Valoración de la severidad en enfermedades degenerativas articulares temporomandibulares mediante tomografía computarizada Cone Beam / Assessment of the severity of temporomandibular articular degenerative diseases through Cone Beam imaging

RESUMEN: Introducción: Muchos estudios han demostrado que las enfermedades degenerativas articulares Temporomandibulares (EDATM) provocan dolor, alteran la función modificando las estructuras esqueletales que se traducen en asimetrías faciales. La valoración imagenológica contribuye a un adecuado diagnóstico con el objetivo de optimizar la evaluación morfológica de las articulaciones temporomandibulares. Metodología: Se realizó una búsqueda electrónica en las bases de datos de PubMed, Google Scholar y SciELO. La estrategia de búsqueda se realizó utilizando una combinación de términos con el objetivo de analizar la valoración de las características imagenológicas y de volumen condilar. Resultados y Discusión: De un total de 9807 artículos se seleccionaron 18 que cumplían con los requisitos. Se han propuesto muchas categorías para clasificar la severidad imagenológica de la EDATM sumado al advenimiento de softwares y reconstrucciones tridimensionales que han propuesto categorías a través de algoritmos matemáticos y de superposición de imagen que son un gran aporte para el diagnóstico, la toma decisiones en la elección del plan de tratamiento y en el seguimiento. Conclusiones: La valoración de la severidad de las EDATM son claves para que la investigación clínica permita esclarecer los procesos que se relacionan con el objeto de valorar la progresión de esta enfermedad.

ABSTRACT: Introduction: Many studies have shown that Temporomandibular degenerative joint diseases (TMDJD) cause pain, alter function by modifying skeletal structures that result in facial asymmetries. Imaging evaluation contributes to an adequate diagnosis with the aim of optimizing the morphological evaluation of the temporomandibular joints. Methodology: An electronic search was performed in the PubMed, Google Scholar and SciELO databases. The search strategy was performed using a combination of terms in order to analyze the assessment of imaging characteristics and condylar volume. Results and Discussion: From a total of 9807 articles, 18 were selected that met the requirements. Many categories have been proposed to classify the imaging severity of the TMDJD added to the advent of software and three-dimensional reconstructions that have proposed categories through mathematical algorithms and image superposition that are a great contribution to diagnosis, decision-making and choice of the treatment plan and follow-up. Conclusions: The assessment of the severity of TMDJD is key for clinical research in order to clarify the processes that are related to assessing the progression of this disease.

Morfología y Fisiopatología del Fibrocartílago de la ATM. Revisión sistemática / Morphology and Pathophysiology of the TMJ Fibrocartilage. Systemic review

RESUMEN: El objetivo: del presente estudio fue efectuar una revisión actualizada de la morfología, fisiopatología y aspectos moleculares de la capa fibrocartilaginosa de las ATM en humanos. Método: se realizó búsqueda electrónica y manual con los términos MeSH "TMJ" y "fibrocartilage", sin límite de fecha o idioma. Los desenlaces definidos fueron: morfología del fibrocartílago, fisiopatología del fibrocartílago articular, modeladores moleculares del fibrocartílago y deterioro del fibrocartílago. Resultados: Se identificaron 1.071 títulos de artículos que después de las exclusiones, fueron seleccionados 16 a texto completo para la revisión. El fibrocartílago (FC) que cubre las superficies de las ATM es un tejido crítico en el establecimiento y la tasa de progresión de las alteraciones óseas degenerativas, clínicamente sus discontinuidades se asocian a patologías que provocan dolor, ruidos y limitación funcional. Conclusiones: A pesar de la diversidad metodológica, heterogeneidad de objetivos y diferentes características de los estudios incluidos en la revisión, el fibrocartílago de la ATM, como tejido avascular, determina fisiología de baja capacidad reparativa y mayor frecuencia de patología del FC en mujeres en edad fértil, asociado a receptores hormonales. La fisiopatología muestra reacciones inmunitarias que incrementan la acción de MMPs, interleucinas y FNTα, responsables de la degradación de la matriz extracelular, destrucción celular y morfológica del fibrocartílago, que conducen a sintomatología inflamatoria y degenerativa de pacientes que presentan artralgias y sinovitis en las ATM.

ABSTRACT: The aim: of the present study was to carry out an updated review of the morphology, physiopathology and molecular aspects of the TMJ fibrocartilage in humans. Method: electronic/manual search was performed with the MeSH terms "TMJ" and "fibrocartilage", with no date or language limit. The defined outcomes were: morphology of the fibrocartilage, physiopathology of the articular fibrocartilage, fibrocartilage molecular modelers and fibrocartilage deterioration. Results: 1071 articles were identified and after exclusions, 16 full-texts were selected for review. The fibrocartilage (FC) that covers the surfaces of the TMJ is a critical tissue in the establishment and progression rate of degenerative bone diseases; clinically, its discontinuities are associated with pain, noise and functional limitation. Conclusions: In spite of the methodological diversity, heterogeneity of objectives and different characteristics of the patients included in the review, TMJ fibrocartilage, as avascular tissue, determines a physiology of low reparative capacity, observed with greater frequency of FC damage in women of fertile age, associated with a greater amount of hormonal receptors. The physiopathology shows that the immune reactions increase some MMPs, interleukins and FNTα, which are linked to the degradation of the extracellular matrix, FC cellular and morphological destruction and define the inflammatory and degenerative symptomatology of patients who present TMJ arthralgia´s and synovitis.

