Efectos en la capacidad funcional de un programa de ejercicio físico terapéutico basado en telesalud en personas con diagnóstico de osteoartritis de rodilla y cadera / Effects of a telehealth-based physical exercise program on functional capacity in patients with osteoarthritis

BACKGROUND: Telehealth is a novel therapeutic alternative. Aim: To determine the effects of a remote therapeutic physical exercise program (TPEP), based on telehealth, on functional physical capacity in people with knee or hip osteoarthritis. PATIENTS AND METHODS: An eight-week TPEP was undertaken by 36 participants with a mean age of 68 years. The control group received printed exercise instructions, while the experimental group received the same instructions plus TPEP using tutorial videos and voice messaging via WhatsApp. Both groups were evaluated at baseline and the end of the intervention with the Lower Extremity Functional Scale (LEFS), Barthel index (BI), Short Physical Performance Battery (SPPB), senior fitness test and with the Visual Analog Scale for pain (VAS). RESULTS: The experimental group decreased the VAS score and improved tandem balance, three-meter walk, sit and stand 5 times, sit and stand in 30 seconds, push-ups in 30 seconds, two minutes' walk, join the right hand behind the back and SPPB general score. The control group increased the BI score and improved the three meters walking test, sitting, and standing 5 times, sit and stand 30 seconds chair test, 2 minutes walking test and the SPPB general score. No differences between groups were observed for the LEFS scale, BI, VAS and functional capacity. CONCLUSIONS: A TPEP based on telehealth has similar effectiveness than a TPEP based on traditional paper-based intervention to improve functional physical capacity in patients with OA. (Rev Med Chile 2022; 150: 33-45)

Short needling for knee osteoarthritis with blood stasis obstruction and its effect on serum inflammatory factors / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and its effect on serum levels of tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), interleukin 6 (IL-6) and prostaglandin E2 (PGE2) between short needling (close-to-bone needling) and conventional acupuncture for knee osteoarthritis (KOA) with blood stasis obstruction.@*METHODS@#A total of 68 KOA patients with blood stasis obstruction were randomized into a short needling group (34 cases, 3 cases dropped off) and a conventional acupuncture group (34 cases, 3 cases dropped off). The same acupoints (Dubi [ST 35], Neixiyan [EX-LE 4], Binzhong [Extra], Liangqiu [ST 34], etc. on the affected side) were selected in the two groups. In the short needling group, short needling technique was adopted, the needles were slowly inserted and the needle bodies were shaken, thus gradually penetrated to the bone. In the conventional acupuncture group, conventional acupuncture was adopted, the needles were penetrated to the muscle. After qi-arrival, Dubi (ST 35) and Neixiyan (EX-LE 4), Zusanli (ST 36) and Liangqiu (ST 34) were connected with CMNS6-1 electronic acupuncture instrument, with disperse-dense wave, 2 Hz/10 Hz in frequency, the current intensity was based on patients' feeling, the needles were retained for 30 min, at the same time, the knee joint was irradiated for 30 min with a special electromagnetic wave apparatus in the two groups. Once every other day, 3 times a week for 4 weeks. Before and after treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, knee joint pain visual analogue scale (VAS) score, inflammatory response related indexes (serum TNF-a, IL-1β, IL-6 and PGE2) and knee joint ultrasound were observed，and the clinical effect was evaluated in the two groups.@*RESULTS@#After treatment，the pain, stiffness, function scores and total scores of WOMAC were decreased as compared with those before treatment in the two groups (P<0.05), except for the pain score, the changes of above scores in the short needling group were greater than the conventional acupuncture group (P<0.05). After treatment, the VAS scores, serum levels of TNF-a, IL-1β, IL-6, PGE2 and knee joint synovium thickness, intra-articular effusion were decreased as compared with those before treatment in the two groups (P<0.05), the levels of TNF-a, IL-1β, IL-6 in the short needling group were lower than the conventional acupuncture group (P<0.05). The total effective rate in the short needling group was 87.1% (27/31), which was superior to 83.9% (26/31) in the conventional acupuncture group (P<0.05).@*CONCLUSION@#Short needling could improve the knee joint function, relieve the pain and inflammatory response, improve the knee joint synovium inflammatory response, reduce the knee joint intra-articular effusion for KOA patients, its effect is better than conventional acupuncture.

Effects of different courses of moxibustion treatment on intestinal flora and inflammation of a rat model of knee osteoarthritis / 中西医结合学报

