El índice de masa corporal como fenotipo en el perfil clínico y funcional en mujeres con osteoartritis de rodilla / Association between the functional impact of osteoarthritis and body mass index in women

Background: Obesity is associated with pain, reduction of function and quality of life in patients with osteoarthritis (OA). Aim: To describe the clinical profile of women with knee OA according to their body mass index (BMI). Material and Methods: Observational study in 308 women with knee OA. According to their BMI, they were classified as normal-weight, overweight and obese. The primary outcome measure was functionality evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI) and quality of life assessed with the European Quality of Life Five Dimension (EuroQol-5D). Results: WOMAC, PSQI and EuroQol-5D scores were significantly higher in obese women. Conclusions: Overweight and obese women with OA have more sleep disorders, reduction on functionality and quality of life compared to their normal weight counterparts.

Efectividad de la distracción tibiofemoral en la funcionalidad adicionada al tratamiento convencional en pacientes mayores de 50 años con osteoartritis de rodilla: un estudio piloto / Effectiveness of tibiofemoral distraction in the functionality added to conventional treatment in patients over 50 years with knee osteoarthritis: a pilot study

RESUMEN: Osteoartritis (OA) es una de las enfermedades reumáticas más frecuentes y la más común enfermedad articular, afecta principalmente al cartílago articular y el hueso subcondral de una articulación sinovial resultando en la incapacidad articular. La OA es reconocida como una causa substancial de discapacidad, con significativos costos sociales y financieros debidos a las frecuentes intervenciones médicas y quirúrgicas además del ausentismo laboral. El objetivo del estudio fue determinar si la distracción tibiofemoral adicionada al tratamiento convencional en pacientes con osteoartritis de rodilla grado 3, presenta mejoras en el dolor, rango de movimiento y funcionalidad de la extremidad inferior, en comparación al tratamiento convencional propuesto por el MINSAL por sí solo. Esta investigación corresponde a un estudio piloto, con diseño experimental del tipo ensayo clínico aleatorizado (ECA), controlado, ciego simple y con una muestra equilibrada. La muestra corresponde a pacientes reclutados del Hospital San Borja Arriarán (Santiago, Chile) con diagnóstico médico de OA de rodilla grado 3. Se realizaron dos mediciones, una al inicio de las diez sesiones y otra al final del tratamiento, donde se midió el dolor con la escala visual análoga (EVA), el rango de movimiento articular pasivo con goniometría y la capacidad funcional con el test de marcha de 6 minutos y el cuestionario de WOMAC. Al comparar ambos grupos muestran diferencias estadísticamente significativas en la funcionalidad, el dolor y distancia de marcha durante 6 minutos. La distracción tibiofemoral adicionada al tratamiento convencional presentó mejoras clínicas significativas cuando comparada con la aplicación del tratamiento convencional de OA de rodilla.

SUMMARY: Osteoarthritis (OA) is one of the most frequent rheumatic diseases and the most common joint disease, primarily affecting joint cartilage and the subchondral bone of a synovial joint resulting in the y articular dysfunction. OA is recognized as a cause of disability, with significant social and financial costs due to medical, surgical interventions in addition to frequent absenteeism at work. The objective was to determine if tibiofemoral distraction, in conjunction with conventional therapy in patients with knee osteoarthritis grade 3, improved performance of the lower extremity in comparison to the conventional treatment alone, as proposed by the Ministry of Health (MINSAL). This research is a pilot, prospective randomized clinical trial (RCT), controlled, single-blind and with a balanced sample. The sample was recruited from patients of the Hospital San Borja Arriarán (Santiago, Chile) with medical diagnosis of knee OA grade 3. Two measurements were performed, one at the beginning of the 10 sessions and at the end of treatment, which was measured with the functionality questionnaire of OA of the Western Ontario and McMaster Universities (WOMAC), the pain visual analog scale (VAS), the passive joint range of motion with goniometry, and distance to the Test 6-minute walk. When comparing the two groups showed statistically significant differences in functionality, pain, distance walked and joint range, except in knee grade extension. The tibiofemoral distraction added to conventional treatment functional improvement in patients with knee OA grade 3.

