Muscle function, physical function, and gait in older women with and without knee osteoarthritis

Abstract Aim: To compare muscle function of knee extensors, gait parameters, and physical function in older women with and without knee osteoarthritis (KOA) and to associate these parameters to the KOA incidence in this population. Methods: Sixteen older women with KOA (66.9 ± 5.5 years; 74.9 ± 10.0 kg; 157.9 ± 0.9 cm; 30.2 ± 5.0 kg/m2) and fourteen healthy counterparts (control group: CG; 68.8 ± 5.8 years; 68.9 ± 10.5 kg; 158 ± 0.06 cm; 27.4 ± 4.0 kg/m2) participated in this study. Muscle function, physical function, and gait parameters were evaluated in both groups. The Western Ontario and McMaster Index (WOMAC) questionnaire was answered only by the KOA group. A correlation was performed to verify if KOA incidence was associated with muscle function, physical function, and gait parameters. Results: KOA group showed lower peak torque at 60°/s (30%; p = 0.003) and 180°/s (37%; p < 0.001), greater acceleration time at 60°/s (382%; p < 0.001), lower cadence (12.2%; p = 0.002), slower gait speed (19.5%; p < 0.001) and greater stride time (12.5%; p = 0.001) than CG group. However, there was no difference between groups in physical function (p < 0.0045). The KOA incidence presented a negative correlation with peak torque (rho = −0.602; p < 0.001), cadence (rho = −0.533; p = 0.002), gait speed (rho = −0.633; p < 0.001), stride length (rho = −0.517; p = 0.003) and a positive correlation with stride time (rho = 0.533; p = 0.002) and acceleration time (rho = 0.655; p < 0.001). Conclusion: Our findings suggest that knee osteoarthritis may impair the function of the knee extensors muscles and gait parameters. An association between the ability to produce force rapidly and gait speed with the KOA incidence in older women was also observed.

Functional index for hand osteoarthritis (FIHOA) is associated with pain, muscle strength, and EQ-5D in hand osteoarthritis

Abstract Background: This study identified whether Functional Index for Hand Osteoarthritis (FIHOA) is associated with pain, hand muscle strength, health-related quality of life, and radiographic severity in hand osteoarthritis (OA). Methods: We consecutively recruited 95 patients with hand OA. The FIHOA was used to assess questionnaire-based physical function in hand OA. Health-related quality of life was evaluated using EuroQol-5 dimension (EQ-5D). Radiographic changes of hand joints were measured by Kellgren-Lawrence (K-L) grade, which was determined based on total radiographic severity score and number of affected joints. Other measures included patient's visual analogue scale (VAS) score for pain and performance-based function indexes such as grip and pinch strength. Statistical analysis was performed using Mann-Whitney U test, Spearman's correlation analysis, and multivariate logistic regression analysis. Results: FIHOA score was negatively associated with grip and pinch hand strength and EQ-5D and positively correlated to VAS pain (p < 0.05 for all). There were significant differences of grip and pinch strength, VAS pain, EQ-5D index, and EQ-VAS between two FIHOA groups (≤ 4 vs. > 4) (p < 0.05 for all). Multivariate logistic regression analysis showed that higher FIHOA score (FIHOA > 4) was related with increased VAS pain and with lower EQ-5D index (p = 0.008 and p = 0.013, respectively). There was no association between FIHOA score and measures of total radiographic severity score and number of affected joints. Conclusion: This study observes that FIHOA score is associated with patient-reported VAS pain, hand muscle strength indexes, and EQ-5D but not radiographic severity in hand OA.

Ejercicio en ratas con osteoartritis: aspectos morfológicos y una revisión de la literatura / Exercise in rats osteoarthritis: morphological aspects and literature review

La osteoartritis (OA) es una enfermedad crónica, degenerativa, muy invalidante, que destruye en forma gradual y progresiva el cartílago articular en diversas regiones: rodillas, caderas, hombros, manos, tobillos y columna vertebral. En este sentido, el ejercicio ha sido descrito como la intervención no farmacológica más recomendada para pacientes con OA. La práctica regular de ejercicio es considerada un componente integral del estilo de vida saludable; sin embargo, su efecto en el cartílago se mantiene como objeto de debate y especulaciones, así como la relación del ejercicio con el desarrollo de OA. Algunos estudios de modelos animales sugieren que el ejercicio puede ser beneficioso para la salud del cartílago, mientras otros demuestran su efecto nocivo. Una explicación general a estos resultados inconsistentes es que el correr a intensidad moderada tiene efectos beneficiosos, mientras que correr "vigorosamente" o de manera "extenuante" lleva a un efecto nocivo. El objetivo de este trabajo consistió en realizar una revisión de la literatura acerca de los efectos del ejercicio sobre el cartílago artícular, especialmente enfocado a modelos animales experimentales con ratas.