OBJECTIVE@#This study was done to determine the effects of different courses of moxibustion on a rat knee osteoarthritis (KOA) model, and explore the dose-effect relationship of moxibustion on KOA from the perspectives of intestinal flora and inflammatory factors.@*METHODS@#Wistar rats were randomly divided into five groups: normal, model, moxibustion for 2 weeks, moxibustion for 4 weeks and moxibustion for 6 weeks groups (n = 5 each group). A KOA rat model was induced by monosodium iodoacetate, and moxibustion intervention was performed at the acupoints "Dubi" (ST35) and "Zusanli" (ST36), once every other day. Pathologic changes in the cartilage of rat knee joints were assessed after intervention, and fecal samples were subjected to 16S rRNA high-throughput sequencing for microbial diversity analysis.@*RESULTS@#Damage to the knee articular cartilage was obvious in the model group, which also had increased levels of pro-inflammatory factors, decreased levels of anti-inflammatory factors, and intestinal flora disorders with decreased diversity. The degree of cartilage damage in the 4 and 6 weeks of moxibustion groups was significantly improved compared with the model group. The 4 and 6 weeks of moxibustion groups also demonstrated reduced levels of interleukin-1β and tumor necrosis factor-α and increased levels of interleukin-10 (P < 0.05). Both the abundance and diversity of the intestinal flora were increased, approaching those of the normal group. Abundances of probiotics Eubacterium coprostanoligenes group and Ruminococcaceae UCG-014 increased, while that of the pathogenic bacteria Lachnospiraceae NK4A136 group decreased (P < 0.05). Although the abundance of Lachnospiraceae NK4A136 group decreased in the 2 weeks of moxibustion group compared with the model group (P < 0.05), there was no statistically significant difference in serum inflammatory factors, flora species diversity or degree of pathological damage compared with the model group.@*CONCLUSION@#Moxibustion treatment led to significant improvements in the intestinal flora and inflammatory factors of rats with KOA. Moxibustion treatment of 4 and 6 weeks led to better outcomes than the 2-week course. Moxibustion for 4 and 6 weeks can regulate intestinal flora dysfunction with increased probiotics and reduced pathogenic bacteria, reduce pro-inflammatory factors and increase anti-inflammatory factors. No significant differences were seen between the effects of moxibustion for 4 weeks and 6 weeks.

Effect of acupotomy intervention on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To observe the effect of acupotomy on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis and to reveal the possible therapeutic mechanism involved in the effect of acupotomology on the treatment of knee osteoarthritis(KOA).@*METHODS@#Twenty-four male New Zealand rabbits aged 6 months and weighed (2.0±0.5) kg were randomly divided into blank group, model group and acupotomy group, 8 rabbits in each group. KOA model was established by modified Videman method with left hind limb extended plaster immobility for 6 weeks. In acupotomy group, the transfascial focal points of quadriceps femoris muscle were released by acupotomy under the guidance of Jingjin theory for 4 times and once a week, and the treatment points include Hedingci, Binwaixia, Binneixia. Blank group and model group were fed normally without intervention. One week after the end of the intervention, the pennation angle(PA), muscle thickness(MT), cross-sectional area(CSA) and strain ratio(SR) of rectus femoris were measured by ultrasound. HE staining was used to observe the changes of the tissue morphology, the number of muscle fibers and the average area of muscle fibers. The myofibril of rectus femoris, sarcomere and myofilament were observed by transmission electron microscope.@*RESULTS@#The PA of rectus femoris muscle in the blank group was (9.05±0.21)°. The MT was(1.09±0.09) cm and the CSA was(1.30±0.01) cm2. The PA of rectus femoris muscle in the model group was (3.06±0.15)°. The MT was (0.71±0.02) cm and the CSA was(0.77±0.02) cm2. The PA of rectus femoris muscle in the acupotomy group was (6.94±0.28)°. The MT was (0.80±0.05) cm and the CSA was(0.94±0.03) cm2. The muscle PA, MT and CSA of rectus femoris in the model group were significantly smaller than those in the blank group (P<0.05). Those in acupotomy group were significantly increased compared with those in model group (P<0.05). The SR of rectus femoris muscle was 1.19±0.02 in the blank group, 3.50±0.05 in the model group and 1.99±0.07 in the acupotomy group. The elastic SR of the model group was significantly higher than that of the blank group (P<0.05). These in acupotomy group was significantly lower than that in model group(P<0.05). The results of HE staining showed:in blank group, the fascicles of rectus femoris were arranged neatly, the number of beam of muscle fibers within the fixed visual field was 94.38±3.50 and the average CSA was(0.75±0.22) mm2. In model group, the fascicles of rectus femoris with different sizes were disorganized with a small amount of inflammatory cell infiltration, the number of beam of muscle fibers within the fixed visual field was 196.63±2.62 and the average CSA was(0.26±0.03) mm2. Compared to the blank group, a significant increase in the number of muscle fibers in the fixed field in the model group (P<0.05) and the average CSA decreased significantly(P<0.05). In acupotomy group, the rectus femoris fascicles in the acupotomy group tended to be arranged in a more orderly manner, with the inflammatory cells decreased, the number of beam of muscle fibers within the fixed visual field was 132.88±4.61 and the average CSA was(0.70±0.07) mm2. Compared to the model group, a significant decrease in the number of muscle fibers in the fixed field in the model group(P<0.05) and the average CSA increased significantly(P<0.05). The results of transmission electron microscope showed:compared with the blank group, the overall arrangement of the myofibrils of the rectus femoris in the model group was less structured. There was fracture between the muscle fibers and the sarcomere, the myofilaments were disordered, and the fracture of the Z line was discontinuous. Compared with the model group, the myofibrillar texture of rectus femoris in acupotomy group was clearer, and the Z line was more continuous.@*CONCLUSION@#Based on the jingjin theory, the release of quadriceps femoris by acupotomy can effectively improve the morphology and structure of rectus femoris, and promote the repair and reconstruction of chronic skeletal muscle injury in rabbits with KOA, which may be one of the mechanisms of acupotomy in the treatment of KOA.

