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O presente relato de caso avaliou o meloxicam solução oral spray com o sistema de absorção transmucosa no tratamento de um cão tripedal acometido por osteoartrose em joelho e coluna. Além da avaliação ortopédica, foram realizados questionários de avaliação de dor, baropodometria, termografia e monitoramento de atividade.
The present case report evaluated the meloxicam oral solution spray with the transmucosal absorption system in the treatment of a three-legged dog affected by osteoarthritis in the knee and spine. In addition to the orthopedic evaluation, assessments of pain, baropodometry, thermography, and activity monitoring were carried out.
El presente informe de caso evaluó el spray de solución oral de meloxicam con el sistema de absorción transmucosa en el tratamiento de un perro de tres patas afectado por osteoartritis en la rodilla y columna. Además de la evaluación ortopédica, se realizaron cuestionarios de evaluación del dolor, baropodometría, termografía y monitoreo de la actividad.
Subject(s)
Animals , Dogs , Osteoarthritis/therapy , Meloxicam/administration & dosage , Pain Measurement/veterinary , Joint Diseases/veterinaryABSTRACT
Introducción: La osteoartritis es una enfermedad articular crónica degenerativa con componente inflamatorio caracterizado por degeneración y pérdida progresiva del cartílago hialino y hueso subcondral y daño del tejido sinovial. Objetivo: Describir los aspectos clínicos y epidemiológicos de los pacientes con diagnóstico de osteoartritis en el Hospital Provincial de Zaire en la República de Angola, en el período comprendido entre septiembre de 2021 a septiembre de 2022. Método: Se realizó un estudio descriptivo, de cohorte longitudinal, con datos del Departamento de Ortopedia y Traumatología de dicha institución. El universo estuvo constituido por 489 pacientes, la muestra del estudio quedó conformada por n꓿167. Se realizaron pruebas de correlación bivariable con el análisis del coeficiente de correlación de Pearson. Resultados: El grupo etario predominante fue de 61 a 70 años (28,7 %), con predominio del sexo femenino (58,1 %), con un tiempo de evolución mayor a 5 años (35,9 %), la articulación mayormente afectada fue la rodilla con 62 pacientes. Se demostró que existe una correlación positiva considerable entre el tiempo de evolución de la enfermedad y el grado de discapacidad, mediante valor del coeficiente de Pearson (0,407), resultado que muestra significación estadística. Conclusiones: La osteoartritis es una enfermedad degenerativa de etiología variada que se presenta en edades tempranas, con mayor frecuencia en el sexo femenino asociada a la articulación de la rodilla, existiendo correlación entre el tiempo de evolución con el grado de discapacidad que produce.
Introduction: Osteoarthritis is a chronic degenerative joint disease, with an inflammatory component included, its characterized by degeneration and progressive loss of hyaline cartilage and subchondral bone and also for synovial tissue damage. Objective: To describe the clinical and epidemiological aspects of patients diagnosed with osteoarthritis at the Provincial Hospital of Zaire in the Republic of Angola, from September 2021 to September 2022. Method: A descriptive, longitudinal cohort study was carried out using the data gathered from the Department of Orthopedics and Traumatology of the institution. The universe consisted of 489 patients and the study sample consisted of n꓿167. Bivariate correlation tests were performed using the Pearson's correlation coefficient analysis. Results: The predominant age group was 61 to 70 years old (28.7%), with women sex as predominant (58.1%), with an evolution time of more than 5 years (35.9%), and the knee was the most affected joint (observed in 62 patients). A considerable positive correlation between the time of the disease evolution and the degree of disability was demonstrated using the Pearson's coefficient value (0.407), value that shows a great statistical significance. Conclusions: Osteoarthritis is a degenerative disease of varied etiology that occurs at early ages, more frequently in the female sex associated with the knee joint, and there is a correlation between the time of evolution and the degree of disability produces by the disease.