Comportamiento de pacientes con artrosis patelofemoral / Behavior of patients with patellofemoral osteoarthritis

Resumen: Antecedentes: La artrosis patelofemoral es detectada en un gran número de pacientes y es responsable de múltiples síntomas y signos entre los que predomina el dolor, su tratamiento es variado y va desde el conservador hasta el quirúrgico, en el que destaca la vía artroscópica. Objetivo: Mostrar el comportamiento de un grupo de pacientes con artrosis patelofemoral. Material y métodos: Se realizó un estudio observacional descriptivo en 96 pacientes con el diagnóstico clínico y radiográfico de artrosis patelofemoral desde Enero de 2015 hasta Abril de 2017. La muestra no probabilística e intencionada quedó constituida por 77 pacientes que reunieron los criterios de selección (inclusión y exclusión). Resultados: El promedio de edades fue de 52.2 años, predominó el sexo femenino, la rótula derecha y la causa que más se observó fue la primaria. El dolor durante el reposo es una de sus principales manifestaciones. Existe correlación entre la clasificación de Iwano T y Outerbridge RE. Por lo general, existen otros compartimentos afectados de la articulación, la presencia aislada es muy infrecuente y el tratamiento por vía artroscópica es de gran utilidad. Conclusiones: La artrosis patelofemoral es frecuente, genera síntomas y signos en un grupo grande de pacientes. La presencia de esta afección por lo regular está asociada a otras lesiones de la articulación y los enfermos pueden ser tratados por vía artroscópica.

Abstract: Background: Patellofemoral osteoarthritis affects a great number of patients complaining chiefly of knee pain, treatment vary from conservative to surgical, especially arthroscopy. Objective: The aim of this study was to show the behavior of a group of patients with patellofemoral osteoarthritis. Material and methods: A descriptive and transversal study with a level of evidence IV and recommendation grade C in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 2015 to April 2017 was performed in 96 patients with the diagnosis of patellofemoral osteoarthritis, but 77 of them were selected as a non-probabilistic sample, based on selected criteria. Results: Mean age was 52.2 years. Female sex, right patella and primary etiology prevailed. Rest pain was the most common symptom. There is a strong correlation between Iwano T and Outerbridge RE classifications systems. In general, more than one compartment of the knee is affected in patellofemoral osteoarthritis, isolated presentation is rare and treatment by arthroscopy is of great help. Conclusions: Patellofemoral osteoarthritis is a common disease, patients usually complain of a great number of symptoms and signs. Patellofemoral osteoarthritis is usually associated to affection of other compartments and patients may be treated by arthroscopy.

Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis / Estudo da relação entre o peso corporal e o quadro de limitação funcional e dor em pacientes com osteoartrite de joelho

ABSTRACT Objective To assess the influence of the body weight in functional capacity and pain of adult and elderly individuals with knee osteoarthritis. Methods The sample consisted of 107 adult and elderly patients with knee osteoarthritis divided into two groups (adequate weight/adiposity and excessive weight/adiposity) according to body mass index and percent of body fat mass, assessed by electric bioimpedance. Subjects were evaluated for functional mobility (Timed Up and Go Test), pain, stiffness and function (Western Ontario and MacMaster Universities Osteoarthritis Index − WOMAC), pain intensity (Visual Analogue Scale − VAS) and pressure pain tolerance threshold (algometry in vastus medialis and vastus lateralis muscles). Data were analyzed with Statistical Package of the Social Sciences, version 22 for Windows. Comparisons between groups were made through Student's t test, with significance level set at 5%. Results There was predominance of females in the sample (81.3%), and mean age was 61.8±10.1 years. When dividing the sample by both body mass index and adiposity, 89.7% of them had weight/adiposity excess, and 59.8% were obese. There was no difference between groups regarding age, pain intensity, pressure pain tolerance threshold, functional mobility, stiffness and function. However, pain (WOMAC) was higher (p=0.05) in the group of patients with weight or adiposity excess, and pain perception according to VAS was worse in the group of obese patients (p=0.05). Conclusion Excessive weight had negative impact in patients with osteoarthritis, increasing pain assessed by WOMAC or VAS, although no differences were observed in functionality and pressure pain tolerance.