Repair impact of vibration exercise with different frequencies on articular cartilage of rats with early knee osteoarthritis and its JNK/NF-κB, SOX9 mechanisms / 中国应用生理学杂志

Objective: To investigate the repair effect and JNK/NF-κB,SOX9 mechanisms of vibration exercise with different frequencies on articular cartilage in rats with early knee osteoarthritis. Methods: Forty-eight adult male SD rats were randomly divided into six groups(n=8):model control group(MC),high frequency vibration group 1 (GP1,60 Hz),high frequency vibration 2 group (GP2,40 Hz),medium frequency vibration group (ZP,20 Hz),minor frequency group(DP,10 Hz)and normal control group(NC). Except for NC group,the rats in each group were made into early knee osteoarthritis model after six weeks of knee joint cavity injection of papain solution and 2% mixture l-cysteine on the 1st,4 th and 7th day. Each exercise group was subjected vibration to 40 minutes a day with amplitude of 2～5 mm and 5 days a week. Four weeks later, the articular cartilage of the lateral femoral condyle of the both back leg knee joints were detected by HE staining,serine O staining and Mankin scores for morphological observation. The expression levels of JNK,NF-κB p65 and Sox9 mRNA in articular cartilage of the medial femoral condyle were detected by RT-qPCR,and the protein expressions of JNK,NF-κB p65 and Sox9 were detected by Western blot. Results: Compared with the NC group,the Mankin score in other groups was significantly higher (P＜0.01). Compared with the MC group,the Mankin score of each vibration group was significantly lower(P＜0.05),the mRNA and protein expressions of JNK and NF-κB p65 in each vibration training group were significantly lower (P＜0.01),the expressions of Sox9 mRNA and protein in vibration training group were increased significantly (P＜0.01). Compared with the higher frequency group,the Mankin score,the mRNA and protein expressions of JNK and NF-κB p65 of lower frequency group were significantly lower (P＜0.05 or P＜0.01). But the expressions of Sox9 mRNA and protein were significantly higher (P＜ 0.05 or P＜0.01). Conclusion: Vibration exercise of different frequencies may present varying degrees of cartilage repair impact in rats with early knee osteoarthritis,and the cartilage repair by low-frequency vibration training is better than that by high-frequency vibration. This can be one of the mechanisms on controlling collagen synthesis by down-regulating JNK/NF-κB expression and increasing SOX9 activity of OA articular cartilage.

Effect of needle knife on mTOR/Atg/ULK1/Beclin-1 axis and chondrocyte autophagy in rats with knee osteoarthritis / 中国针灸

OBJECTIVE@#To observe the effect of needle knife on chondrocyte autophagy and expressions of autophagy-related protein and mammalian target of rapamycin (mTOR) in rats with knee osteoarthritis (KOA), and to explore the possible mechanism of needle knife for KOA.@*METHODS@#A total of 42 SD rats were randomly divided into a normal group, a model group and a needle knife group, 14 rats in each group. Except for the normal group, the other two groups were injected with the mixture of papain and L-cysteine into the left hind knee joint to establish the KOA model. After modeling, the rats in the needle knife group were treated with needle knife at strip or nodule around the quadriceps femoris and medial and lateral collateral ligament on the affected side, once a week for 3 times (3 weeks). The changes of left knee circumference in each group were observed; the chondrocytes and ultrastructure of left knee joint were observed by HE staining and electron microscope; the mRNA and protein expressions of autophagy-related genes (Atg5, Atg12, Atg4a), Unc-51 like autophagy activated kinase 1 (ULK1), autophagy gene Beclin-1 and mTOR in left knee cartilage were detected by real-time fluorescence quantitative PCR and Western blot.@*RESULTS@#After modeling, the left knee circumferences in the model group and the needle knife group were increased compared with those before modeling and in the normal group (P<0.05); after intervention, the left knee circumference in the needle knife group was smaller than that in the model group and after modeling (P<0.05). Compared with the normal group, the number of chondrocytes was decreased, and a few cells swelled, nuclei shrank, mitochondria swelled and autophagosomes decreased in the model group; compared with the model group, the number of chondrocytes was increased , and most cell structures returned to normal, and autophagosomes was increased. Compared with the normal group, the mRNA and protein expressions of Atg5, Atg12, Atg4a, Beclin-1 and ULK1 in the knee cartilage in the model group were decreased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were increased (P<0.05). Compared with the normal group, the mRNA and protein expressions of mTOR in the knee cartilage in the model group were increased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were decreased (P<0.05).@*CONCLUSION@#The needle knife intervention could improve knee cartilage injury in rats with KOA, and its mechanism may be related to reducing the expression of mTOR and up-regulating the expressions of Atg5, Atg12, Atg4a, ULK1 and Beclin-1, so as to promote chondrocyte autophagy and delay the aging and degeneration of chondrocytes.