Introdução: A osteoartrite é uma doença articular degenerativa crônica com componente inflamatório caracterizada por degeneração e perda progressiva da cartilagem hialina e lesão do osso subcondral e tecido sinovial. Objetivo: Descrever os aspectos clínicos e epidemiológicos dos pacientes diagnosticados com osteoartrite no Hospital Provincial do Zaire na República de Angola, no período de setembro de 2021 a setembro de 2022. Método: Foi realizado um estudo descritivo, de coorte, longitudinal, com dados do Departamento de Ortopedia e Traumatologia da referida instituição. O universo foi composto por 489 pacientes, a amostra do estudo foi composta por n꓿167. Os testes de correlação bivariada foram realizados por meio da análise do coeficiente de correlação de Pearson. Resultados: A faixa etária predominante foi de 61 a 70 anos (28,7%), com predominância do sexo feminino (58,1%), com tempo de evolução superior a 5 anos (35,9%), a articulação mais acometida foi o joelho com 62 pacientes. Foi demonstrado que existe uma correlação positiva considerável entre o tempo de evolução da doença e o grau de incapacidade, através do valor do coeficiente de Pearson (0,407), resultado que apresenta significância estatística. Conclusões: A osteoartrite é uma doença degenerativa de etiologia variada que ocorre em idade precoce, mais frequentemente no sexo feminino associada à articulação do joelho, havendo correlação entre o tempo de evolução com o grau de incapacidade que produz.
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@#Condylar displacement can lead to temporomandibular joint (TMJ) symptoms and relapse after orthognathic surgery. To minimize condylar displacement, numerous condylar positioning techniques have been applied in clinical practice. To verify the effectiveness of condylar positioning techniques in preventing postoperative TMJ symptoms and relapse, we reviewed the literature related to all types of intraoperative condylar positioning techniques in the past 20 years. According to a literature review, positioning techniques aim to seat the condyles at a preoperative position during surgery and are divided into noncomputer-aided and computer-aided condyle positioning methods. At present, computer-aided design/computer-aided manufacturing condylar positioning devices (CAD/CAM CPDs) are the most superior positioning methods and are composed of teeth-supported and bone-supported guidance. The sequence of the remaining technology positioning effect from high to low is as follows: CAD/CAM titanium plate positioning > manual positioning > computer-aided navigation system > image positioning system. Different techniques reach considerable accuracy within 1-2 mm and 1°-2° in locating the preoperative condylar position and preventing TMJ symptoms or disorders and surgical relapse to provide a clinical reference for different levels of surgeons and cases. However, this study lacks randomized controlled trials with large samples and long-term follow-up. Future studies should upgrade the current methods, improve the clinical utility, and develop new positioning techniques.
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RESUMEN Introducción: La artropatía hemofílica (AH) cursa con diferentes manifestaciones clínicas importantes, como son las hemorragias articulares, el dolor, la disminución de la amplitud del movimiento y las alteraciones funcionales que pueden causar secuelas en la funciona lidad y movilidad. El ejercicio físico adaptado a los pacientes con hemofilia puede ser una adecuada estrategia terapéutica, que repercuta positivamente sobre la calidad de vida de dichos sujetos. Objetivos: Evaluar la eficacia de la rehabilitación física en el tratamiento de la artropatía hemofílica. Materiales y métodos: Se ha realizado una revisión sistemática y metaánálisis de ensayos clí nicos (seleccionados según criterios de elegibilidad). Para ello, se han utilizado las siguientes bases de datos: PEDro, Pubmed, Scopus y Web of Science. Se empleó la escala «PEDro¼ para evaluar la calidad metodológica de los estudios. Resultados: Tras aplicar los criterios de inclusión y exclusión, en la revisión final fueron incluidos siete artículos, los cuales aportaron resultados favorables sobre la fuerza y el diá metro muscular, el rango de movilidad, el estado articular y la calidad de vida. De ellos, dos estudios aportaron datos para metaanálisis, con resultados favorables sobre la variable dolor [Diferencia de medias estandarizada (DME) = -2,64; IC 95%: (-4,26; 1,03)]. Conclusiones: Se encontró evidencia sobre la eficacia de la rehabilitación física en el trata miento de la artropatía hemofílica. El ejercicio terapéutico (ET) es el principal tratamiento realizado; con este se obtuvieron mejoras significativas en distintas variables físicas.