Clinical audit on outcome measures used in examination of knee osteoarthritis in selected hospitals and clinics in the Philippines

BACKGROUND@#Knee osteoarthritis is a degenerative joint disease affecting the aging Filipino population. Outcome measure tools are used to assess a patient’s health status for the quality of care improvement. With the increasing prevalence of knee osteoarthritis, it warrants the need to conduct a clinical audit to identify the most common outcome measure tools used by Filipino Physical Therapists.@*OBJECTIVES@#To determine the outcome measure tools used by Filipino Physical Therapists in assessing knee osteoarthritis in hospitals and clinics and compare it to the current global standard of assessment.@*METHODS@#A retrospective record audit study design was used to determine the current assessment tool compared with standards of assessment.@*RESULTS@#Of the 45 of 285 charts reviewed, 80% were females and 73.33%, aged older than 60 years. The following were examination tools used by Physical Therapists: In Subjective; a. pain score (97.77%), b Functional status (80%), and c. stiffness ( 4.44%). In Objective; a. ocular inspection and palpation(97.77% ), b. range of motion and manual muscle testing (93.33%), c. posture ( 48.89%), d. special testsB (33.33%), e. gait analysis ( 71.11%), and f. Functional assessment ( 91.11%). Physical Therapists did not use Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Visual Analog Scale (VAS), Short Form-36 (SF-36), and Knee Injury and Osteoarthritis Outcome Score ( KOOS) outcome measures for assessing knee osteoarthritis.@*CONCLUSION@#Physical Therapists did not use standardized outcome measure tools in the assessment for knee osteoarthritis. Thus, the study shows the gap in the assessment for knee osteoarthritis in the Philippines and global standards.

Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.

Reunión multidisciplinaria de expertos para el diagnóstico y tratamiento de la osteoartritis. Actualización basada en evidencias / Multidisciplinary meeting of experts for diagnosis and treatment of osteoarthritis. Up-to-date based on evidence

Resumen La osteoartritis es una enfermedad articular crónica degenerativa, es la afección articular observada con más frecuencia en la población adulta y una de las principales causas de discapacidad en todo el mundo, por lo que es de importancia el diagnóstico y tratamiento en las fases tempranas de la enfermedad. En la actualidad los nuevos tratamientos, además de aliviar el dolor, pueden disminuir la limitación funcional y modificar el curso de la enfermedad. El objetivo de este artículo es actualizar la evidencia acerca del diagnóstico y de las nuevas formas de tratamiento de la osteoartritis, así como evaluar los cambios en la evidencia que ha habido en relación con la guía anterior. Para la elaboración de la guía motivo de esta reunión, se contó con la participación de especialistas en Medicina Interna, Reumatología, Ortopedia y Rehabilitación física, un bibliotecario y un experto en metodología; se realizó una búsqueda extensa en PubMed y en otros sitios web especializados. Se estableció una serie de recomendaciones y niveles de evidencia basados en la bibliografía consultada. Se concluye que la osteoartritis es una enfermead compleja que implica múltiples factores de riesgo, por lo que es importante tomar en cuenta que el tratamiento es multidisciplinario y consta de un enfoque no farmacológico y uno farmacológico; sin embargo, es necesario crear una cultura preventiva de la osteoartritis en los médicos tratantes, en la que se eduque y se dé información al paciente para evitar que la enfermedad progrese.

Abstract Osteoarthritis, a chronic degenerative joint disease, is the joint condition most frequently observed in the adult population; is one of the leading causes of disability worldwide. Therefore, it is important the diagnosis and treatment in the early stages of the disease. Currently new therapies, in addition to relieving pain, can reduce functional limitation and modify the course of the disease. The objective of this article is to update the evidence on diagnosis and new forms of osteoarthritis treatment, as well as to evaluate the changes in the evidence that has been in relation to the previous guide. For the elaboration of the guide, there was participation of specialists (Internal Medicine, Rheumatology, Orthopedics and Physical Rehabilitation), a librarian and an expert in methodology; an extensive search was carried out in PubMed and other specialized websites. A series of recommendations and levels of evidence were established based on the bibliography consulted. Concluding that osteoarthritis is a complex pathology involving multiple risk factors, it is important to consider that the treatment is multidisciplinary and consists of a non-pharmacological approach and a pharmacological treatment; however, it is necessary to create a preventive culture on osteoarthritis in treating doctors, in which the patient is educated and given information to prevent the disease from progressing.