Revealing characteristics and rules of acupoint sensitization phenomena: based on knee osteoarthritis / 中国针灸

OBJECTIVE@#To explore the characteristics and rules of acupoint sensitization phenomena based on knee osteoarthritis (KOA), one of the clinical dominant diseases of acupuncture-moxibustion.@*METHODS@#In combination with literature and expert experiences, the acupoints with the highest use frequency in treatment of KOA were screened, e.g. Heding (EX-LE 2), Liangqiu (ST 34), Mingmen (GV 4), Neixiyan (EX-LE 4), Ququan (LR 8) and Dubi (ST 35). In 814 patients with KOA and 217 healthy subjects, the acupoint temperature, mechanic pain threshold and pressure pain threshold were detected separately. Using machine learning method, the sensitization was judged at each acupoint.@*RESULTS@#Compared with healthy subjects, the acupoint temperature was increased and the mechanic pain threshold and pressure pain threshold were reduced in KOA patients (P<0.05). Besides, the cut-off value was presented to distinguish whether the acupoint was sensitized or not. The results of machine learning showed that the highest prediction accuracy of acupoint sensitization was 86.7% (Shenshu [BL 23]) and the lowest one was 73.9% (Heding [EX LE 2]). The prediction accuracy at the third clinical stage trial was higher, the highest was 93.3% (Ququan [LR 8]) in KOA patients.@*CONCLUSION@#It is confirmed that the acupoint sensitization reflects the characteristics of disease and is correlative with the conditions of illness, which may provide the reference for the auxiliary diagnosis and condition assessment of KOA.

Viscosuplementación con ácido hialurónico de alto peso molecular doblemente reticulado en el tratamiento de la artrosis de rodilla. Estudio de su eficacia y seguridad / Viscosupplementation with hyaluronic acid with double cross-linked high molecular weight in knee osteoarthritis

Objetivos: La osteoartrosis (OA) es una artropatía incurable mono o poliarticular. En la rodilla es la enfermedad degenerativa más común, con gran incidencia de los factores mecánicos. El arsenal terapéutico para el manejo de la OA de rodilla (OAR) comprende medidas no farmacológicas, farmacológicas, medicación de técnicas intraarticulares y cirugía. Los objetivos de este trabajo fueron evaluar la eficacia en términos de dolor, función articular y calidad de vida de los pacientes infiltrados con ácido hialurónico (AH) de alto peso molecular (PM), doblemente reticulado (Cientific Synovial®, en adelante: CS) así como la seguridad de su uso. Adicionalmente se intentó objetivar el tiempo libre de prótesis en pacientes con esta indicación. Materiales y métodos: Se efectuó un diseño pre y post (un solo grupo) para pacientes con gonartrosis. Se analizó una muestra de cuarenta y seis pacientes (n = 46) a quienes se dividió en dos grupos según clasificación de Kellgren-Lawrence (KL). Un grupo KL 1­2 fue infiltrado con AH 40 mg (CS40), y otro grupo KL 3­4 fue infiltrado con AH 60 mg (CS60). A todos los pacientes se les suministró el cuestionario KOOS-12 (Knee injury and Osteoarthritis Outcome Score) pre y postinfiltración y se efectuó estadística descriptiva e inferencial apropiada. Conclusiones: el AH de alto PM y doblemente reticulado (Cientific Synovial®) mejoró estadística y clínicamente todos los parámetros de eficacia analizados por medio del cuestionario KOOS-12. El preparado se mostró seguro y sin aparición de efectos adversos de relevancia. Tanto en los pacientes con indicación previa de reemplazo total de rodilla (RTR) rechazada (n = 12) como en el resto de los pacientes de la muestra se verificó la supervivencia libre de prótesis hasta el final del estudio

Objectives: Osteoarthrosis (OA) is an incurable mono or polyarticular arthropathy and in the knee it is the most common degenerative disease with a high incidence of mechanical factors. The therapeutic arsenal for the management of knee OA (OAR) includes non-pharmacological and pharmacological measures, medication and intra-articular techniques, and surgery. The objectives of this study were to evaluate the efficacy in terms of pain, joint function and quality of life of patients infiltrated with double cross-linked high molecular weight (MW) hyaluronic acid (HA) (Cientific Synovial®, ­CS­) as well as the safety of its use. Additionally, we tried to objectify the prosthesis-free time in patients with this indication. Materials and methods: a pre - post design (single group) was carried out for patients with knee osteoarthritis. A sample of fortysix patients (n = 46) was analyzed who were divided into two groups according to the Kellgren-Lawrence (KL) classification. A group KL 1­2 was infiltrated with HA 40 mg (CS40) and another group KL 3­4 was infiltrated with HA 60 mg (CS60). All patients filled out the KOOS-12 questionnaire (Knee injury and Osteoarthritis Outcome Score) pre and post infiltration and appropriate descriptive and inferential statistics were performed. Conclusions: The double-crosslinked, high-MW HA (Cientific Synovial®) improved statistically and clinically all the efficacy parameters analyzed using the KOOS-12 questionnaire. The preparation was shown to be safe and without the appearance of significant adverse effects. Both in the patients with a previous indication for total knee replacement (TKR) rejected (n = 12), as in the rest of the patients in the sample, prosthesis-free survival was verified until the end of the study