ABSTRACT Introduction: Haemophilic arthropathy presents with different important clinical disorders, such as joint disease, pain, decreased range of motion, and functional alterations that can produce limitations in functionality and mobility. The physical exercise adapted to patients with haemophilia can be an adequate therapeutic strategy, having a positive impact on the quality of life of these subjects. Objectives: To identify the published clinical trials that evaluate the efficacy of physical rehabilitation in the treatment of haemophilic arthropathy. Materials and methods: A systematic review and meta-analysis of clinical trials was con ducted (using pre-defined eligibility criteria). The literature search was performed in the databases: PEDro, Pubmed, Scopus, and Web of Science. The quality of the methods used in the studies was evaluated using the PEDro scale. Results: After applying the inclusion and exclusion criteria, 7 studies were included in this review, providing favourable results on muscle strength and circumference, range of motion, joint disease, and quality of life. Moreover, 2 articles contributed information to the meta-analysis, showing favourable results on pain [Standardised mean difference (SMD) = -2.64; 95% CI: (-4.26; 1.03)]. Conclusions: This systematic review found evidence on the efficacy of physical rehabilitation in the treatment for haemophilic arthropathy. Therapeutic exercise is the main treatment carried out, obtaining significant improvements in the different physical outcomes.
Subject(s)
Humans , Child , Middle Aged , Rehabilitation , Therapeutics , Blood Coagulation Disorders , Patient Care , Hemic and Lymphatic Diseases , Hemophilia AABSTRACT
Objetive: The degenerative diseases of the tempo-romandibular joint (TMJ) are characterized by a progressive destruction of the articular tissues of the condyle and the glenoid fossa. The main aim of this review is to describe the effectiveness of the hyaluronic acid (HA) in the treatment of degenerative diseases of the TMJ in accordance with the available scientific evidence. Material and Methods: A literature search was made in the following databases EBSCO, Pubmed, Cochraneand Trip Database, using the keywords hyaluronic, hyaluronan, NaH, hyaluronate, TMJ, TMD, CMD, craniomandibular, orofacial pain and temporomandibular. There were no date or language restrictions applied. Results: After applying inclusion and exclusion criteria, 14 studies were included in this review (11 randomized controlled clinical trials and 3 non-randomized clinical trials). Conclusion: The studies reported a decrease in pain and improvement in functional parameters after treatment of TMJ osteoarthritis with HA . The use of arthrocentesis associated with the administration of HA provides effects synergistic, reaching a superiority the protocols with multiple injections with respect to those of a single session. The adverse effects related to the injection of HA with or without associated arthrocentesis were minor and transitory.
Resumen: Objetivo: Las enfermedades degenerativas de la articulación temporomandibular (ATM) se caracterizan por una destrucción progresiva de tejidos articulares en el cóndilo y la fosa glenoidea. El objetivo principal de esta revisión es describir la efectividad del uso de ácido hialurónico en el tratamiento de enfermedades degenerativas de la articulación temporomandibular de acuerdo con la evidencia científica disponible. Material y Métodos: Se realizó una búsqueda de la literatura en las bases de datos electrónicas EBSCO, PubMed, Cochrane y Trip Database, utilizando las palabras claves hyaluronic, hyaluronan, NaH, hyaluronate, tmj, tmd, cmd, craniomandibular, orofacial pain y temporomandibular, sin límite de fecha ni de idioma hasta Mayo del año 2020, complementada con una búsqueda retrógrada. Resultados: Con base en los criterios de inclusión y exclusión, 14 estudios fueron incluidos en esta revisión (11 ensayos clínicos controlados aleatorizados y 3 ensayos clínicos controlados no aleatorizados). Conclusión: Los estudios reportaron una disminución del dolor y mejora en los parámetros funcionales luego del tratamiento de osteoartritis de la ATM con AH. El uso de artrocentesis asociada a la administración del AH provee efectos sinérgicos, alcanzando una superioridad los protocolos con múltiples inyecciones con respecto a aquellos de una sola sesión. Los efectos adversos relacionados con la inyección de AH con o sin artrocentesis asociada fueron menores y transitorios.
Subject(s)
Humans , Osteoarthritis/drug therapy , Temporomandibular Joint Disorders/drug therapy , Hyaluronic Acid/administration & dosage , Facial Pain , Viscosupplementation , ArthrocentesisABSTRACT
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.