Osteoarthritis (OA) is a chronic, degenerative, and very disabling disease that gradually and progressively destroys articular cartilage in various regions: knees, hips, shoulders, hands, ankles and spine. In this sense, exercise has been described as the most recommended non-pharmacological intervention for patients with OA. Regular exercise is considered an integral component of the healthy lifestyle. However, its effect on cartilage remains the subject of debate and speculation, as well as the relationship between exercise and the development of OA. Some animal model studies suggest that exercise may be beneficial for cartilage health, while others demonstrate its harmful effect. A general explanation for these inconsistent results is that running at moderate intensity has beneficial effects, while running "vigorously" or "strenuously" leads to a harmful effect. The aim of this work was to make a literature review about the effects of exercise on cartilage, especially focused on experimental animal models with rats.

Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations

Abstract Background: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. Methods: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. Results: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. Conclusions: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.(AU)

Hylan G-F20 and galactomannan joint flares are associated to acute synovitis and release of inflammatory cytokines

Abstract Background: Injection of Hylan G-F20 (HY) into joints may provoke local flares, which mechanisms may involve reaction to protein contaminants. We have previously developed a protein-free saline-soluble galactomannan derived from guar gum (GM) that displays both analgesia and chondroprotection in experimental osteoarthritis (OA). We now demonstrate that both GM and Hylan G-F20 (HY) promote mild synovitis with cytokine release after intra-articular injection. Methods: Mice received 100 μg/25 μL GM or HY or saline into the knees. Joint pain was evaluated using von Frey test; cell influx, interleukin (IL)-1, IL-6, and CXCL-1 (pg/mL) levels were assessed in joint lavage at 6 h. Synovia were excised for histopathology. Results: Neither GM nor HY after being given into mice knee joints induced pain albeit promoting mild cell influx into joint washings as well as mild synovitis at histology, with no damage to the underlying cartilage. HY but not GM promoted IL-1 release into mice joints. Both compounds induced IL-6 and CXCL-1 release. Conclusion: Intra-articular injection of HY or GM promote acute transient synovitis whilst not provoking detectable significant joint damage. Local administration of these polysaccharides induces acute intra-articular release of inflammatory cytokines, which may account for joint flares following viscosupplementation.(AU)

Functional status and severity of osteoarthritis in elderly is associated to the polymorphism of TNFA gene

Abstract Background: Osteoarthritis (OA) is a major musculoskeletal disease with high prevalence in the elderly. The study of genetic polymorphisms of inflammatory mediators involved in OA may contribute to the elucidation of the complex pathophysiology of this disease and identification of susceptibility individuals. Aim: This study aimed to evaluate the association between polymorphism at tumor necrosis factor alpha gene (SNP - 308 G/A TNFA) with presence, severity and functional status of osteoarthritis in elderly. Methods: This study was characterized as case-control and encompassed 257 physically independent elderly (Mean Age: 68.55 ± 5.2; Minimum age: 60 and Maximum age: 82) were recruited. After this selection, the groups were divided in: 92 elderly individuals with osteoarthritis (case group) and 165 without the disease (control group). Methods: The individuals were genotyped by the TaqMan real-time PCR system. The subjects were classified based on the degree of radiological impairment according to the criteria of Kellgren-Laurence and regarding functional impairment using the WOMAC and LEQUESNE questionnaires. Results: TNFA gene polymorphic individuals (subjects harboring allele A) are more affected by OA (χ2 = 8.7, p = 0.003), once they have major radiological lesion both in hip (Fisher-Freeman-Halton Test = 3.9, p = 0.04) and knee (Fisher- Freeman-Halton Test = 4.0, p = 0.04) as well as worse functional status assessed by the Lequesne questionnaire (Mann- Whitney, p = 0.04). At the multivariate analysis, after adjustment for age, gender, body mass index, the presence of rare allele for TNFA (allele A) increases the susceptibility to OA development [OR: 1.87 (95% CI: 1.1 —3.2)]. Conclusion: We conclude that the SNP - 308 G/A of TNFA gene may affect osteoarthritis susceptibility, severity and functional status of individuals with osteoarthritis.