Chinese Medicine Involving Triple Rehabilitation Therapy for Knee Osteoarthritis in 696 Outpatients: A Multi-Center, Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To determine the effects of Chinese medicine (CM) involving triple rehabilitation therapy on the progression of knee osteoarthritis (KOA).@*METHODS@#A total of 722 patients recruited from 38 community health service centers located in China from March 2013 to March 2017 were randomly divided into treatment and control groups equally, using a cluster randomization design. Health education combined with CM involving triple rehabilitation therapy for KOA (electro-acupuncture, Chinese medicinal herb fumigating-washing, and traditional exercises) was administered in the treatment group while conventional rehabilitation therapy (physical factor therapy, joint movement training, and muscle strength training) was administered in the control group. Patients with a visual analog scale (VAS) scores ≽4 were treated with dispersible meloxicam tablets (7.5 mg, once daily). The Lequesne index scores, VAS scores, range of motion (ROM), lower limb muscle strength, knee joint circumference, quantitative scores of KOA symptoms, and the short-form 36 item health survey questionnaire (SF-36) scores were measured for each patient at 5 checkpoints (before treatment, at the 2nd week and the 4th week during the 4-week treatment period, at 1 month and 3 months after end of treatment), and adverse reactions were observed also.@*RESULTS@#A total of 696 patients completed the entire process, with 351 in the treatment group and 345 in the control group. At all treatment checkpoints, the treatment group demonstrated better outcomes than the control group with regard to the total Lequesne index scores, effective rate and improvement rate of the total Lequesne index scores, VAS scores, lower limb muscle strength, knee circumference, quantitative scores of KOA symptoms, and SF-36 scores as well (P<0.05 or P<0.01). No adverse reactions were encountered in this study.@*CONCLUSIONS@#CM involving triple rehabilitation therapy can alleviate KOA-related pain and swelling, improve lower limb muscle strength, promote flexion and activity of the knee and improve the quality of life in patients undergoing KOA. It is suitable for patients with early or mid-stage KOA. (Registration No. ChiCTR-TRC-12002538).

Heat-sensitive moxibustion of different suspension moxibustion methods and imitation moxibustion apparatus on moxibustion sensation and clinical efficacy in knee osteoarthritis / 中国针灸

OBJECTIVE@#To observe the moxibustion sensation and the clinical therapeutic effect of heat-sensitive moxibustion of two different suspension moxibustion methods and imitation moxibustion apparatus on mild to moderate knee osteoarthritis (KOA), and compare the therapeutic effect of different moxibustion methods.@*METHODS@#A total of 90 patients with mild to moderate KOA were randomized into a hand-held group (30 cases, 1 case dropped off), an imitation moxibustion apparatus group (30 cases) and a moxibustion shelf group (30 cases, 1 case dropped off). @*RESULTS@#The compositions of moxibustion sensation and numbers of moxibustion sensation types in individuals in the hand-held group and the moxibustion shelf group were richer, the moxibustion sensation intensity was higher than that in the imitation moxibustion apparatus group (@*CONCLUSION@#Heat-sensitive moxibustion can effectively treat knee osteoarthritis, while the different suspension moxibustion methods have an influence on clinical therapeutic effect, hand-held suspension moxibustion has the best efficacy.

Considerations and suggestions on influencing factors of compliance in clinical trial of acupuncture and moxibustion: experience in case study of knee osteoarthritis treated with acupuncture / 中国针灸

Strengthening the compliance is conductive to the quality improvement of clinical trial of acupuncture and moxibustion. In terms to planning behavior and influencing factors of loyalty, the questionnaire was conducted among 200 participants on the compliance of clinical trial on knee osteoarthritis treated with acupuncture. The results showed that the subjective norms and perceptual behavior control of subjects affected their compliance in the trial. Medical service compensation became the primary factor of the subjects' loyalty, which further affected their compliance in the trial. It is suggested that the compliance should be managed according to the characteristics of different clinical researches, and the feasible medical service compensation scheme should be designed in advance by actively focusing on the subjects' features.

