-mass meta-analysis, a placebo-response meta-regression and hand-OA contextual effects.
  • Statistics: Johnston County 2019–2024 prevalence, the rise in Dutch hand-OA prevalence, and ComOA comorbidity associations.
  • Deliberately not added. These were triaged as no change: GBD secondary re-analyses, single-cell and Mendelian randomization target papers, the bulk of preclinical DMOAD chemistry, AI KL-grading models, small TKA anaesthesia RCTs, a post-hoc pooled industry celecoxib analysis, and preprints. No paper met the landmark bar for a new notes/ file; the ACR 2026 summary should get one once its full text is published.
  • Changed.
  • Wiki pages, all set to status: draft and last-curated: 2026-10-15: wiki/guidelines.md (new ACR 2026 section and table, AAOS corrections, TL;DR and open questions), wiki/disease-modifying-therapies.md, wiki/exercise-weight-and-self-management.md, wiki/surgery-and-joint-replacement.md, wiki/hip-osteoarthritis.md, wiki/injections-and-orthobiologics.md, wiki/biomarkers-and-imaging-markers.md and wiki/clinical-trials-landscape.md. On the trials page, NCT04928170 now shows Unknown (it previously said Active not recruiting), NCT05986292 shows its added intervention, and four rows were added.
  • OPEN-QUESTIONS.md: sharpened OQ-2, OQ-3, OQ-11 and OQ-16. OQ-23 was corrected and re-posed as an hs-CRP enrichment question.
  • Literature layer: appended a 29-record sweep block to BIBLIOGRAPHY.md. REGISTRY.md gained the ACR 2026, AAOS hip 2023 and EUROVISCO rows, the ACR chain, two new disagreement rows and watch items. STATISTICS.md gained a sweep section, and patient-voice/sources.md an Arthritis UK Scotland campaign item. INDEX.md statuses now match the page frontmatter. Before this sweep, INDEX listed all 18 as draft although all were curated.
  • The other 10 pages are untouched and remain curated.
  • For the auditor (a different engine).
  • Re-read the ACR 2026 PDF against the guidelines table row by row.
  • Check that every PROMOTE, TRIUMPH-1 and RACER number matches its abstract.
  • wiki/pharmacologic-treatment.md was not edited and still describes ACR/AF 2019 positions only. It needs ACR 2026 language on glucosamine/chondroitin, opioids and duloxetine. I left it alone to keep this sweep's draft footprint to pages whose new evidence I had read.
  • Next sweep should chase:
  • the ACR 2026 full manuscript and its PMID;
  • the text of the AAOS corrections;
  • TRIUMPH-4 results;
  • TRIUMPH-1 knee-OA structural or secondary outcomes, if they are published;
  • any IPD or hs-CRP-stratified methotrexate analysis (OQ-23);
  • an OARSI successor guideline, given the 404 at its former guideline URL;
  • sham-controlled genicular artery embolization trials.

Regional transport claims remain unsupportable until SciELO/LILACS can be searched.

2026-10-22 — Periodic literature sweep (author: Codex; independent audit pending)

  • Window and PubMed coverage. Live E-utilities publication-date searches used 2026-08-28 through 2026-10-22 across guidelines, burden, diagnosis, biology, pain, genetics, exercise/weight, incretins, drugs, injections, surgery, disease modification, biomarkers, phase-3 trials, hand/hip OA, patient experience and safety. Added direct searches for OQ-1–OQ-12, inflammatory-treatment predictors, ACR manuscript, retatrutide/TRIUMPH-4 and sham embolization. The catchall publication query returned 1,935 records; the entry-date catchall returned 1,418. The combined searches yielded 2,121 unique live-fetched articles. Screening prioritized guideline/RCT/systematic-review returns and the previous sweep's follow-ups; this is a maintenance sweep, not an exhaustive systematic review of every catchall record. Exact queries, translations, returned IDs, source boundaries and checks are in the manifest.