Análise das internações por osteoartrite em mulheres em idade menopausal / Analysis of hospitalizations for osteoarthritis of women in menopausal

OBJETIVO: Identificar e avaliar dados epidemiológicos referentes à osteoartrite em mulheres em idade menopausal. MÉ- TODOS: Pesquisa e análise de informações de saúde disponibilizadas pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), utilizando-se as variáveis artrose, sexo feminino, faixa etária de 40 a 59 anos, período de janeiro de 2012 a dezembro de 2016. RESULTADOS: Nos 5 anos estudados, notificaram-se 13.077 internações por osteoartrite em mulheres em idade menopausal, 2.180 delas (16,67%) em 2012, 2.557 (19,55%) em 2013, 2.686 (20,53%) em 2014, 2.792 (21,35%) em 2015 e 2.862 (21,88%) em 2016. A Região Sudeste se destacou, com 54,84% do total de internações, das quais 1.983 se deram de 40 a 49 anos e 5.313, de 50 a 59 anos. Nas outras regiões, o número de internações, de 40 a 49 anos, foi de 94 pacientes no Norte, 370 no Nordeste, 955 no Sul e 214 no Centro-Oeste; já de 50 a 59 anos, o Norte notificou 182 internações; Nordeste, 684; Sul, 2.827; e Centro-Oeste, 455. O Nordeste apresentou maior média de permanência hospitalar (5,9 dias), porém teve o segundo menor gasto por internação (R$2.836,00); já o Sudeste foi responsável pelo montante de R$22.640.928,14 em gastos totais. CONCLUSÃO: De 2012 a 2016, o índice de internações por osteoartrite em mulheres de 40 a 59 anos no território brasileiro mostrou ligeiro aumento. Isso é um dado preocupante, pois esta é uma afecção de manejo predominantemente ambulatorial; logo, infere-se que são necessárias mais ações de prevenção, tratamento e reabilitação, principalmente, na Região Sudeste, que detém mais de 50% das internações. (AU)

OBJECTIVE: To identify and evaluate epidemiological data regarding osteoarthritis in menopausal women. METHODS: Research and analysis of health information provided by the Department of Informatics of the Unified Health System (DATASUS), using the variables osteoarthritis, female gender, age range of 40-59 years, from January 2012 to December 2016. RESULTS: In the 5 years studied, 13,077 hospitalizations for osteoarthritis were reported in menopausal women, 2180 of them (16.67%) in 2012; 2557 (19.55%) in 2013; 2686 (20.53%) in 2014; 2792 (21.35%) in 2015; and 2862 (21.88%) in 2016. The Southeast region stands out with 54.84% of the total hospitalizations, of which 1983 were reported between 40-49 years old, and 5313, from 50 to 59 years. In the other regions, the number of hospitalizations between 40-49 years old was of 94 patients in the North, 370 in the Northeast, 955 in the South, and 214 in the Midwest; from 50-59 years old, the North reported 182 hospitalizations; Northeast, 684; South, 2827; and Center-West, 455. The Northeast had the highest average hospital stay (5.9 days), but had the second lowest hospitalization cost (R$ 2,836); on the other hand, the Southeast accounted for the amount of R$22,640,928.14 in total expenses. CONCLUSION: From 2012 to 2016, the rate of hospitalizations for osteoarthritis in women aged 40-59 years in Brazil showed a slight increase. These data are worrying, because it is predominantly a condition for outpatient management; therefore, it is inferred that more actions of prevention, treatment and rehabilitation are necessary, mainly in the Southeast, which is responsible for >50% of hospitalizations. (AU)

Role of HIF-1α signaling pathway in osteoarthritis: A systematic review / Papel da via de sinalização do HIF-1α; na osteoartrite: revisão sistemática