Effect of acupoint application of / 中国针灸

OBJECTIVE@#To compare the effect between acupoint application of @*METHODS@#A total of 62 KOA patients with knee swelling after knee arthroscopy were randomly divided into an observation group and a control group, 31 cases in each group. In the control group, cold compress was adopted after surgery, 3 times a day. On the basis of the treatment as the control group, acupoint application of @*RESULTS@#The VAS scores 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (@*CONCLUSION@#Acupoint application of

Effect of fire needling on mild to moderate knee osteoarthritis and related serum inflammatory cytokines / 中国针灸

OBJECTIVE@#To compare the clinical effect of fire needling and filiform needling for mild to moderate knee osteoarthritis (KOA) and observe the influence on related serum inflammatory sytokines.@*METHODS@#A total of 60 patients with mild to moderate KOA were randomly divided into an observation group (30 cases, 4 cases dropped off) and a control group (30 cases, 4 cases dropped off). Both groups were given basic health management, and the acupoints of the two groups were Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34) and @*RESULTS@#At each time point of treatment and follow-up, the pain, stiffness, difficulty of daily activities scores and WOMAC total scores of the two groups were lower than those before treatment (@*CONCLUSION@#Fire needling can improve the pain, stiffness and joint dysfunction of patients with mild to moderate KOA, and increase serum MMP-3 and IL-1α levels. Its short and long term clinical effects are better than filiform needling.

Effect of acupuncture on knee injury and osteoarthritis outcome score in patients with knee osteoarthritis / 中国针灸

OBJECTIVE@#To verify the clinical effect of acupuncture on knee osteoarthritis (KOA).@*METHODS@#Forty-two patients with KOA were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases, 1 case dropped off). The patients in the acupuncture group were treated with routine acupuncture at 5-6 local acupoints [Dubi (ST 35), Neixiyan (EX-LE 4), Heding (EX-LE 2), Yinlingquan (SP 9), Xuehai (SP 10), Zusanli (ST 36), etc.] and 3-4 distal acupoints [Fengshi (GB 31), Waiqiu (GB 36), Xuanzhong (GB 39), Zulinqi (GB 41), etc.]. The patients in the sham acupuncture group were treated with shallow needling technique at non-acupoint. The needles were retained for 30 min in both groups. All the treatment was given three times a week for 8 weeks. Knee injury and osteoarthritis outcome score (KOOS) were recorded before and after treatment and 18-week follow-up.@*RESULTS@#Compared before treatment, the scores of 5 dimensions of KOOS [pain, symptoms (except pain), daily activities, sports and entertainment, and quality of life] were increased after treatment and during follow-up in the two groups (@*CONCLUSION@#Acupuncture can reduce the pain symptoms and improve daily activities in patients with KOA.

Clinical observation on distribution characteristics and rules of pain sensitivity points on body surface in patients with knee osteoarthritis / 中国针灸

OBJECTIVE@#To observe the distribution characteristics and rules of pain sensitivity points on body surface in patients with knee osteoarthritis (KOA).@*METHODS@#A total of 916 patients with KOA were selected in this study, the pain sensitivity points of local site of knee joint were probed by thumb palpation. Tape was used to measure the distance between the pain sensitivity points and the most nearby acupoints. The Wagner tenderness measuring instrument was used to measure the tenderness threshold of pain sensitivity points.@*RESULTS@#A total of 3618 pain sensitivity points were probed, among them, 3338 pain sensitivity points were sensitized. The minimum sensitization degree was 1.00, the maximum sensitization degree was 3.39, while the average sensitization degree was (2.16±0.60). Pain sensitivity points were distributed 0.37-1.73 @*CONCLUSION@#The pain sensitivity points of patients with KOA may be the expansion effect of acupoint areas in the disease states, pain sensitivity points are more likely to appear on the medial side of knee joint.

Exploration on effect mechanism of Miao medicinal acupuncture therapy in treatment of knee osteoarthritis based on TRPV ion channel / 中国针灸

OBJECTIVE@#To observe the effect of Miao medicinal acupuncture therapy on transient receptor potential vanilloid (TRPV) channel in knee joint synovial tissue of the rabbits with knee osteoarthritis (KOA) model and to explore the mechanism of Miao medicinal acupuncture therapy in treatment of KOA.@*METHODS@#Of 34 New Zealand male rabbits, 6 rabbits were selected randomly as the normal group. KOA model was established in the rest rabbits by injecting a mixture of papain and L-cysteine in right knee joints. The 24 successfully modeled rabbits were randomized into a model group, a Miao medicinal acupuncture therapy group, a dermal needle group and a smearing group, 6 rabbits in each one. In the Miao medicinal acupuncture therapy group, Miao medicinal acupuncture therapy was adopted, in which, the roller type of dermal needle was used on the surface of right knee joint [a rectangle shape formed by "Xuehai" (SP 10), "Liangqiu" (ST 34), "Yanglingquan" (GB 34) and "Yinlingquan" (SP 9)], rolling in a " shape, on which, Miao medicinal solution was smeared in advance. In the dermal needle group, the rolling stimulation was exerted on the right the right knee joint surface with the roller type of dermal needle. In the smearing group, Miao medicinal solution was smeared on the right knee joint surface. The intervention was given once every two days, 3 times weekly and the intervention was exerted consecutively for 4 weeks. Successively, on day 1, 21, 28, 35, 42 and 49 of experiment, paw withdrawal threshold (von Frey threshold) after mechanical stimulation was detected in the rabbits. HE staining was adopted to observe the histomorphological changes of the right knee joint cartilage in the rabbits. ELISA was used to determine the contents of interleukin-1 (IL-1β) and tumor necrosis factor-α (TNF-α) in the right knee synovial fluid. Western blot method and real-time PCR were used to determine the relative expressions of protein and mRNA of TRPV1 and TRPV4 in knee synovial tissue of the rabbits.@*RESULTS@#Compared with the normal group, on day 49 of experiment, von Frey threshold was reduced significantly in the rabbits of the model group (@*CONCLUSION@#Miao medicinal acupuncture therapy plays a role in treatment of KOA probably through inhibiting the expressions of IL-1β and TNF-α of knee synovial fluid and down-regulating the expressions of protein and mRNA of TRPV1 and TRPV4 in knee synovial tissue.