Subject(s)
Humans , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Studies have shown that arthroscopic single-bundle anterior cruciate ligament reconstruction can restore the forward stability of the knee joint, but the rotational stability of the knee joint and the matching degree with the patellofemoral joint are affected by the central position of the femoral and tibial tunnels. OBJECTIVE: To investigate the relationship between the location of different femoral tunnel centers and patellofemoral articulation and cartilage conditions in young and middle-aged patients with anterior cruciate ligament reconstruction, and to carry out the correlation analysis of patient study factors to further explore the location of the femoral tunnel with the least influence on the patellofemoral joint. METHODS: Seventy patients with anterior cruciate ligament rupture were diagnosed by preoperative MRI, physical examination and intraoperative arthroscopy. All patients were divided into quasi-isometric group and quasi-anatomical group according to the parity of random numbers. In the quasi-isometric group, a Kirschner needle was inserted 7 mm distal to the apex of the lateral wall of the intervertebral fossa using a femoral locator. In the quasi-anatomical group, the Kirschner needle was inserted at the lateral wall of the intercondylar fossa and at the foot print center of the original anterior cruciate ligament. The central coordinates of the femoral tunnel were evaluated on the near-far-front-rear plane based on a standardized grid system, while the central coordinates of the tibial tunnel was evaluated on the anterior-posterior-inner-outer plane, labeled as quadrant Y% and quadrant X%. By comparing the baseline data of patients in the two groups, the difference of lateral patellofemoral angle (LPFA), the difference of cartilage quantitative T2 value, and the correlation between various research factors, the surgical operators were further guided to carry out clinical practice. The implementation of the study protocol complied with the relevant ethical requirements of the First Affiliated Hospital of Anhui Medical University, and all patients signed an informed consent form prior to the participation in the trial. RESULTS AND CONCLUSION: There was no significant difference in baseline data between the two groups, but a significant difference in LPFA existed between the two groups, (0.57±0.33)° in the quasi-anatomical group vs. (1.55±0.36)° in the quasi-isometric group (P<0.001). The T2 values of medial patella, lateral patella and trochlear cartilage in the quasi-anatomical group were all smaller than the corresponding values of the quasi-isometric group. Quadrant X% had a significant negative correlation with LPFA difference (R=-0.664, P<0.01). Quadrant Y% was positively correlated with LPFA difference (R=0.804, P<0.01). The difference of LPFA was significantly positively correlated with T2 values of trochlear and patellar outer cartilage (R=0.651, 0.655, P<0.01). T2 values of trochlea and lateral patella cartilage were negatively correlated with postoperative Lysholm score (R=-0.505, -0.529, P<0.01). Quadrant Y% was highly correlated with T2 value of lateral patella (R=0.825, P<0.01), and significantly correlated with T2 value of trochlear cartilage (R=0.798, P<0.01). Quadrant X% was negatively correlated with T2 values of lateral patella and pulley cartilage (R=-0.639, -0.657, P<0.01). By exploring the change of the patellofemoral joint at early stage after single-bundle anterior cruciate ligament reconstruction, we found that the quasi-anatomical reconstruction relative to the quasi-isometric reconstruction requires less patellofemoral articular cartilage degeneration and smaller patellar tilt angle. Therefore, the surgeon is required to local the center point of the femoral tunnel as far as possible at the quasi-anatomical position, thereby minimizing the degeneration of the patellofemoral joint.
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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.