Abstract Osteoarthritis (OA) is the most common form of arthritis and is frequently diagnosed and managed in primary care; it is characterized by loss of articular hyaline cartilage, which is a unique connective tissue that physiologically lacks blood vessels. Articular cartilage survives in a microenvironment devoid of oxygen, which is regulated by hypoxia inducible factor (HIF-1α). HIF-1α is considered the main transcriptional regulator of cellular and developmental response to hypoxia. To date, the relevance of HIF-1α in the assessment of cartilage has increased since its participation is essential in the homeostasis of this tissue. Taking into account the new emerging insights of HIF-1α in the scientific literature in the last years, we focused the present review on the potential role of HIF-1α signaling pathway in OA development, especially in how some genetic factors may influence the maintenance or breakdown of articular cartilage.

Resumo A osteoartrite (OA) é a forma mais comum de artrite e frequentemente é diagnosticada e gerenciada na atenção primária; é caracterizada por perda da cartilagem articular hialina, um tecido conjuntivo único que fisiologicamente carece de vasos sanguíneos. A cartilagem articular sobrevive em um microambiente desprovido de oxigênio, que é regulado pelo fator induzível por hipóxia-1α (HIF-1α). O HIF-1α é considerado o principal regulador transcricional da resposta celular e de desenvolvimento à hipóxia. Na atualidade, a relevância do HIF-1α na avaliação da cartilagem tem aumentado, já que a sua participação é essencial na homeostase desse tecido. Considerando as novas perspectivas emergentes do HIF-1α na literatura científica nos últimos anos, foca-se a presente revisão no potencial papel da via de sinalização do HIF-1α no desenvolvimento da OA, especialmente no modo como alguns fatores genéticos podem influenciar na manutenção ou ruptura da cartilagem articular.

Metabolomics as a promising tool for early osteoarthritis diagnosis

Osteoarthritis (OA) is the main cause of disability worldwide, due to progressive articular cartilage loss and degeneration. According to recent research, OA is more than just a degenerative disease due to some metabolic components associated to its pathogenesis. However, no biomarker has been identified to detect this disease at early stages or to track its development. Metabolomics is an emerging field and has the potential to detect many metabolites in a single spectrum using high resolution nuclear magnetic resonance (NMR) techniques or mass spectrometry (MS). NMR is a reproducible and reliable non-destructive analytical method. On the other hand, MS has a lower detection limit and is more destructive, but it is more sensitive. NMR and MS are useful for biological fluids, such as urine, blood plasma, serum, or synovial fluid, and have been used for metabolic profiling in dogs, mice, sheep, and humans. Thus, many metabolites have been listed as possibly associated to OA pathogenesis. The goal of this review is to provide an overview of the studies in animal models and humans, regarding the use of metabolomics as a tool for early osteoarthritis diagnosis. The concept of osteoarthritis as a metabolic disease and the importance of detecting a biomarker for its early diagnosis are highlighted. Then, some studies in plasma and synovial tissues are shown, and finally the application of metabolomics in the evaluation of synovial fluid is described.

Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis: a systematic review / Efeitos do exercício aquático na força muscular e no desempenho funcional de indivíduos com osteoartrite: uma revisão sistemática

ABSTRACT Water-based exercises are recommended for people with osteoarthritis (OA), due to the beneficial effects on physical function, quality of life and symptom reduction. However, the effects on muscle strength are still controversial. The aim of this review was to assess and compare the effects of aquatic exercise programs on muscle strength and physical function in people with OA. A systematic search was performed at Pubmed, Scopus and Web of Science databases. Clinical trials with interventions involving aquatic exercises for individuals with OA were included. The methodological quality of the studies was evaluated using the PEDro scale. 296 studies were found and twelve were selected: six studies comparing water-based exercises with land-based exercise, and six comparing water-based exercise groups with the control group. Exercise programs included muscle strengthening, aerobic, balance, flexibility and stretching exercises. Duration of the program, weekly frequency, intensity and progression varied between studies. Beneficial effects of aquatic exercise were found on physical function. However, only two of five studies that assessed muscle strength observed positive effect of aquatic exercise. Although it is difficult to compare studies and establish guidelines for the standardized protocol formulation, it was observed that water-based exercises can be effective on improving physical function and increasing muscle strength, since they are well-structured, with exercise intensity and overload controlled.