X-ray diagnosis and significance of degenerative osteoarthritis / 中国生化药物杂志

Objective To analyze the X-ray diagnosis and significance of degenerative joint disease. Methods From September 2015 to January 2017 in our hospital 86 cases of degenerative joint disease patients as the research object, a retrospective analysis of clinical data of the patients, in the premise of pathological diagnosis, all patients underwent X-ray diagnosis. Analysis of degenerative joint disease to X-ray diagnosis. Results Men showed left and right tibiofemoral joint and patellofemoral joint involvement; women showed left and right tibiofemoral joint and patellofemoral joint involvement. Patients showed more changes to the knee joint degenerative bone, periosteal thickening, stenosis, visible osteophytes, or bone hyperplasia, calcification of symptoms. 41 cases (47.6%) accompanied by joint swelling, 22 cases (25.6% limbs) joint involvement, 13 cases (15.1%) of spinal involvement, 10 cases (11.7%) with small joint involvement. Conclusion The X-ray diagnosis of degenerative joint disease, high clinical value, worthy of promotion.

X-ray diagnosis and significance of degenerative osteoarthritis / 中国生化药物杂志

Objective To analyze the X-ray diagnosis and significance of degenerative joint disease. Methods From September 2015 to January 2017 in our hospital 86 cases of degenerative joint disease patients as the research object, a retrospective analysis of clinical data of the patients, in the premise of pathological diagnosis, all patients underwent X-ray diagnosis. Analysis of degenerative joint disease to X-ray diagnosis. Results Men showed left and right tibiofemoral joint and patellofemoral joint involvement; women showed left and right tibiofemoral joint and patellofemoral joint involvement. Patients showed more changes to the knee joint degenerative bone, periosteal thickening, stenosis, visible osteophytes, or bone hyperplasia, calcification of symptoms. 41 cases (47.6%) accompanied by joint swelling, 22 cases (25.6% limbs) joint involvement, 13 cases (15.1%) of spinal involvement, 10 cases (11.7%) with small joint involvement. Conclusion The X-ray diagnosis of degenerative joint disease, high clinical value, worthy of promotion.

Morgan line and its relationship with distraction index, angle of inclination and degenerative joint disease in the diagnosis of canine hip dysplasia / Linha Morgan e sua relação com índice de distração, ângulo de inclinação e doença articular degenerativa no diagnóstico da displasia coxofemoral canina

We evaluated 160 hip joint radiographs of 40 dogs of different large breeds (25 females and 15 males) from the metropolitan area of Belo Horizonte, Minas Gerais, Brazil. The radiographs of each dog were obtained at two different stages: stage 1 (mean 7.23 months) and stage 2 (mean 14.25). The conventional radiographic method (CRM) and the radiographic distraction method (RDM) were used, carried out in both stages. CRM measured the Norberg angle (NA), the angle of inclination (AI) and evaluated the presence of degenerative joint disease (DJD). The MRD was performed to establish the distraction index (DI). The aims were to evaluate the presence of the Morgan line and other signs of DJD and correlate them with the degree of canine hip dysplasia (CHD) and also check if the DI greater than 0.3 (first stage) was associated with the presence of ML (second stage). It was found that DI, AI and changes of femoral neck and the formation of osteophytes were associated with the presence of ML. It was observed that if the DI is greater than 0.3 at the first stage, the chance of a positive outcome of ML in the second stage increases by 7.2 times. Thus, 49 joints showed DI > 0.3 at the first stage, in which 31 (63.3 %) presented ML at the second stage. Of the 31 animals that showed DI ≤ 0.3 at first, six (19.4%) had LM at the second stage. There has been a significant association between the presence of ML and the degree of CHD. The more severe the CHD, the higher the percentage of positive ML results. Thus, among the 24 (60 %) animals that showed ML, 11 (45.83 %) were classified as severe dysplastics, 5 (20.83%) as moderate and 8 (33.33 %) as mild. None of the animals classified as normal or borderline presented ML. Among the 8 animals classified as mild dysplastics, 5 showed only ML as DJD.(AU)

Avaliaram-se 160 radiografias das articulações coxofemorais de 40 cães de diferentes raças de grande porte, provenientes de Belo Horizonte, Brasil. As radiografias de cada animal foram obtidas em dois momentos: um (média de 7,23 meses de idade) e dois (média de 14,25 meses). Utilizaram-se o método radiográfico convencional (MRC) e o método radiográfico em distração (MRD), ambos realizados nos dois momentos. No MRC, mensurou-se o ângulo de Norberg (AN), o ângulo de inclinação (AI) e avaliou-se a presença de doença articular degenerativa (DAD). O MRD foi realizado para se estabelecer o índice de distração (ID). Os objetivos foram avaliar a presença da linha Morgan (LM) e de outros sinais de DAD, correlacionando-os com o grau de displasia coxofemoral (DCF); além de se verificar se o ID maior que 0,3 (primeiro momento) possui associação com a presença de LM (segundo momento). Verificou-se que ID, AI e encurtamento e/ou espessamento do colo femoral e formação de osteófitos foram associados à presença da LM. Observou-se que, quando o ID era maior que 0,3 no primeiro momento, a chance de um resultado positivo da LM no segundo momento aumentava em 7,2 vezes. No primeiro momento, 49 articulações apresentaram ID > 0,3. Destas, 31 (63,3%) apresentaram LM no segundo momento. Dos 31 animais que apresentaram ID ≤ 0,3 no primeiro momento, seis (19,4%) desenvolveram LM no segundo momento. Houve associação significativa entre presença de LM com o grau de DCF, e quanto mais grave a DCF, maior foi o percentual de resultados positivos da LM. Dos 24 (60%) animais que apresentaram LM, 11 (45,83%) foram classificados como displásicos graves, cinco (20,83%) como médios e oito (33,33%) como leves. Nenhum dos animais considerados suspeitos ou normais apresentou LM. Dos oito animais classificados como displásicos leves, cinco apresentaram apenas LM como sinal de DAD.(AU)

