Interstitial cystitis - intravesical treatment

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

Consideraciones clínicas e imagenológicas de la osteoartrosis en la articulación temporomandibular / Clinical and imaging remarks on temporomandibular joint osteoarthrosis

La osteoartrosis es una enfermedad degenerativa que, instalada en la articulación temporomandibular, genera efectos deletéreos en los tejidos blandos y óseos que la constituyen. En los tejidos duros se destaca la aparición de procesos osteolíticos a nivel condilar y de la cavidad glenoidea con cambios morfológicos importantes. Estas modificaciones están íntimamente relacionadas con el debilitamiento y/o destrucción de los tejidos blandos que ocurren previamente. Los síntomas que se presentan con mayor frecuencia en esta afección son la alteración del rango de movimiento, el dolor y, el más característico, la crepitación durante el examen con estetoscopio. La frecuencia de aparición alcanza entre un 8% y un 18%. Las causas para su documentación son variables y están vinculadas al desplazamiento discal, el trauma, hormonales y la inestabilidad oclusal, siendo el aumento de carga (bruxismo) la de mayor significación. El examen imagenológico puede documentar aplanamiento de los componentes óseos, disminución del espacio articular, discontinuidad de las corticales, esclerosis subcondral, osteofitos, quistes subcondrales y cuerpos libres periarticulares. En ocasiones la radiografía panorámica puede ser poco demostrativa para la documentación de esas particularidades; por el contrario, la tomografía computada es un excelente procedimiento diagnóstico. El aporte de la IRM es relevante en la ubicación del disco articular; asimismo, posibilita la observación de colección de fluido en los espacios articulares, generando una señal hiperintensa. Tratamiento: actuar principalmente para disminuir la carga sobre la ATM y,`por lo tanto, concientizar al paciente de la presencia del bruxismo, instalar un dispositivo oclusal miorrelajante (DOM) y suplementar con analgésicos, antiinflamatorios y antiartrósicos. Cuando la OA está asociada al desplazamiento discal, debe indicarse un dispositivo oclusal de desplazamiento anterior mandibular (DODAM) (AU)

Osteoarthrosis is a degenerative disease. When is located in the TMJ produces deleterious effects in its soft and hard tissues, osteolytic processes on condyle and glenoid cavity in the latter, with significant morphological changes, closely related to weakening and destruction of the tissues that had happened previously. Symptoms most frequent are alteration of the range of movement, pain and,the most characterystic, cracking while examination through stethoscope. Its frequency is between 8 and 18%.Causes for its documentation are variable and related to disc displacement, trauma, hormones and occlusal unsteadiness, being de increase of charge (clenching) the most relevant. Imaging can show flattening on osseusparts,, the articular space, discontinuation of cortexes, subchondral sclerosis, osteophytes, subchondral cysts,and loose particular bodies. Sometimes orthopantomograph may be barely demonstrative to document these phenomena, conversely CT is an excellent diagnostic procedure. The contribution of MRI is relevant to locate articular disc, and facilitate visualize fluid collection within the articular spaces, producing a hiperintense signal. Treatment: to act mainly for diminishing charge on the TMJ, so to raise patients conscience of the presence of clenching, install a myorelaxant occlusal device (DOM) and additionally analgesics, antiinflamatories and antiarthrosis When osteoarthrosis is associated with disc displacement and occlusal device for anterior mandibular displacement (DODAM) is suitable(AU)

Chondroitin sulfate and glucosamine in the cartilage and subchondral bone repair of dogs - Histological findings / Sulfato de condroitina e glucosamina na reparação da cartilagem e do osso subcondral de cães - Achados histológicos