RESUMO Exercícios aquáticos são recomendados para pessoas com osteoartrite (OA), pois melhoram a funcionalidade e a qualidade de vida e reduzem os sintomas da doença. Entretanto, os efeitos na força muscular ainda são controversos. O objetivo desta revisão foi avaliar e comparar o efeito de programas de exercícios aquáticos na força muscular e na funcionalidade de pessoas com OA. Foi feita uma busca bibliográfica nas bases de dados Pubmed, Scopus e Web of Science. Foram incluídos ensaios clínicos feitos com intervenções que envolveram exercícios aquáticos para indivíduos com OA. A qualidade metodológica dos estudos foi avaliada por meio da escala PEDro. Foram encontrados 296 estudos. Desses, 12 foram selecionados, seis que compararam exercícios aquáticos com exercícios feitos em solo e seis que compararam um grupo de exercícios aquáticos com grupo controle. Os programas contemplaram exercícios de fortalecimento muscular, aeróbios, de equilíbrio, de flexibilidade e alongamento. A duração do programa, a frequência semanal, a intensidade e a progressão variaram entre os estudos. Foram encontrados efeitos benéficos do exercício aquático na funcionalidade, porém, dos cinco estudos que avaliaram a força muscular, apenas dois verificaram efeito positivo dos exercícios aquáticos. Embora haja dificuldades para comparar os estudos e estabelecer diretrizes para a formulação de protocolos padronizados, observou-se que exercícios aquáticos podem ser eficientes na melhoria da funcionalidade e no aumento da força muscular, desde que os programas sejam bem estruturados com intensidade e sobrecarga controlada e progressiva.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Influence of obstructive sleep apnea syndrome in the fluctuation of the submaximal isometric torque of knee extensors in patients with early-grade osteoarthritis

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA).METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed.RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143).CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

Assessing joint effusion and bone changes of the head of the mandible in MR images of symptomatic patients

The aim of the present study was to investigate the relationship between degenerative bone changes of the head of the mandible and the presence of joint effusion (JE). This study was based on sagittal magnetic resonance imaging (MRI) reports of 148 temporomandibular joints (TMJs) of 74 patients complaining of pain and/or dysfunction in the TMJ area. The mandible heads were surveyed for osteoarthritis characteristics, which were classified as osteophytosis, sclerosis or erosion. The presence of JE was checked whenever high signal intensity was observed in the articular space. The results evidenced the presence of bone changes in 30% of the sample. Osteophytes and erosions were the changes most commonly observed. JE was reported in 10% of TMJs. The results from the statistical tests revealed that bone changes in the head of the mandible are associated with the presence of JE.

Aspectos moleculares dos esteroides sexuais sobre a cartilagem e os ossos / Molecular features of sexual steroids on cartilage and bone

No Brasil, o crescimento dos casos registrados de doenças degenerativas das cartilagens articulares por ano é de 20%, o que representa, anualmente, que mais de 200 mil brasileiros desenvolvem doenças degenerativas das articulações e, com repercussões negativas sobre a massa óssea. Este trabalho mostra evidências que a produção hormonal de esteroides sexuais (estrogênios, progestagênios e androgênios) têm influência na qualidade da cartilagem, bem como na massa óssea. Portanto, o objetivo dessa revisão foi o de analisar os dados da literatura sobre a ação molecular e gênica dos esteroides sexuais na fisiologia da cartilagem hialina e do osso, bem como a interferência da osteoartrite na qualidade dessas estruturas.

In Brazil, the increase in the reported cases of degenerative diseases of articular cartilage is 20% per year, meaning that 200,000 Brazilians develop degenerative joint diseases every year, which have a negative impact on bone mass. This study shows evidence that hormone production of sexual steroids (estrogens, progestogens, and androgens) have an influence on cartilage quality, as well as on bone mass. Therefore, this review aimed to analyze literature data on the molecular and genic action of sexual steroids on hyaline cartilage and bone physiology, as well as osteoarthritis interference on the quality of these structures.