RESUMO Objetivo Avaliar a influência do peso corporal na capacidade funcional e na dor de adultos e idosos com osteoartrite de joelho. Métodos A amostra foi constituída por 107 pacientes adultos e idosos com osteoartrite do joelho, divididos em dois grupos (peso/adiposidade adequados e peso/adiposidade em excesso), de acordo com o índice de massa corporal e a porcentagem de adiposidade corporal, e avaliados por bioimpedância elétrica. Os sujeitos foram avaliados quanto à mobilidade funcional (Timed Up and Go), dor, rigidez e função (Western Ontario and McMaster Universities Osteoarthritis Index − WOMAC), intensidade da dor (Escala Visual Analógica - EVA) e limiar de limiar de dor à pressão (algometria nos músculos vasto medial e vasto lateral). Os dados foram analisados pelo Statistical Package of the Social Sciences, versão 22 para Windows. As comparações entre os grupos foram feitas por meio do teste t de Student, com nível de significância estabelecido em 5%. Resultados Houve predomínio de mulheres na amostra (81,3%), com média de idade de 61,8±10,1 anos. Ao dividir a amostra por índice de massa corporal e adiposidade, 89,7% apresentaram peso/adiposidade em excesso, e 59,8% eram obesos. Não houve diferença entre os grupos quanto a idade, intensidade da dor, limiar de dor à pressão, mobilidade funcional, rigidez e função. Entretanto, a dor (WOMAC) foi maior (p=0,05) no grupo de pacientes com excesso de peso ou adiposidade, e a percepção da dor pela EVA foi pior no grupo de pacientes obesos (p=0,05). Conclusão O peso em excesso teve impacto negativo em pacientes com osteoartrite, aumentando a dor avaliada pelo WOMAC ou pela EVA, embora não tenham sido observadas diferenças na funcionalidade e na tolerância à dor sob pressão.

Effects of Motor Learning on Clinical Isokinetic Test Performance in Knee Osteoarthritis Patients

OBJECTIVES: To analyze the effects of motor learning on knee extension-flexion isokinetic performance in knee osteoarthritis patients. METHODS: One hundred and thirty-six middle-aged and older sedentary individuals (111 women, 64.3±9.9 years) with knee osteoarthritis (130 patients with bilateral) and who had never performed isokinetic testing underwent two bilateral knee extension-flexion (concentric-concentric) isokinetic evaluations (5 repetitions) at 60°/sec. The tests were first performed on the dominant leg with 2 min of recovery between test, and following a standardized warm-up that included 3 submaximal isokinetic repetitions. The same procedure was repeated on the non-dominant leg. The peak torque, peak torque adjusted for the body weight, total work, coefficient of variation and agonist/antagonist ratio were compared between tests. RESULTS: Patients showed significant improvements in test 2 compared to test 1, including higher levels of peak torque, peak torque adjusted for body weight and total work, as well as lower coefficients of variation. The agonist/antagonist relationship did not significantly change between tests. No significant differences were found between the right and left legs for all variables. CONCLUSION: The results suggest that performing two tests with a short recovery (2 min) between them could be used to reduce motor learning effects on clinical isokinetic testing of the knee joint in knee osteoarthritis patients.