Chondroitin and glucosamine sulfate nutraceuticals are commonly used in the management of degenerative articular disease in veterinary routine. However, there are controversies on the contribution of these substances to articular cartilage. The purpose of this study was to evaluate the efficiency of a chondroitin and glucosamine sulfate-based veterinary nutraceutical on the repair of an induced osteochondral defect in a dog femoral condyle, by macroscopic, histological and histomorphometric analyses. The nutraceutical was orally administered the day following injury induction, every 24 hours (treated group, TG, n=24), compared with animals that did not receive the product (control group, CG, n=24). Six animals per group were anaesthetized for sample collection at 15, 30, 60 and 90 days after surgery. At 15 days, defects were macroscopically filled with red-pinkish tissue. After 30 days, whitish color tissue was observed, both in TG and CG animals, with firmer consistency to touch at 60 and 90 postoperative days. Histological analysis demonstrated that, in both groups, there was initial blood clot formation, which was subsequently substituted by a fibrin net, with capillary proliferation from the adjacent bone marrow and infiltration of mesenchymal cells in clot periphery. As cellular differentiation developed, repair tissue presented a fibrocartilage aspect most of the time, and new subchondral bone formation occurred in the deepest area corresponding to the defect. Histomorphometry suggested that the nutraceutical did not favor the articular cartilage repair process. It was concluded that nutraceutical did not significantly influence chondrocytes proliferation or hyaline architecture restoration.(AU)

Os nutracêuticos compostos de sulfato de condroitina e glucosamina são comumente utilizados no manejo da doença articular degenerativa na rotina veterinária. Entretanto, existem controvérsias sobre a contribuição dessas substâncias à cartilagem articular. O objetivo deste trabalho foi avaliar a eficácia de um nutracêutico veterinário à base de sulfato de condroitina e glucosamina na reparação de defeitos osteocondrais induzidos no côndilo femoral de cães, através de análises macroscópica, histológica e histomorfométrica. O nutracêutico foi administrado no dia seguinte à indução da lesão, pela via oral, a cada 24 horas (grupo tratado - GT, 24 animais), sendo comparado a animais que não receberam o produto (grupo controle - GC, de igual número de animais). Aos 15, 30, 60 e 90 dias após a cirurgia, seis animais por grupo foram anestesiados para ser realizada a coleta das amostras. Aos 15 dias, os defeitos eram macroscopicamente preenchidos por tecido de coloração rósea a avermelhada. Já a partir dos 30 dias, observou-se preenchimento por tecido de coloração esbranquiçada, tanto nos animais do GT quanto nos do GC, com consistência mais firme ao toque digital aos 60 e 90 dias de pós-operatório. A análise histológica revelou que, em ambos os grupos, houve inicialmente formação de coágulo sanguíneo que, posteriormente, foi substituído por uma rede de fibrina, com proliferação de capilares a partir da medula óssea adjacente e infiltração de células mesenquimais na periferia do coágulo. À medida que se processou a diferenciação celular, o tecido de reparação se apresentou na maioria das vezes com aspecto de fibrocartilagem e, na região mais profunda da área correspondente ao defeito, ocorreu formação de osso novo subcondral. A histomorfometria sugeriu que o nutracêutico não favoreceu o processo de reparação da cartilagem articular. Concluiu-se que o nutracêutico não influenciou consideravelmente na proliferação de condrócitos nem na restauração da arquitetura hialina.(AU)

A influência da suplementação de sulfato de condroitina na dor e nos aspectos funcionais associados à osteoartrose / Influence of chondroitin sulfate supplementation in pain and functional aspects associated with osteoarthritis

Introdução: A osteoartrose é a principal causa de limitação da funcionalidade e incapacidade nos idosos. Dentre os tratamentos farmacológicos está a suplementação com sulfato de condroitina. Objetivo: Realizar uma revisão sistemática sobre a influência do sulfato de condroitina na dor e aspectos funcionais associados à osteoartrose. Métodos: Foram utilizados os descritores "osteoarthritis" e "chondroitin". Os artigos foram selecionados de forma independente e cega, por dois pesquisadores. Foram incluídos somente ensaios clínicos primários, escritos na língua portuguesa, inglesa e espanhola entre 2005 a 2013. A escala PEDro foi utilizada como instrumento de avaliação. Resultados: Foram encontrados 1.916 estudos, permanecendo nove artigos para a análise. Dos nove analisados, quatro mostraram a eficácia da suplementação do sulfato de condroitina na redução da dor e da incapacidade funcional, enquanto cinco investigações não mostraram efeitos estatisticamente significantes. Conclusões: A influência do sulfato de condroitina na dor e aspectos funcionais na osteoartrose permanece questionável.