Osteoarthritis in horses - Part 1: relationship between clinical and radiographic examination for the diagnosis

ABSTRACT Locomotor disorders are very common in the equine clinic, which may be partly due to the different types of activities horses develop. Osteoarthritis (OA), commonly known as degenerative joint disease, presents an considerable role in the series of disorders of the musculoskeletal system and may be associated with other problems such as navicular syndrome, periostitis or osteochondrosis. This affection causes progressive deterioration of articular cartilage, accompanied by bone and soft-tissue periarticular changes. In fact, it results from a complex interaction between biochemical and biomechanical factors. The objective of this article is to review information about clinical and radiographic findings of OA, the biochemical and biomechanical changes manifested in the disease and the importance of the synovial fluid. Additionally, some information on other species is also presented. This review refers to Part 1 of a study whose sequence is entitled "Osteoarthritis in horses - Part 2: a review of the intra-articular use of corticosteroids as a method of treatment."

Osteoarthritis in horses - Part 2: a review of the intra-articular use of corticosteroids as a method of treatment

ABSTRACT: The problem considered in this review is related to the frequent use of corticosteroids (COs) (i.e. steroids) in the practice of equine medicine and surgery as a therapeutic strategy in the treatment of degenerative joint disease, commonly known as osteoarthritis (OA). This disease is one of the most common among the equine musculoskeletal diseases, and is clinically characterized by pain, lameness, joint effusion at the initial stage, which usually reduces with the progression of the disease, and reduced physical performance. Although steroids are considered excellent drugs in the control of clinical signs resulting from osteoarthritis, they also influence cellular activity through activation of various signaling mechanisms. However, they can cause adverse effects when administered intra-articularly, since they are immunosuppressive drugs of many cell types. They are also incriminated as suppressors of the chondrocyte matrix synthetic activities, which may contribute to 'arthropathy by corticosteroids', which can also be associated with cumulative injury resulting from improper use (dose and frequency of application) of already damaged joints. The objective of this article is to review information about the advantages and disadvantages of intra-articular COs for treatment of the disease in horses. In addition, some important information of other species is also presented.

Prevalência de alterações ósseas no tarso de potros Crioulos de até vinte e seis meses de idade / Bone changes prevalence in the tarsus of Crioulo yearlings up to 26 months of age

Com o objetivo de definir a prevalência de alterações ósseas no tarso, foram examinados radiograficamente 77 potros da raça Crioula, com até 26 meses de idade e a relação das lesões com parâmetros biométricos e de manejo. Os animais foram divididos em dois grupos por idade: G1, incluindo potros de nove a 18 meses (34/77); e G2, com animais de 19 a 26 meses (43/77). Os animais também foram divididos pelo tempo de preparo para exposição morfológica em GC, grupo controle (29/77), os animais sem preparo para exposição; e GI, grupo incentivo (48/77), animais com preparo médio de 4,55 meses, e foram separados por sexo em machos (46/77) e fêmeas (31/77). Os dados foram coletados em 24 propriedades de criação ou centros de treinamento/preparo do estado do Rio Grande do Sul. Lesões radiograficamente visíveis foram observadas em 79,2% (61/77) dos animais, 80,4% dos machos, 77,4% das fêmeas, 77,3% dos animais do GC, 79,2% dos animais do GI, 86,7% dos animais do G1 e 76,7% dos animais do G2. O peso médio dos potros de 10 a 12 meses de idade foi 293,2kg, representando 71,3% do peso adulto; o peso médio dos animais com idade de 19 a 26 meses foi de 360,5kg (87,6% do peso adulto); do GC foi de 288,9kg (70,2% do peso adulto); e do GI 341,9kg (83,1% do peso adulto), apesar da idade média dos dois últimos grupos ter sido de apenas 16,8 e 19,0 meses, respectivamente. Observou-se relação positiva entre o aumento do escore corporal dos animais (P=0,01; r=0,3), do tempo de preparo dos animais para exposição morfológica (P=0,0001; r=0,7) e do escore de deposição de gordura na crista do pescoço (P=0,02; r=0,3) com as lesões radiográficas observadas no tarso dos potros. Vários fatores podem estar envolvidos na osteoartrite társica distal, entretanto, em cavalos Crioulos, o fator mais importante presente nas criações foi o sobrepeso.