Secondary hyperalgesia occurs regardless of unilateral or bilateral knee osteoarthritis involvement in individuals with mild or moderate level / A hiperalgesia secundária ocorre independentemente do envolvimento unilateral ou bilateral da osteoartrite de joelho em indivíduos com doença leve ou moderada

ABSTRACT Background: Secondary hyperalgesia in individuals with less severe levels of knee osteoarthritis remains unclear. The objective of this study was to measure the pressure pain threshold of individuals with mild or moderate knee osteoarthritis and compare with no osteoarthritis. Methods: Ten healthy controls and 30 individuals with mild or moderate knee osteoarthritis divided into two groups (unilateral and bilateral involvement) were included. Dermatomes in lumbar levels (L1, L2, L3, L4 and L5) and sacral level (S1 and S2), myotomes (vastus medialis, vastus lateralis, rectus femoris, adductor longus, tibialis anterior, peroneus longus, iliacus, quadratus lumborum, and popliteus muscles), and sclerotomes in lumbar levels (L1-L2, L2-L3, L3-L4, L4-L5 supraspinous ligaments), over the L5-S1 and S1-S2 sacral areas, pes anserinus bursae, and at the patellar tendon pressure pain threshold were assessed and compared between individuals with and without knee osteoarthritis. Results: Knee osteoarthritis groups (unilateral and bilateral) reported lower pressure pain threshold compared to the control group in most areas (dermatomes, myotomes, and sclerotomes). There were no between group differences in the supra-spinous ligaments and over the L5-S1 and S1-S2 sacral areas of the sclerotomes. No difference was seen between knee osteoarthritis. Conclusion: These findings suggest that individuals with mild to moderate knee osteoarthritis had primary and secondary hyperalgesia, independent of unilateral or bilateral involvement. These results suggest that the pain have to be an assertive focus in the clinical practice, independent of the level of severity or involvement of knee osteoarthritis.

RESUMO Introdução: A ocorrência de hiperalgesia secundária em indivíduos com níveis menos graves de osteoartrite de joelho ainda é incerta. O objetivo deste estudo foi medir o limiar de dor à pressão (LDP) de indivíduos com osteoartrite de joelho (OAJ) leve ou moderada e comparar com indivíduos sem osteoartrite. Métodos: Foram incluídos 10 controles saudáveis e 30 indivíduos com OAJ leve ou moderada, divididos em dois grupos (envolvimento unilateral e bilateral). Foi avaliado e comparado o LDP em dermátomos (L1, L2, L3, L4, L5, S1 e S2), miótomos (músculos vasto medial, vasto lateral, reto femoral, adutor longo, tibial anterior, fibular longo, ilíaco, quadrado lombar e poplíteo) e esclerótomos (ligamentos supraespinais L1-L2, L2-L3, L3-L4, L4-L5), sobre as áreas sacrais L5-S1 e S1-S2, bolsa anserina e tendão patelar entre os indivíduos com e sem OAJ. Resultados: Os grupos OAJ (unilateral e bilateral) relataram menor LDP em comparação com o grupo controle na maior parte das áreas (dermátomos, miótomos e esclerótomos). Não houve diferenças entre os grupos nos ligamentos supraespinais e ao longo das áreas sacrais L5-S1 e S1-S2 dos esclerótomos. Não foi observada qualquer diferença entre os indivíduos com OAJ. Conclusão: Esses achados sugerem que os indivíduos com OAJ leve a moderada tinham hiperalgesia primária e secundária, independentemente do acometimento unilateral ou bilateral. Esses resultados sugerem que a dor precisa ser um foco assertivo na prática clínica, independentemente do grau de gravidade ou envolvimento da OAJ.