Subject(s)
Humans , Temporomandibular Joint/anatomy & histology , Temporomandibular Joint/physiopathology , Fibrocartilage/anatomy & histology , Fibrocartilage/physiopathologyABSTRACT
BACKGROUND: Three-dimensional (3D) printing-assisted total hip arthroplasty plays an important role in preoperative planning, intraoperative guidance and positioning, and production of individualized implants. It has important clinical significance for the treatment of hip joint diseases. OBJECTIVE: To evaluate the clinical efficacy of preoperative planning using 3D printed models to assist total hip arthroplasty by systematic evaluation and meta-analysis. METHODS: PubMed, Embase, Cochrane Libray, CNKI, Wanfang databases were retrieved electronically for the articles published before December 2019. The keywords were “hip arthroplasty, hip replacement, THA, 3D printing, three dimensional printing” in Chinese and English, respectively. The clinical controlled trials of 3D printed models versus non-3D printed models to assist total hip arthroplasty in the treatment of hip joint diseases were enrolled. The literature was screened according to the inclusion and exclusion criteria; data were extracted; and the quality of the included studies was evaluated using the Cochrane 5.1.0 bias risk assessment tool, followed by data analysis using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Fourteen controlled studies were included, involving 601 participants, including 279 cases in the 3D group and 322 cases in the traditional surgery group. (2) Meta-analysis results showed that during the first hip arthroplasty, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-0.89, 95%CI (-1.15, -0.64), P 0.05]. During revision surgery, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-1.39, 95% CI (-1.92, -0.86), P < 0.05], and Harris score was higher than that in the traditional surgery group [SMD=1.51, 95%CI (-0.05, 2.96), P < 0.05]. The intraoperative blood loss and postoperative drainage volume in the 3D group were less than those in the traditional surgery group [SMD=-1.90, 95%CI (-2.82, -0.99), P < 0.05; SMD=-2.87, 95%CI (-3.36, -2.37), P < 0.05]. The anteversion angle and abduction angle in the 3D group were closer to the preoperative design angle compared with the traditional surgery group [SMD=-1.24, 95%CI (-1.57, -0.91), P < 0.05; SMD=-1.71, 95%CI (-2.96, -0.45), P < 0.05]. (3) These results show that compared with traditional total hip arthroplasty, 3D printing assisted total hip arthroplasty can significantly shorten the operation time, reduce the amount of intraoperative blood loss and postoperative drainage, improve the accuracy of total hip arthroplasty, and can better relieve pain, and improve the quality of life. However, due to the low quality of the included literature, high-quality large-sample, multi-center randomized controlled trials are still needed to confirm the clinical efficacy.
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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.
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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.
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@#Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints with the involvement of other systems. Previous studies have demonstrated its association with chronic periodontitis (CP), a chronic inflammatory disease of tooth-supporting tissues. Positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in RA patients have been found to be associated with CP. The aim of this study is to determine the prevalence of CP in RA patients, and to investigate the association of ACPA, RF status and RA disease activity with CP and non-CP RA patients. Materials and Methods: A comparative cross-sectional study involving 98 RA patients was conducted at Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia. Clinical oral examination was carried out to determine the CP status of RA patients. RF, ACPA and erythrocyte sedimentation rate (ESR) were measured, and the 28-joint Disease Activity Score (DAS-28) was assessed. Results: Forty-five patients (45.9%) were found to have CP (95% CI: 0.36-0.56). No significant difference was observed in the prevalence of positive RF (p=0.989) or ACPA (p=0.431) in CP and non-CP RA patients. There was also no significant association between active RA disease (DAS-28 score ≥3.2) and RF positivity in CP (p=0.927) and non-CP (p=0.431) RA patients as well as ACPA positivity in CP (p=0.780) and non-CP (p=0.611) RA patients. Conclusion: In our cohort of RA patients, we did not find significant associations between elevated RF, ACPA, or active RA disease with the presence of CP. There were also no significant associations between elevated RF or ACPA with active RA disease.
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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.