Aiming to evaluate the prevalence of bone changes, radiographs were taken from both tarsal joints of 77 Crioulo yearlings, up to 26 months of age. The degree of changes was correlated with biometric parameters and management practices. The animals were separated into six groups, according to age: G1, including nine to 18 months old foals (34/77) and G2, with animals between 19 to 26 months of age (43/77); preparation time to halter class shows: GC, including animals who were not submitted to any preparation (29/77), and GI, consisting of young horses prepared to participate (average of 4.55 months of preparation time) in halter shows (48/77); and gender: colts (46/77) and fillies (31/77). Data were obtained from 24 breeding farms or training centers in Rio Grande do Sul state. Results showed that 79.22% (61/77) of the animals presented some degree of radiographically visible lesions, being 80.4% of males, 77.4% of females, 77.3% in GC, 79.2% in GI, 86.7% in G1 and 76.7% in G2. The mean body weight of the 10 to 12 month old yearlings (G1) was 293.2kg, representing 71.3% of the breed's mature weight and that of the 19 to 26 month old (G2) animals was 360.5kg (87.6% of the mature weight). The mean body weight of the GC was 288.9kg (70.2% of the mature weight) and of GI was 341.9kg (83.1% of the mature weight), although the average age of both groups was 16.8 and 19.0 months, respectively. A significant relationship was found between the animal's body condition score (P=0.01; r=0.3), time of preparation to halter class shows (P=0.0001; r=0.7), and neck crest score (P=0.02; r=0.3), and degree of the radiographic lesions found in the tarsi. Several factors can be involved in the development of distal tarsal juvenile osteoarthritis; however, in Crioulo breeding farms, the most important factor present was the horse's overweight.

Desnervação capsular percutânea ou aberta no tratamento da dor na displasia coxofemoral canina / Percutaneous versus open hip denervation in the treatment of canine pain hip dysplasia

A desnervação capsular (DC) se baseia na desperiostização da borda acetabular e tem sido utilizada como uma das técnicas de alívio da dor articular em cães displásicos. Compararam-se as técnicas de DC percutânea e aberta, aplicadas em 25 cães, que apresentaram diagnóstico clínico e radiográfico de displasia coxofemoral, totalizando 31 cirurgias. Os efeitos das técnicas foram comparados, em período de 180 dias, por meio de avaliação subjetiva de claudicação e dor, perimetria da coxa, graus máximos de flexão e extensão da articulação coxofemoral e amplitude de movimento articular. Os graus de claudicação e dor apresentaram decréscimo significativo ao longo do período avaliado em ambos os grupos, sem apresentarem diferenças quando comparados entre si. Com relação à perimetria da coxa, flexão, extensão e amplitude de movimento articular, foi observado o aumento dos valores numéricos destas variáveis ao longo do estudo. Baseado nos achados, concluiu-se que a abordagem percutânea ou aberta na DC produz similitude nas variáveis avaliadas, e ambas trazem bons resultados.

Joint capsule denervation is based on removal of sensitive fibers from the acetabular edge and has been used as one of the techniques to joint pain relief in the canine dysplastic hip. This study compared the techniques of percutaneous and open hip denervation in 25 dogs that showed clinical and radiographic signs of hip dysplasia, totaling 31 surgeries. The effects of the techniques were evaluated and compared in a period of 180 days following surgery, including subjective evaluation of lameness and pain, thigh girth, maximum degree of hip flexion and extension and range of motion (ROM). Degree of lameness and pain significantly decreased during the study period for both groups, and no difference could be observed between groups. Thigh girth, degree of flexion, extension and ROM presented an increase in the numerical values throughout the study. Based on these findings, it is concluded that the percutaneous or open approach for capsular denervation produced similar results.

Rethinking the Possibilities and Limitations of a Study on the Skeletal Markers Reconstructing the General Level of Physical Activity / 체질인류학회지

The reconstruction of activity and of work patterns has been approached by examinations of activity-related skeletal markers. Among several different methods, in particular, a number of anthropologists have widely applied the patterns of enthesopathies and degenerative joint disease in studies of past activity. The purpose of this study is to better understand and use these indicators in reconstructing the levels of physical activities of past populations. This review will provide information on the most recent anthropological research on the behavioral interpretation on degenerative joint disease and enthesopathies, to better use these indicators in understanding past populations. There are obvious limitations in using these markers, and it is necessary to consider them. Firstly, it is uncertain as to whether there are certain activities that are performed repetitively throughout their lives of those who lived in past civilizations. A second limitation involves the etiology of skeletal markers related to mechanical stress. There are multiple-factors, including genetic predisposition, sex, the aging process, and diet that may affect the way people practice a specific activity. Accordingly, this makes it difficult to evaluate the underlying etiological factors and their roles in activity-related skeletal changes. In conclusion, to circumvent these limitations, the use of multiple skeletal markers together in studies of the activities of past populations may enable to more reliable interpretations. However, to ensure more reliable interpretations, the validity of such combinations of makers should be challenged. Therefore, more work on the validity of activity-related markers is needed to clarify the activities that are responsible for the development in life of the features observable in skeletal populations. This type of research can contribute to the discussion of the use of activity-related skeletal markers in studies of behavioral interpretations with more certainty regarding which morphological characteristics are responses to physical activity and mechanical loading as the pathogenesis of such characteristics.