Osteoarthritis model induced by intra-articular monosodium iodoacetate in rats knee

ABSTRACT PURPOSE: To evaluate the usefulness of a knee osteoarthritis model through functional, radiological and microscopic changes of the synovial membrane. METHODS: Forty eight rats were divided randomly into two groups. The first received 0.9% saline in the joint and corresponded to the control group. The second was submitted to experimental osteoarthritis of the right knee induced by monosodium iodoacetate and corresponded to the osteoarthritis group. All animals were subjected to comparative tests of forced ambulation and joint movements, inability to articulate and tactile allodynia on day 1 post-experiment by forced ambulation (Roto-rod test), joint assessment of disability (weight bearing test) and assessment of tactile allodynia (Von Frey test). After inflammatory induction they were divided into four sub-groups corresponding to the scheduled death in 7, 14, 21 and 28 days when they were submitted to radiographic examination of the knee, arthrotomy and collection of the synovial membrane. RESULTS: The osteoarthritis group showed significant differences compared to control group on days 7 and 14 in Roto-rod, in weight bearing and Von Frey tests in all days, and in radiological evaluation. Microscopic examination of the synovial membrane showed abnormalities of inflammatory character at all stages. CONCLUSION: The osteoarthritis induced by intra-articular monosodium iodoacetate in rats knee is a good model to be used in related research, because it provides mensurable changes on joint movements, tactile allodynia, progressive radiological degeneration and microscopic inflammation of the synovial membrane, that represent markers for osteoarthritis evaluation

Effectiveness of a healthy lifestyle intervention for low back pain and osteoarthritis of the knee: protocol and statistical analysis plan for two randomised controlled trials

ABSTRACT Background These trials are the first randomised controlled trials of telephone-based weight management and healthy lifestyle interventions for low back pain and knee osteoarthritis. This article describes the protocol and statistical analysis plan. Method These trials are parallel randomised controlled trials that investigate and compare the effect of a telephone-based weight management and healthy lifestyle intervention for improving pain intensity in overweight or obese patients with low back pain or knee osteoarthritis. The analysis plan was finalised prior to initiation of analyses. All data collected as part of the trial were reviewed, without stratification by group, and classified by baseline characteristics, process of care and trial outcomes. Trial outcomes were classified as primary and secondary outcomes. Appropriate descriptive statistics and statistical testing of between-group differences, where relevant, have been planned and described. Conclusions A protocol for standard analyses was developed for the results of two randomised controlled trials. This protocol describes the data, and the pre-determined statistical tests of relevant outcome measures. The plan demonstrates transparent and verifiable use of the data collected. This a priori protocol will be followed to ensure rigorous standards of data analysis are strictly adhered to.

Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho / Impact of a structured aquatic therapy program on patients with knee osteoarthritis

A osteoartrite é uma doença articular degenerativa, reumática crônica, multifatorial de alta prevalência, atinge 10% da população com mais de 65 anos. Afeta igualmente ambos os sexos, sendo que na mulher a incidência é maior após o período da menopausa. Esta doença compreende 65% das causas de incapacidade, atrás somente de doenças cardiovasculares e mentais. A reabilitação do paciente com artrose é um processo complexo que envolve procedimentos especializados Objetivo: Avaliar os efeitos de um programa de hidrocinesioterapia sobre a capacidade de realização de atividades da vida diária em pacientes com osteoartrite. Métodos: Este é um estudo prospectivo, onde vinte e seis pacientes com histórico de osteoartrite de joelho foram submetidos a um programa de tratamento em hidrocinesioterapia, com frequência de duas vezes por semana com duração de 50 minutos cada sessão. O programa consistia de quatro fases, sendo elas: aquecimento, alongamento, fortalecimento e relaxamento. Estes pacientes foram avaliados pré e pós-tratamento. Utilizando como método de avaliação a goniometria, escala de dor EVA e Teste de Caminhada de Seis Minutos. Resultados: Houve melhora significante da amplitude de movimento ao realizar flexão dos joelhos acometidos, também foi visto diminuição significativa da dor e melhora significante na capacidade de realização das atividades de vida diária avaliada por meio da distância percorrida no teste de caminhada de seis minutos. Conclusão: Houve melhora da capacidade de realizar AVD e da capacidade física, assim como redução do quadro álgico e aumento da amplitude de movimento

Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion

Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoarthritis / Estudo comparativo da capacidade funcional e qualidade de vida entre idosos com osteoartrite de joelho obesos e não obesos