Tratamiento conservador de artrosis de rodilla: revisión bibliográfica / Knee arthrosis conservative treatment: Bibliographic Review

INTRODUCCIÓN: La artrosis rodilla es una enfermedad crónica, degenerativa, inflamatoria y multifactorial que afecta el cartílago articular, provocando dolor y pérdida de funcionalidad. Actualmente, existen una variedad de nuevos fármacos y protocolos terapéuticos, generando dudas al momento del tratamiento. Por lo anterior, el objetivo de este trabajo es entregar una revisión de la literatura con información reciente, con el fin de brindar una recomendación actualizada para el manejo de la artrosis de rodilla. MATERIALES Y MÉTODOS: Se realizó una revisión no sistemática de estudios publicados entre enero del 2000 y agosto del 2020, utilizando los términos MeSH "knee", "osteoarthritis" y "therapeutics". Se usaron como motores de búsqueda PubMed, The Cochrane Library y Trip Data base, excluyendo estudios en animales y población pediátrica. DISCUSIÓN: Es importante destacar que independientemente de la modalidad de tratamiento, este debe ser escalonado e individualizado, pues cada paciente va a responder de forma diferente. Se recomienda en primer lugar los cambios de estilo de vida, autocuidado y educación. En segundo lugar, la kinesioterapia, seguido de la farmacología tópica y oral (AINES y paracetamol) y como última opción, el tratamiento intraarticular en base a corticoides. CONCLUSIÓN: El tratamiento de la artrosis de rodilla debe ser integral y centrado tanto en el manejo farmacológico como no farmacológico. Actualmente, no existe un único fármaco seguro, altamente útil y costo-efectivo para el tratamiento crónico

INTRODUCTION: Knee osteoarthritis is a chronic, degenerative, inflammatory, and multifactorial disease that affects joint cartilage, causing pain and loss of functionality. Currently, there are a variety of new drugs and therapeutic protocols, raising doubts at the time of treatment. Therefore, the objective of this work is to provide a review of the literature with recent information, to provide an updated recommendation for the management of knee osteoarthritis. MATERIALS AND METHODS: A non-systematic review of studies published between January 2000 and August 2020 were performed, using the MeSH terms "knee", "osteoarthritis" and "therapeutics". PubMed, The Cochrane Library, and Trip Database were used as search engines, excluding studies in animals and the pediatric population. ABSTRACT: It is important to highlight that regardless of the treatment modality, it must be stepped and individualized, since each patient will respond differently. Lifestyle changes, self-care, and education are recommended first. Secondly, kinesiotherapy, followed by topical and oral pharmacology (NSAIDs and paracetamol) and as a last option, intra-articular treatment based on corticosteroids. CONCLUSION: Treatment of osteoarthritis of the knee should be comprehensive and focused on both pharmacological and non-pharmacological management. Currently, there is no single safe, highly useful, and cost-effective drug for chronic treatment

Eficacia de la viscosuplementación con ácido hialurónico de alto y de mediano peso molecular en pacientes con gonartrosis sintomática grados II-III / Efficacy of viscosupplementation with high and medium molecular weight hyaluronic acid in patients with symptomatic gonarthrosis grades II-III

Resumen: Introducción: La osteoartrosis es actualmente la quinta causa de discapacidad en el adulto. Su prevalencia aumenta a partir de los 40 años. La viscosuplementación es un tratamiento para las etapas iniciales de la osteoartrosis de rodilla. Objetivo: Comparar la eficacia y la calidad de vida en pacientes con gonartrosis sintomática tratados con ácido hialurónico de alto y mediano peso molecular. Material y métodos: Estudio analítico, retrospectivo, transversal, observacional de expedientes clínicos de pacientes con diagnóstico de gonartrosis grado II y grado III, de Octubre de 2017 a Junio de 2018, tratados con viscosuplementación con ácido hialurónico de alto o de mediano peso molecular; se analizó la calidad de vida y la escala de WOMAC de manera previa a la primera aplicación y con seguimiento a los dos, cuatro y seis meses. Resultados: 194 pacientes, con edades entre 30 y 87 años (promedio 61.85; DE = 11.3); 134 mujeres (69.1%) y 60 hombres (30.9%). En ambos grupos la evolución fue hacia la mejoría, con disminución en el puntaje WOMAC, sin diferencia significativa entre grupos. El puntaje de WOMAC tuvo un aumento mínimo pasados seis meses de la aplicación en ambos grupos, lo que se interpreta como disminución del efecto terapéutico. Dos pacientes tuvieron reacciones adversas mínimas localizadas, las cuales se resolvieron con medidas generales. Conclusión: El ácido hialurónico en ambas presentaciones, de alto y de bajo peso molecular, es efectivo en el tratamiento de la gonartrosis sintomática sin diferencia con el peso molecular.