Rizartrosis: trapecectomía total video asistida / Trapeziometacarpal joint arthritis: videoassisted total trapezectomy

Introducción: La artrosis carpo-metacarpiana del pulgar es una patología frecuente, que produce severos déficits en las actividades de la vida diaria. Consideramos que la trapecectomía total simple aún no ha podido ser superada por otras técnicas. Las técnicas artroscópicas han permitido desarrollar la trapecectomía simple intentando ofrecer una mejor calidad de vida en el postoperatorio inmediato. Material y método: se operaron 38 manos entre los años 2001 al 2005. La técnica se realizó con óptica de 2,7 mm, con portales trapecio metacarpianos convencionales (1 R y 1 U) Y ayuda del intensificador de imágenes. La cirugía finalizó con vendaje blando y precozmente se comenzó con la rehabilitación. Resultados: se compararon resultados pre y post-operatorios. Se encontraron mejorías de un 92 por ciento y un 86 por ciento en la fuerza de puño y pinzas respectivamente. Hubo 86 por ciento de resultados excelentes y buenos en términos de dolor usando una escala subjetiva. Conclusiones: la trapecectomía simple sigue siendo válida en el tratamiento de la rizartrosis no complicada. La trapecectomía simple video asistida ofrece una técnica simple, con gran confort post-operatorio y rápido retorno a las actividades de la vida diaria. Diseño del estudio: Serie de casos. Nivel de evidencia: IV.

Comorbidades em pacientes com osteoartrite: frequência e impacto na dor e na função física / Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function

INTRODUÇÃO: Uma vez que a prevalência da osteoartrite (OA) aumenta com o envelhecimento, é comum a coexistência de outras doenças crônicas. OBJETIVOS: Avaliar a frequência de comorbidades em pacientes com OA e mensurar o impacto destas na dor e a função física nesses pacientes. MÉTODOS: Estudo transversal em pacientes portadores de OA do ambulatório de reumatologia do IMIP. A dor foi mensurada pela Escala Visual Analógica (EVA) e a função física pelos índices de Lequesne e SACRAH. Foi realizado um screening para depressão, além de aferição de medidas antropométricas, pressão arterial, dosagem da glicemia de jejum e perfil lipídico. RESULTADOS: Foram estudados 91 pacientes, com média de idade de 59,3 anos, sendo 91,4 por cento do sexo feminino. A frequência de síndrome metabólica foi de 54,9 por cento. Hipertensão arterial sistêmica ocorreu em 75,8 por cento dos casos, dislipidemia em 52,6 por cento e obesidade em 57,1 por cento. O screening para depressão foi positivo em 61,3 por cento dos pacientes. Quando comparamos individualmente os componentes da síndrome metabólica, observamos que pacientes com hipertensão apresentavam maiores escores no SACRAH com diferença estatisticamente significante (P = 0,035). Para as outras variáveis, não foram demonstradas diferenças entre os escores Lequesne, SACRAH e EVA. CONCLUSÃO: Foi observada uma alta frequência de depressão, síndrome metabólica e de seus componentes isoladamente nesse grupo de pacientes com OA, podendo haver impacto da presença destes na dor e na função física desses pacientes. Tais resultados demonstraram a necessidade de investigação e tratamento dessas comorbidades em pacientes com OA.

INTRODUCTION: As the prevalence of osteoarthritis (OA) increases with age, the coexistence of other chronic diseases is common. OBJECTIVES: To evaluate the frequency of comorbidities in OA patients and to measure their impact on pain and physical function of those patients. METHODS: Cross-sectional study in OA patients of a public rheumatology clinic. Pain was measured by use of the Visual Analogue Scale (VAS) and physical function by use of the Lequesne's and SACRAH indices. A screening for depression was performed, as were the following measurements: anthropometric data; blood pressure; fasting glycemia; and lipid profile. RESULTS: The study assessed 91 patients (mean age 59.3 years; 91.4 percent female). The metabolic syndrome frequency was 54.9 percent. Hypertension occurred in 75.8 percent of the patients, dyslipidemia in 52.6 percent, and obesity in 57.1 percent. The screening for depression was positive in 61.3 percent of patients. When comparing the metabolic syndrome components individually, patients with hypertension had higher SACRAH scores, with statistically significant differences (P = 0.035). For the other variables, no differences among the Lequesne's, SACRAH and VAS scores were observed. CONCLUSION: This group of OA patients showed a high frequency of depression, metabolic syndrome and its components in isolation, which can impact the pain and physical function of those patients. Such results showed the need for investigating and treating those comorbidities in OA patients.