ABSTRACT Introduction: The association between osteoarthritis (OA) and obesity can lead to a reduced functional capacity, compromising the quality of life (QoL) of the elderly. Objective: To compare the functional capacity and QoL of obese and non-obese older adults with knee OA. Methods: The sample consisted of 35 subjects with OA divided into two groups, obese and non-obese subjects, according to their body mass index. To assess functional capacity, performance tests such as Timed Up and Go (TUG), gait speed test, and the six-minute walk test (6 MWT) were carried out. To assess QoL, WOMAC and SF-36 questionnaires were administered. We performed descriptive and inferential statistics using SPSS software version 20.0. Results: Elderly patients with OA were divided into two groups (obese, n = 16; non-obese, n = 19). Socio-demographic characteristics were similar between groups (p > 0.05). The obese group showed a worst performance in TUG, brisk walking speed and 6 MWT. A more severe pain was found in the following items: “performing heavy housework chores”, “going down stairs”, “bending to floor” and “getting up from bed” in the obese group (p < 0.05). In addition, the obese group had more difficulty to perform tasks for the following items: “going down stairs”, “rising from a chair”, “standing” and “getting on/off toilet” (p < 0.05). There was no statistically significant difference in the assessed domains of SF-36 between groups (p > 0.05). Conclusion: OA associated with obesity caused a negative impact on functional capacity; however, quality of life scores were low, and no difference in obese and non-obese subjects was found.

RESUMO Introdução: A associação entre osteoartrite (OA) e obesidade pode gerar redução da capacidade funcional e comprometer a qualidade de vida (QV) de idosos.Objetivo Comparar a capacidade funcional e a QV entre idosos com OA no joelho, obesos e não obesos.A amostra foi constituída por 35 idosos com OA divididos em dois grupos, obesos e não obesos, de acordo com o índice de massa corporal. Para avaliação da capacidade funcional foram feitos testes de desempenho, como Timed Up and Go (TUG), velocidade da marcha e teste de caminhada de seis minutos (TC6). Para avaliação da QV foram aplicados os questionários WOMAC e SF-36. Foi feita estatística descritiva e inferencial com o uso do software SPSS versão 20.0. Métodos: Os idosos com OA foram divididos em dois grupos (obesos, n = 16) e (não obesos, n = 19). As características sociodemográficas foram similares entre os grupos (p > 0,05). Foi observada redução de desempenho no TUG, velocidade da marcha rápida e TC6, com maior intensidade de dor nos itens: “executar tarefas domésticas pesadas”, “descer escadas”, “curvar-se em direção ao chão” e “levantar-se da cama” no grupo dos obesos (p < 0,05). Além disso, o grupo de obesos apresentou maior dificuldade ao executar tarefas para os itens: “descer escadas”, “levantar da cadeira”, “ficar de pé” e “sentar/levantar do vaso sanitaria” (p < 0,05). Não foi observada diferença estatisticamente significativa nos domínios avaliados do SF-36 entre os grupos (p > 0,05). Conclusão: A OA associada à obesidade impactou negativamente a capacidade functional. Entretanto, os escores de QV foram baixos sem diferença para obesos e não obesos.

Comparação dos efeitos de exercícios resistidos versus cinesioterapia na osteoartrite de joelho / Comparison of the effects of resistance exercise versus kinesiotherapy in knee osteoarthritis