Efeitos dos glicosaminoglicanos e sulfato de condroitina A sobre a cartilagem articular normal e com doença articular degenerativa em cães / Glycosaminoglycans and chondroitin sulphate A effects on normal and osteoarthritic articular cartilage in dogs

Avaliaram-se os efeitos dos precursores dos glicosaminoglicanos (GAG) e do sulfato de condroitina A (SC) sobre a histomorfometria da cartilagem articular normal ou de cartilagem de cães com doença articular degenerativa (DAD) experimental. Os grupos experimentais constituíram-se de animais com articulação direita normal, que não foi submetida a procedimento cirúrgico, e com articulação esquerda osteoartrótica e que foi submetida à intervenção cirúrgica. Os grupos foram subdivididos em animais com articulação não tratada e tratada, portanto: normais (N) (n=5), NGAG (n=5) e NSC (n=4); e osteoartróticos (O) (n=5), OGAG (n=5) e OSC (n=4). Secções de cartilagens do fêmur, da tíbia e da patela foram utilizadas neste estudo. Nos normais (N, NGAG e NSC), não se encontraram lesões que caracterizassem a DAD, embora tenha havido diminuição na celularidade nos de NGAG e NSC, em relação a N. Foram observadas alterações em graus variáveis entre os grupos osteoartróticos. Houve redução acentuada dos condrócitos no grupo O em comparação aos normais enquanto os grupos osteoartróticos tratados apresentaram celularidade semelhante aos normais tratados. Estes resultados foram confirmados pela análise do índice de proporção (IP), que se mostrou elevado em O, indicando menor síntese de proteoglicanos. Não houve diferença significativa entre os IPs dos grupos osteoartróticos tratados (OGAG, OSC) apesar do comportamento distinto do OSC ao assemelhar-se aos grupos N e NSC. Estes resultados sugeriram que o SC agiu na cartilagem osteoartrótica de maneira mais eficaz, reduzindo a perda de proteoglicanos e estimulando a viabilidade celular e a atividade metabólica.

The effects of precursors of glycosaminoglycans (GAG) and chondroitin sulphate A (CS) on the histomorphometry of normal articular cartilage and with experimental degenerative joint disease (DJD) in dogs were evaluated. The groups were constituted as follows: normal joints were not undergone to the surgical procedure and left osteoarthritics that suffered surgical intervention. These were then distributed into joints that did not receive drug treatment and those that received: normal (N) (n = 5); NGAG (n = 5), and NCS (n = 4); and osteoarthritics: O (n = 5); OGAG (n = 5); and OCS (n = 4). Cartilage sections of the femur, tibia, and patella were used in this study. In normal groups (N, NGAG, and NCS) no lesions were found that could characterize DJD, although the cellularity was shown to be slightly diminished in NGAG and NCS, in relation to N. Characteristic DJD disorders were identified in variable degrees among osteoarthritic groups and were more severe in O. There was marked reduction of the number of chondrocytes in group O, as compared to the normal groups, while treated osteoathritic groups showed similar cellularity to that of normal groups. These results were supported by the analysis of the index of proportion (IP), which was high in O, indicating less synthesis of proteoglycans. These results suggest that chondroitin A sulphate acted on osteoarthritic cartilage in a more efficient way than glycosaminoglycan precursors, reducing the loss of proteoglycans caused by the degenerative process, stimulating cellular viability and metabolic activity.

A CLINICAL CASE OF ALLOPLASTIC CONDYLE REPLACEMENT WITH CONDYLAR PROSTHESIS IN SEVERE DEGENERATIVE JOINT DISEASE

Sulfato de condroitina e hialuronato de sódio no tratamento da doença articular degenerativa em cães: estudo histológico da cartilagem articular e membrana sinovial / Chondroitin sulfate and sodium hyaluronate in the treatment of the degenerative joint disease in dogs: histological features of articular cartilage and synovium