Effect of hydrostatic pressure of various magnitudes on osteoarthritic chondrocytes exposed to IL-1β.

Background & objectives: Several in vitro studies have shown the importance of mechanical compression or hydrostatic pressure (HP) as a modulator of cartilage metabolism. The present study was undertaken to evaluate the in vitro effects of cyclical low HP (1-5 MPa) and continuous high HP (24 MPa) applied in the presence or absence of interleukin (IL)-1β on human osteoarthritis (OA) chondrocytes. Methods: Chondrocytes obtained from OA cartilage were cultivated for 48 h and then exposed to pressurization in the presence or absence of IL-1β. After pressurization, the culture medium was collected to detect the amount of proteoglycans (PG) and nitric oxide (NO) and the chondrocytes were immediately fixed for transmission electron microscopy (TEM) and processed for immunocytochemistry to localize the inducible nitric oxide synthase (iNOS). Results: A significant increase in the level of PG and a small, non-significant, decrease in NO production were observed upon exposure to cyclical low HP. On the other hand, exposure to continuous high HP resulted in a significant decrease in the PG levels and a significant increase in NO production. The presence of IL-1β led to a significant decrease in PG levels as well as a significant increase in NO production. The cyclical low HP did not increase the PG levels significantly but caused a statistically significant decrease in NO production in cultures damaged with IL-1β. The continuous high HP in chondrocyte cultures stimulated with IL-1β did not significantly decrease PG production, but significantly increased NO production. The results concerning metabolic production were further confirmed by morphological findings obtained by TEM and immunocytochemical studies. Interpretation & conclusion: The findings of this study confirmed that the response of chondrocytes varies with magnitude and frequency of HP. These findings are important to understand aetiopathogenetic mechanisms of OA and to find out which type of physical activity may be best suited for the prevention and therapy of OA.

Osteoartrose e atividade física / Osteoarthritis and physical activity

A atividade física desempenha papel importante no tratamento da coadjuvante da osteoartose.Intervenções com programas de exercícios mostraram impacto no tratamento da osteoartose de joelho em idosos.A inatividade física com osteoartose traz fraqueza,hipotrofia muscular,descondicionamento físico e dor,levando o indivíduo à incapacidade física em um ciclo vicioso.Atividade física é qualquer movimento do corpo com gasto energético maior que o repouso e exercício é uma forma mais elaborada dessa atividade,incluindo intensidade,frequência e duração.

Obesidade e osteoartrite: atualiazação em implicações clínicas e metabólicas / Obesity and osteoarthritis: metabolic and clinical implications updated

Nas últimas décadas, a obesidade vem assumindo proporções epidêmicas alarmantes, acarretando em custos enormes para a saúde dos indivíduos e para a economia da sociedade. Dentre as inúmeras implicações orgânicas que acompanham a obesidade, destaca-se aqui a osteoartrite, doença degenerativa e de alta prevalência. A obesidade é um fator de risco potencialmente modificável para OA. Dessa forma, tal relação precisa ser bem compreendida, a fim de que medidas eficazes de tratamento e prevenção sejam delineadas. Neste artigo é feito uma revisão bibliográfica atualizada do assunto.

In the last decades, the obesity is assuming alarming epidemic proportions, carting in enormous costs for the individuals’ health and for the economy of the society. Among the countless organic implications that accompany the obesity, stands out the osteoarthritis, which is considered a degenerative disease with high prevalence. The obesity is a risk factor potentially soft for osteoarthritis. In that way, such a necessary relationship to be well understood, so that effective measures of treatment and prevention are delineated. In this article it is made an updated bibliographical revision of this subject.

Osteoartrose / Osteoarthrosis

Dos mais de cem tipos de doenças articulares, a artrose, osteoartrite ou osteoartrose (OA) é a mais frequente e causa importante dos diferentes graus de incapacidade. Se tivermos em conta que é uma doença cuja frequencoa aumenta com a idade e que a expectativa de vida da população está aumentando, é um problema de saúde não só pessoal, como pública e de crescimento constante.