Introduction: Osteoarthritis is the leading cause of limitation of functionality and disability in the elderly. The supplementation with chondroitin sulfate is among the pharmacological treatments. Objective: To conduct a systematic review of the influence of chondroitin sulfate on pain and functional aspects associated with osteoarthritis. Methods: The keywords "osteoarthritis" and "chondroitin" were used. The articles were selected independently and blindly by two researchers. Only primary clinical trial, written in Portuguese, English and Spanish in the period between 2005 to 2013 were included. The PEDro scale was used as an evaluation tool. Results: A total of 1.916 studies with appropriate descriptors were found, and nine of these papers remained for analysis. Of these nine studies analyzed, four showed the effectiveness of supplementation of chondroitin sulfate in reducing pain and functional disability, while five studies showed no statistically significant effects. Conclusions: The influence of chondroitin sulfate in pain and functional aspects in osteoarthritis remains questionable.

Evaluación de la eficacia y seguridad del ácido hialurónico por vía oral asociado con glucosamina sulfato, condroitín sulfato y metilsulfonilmetano comparado con la asociación por vía oral de glucosamina sulfato, condroitín sulfato y metilsulfonilmetano en la osteoartritis de rodilla / Evaluation of the efficacy and safety of the orally association of hyaluronic acid, glucosamine sulfate, chondroitin sulfate and methylsulfonylmethane compared with the association of glucosamine sulfate, chondroitin sulfate and methylsulfonylmethane in knee osteoarthritis

Objetivo. Comparar la eficacia y la seguridad de la asociación de ácido hialurónico (AH), glucosamina sulfato (GS), condroitina sulfato (CS) y metilsulfonilmetano (MSM) versus GS, CS y MSM en el control de los síntomas de la osteoartritis (OA) de rodilla. Material y Método. Estudio comparativo, aleatorizado prospectivo, a doble ciego, en pacientes con OA de rodilla, divididos en dos grupos, durante tres meses de tratamiento diario, vía oral. El grupo 1 recibió AH 120 mg + GS 1 500 mg + CS 1 200 mg + MSM 1 000 mg y el grupo 2, la misma asociación pero sin AH. Se incluyeron hombres y mujeres mayores de 40 años y menores de 80 años con diagnóstico de OA de rodilla, según el criterio modificado del Colegio Americano Reumatología (ACR). Se realizaron cuatro evaluaciones, inicial y a las 4, 8 y 12 semanas de tratamiento. El dolor se evalúo con la escala de WOMAC 3.1 y la escala visual análoga (EVA) y el estado de salud, con el cuestionario SF-36 versión 2. En todas las visitas se proporcionó al paciente un formulario para que anote la presencia de algún evento adverso. Resultados. Los grupos 1 y 2 tuvieron similares datos en edad, género, grado de instrucción y tiempo de enfermedad, sin diferencia estadística significativa. Todos los pacientes cumplieron con los criterios del ACR. El grupo 1 tuvo mejores puntajes con diferencia estadísticamente significativa en la variable EVA entre todos los grupos en la semana 12 y en la variable SF-36 en la semana 12. Conclusiones. Se puede concluir que la asociación GS-CS-MSM-AH por vía oral sería más eficaz y de igual seguridad que la asociación GS-CS-MSM en el control de los síntomas de la OA de rodilla.