  • Cochrane first. Ran a date-window CDSR query for each of the 18 major topic searches, plus overall publication- and entry-date queries: all returned zero in PubMed. Europe PMC's date-window CDSR query also returned zero. These are database-specific findings; the Cochrane Library/CENTRAL were not searched (HTTP 403).
  • Europe PMC. Queried each major topic, then repeated with OA restricted to title/abstract to avoid matches solely in reference lists. All 18 final topic result sets fit within the 1,000-record limit. A separately paginated all-topic title/abstract query retrieved 1,300 records: 180 had no PMID field, including duplicate PMC versions and 91 preprints, so 180 is not a count of independent non-PubMed studies. No DOI-only record survived triage. Two Europe PMC-supplied PubMed identifiers did not resolve through E-utilities and were not cited. Full-text availability fields were retained; the rehabilitation reviews were read through Europe PMC full-text XML.
  • Trial registries. Queried all 35 distinct NCT strings in condition Markdown, including two historical failed IDs. The 33 previously resolved registrations resolved again; the two historical failures still returned 404 and were not introduced as evidence. No overall-status change or new first-results posting was detected against the 2026-10-15 snapshot. The polyethylene/vitamin-E arthroplasty study has a new update posted 2026-10-20, remains active/not recruiting and has no results; TRIUMPH-4 remains completed without posted API results. Its date-limited PubMed search returned retatrutide papers, but none identified as a TRIUMPH-4 results report.
  • Beyond US registration. WHO ICTRP's OA request returned HTTP 403. Ordinary ISRCTN pages redirected to a JavaScript holding page; after reading its API documentation, the documented XML API succeeded for PROMOTE and RACER-Knee and for condition:osteoarthritis AND lastEdited GE 2026-08-28T00:00:00 (8 records). It identified recruiting GEKO, a multicentre placebo-procedure comparison of embolization with participant/assessor blinding and six-month VAS pain primary outcome. No results were posted in the retrieved record. CTRI's search page was fetched, but no trial-level query completed; no Indian-registry absence is asserted.
  • Official sources actually checked. ACR guideline portal and four-page summary; VA/DoD portal, full guideline and provider summary; EULAR management listing; NICE NG226; AAOS knee portal; OARSI guideline page; NJR annual-report portal and executive summary; Arthritis UK news; Arthritis Foundation webinar listing; and OAFI patient-congress listing. ACR still posts a summary and the windowed PubMed manuscript query returned zero. OARSI's page now resolves and lists the 2019 nonsurgical document. NICE still displays a 2022 review date, AAOS its 2021 knee third edition. VA/DoD 2026 and EULAR's physical-activity update were missing from this registry: both predate the requested window and are explicitly labelled catch-up additions, not new October publications.
  • What survived triage. Five bibliography records: digital-support network review, manual-therapy adjunct review, German embolization registry, Lancet health-policy roadmap (catalogue only), and the earlier EULAR physical-activity update. The two rehabilitation reviews informed a short exercise-page addition. No numerical manual-therapy estimate was transferred because abstract and full-text Results differ. The German paper contributed procedural statistics with its voluntary-reporting limitation; the NJR portal contributed explicitly all-indication submissions, with its knee-definition ambiguity retained. Two public patient-organisation event listings were added as scheduled material, not completed events or representative testimony. No landmark deep note was warranted.
  • Retraction and full-text integrity. Every added journal record was checked against live PubMed publication types and Crossref updated-by: no retraction/expression-of-concern flag or update was found. Both AAOS errata were also re-fetched and their correction relationships confirmed, but publisher text remained unavailable. Full-text verification excerpts and table locations are in the manifest. Crossref's initial rate limit was resolved with sequential retries; no personal email was sent. Unpaywall skipped because LIFEBANK_CONTACT_EMAIL is unset.