Abstract: Introduction: OA is currently the fifth leading cause of adult disability, its prevalence increases from age 40. Viscosupplementation is a treatment for the early stages of knee OA. Objective: To compare efficacy and quality of life in patients with symptomatic gonartrosis, treated with high and low molecular weight hyaluronic acid. Material and methods: Analytical, retrospective, cross-sectional, observational study of clinical records of patients diagnosed with grade II and grade III gonarthrosis, October 2017 to June 2018, treated with viscosupplementation with high molecular weight hyaluronic acid or low molecular weight; WOMAC quality of life and scale were analyzed prior to the first application and tracked at two, four and six months. Results: 194 patients, aged between 30 to 87 years (promedio 61.85; SD = 11.3); 134 women (69.1%), 60 men (30.9%). In both groups the evolution was towards improvement, with a decrease in the WOMAC score, with no significant difference between groups. The WOMAC score had a minimum increase after 6 months of application in both groups, which is interpreted as decreasing the therapeutic effect. Two patients had localized minimal adverse reactions which were resolved with general measures. Conclusion: Hyaluronic acid in both presentations, high and low molecular weight, are effective in the treatment of symptomatic goonarthrosis without difference to molecular weight.

Registro de acido hialuronico intrarticular en el tratamiento de la artrosis de rodilla, en la Argentina / Registry of intra-articular hyaluronic acid for the treatment of knee osteoarthritis in Argentina

Introducción: El acido hialuronico intrarticular se suele utilizar con diferentes esquemas para tratar la artrosis de rodilla. Nuestro objetivo fue analizar la eficacia y el uso del acido hialuronico intrarticular en la practica habitual. Materiales y Métodos: Cohorte retrospectiva observacional. Se evaluo a 1227 pacientes con artrosis de rodilla tratados con acido hialuronico intrarticular 20 mg/2 ml/semana (76%, 20 mg) y 40 mg/2 ml (24%, 40 mg) segun la practica habitual. Seguimiento de 6 meses. Se evaluo la eficacia con la escala de Likert de 5 puntos y la proporcion de respuesta ≥50%. Resultados: La mediana de aplicaciones fue de 5 (20 mg) y 3 (40 mg). El puntaje de Likert mejoro significativamente en ambos grupos a los 6 meses. La mediana del puntaje mejoro de 4 (media 3,77 ± 0,69) al inicio a 2 (media 1,99 ± 0,76) a los 6 meses con 20 mg (p <0,001) y de 4 (media 3,65 ± 0,65) a 2 (media 1,86 ± 0,72) con 40 mg (p <0,001). La proporcion de respuesta ≥50% a los 6 meses fue del 61% y 66%, respectivamente. En el analisis multivariado, la tasa de respuesta ≥50% se asocio con un mayor puntaje inicial, edad mas joven y menor duracion de la enfermedad. Solo un paciente con 20 mg (0,1%) tuvo un episodio adverso serio (artritis septica). Conclusión: Nuestro estudio en la practica clinica comun respalda la efectividad del acido hialuronico intrarticular para tratar la artrosis de rodilla, con un beneficio clinico a los 6 meses de seguimiento. Nivel de Evidencia: IV

Background: Treatment of knee osteoarthritis with intra-articular hyaluronic acid (IA-HA) is frequently used in Argentina, with different dosing forms and injection regimens. Our main objective was to provide real world data on the use and effectiveness of IA-HA. Methods: In this observational retrospective cohort study we studied 1227 patients with knee osteoarthritis treated with IA-HA 20 mg/2 ml weekly (76%-20 mg group) and 40 mg/2 ml (24%-40 mg group) according to standard practice. Follow-up was 6 months and effectiveness was assessed by the 5-point Likert scale and a response of 50% or more. Results: Median number of injections was 5 (20 mg) and 3 (40 mg). Both groups had a significant improvement in the Likert scale from baseline to 6 months. Median score improved from 4 (mean 3.77 ± 0.69) at baseline to a median of 2 (mean 1.99 ± 0.76) at 6 months (20 mg group, p<0.001) and from a median of 4 (mean 3.65 ± 0.65) to a median of 2 (mean 1.86 ± 0.72) in the 40 mg group, p<0.001. The percentages of patients with a response of 50% or more at 6 months were 61% and 66%, respectively. In the multivariate analysis, the 50% response rate was associated with a higher baseline score, younger age and shorter duration of disease. Only one patient in the 20 mg group (0.1%) experienced a serious treatment-related adverse event (septic arthritis) following injection. Conclusion: Our study carried out during routine clinical practice supports the effectiveness of IA-HA for the management of knee osteoarthritis with a clinical advantage observed at a 6-month follow-up. Level of Evidence: IV