Objective. To compare the efficacy and safety of the orally combination of hyaluronic acid (HA), glucosamine sulfate (GS), chondroitin sulfate (CS) and methylsulfonylmethane (MSM) versus GS, CS and MSM for controlling the symptoms of osteoarthritis (OA) knee. Material and Methods. Prospective randomized, double-blind, comparative study, in patients with knee OA were divided into two groups for three months of daily treatment, orally. Group 1 received HA 120 mg + GS 1500 mg + CS 1200 mg + MSM 1000 mg, and group 2, the same association but without HA. Men and women aged 40 years and under 80 years diagnosed with knee OA were included, according to the modified criteria of the American College of Rheumatology (ACR). Four evaluations, initial and at 4, 8 and 12 weeks of treatment were made. Pain was assessed with the WOMAC 3.1 scale and visual analogue scale (VAS) and health status with the SF-36 version 2 questionnaire. In all patient visits provided a form to record the presence of any adverse events. Results. Groups 1 and 2 were similar in age, gender, level of education and sick time, without statistically significant differences. All patients fulfilled the ACR criteria. Group 1 had better scores with statistically significant difference in VAS variable among all groups at week 12 and the SF-36 variable in week 12. Conclusions. It can be concluded that HA-GS-CS-MSM orally association would be more effective and equally safety that GS-CS-MSM association in controlling the symptoms of knee OA.

Biocompatibility of Ferrara intracorneal ring segment with and without chondroitin sulfate coating: clinical and histopathological evaluation in rabbits

PURPOSE: To investigate and compare the biocompatibility of two types of Ferrara intracorneal ring segment: with and without chondroitin sulfate coating by clinical and histopathological evaluation. METHODS: A randomized experimental study was carried out on thirty right-eye corneas from 30 Norfolk albino rabbits allocated into two experimental groups: Group G1 - implanted with Ferrara intracorneal ring segment without coating (FICRS) and Group G2 - implanted with Ferrara intracorneal ring segment with chondroitin sulfate coating (FICRS-CS). Left eyes formed the control group. Clinical parameters analyzed were: presence of edema, vascularization, infection and ring extrusion one, 30, and 60 days after surgery. Histopathological parameters analyzed were: number of corneal epithelial layers over and adjacent to the ring, presence of spongiosis, hydropic degeneration, basement membrane thinning, inflammatory cells, neovascularization and pseudocapsule formation. RESULTS: At clinical examination 60 days after implant, edema, vascularization and extrusion were observed respectively in 20%, 26.7%, 6.7% of FICRS corneas and in 6.7%, 6.7%, and 0% of FICRS-CS corneas. Histopathological evaluation showed epithelial-layer reduction from 5 (5;6) to 3 (3;3) with FICRS and from 5 (5;5) to 4 (3;5) with FICRS-CS in the region over the ring. Epithelial spongiosis, hydropic degeneration, and basement membrane thinning were present in 69.2%, 53.8%, and 69.2% of FICRS and in 73.3%, 73.3%, and 46.7% with FICRS-CS, respectively. Vascularization was present in 38.5% of FICRS and 13.3% with FICRS-CS, inflammatory cells in 75% of FICRS and 33.3% with FICRS-CS, and pseudocapsule in 66.7% of FICRS and 93.3% with FICRS-CS. Giant cells occurred only in the FICRS-CS group (20%). CONCLUSION: Ferrara intracorneal rings coated with chondroitin sulfate (FICRS-CS) caused lower frequency of clinical and histopathological alterations than Ferrara intracorneal rings without the coating (FICRS), demonstrating higher biocompatibility of the FICRS-CS.

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.

Disfunción temporomandibular: el desplazamiento discal asociado a asimetría por alteración de crecimiento cóndilomandibular: dos casos clínicos / Temporomandibular dysfunction: disc displacement associated with asymmetry due to mandibular condyle growth alteration: two clinical cases

El desplazamiento discal en la articulación temporomandibular es una afección habitual. En algunos casos, el disco desplazado sin reducción, puede producir, si la manifestación ocurre durante el período de crecimiento, alteraciones de desarrollo cóndilo mandibular, tales como asimetrías y disminución del tamaño de esas estructuras a partir de procesos degenerativos a nivel condilar. Estos hechos han sido observados en otros estudios de los que se hace una breve reseña. A continuación se presentan dos casos clínicos en pacientes con DDsR, proceso degenerativo condilar, alteración de crecimiento y asimetría.