Quinze cães, sem raça definida, de ambos os sexos, de peso entre 18 e 25kg, foram submetidos à secção artroscópica do ligamento cruzado cranial (LCCr) para indução da doença articular degenerativa (DAD). Após três semanas de instabilidade articular, o LCCr foi substituído pela fáscia lata segundo a técnica de Schwalder (1989) e os animais foram distribuídos em três grupos de cinco. Os animais do grupo I, controle, não receberam tratamento medicamentoso; os do grupo II, 24mg/animal de sulfato de condroitina, por via IM, de cinco em cinco dias, totalizando seis aplicações; e os do grupo III foram tratados com hialuronato de sódio na dose de 20mg/animal, por via IV, de cinco em cinco dias num total de três administrações. Ao final de 90 dias, os animais foram eutanasiados e procedeu-se à colheita e ao processamento histológico da membrana sinovial e da cartilagem articular para avaliações morfológica e morfométrica. No grupo I foram observadas alterações degenerativas de DAD mais acentuadas que nos demais grupos, como redução do número de condrócitos, presença de pânus, fibrilações, fissuras, erosões e irregularidades na superfície articular. No grupo II observou-se elevação do número de condrócitos com aumento da atividade de síntese da matriz e redução das lesões na superfície da cartilagem. No grupo III houve aumento do número de condrócitos que eram, muitas vezes, morfologicamente inviáveis. Todos os grupos apresentaram proliferação da membrana sinovial e presença de infiltrado linfoplasmocitário na subíntima e na perivascular. Nos grupos I e III, a proliferação da membrana sinovial era exuberante com formação de pânus, presença de sinoviócitos achatados ou ausência de sinóvia com tecido de granulação. Os resultados sugerem que o sulfato de condroitina estimulou a cartilagem articular, diminuindo ou retardando as alterações da DAD e o hialuronato de sódio não interferiu no processo degenerativo da cartilagem articular. Não foi constatada ...

Fifteen mongrel dogs, both genders, weighting from 18 to 25kg were used and Degenerative Joint Disease (DJD) was induced through cranial cruciate ligament (CCrL) artroscopical section. After three weeks, CCrL was reconstructed by Schawalder's (1989) technique. Then, dogs were distributed in three groups and the following protocols were used: group I, control, no other treatment but the CCrL reconstruction; group II received chondroitin sulfate 24mg per animal every five days, intramuscularly, in a total of six injections; and group III received sodium hyaluronate 20mg per animal every five days, intravenously, in a total of three injections. Clinical observation was done until 90 days after treatments. By that time, the articular cartilage and synovium were collected and their morphology was evaluated. In group I, the degenerative alterations of the DJD were the most intense. Thus, decrease of chondrocytes number, pannus, fibrillations, grooves, erosion, and irregular articular surface were observed on the cartilage. In group II, raise of chondrocytes number was observed, with increase of synthesis activity of matrix and decrease of lesions on the articular surface. There was an increase of chondrocytes in group III, but the cells were morphologically unviable. All the groups showed proliferation of the synovial membrane, with limpho-plasma cells infiltrated in subintim and perivascular. In groups I and III, the proliferation of synovium was abundant, with formation of pannus, flattened synoviocytes or synovium absent with granulation tissue. Those results suggest that the chondroitin sulfate stimulated the articular cartilage; decreasing or delaying the alterations of DJD, as well as, the sodium hyaluronate did not interfere on degenerative process in articular cartilage. No favorable action of these drugs in the synovial membrane was verified.

Effects of chondroitin sulfate and sodium hyaluronate on chondrocytes and extracellular matrix of articular cartilage in dogs with degenerative joint disease / Efeitos do sulfato de condroitina e do hialuronato de sódio nos condrócitos e na matriz extracelular na cartilagem articular de cães com doença articular degenerativa

Samples of articular cartilage of femur, tibia and patella of 15 dogs with experimentally induced degenerative joint disease (DJD) were microscopically analyzed. Animals were distributed into three groups (n=5): the control group received no medication; the second group was treated with chondroitin sulfate and the third received sodium hyaluronate. Samples were processed and stained with HE and toluidine blue for morphological evaluation. The metabolic and proliferative activity of the chondrocytes was evaluated by the measurement of nucleolar organizer regions (NORs) after impregnation by silver nitrate. Significant differences were not observed (P>0.05) in the morphology among the groups, however, the group treated with sodium hyaluronate had a higher score suggesting a trend to a greater severity of the lesions. Significant differences were not observed (P>0.05) in the measurement of NORs, cells and NORs/cells among the groups. Although differences were not significant, sodium hyaluronate group showed higher NOR and cell counts which suggested an increase of the proliferation rate of chondrocytes. In addition, a higher NOR/cell ratio in the group treated with chondroitin sulfate suggested that this drug may have stimulated the metabolic activity of the chondrocytes, minimizing the lesions resulting from DJD.