  • Changed. wiki/pharmacologic-treatment.md now reflects the verified ACR 2026 summary; wiki/guidelines.md adds the VA/DoD comparator and official-source refresh; exercise, injection and trials pages carry the selected evidence/registry updates. Updated bibliography, guideline registry, statistics, patient-voice sources, index and OQ-3/OQ-12; added a concrete GEKO follow-up without renumbering questions or claiming a question closed. All 11 edited content pages have last-curated: 2026-10-22 and status: draft; the remaining 9 wiki pages keep their earlier curated status. The log and permitted JSON manifest complete the sweep. No repository files outside this condition were changed, and no publishing or git command was run.
  • Local verification. New content passed checks for live-fetched PMID/NCT provenance, both retraction checks for every added journal record, required wiki sections, reference coverage/numbering, frontmatter dates/statuses and every added relative link. Final wiki state: 9 draft / 9 curated. This is author verification, not the independent audit. No whole-site build was run because publishing is handled separately.
  • Next sweep. Chase the ACR full manuscript and AAOS correction text; TRIUMPH-4 results and joint-structure outcomes from incretin trials; prospectively inflammation-stratified methotrexate evidence; GEKO results and other sham-controlled GAE reports; clarification of the manual-therapy abstract/body discrepancy; and OA-specific NJR denominators before interpreting portal volumes as disease burden. An independent different-engine audit must review the new material before promotion. SciELO and LILACS could not be searched (HTTP 403), so regional transportability remains unassessed.

2026-10-29 — Periodic literature sweep (author: Grok; independent audit pending)

  • Window and PubMed coverage. Live E-utilities publication-date searches used 2026-08-28 through 2026-10-29 across guidelines, burden, diagnosis, biology, pain, genetics, exercise/weight, incretins, drugs, injections, surgery, DMOADs, biomarkers, phase-3 trials, hand/hip OA, patient experience and safety, plus all-RCT and all-SR/MA queries. Direct follow-up searches covered the ACR manuscript, TRIUMPH-4/retatrutide, methotrexate, sham embolization, AAOS corrections, manual therapy, and OQ-1–OQ-12 plus OQ-23. Catchall publication-date count 2,184; entry-date catchall 1,670. Topic and follow-up searches yielded 427 unique live-fetched summaries after merging retry IDs. Screening prioritized guideline/RCT/SR returns and the previous sweep’s follow-ups; this is a maintenance sweep, not an exhaustive systematic review of every catchall record. Exact queries, translations, returned IDs, source boundaries and checks are in the manifest.
  • Cochrane first. "Cochrane Database Syst Rev"[jour] plus OA, overall by publication date and by entry date, and per-topic CDSR queries (guidelines, exercise, pharmacology, injections, surgery, DMOAD, pain, weight): all 0 in PubMed. Europe PMC’s date-window CDSR query also returned 0. These are database-specific findings; the Cochrane Library/CENTRAL were not searched (HTTP 403).
  • Europe PMC. Title-OA window hitCount 899 (200 returned); title/abstract 1,532; 59 preprints; 69 RCT-title records; 16 GAE records; ACR-and-guideline 20. Cochrane 0. No DOI-only record survived triage. Pasqualotto’s DOI was taken from Europe PMC/Crossref (10.1007/s00402-026-06543-6) after a PubMed article-id field pointed at an unrelated 2022 paper. van Zadelhoff full text was read as Europe PMC XML.
  • Trial registries. Re-fetched 36 NCT strings. 34 resolved; NCT01558727 and NCT03491188 still 404 and were not introduced as evidence. No overall-status change among resolved IDs versus the 2026-10-22 snapshot. NCT06681142 has a new update posted 2026-10-27, remains RECRUITING, no results. TRIUMPH-4 (NCT05931367) remains COMPLETED without API results. Recruiting OA count 606; four-status active count 1,250. NCT03884049 (NEO) COMPLETED; its 12-month paper is now cited.