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Objective@#To explore the evaluation of joint injury by HEAD-US-C (Hemophilic Early Arthropathy Detection with UltraSound in China, HEAD-US-C) in patients with moderate or severe hemophilia A treated with prophylaxis vs on-demand.@*Methods@#The patients from June 2015 to July 2017 with moderate or severe hemophilia A were examined by ultrasound imaging of the elbows, knees and ankles; Meanwhile the HEAD-US-C ultrasound assessment scale and hemophilia joint health score scale 2.1 (HJHS2.1) were used to score the joint status. The correlation between the HEAD-US-C and HJHS score was performed in prophylaxis group and on-demand group patients, respectively.@*Results@#A total of 925 cases of joint ultrasonography were conducted in 70 patients with moderate or severe hemophilia A. Among patients with moderate hemophilia, the median (IQR) of HEAD-US-C score and HJHS score in on-demand group were significantly higher than those in the prophylaxis group[1 (0, 6) vs 0.5 (0, 3) , z=0.177, P=0.046],[2 (0, 4) vs 2 (0, 3) z=0.375, P=0.007], even though there was no significant difference of the median (IQR) number of annualized target joints bleeding episodes between on-demand and prophylaxis groups[1 (0, 7) vs 1 (0, 5) , z=1.271, P=0.137]. Unlike in moderate cases, on-demand treatment group had more annualized target joints bleeding episodes than prophylaxis group among patients with severe hemophilia[3 (0, 8) vs 2 (0, 8) , z=0.780 P=0.037]. The prophylaxis group compared favorably with on-demand therapy group in terms of HEAD-US-C score[1 (0, 6) vs 4 (0, 7) , z=2.189, P=0.008], and HJHS score[2 (0, 5) , 4 (1, 6) , z=3646, P<0.001]for the severe hemophilia patients. The positive correlation between HEAD-US-C score and HJHS score was identified (P<0.05) , whether on-demand treatment or prophylaxis groups. The correlation coefficient between HEAD-US-C score and HJHS score in on-demand treatment and prophylaxis groups were 0.739 (95% CI 0.708-0.708) , 0.865 (95% CI 0.848-0.848) respectively, and 95% CI didn’t overlap (P<0.05) , indicating that the correlation coefficient in prophylaxis group had stronger correlation than that in on-demand group.@*Conclusions@#Clinical effects of prophylaxis were significantly better than those of on-demand treatment in patients with moderate or se-vere haemophilia A. HEAD-US-C scoring system could effectively evaluate joints damage in hemophilia A patients treated with on-demand or prophylaxis, companied by significantly positive correlation with HJHS clinical evaluation system, and provided objective index for clinical effect assessment.
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The prevalence of joint diseases in Japan is increasing yearly and it causes the need of nursing care and reduces quality of life. Therefore, there is an urgent need for the development of approaches to prevent and treat the diseases. In the present study, we investigated the effective, healthy food material focusing on the metabolism of joint cartilage. Ampelopsis glandulosa (A. g. ) extract improved exacerbation of hyaluronic acid metabolism and NFκB nuclear translocation caused by inflammatory cytokines, and it suppressed the onset of collagen-induced arthritis in mice. Moreover, intake of the drink containing A. g. extract for three months improved discomfort, pain, and bending angle of knee joint in activities of daily living. These results suggest that A. g. extract improves hyaluronic acid metabolism of joint cartilage, and it is expected to prevent and improve joint disease by long-term intake of the drink containing A. g. extract.
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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.
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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.
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Objective To analyze the clinical characteristics of children with knee joint diseases and discuss the curative effect of arthroscopy.Methods Eighty-nine children with knee joint diseases in Department of Orthopedics,the First Affiliated Hospital of Xinxiang Medical University from October 2012 to October 2015 were selected,and they were given knee arthroscopic surgery according to the disease types and characteristics,such as meniscal suture,suture plus angioplasty and synovectomy etc.All the symptoms,signs and the joint functions were recorded preoperatively and postoperatively.At the end of follow-up,surgical results were analyzed according to Lysholm score and International Knee Documentation Committee Knee evaluation form (IKDC) classification standard.Results The patients with discoid meniscus tear were the most,accounting for 55.55％ (55/99 knees).All patients were followed up for 6-30 months(the average time was 21 months) to find that all symptoms were relieved or disappeared within 1 year after operation.The outcome was evaluated according to the Tegner knee function:76 knees (76.76％) were markedly effective,16 knees (16.16％) were effective,6 knees (6.06％) were invalid and 1 knee (1.01％) was poor,and the excellent rate was 92.92％.The curative effect was evaluated according to Lysholm knee function score and IKDC score at the last follow-up.The Lysholm score in preoperation [(52.46 ± 4.79) scores] improved to (96.52 ± 3.97) scores in postoperation,and the difference was significant (t =-36.24,P ＜ 0.05);the IKDC score in preoperation [(46.52 ± 10.25) scores] improved to (90.67-± 5.89) scores in postoperation,and the difference was significant (t =-50.69,P ＜ 0.05).There was no joint infection,blood vessel or nerve damage and so on.Conclusions Meniscus tear is common in children with knee joint diseases,and most common is discoid lateral meniscus tear,and arthroscopy can have satisfactory outcome,with no obvious complications.Therefore,arthroscopic surgery is an ideal method for surgical treatment of children with knee joint disease.
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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)
Subject(s)
Animals , Male , Female , Dogs , Hip Dysplasia, Canine , Osteoarthritis/veterinary , Joint Instability/veterinary , Radiography/veterinaryABSTRACT
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."