Foram utilizadas amostras de cartilagem articular do fêmur, tíbia e patela de 15 cães com doença articular degenerativa (DAD), induzida experimentalmente. Foram constituídos três grupos de cinco animais: grupo 1 - controle, não medicado; grupo 2 - tratado com sulfato de condroitina e grupo 3 - tratado com hialuronato de sódio. As amostras foram processadas e coradas pelas técnicas de HE e de azul de toluidina para avaliação das alterações morfológicas, e impregnadas pelo nitrato de prata para análise da atividade metabólica e/ou proliferativa dos condrócitos, por meio da visualização e quantificação de regiões organizadoras do nucléolo (NORs). Não foram notadas diferenças significativas (P<0,05) na avaliação morfológica entre os grupos. O grupo tratado com hialuronato obteve maior escore sugerindo maior gravidade das lesões. Não foram observadas diferenças significativas (P>0,05) na contagem de NORs, células e NORs/célula entre os grupos. As maiores contagens de NORs e de células no grupo tratado com hialuronato de sódio sugeriram aumento da taxa de proliferação dos condrócitos. A maior relação de NORs/célula obtida no grupo tratado com sulfato de condroitina sugere que essa droga estimula a atividade metabólica do condrócito, minimizando as lesões ocorridas durante a DAD.

Distribution and clinical features of patients with degenerative change of the mandibular condyle / 대한치과교정학회지

OBJECTIVE: This study was carried out to evaluate the distribution and clinical features of patients with degenerative change of the mandibular condyle. METHODS: Six thousand and seventy patients with TMD (temporomandibular disorder) were selected for this study, who had complete initial clinical records and radiographs. Panorama and TMJ panorama radiographs were used to screen the degenerative change in the condyle, and the patients were divided into DJD (degenerative joint disease) and non-DJD groups. RESULTS: The distribution and clinical features of the two groups were compared. Out of the total number of patients, 31.7% were in the DJD group, and 68.3% were in the non-DJD group. The portion of females was larger in the DJD group (80.8%) than in the non-DJD group (67.5%), and the DJD group had high prevalence in the second and third decades. Lack of incisal contact, retrusive chin, facial asymmetry, and mouth opening limitation were the chief complaints of the patients who had positive relation to DJD. CONCLUSION: Patients with an orthodontic treatment history, CO-CR discrepancy and crepitation were at possible risk of having DJD.

MRI study of temporomandibular joint disorder in orthodontic patients / 대한치과교정학회지

Magnetic resonance imaging(MRI) of the temporomandibular joint(TMJ) is very useful method to diagnose internal derangement of the TMJ because of its high specificity for identification of condyle-disc relationships. The purpose of this study was to evaluate the existence, incidence and severity of internal derangement of th TMJ by the MRI of patients who are suspected to have TMJ disorder. MRI sample was composed of 50 subjects(10 males, 40 females) and the mean age was 22.9 years. 43 subjects of the sample were found to have positive findings. 56% of the subjects with positive findings had ADD(anterior disc displacement) without reduction, and 65% had internal derangement of bilateral joints. Distributions in the types of malocclusion in patients with positive findings, the Angle's classification had shown : the largest 41.9% for Cl II (39.6 for Cl II div 1 and 2.3% for Cl II div 2), 37.2% for Cl III, and 2.3% for the nuidentified. 8.6% of the subjects with positive findings had facial asymmetry and 55.8% had openbite. We can conclude that the percentage of CI II is the highest in patients with internal derangement of the TMJ. Openbite or facial symmetry is considered to be uncompensated or compensated deformity which results from facial skeleton remodeling in the process of degenerative joint disease(DJD) due to TMJ degeneration. Therefore it is recommended to screen the patients with facial asymmetry or openbite by MRI before the beginning of orthodontic treatment. Differential diagnosis is essential because the tendency of relapse is high after the orthodontic treatment and continuous observation of TMJ is needed in patients with TMJ disorder.

A Study On The Foot In Patients With Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: Aims were to evaluate foot deformity in patients with rheumatoid arthritis for its types, prevalence, and relation with duration of the disease. METHODS: Inspection, measuring of hallux valgus and calcaneal angle and footprint were done on 256 feet of 128 patients with rheumatoid arthritis. Transverse (metatarsal) arch and longitudinal arch were evaluated by foot printings. RESULTS: 1) The most common type of foot deformities was hallux valgus in 175 of 256 feet(68.4%). Depressed transverse arches were in 169(66.0%), toe deformities including claw toe, hammer toe, curl toe and mallet toe in 125(48.9%), calcaneal valgus in 87(34.0%), callus in 67(26.2%), pes planus in 37(14.5%), and bunion in 25 (9.8%) of 256 feet. 2) Foot involvements as the initial manifestation were seen in 41 (32.0%) of 128 patients with rheumatoid arthritis. A duration of rheumatoid arthritis over 10 years were seen in 37 of 128 patients. In this patients mean number of involved toes per foot was 2.78 which was not statistically significant increase compared to that of all patients, 2.23 (p-value>0.05). Even with absence of foot symptoms in 28 of 128 patient with rheumatoid arthritis, toe deformities were seen in 1.55 toes per foot. And prevalence of hallux valgus, pes planus, depressed transverse arch and calcaneal valgus were 58.9%, 10.7%, 51.8% and 39.3% respectively. CONCLUSIONS: Foot deformities in patients with rheumatoid arthritis were usually inevitable complication. Even in the patients who had no foot symptom, there were foot deformities. So, we think that physicians should pay attention to the foot in all rheumatoid arthritis.