  • Beyond US registration. WHO ICTRP homepage HTTP 200 (JS portal); no completed trial-level search. ISRCTN WHO-format XML: GEKO still Recruiting, target 216, no results element; OA lastEdited GE 2026-08-28 returned 9 records, none with posted results. PROMOTE WHO-format returned HTTP 500 this session; RACER query returned an empty payload. CTRI connection failed. ChiCTR was not queried beyond the celecoxib-patch trial registration printed in an abstract that did not survive triage.
  • Official sources actually checked. ACR guideline page and 2026 summary PDF (still summary only; posted 2026-09-14); NICE NG226; AAOS knee quality-programs URL (200) and the library URL used in the prompt (404); OARSI guidelines page (2019 document); EULAR recommendations listing; VA/DoD 2026 portal; NJR Annual Report 2026 landing page (no OA-specific denominators extractable); Arthritis UK news; Arthritis Foundation homepage. ACR manuscript PubMed query 0.
  • Not searched, so not claimed. SciELO/LILACS (HTTP 403). Cochrane Library/CENTRAL (HTTP 403). Unpaywall skipped because LIFEBANK_CONTACT_EMAIL is unset. Crossref queried without mailto.
  • What survived triage.
  • van Zadelhoff 2026 (PMID 42009866; catch-up, first publication 2026-04-20). Sham-controlled GAE RCT, n=58, 12-month KOOS-pain difference 7.46 (−13.63 to 28.56), synovitis unchanged. Full text Table 2. This is the sham-GAE chase from 2026-10-22.
  • Lanza 2026 (PMID 42208168; print in window). Three sham-controlled GAE RCTs pool to SMD −0.23 (−0.71 to +0.25). Abstract only.
  • Pasqualotto 2026 (PMID 42918921). PRP structural SR, 12 RCTs, inconsistent imaging effects. Abstract only.
  • Hawker 2026 (PMID 42880894). Sex differences in TKA willingness and surgeon recommendation, n=2,035. Abstract only.
  • Betensky 2025 (PMID 40953447; catch-up). Tirzepatide ICER $57,400/QALY vs diet and exercise. Surfaced by in-window Annals letters that were not themselves cited.
  • Super 2026 (PMID 42809374). Unloader-brace Delphi, registry watch-list only.
  • Deliberately not added. TRIUMPH-2 (T2D, not knee-OA results); GAUCHO (agent-vs-agent RCT with a Crossref correction); underpowered telehealth GLA:D RCT; exercise-snacking meta-analysis with inflated SMDs; PRP-pathway-vs-PRP RCT (no saline); open-label 14-day celecoxib-plus-patch trial; GAE expert Delphi as a CPG; genicular-nerve RFA SR whose corrigendum text is unavailable; GBD re-analyses; single-cell papers; preprints. No paper met the landmark bar for a new notes/ file.
  • Retraction checks. All six added journal records: no PubMed retraction/expression-of-concern type; empty Crossref updated-by. GAUCHO’s correction was the reason it was not added.
  • Changed. wiki/injections-and-orthobiologics.md, wiki/clinical-trials-landscape.md, wiki/exercise-weight-and-self-management.md, wiki/surgery-and-joint-replacement.md (already draft; last-curated: 2026-10-29). Bibliography, statistics, guideline registry, INDEX, OPEN-QUESTIONS (OQ-4, OQ-11, OQ-21 sharpened; GAE follow-up rewritten). No curated wiki page was touched. No question closed. No new landmark note.
  • Follow-ups still open. ACR 2026 full manuscript and PMID; AAOS correction text; TRIUMPH-4 results and incretin structural outcomes; hs-CRP-stratified methotrexate evidence; GEKO results; OA-specific NJR denominators; manual-therapy abstract/body discrepancy. An independent different-engine audit must review the new material before promotion. SciELO and LILACS could not be searched (HTTP 403), so regional transportability remains unassessed.