O aumento da expectativa de vida de diversas populações coloca a osteoartrite (OA) como uma importante questão de saúde pública, por se tratar de uma doença crônica muito prevalente e que lidera as causas de dor e incapacidade entre adultos e idosos. Objetivo: Comparar a dor, mobilidade, capacidade funcional e força de indivíduos com OA de joelhos submetidos a dois tipos de intervenção: exercício resistido (GER) e cinesioterapia (GCI). Métodos: Tratou-se de um ensaio clínico prospectivo, randomizado e simples-cego do qual participaram 30 pacientes com OA de joelhos, adultos de ambos os sexos. Os voluntários foram avaliados quanto à dor, rigidez articular, funcionalidade, mobilidade funcional e força, por um avaliador cego, antes e após as intervenções. Por meio de sorteio simples, os participantes foram aleatoriamente direcionados a um dos 2 grupos de intervenção, e submetidos a 15 sessões de tratamento, com duração de 30 minutos cada, 2 vezes por semana. Resultados: Ambas as intervenções promoveram melhorias significantes em todas as variáveis avaliadas, e não houve relato de nenhum efeito adverso ao longo da pesquisa. Conclusão: Tanto o exercício resistido como a cinesioterapia são eficazes para melhorar a dor, rigidez articular, funcionalidade, mobilidade funcional e força de pacientes com OA de joelhos

Increased life expectancy in several populations makes osteoarthritis (OA) an important public health issue, as it is a very prevalent chronic disease and leading cause of pain and disability among adults and elderly. Objective: The aim of this study was to compare pain, mobility, functional capacity, and strength of patients with knee osteoarthritis submitted to two different interventions: resistance exercise (REG) and kinesiotherapy (KIG). Methods: This was a prospective randomized single blind clinical trial, which involved the participation of 30 adults of both sexes diagnosed with knee OA. Volunteers were evaluated for pain, stiffness, function, functional mobility, and strength by a blinded evaluator before and after the interventions. Through a simple drawing, participants were randomly assigned to one of the two intervention groups, and underwent 15 twice-weekly treatment sessions, lasting 30 minutes each. Results: Both interventions promoted significant improvements in all variables, and there were no reports of any adverse effects throughout the research. Conclusion: Both resistance exercise and kinesiotherapy are effective in improving pain, stiffness, function, functional mobility, and strength in patients with knee OA

Osteoartritis (artrosis) de rodilla / Knee osteoarthritis (osteoarthrosis)

La artrosis de rodilla (OA) es uno de los principales problemas de salud a nivel mundial debido a su alta prevalencia y costos asociados. Los conocimientos disponibles demuestran que el componente inflamatorio es fundamental en el desarrollo de esta condición, abandonándose el concepto de que la OA es una enfermedad puramente degenerativa. En el presente escrito revisaremos, basándonos en la literatura disponible, la epidemiología y los factores de riesgo involucrados, los nuevos conocimientos fisiopatológicos, el enfrentamiento clínico y los tratamientos disponibles tanto médicos como quirúrgicos de esta condición...

Knee osteoarthritis (OA) is one of the major public health problems worldwide, due to its high prevalence and associated costs. The available knowledge shows that the inflammatory component is critical in the development of this condition, abandoning the concept that OA is only a degenerative disease. A review is presented in this article, based on the available literature, on the epidemiology and risk factors involved, recent knowledge about the pathophysiological and clinical management, and the medical and surgical treatments available for this condition...

The role of MCP-1-CCR2 ligand-receptor axis in chondrocyte degradation and disease progress in knee osteoarthritis

BACKGROUND: Osteoarthritis (OA) is a common arthritic disease and multifactorial whole-joint disease. Interactions of chemokines and OA is inadequately documented. RESULTS: In vivo and in vitro studies were conducted to investigate monocyte chemoattractant protein 1 (MCP-1) and receptor chemokine (C-C motif) receptor 2 (CCR2) in chondrocyte degradation and cartilage degeneration. Chondrocytes from 16 OA patients and 6 normal controls were involved in this study. After stimulation of MCP-1, the expression of MCP-1 and CCR2 increased significantly (P < 0.001) and the expression of MMP-13 also increased (P < 0.05). MCP-1 stimulation also induced (or enhanced) the apoptosis of OA chondrocytes (P < 0.05). Additionally, the degradation of cartilage matrix markers (metalloproteinase 3 and 13, MMP3 and MMP13) in the culture medium of normal chondrocytes was also assessed. Furthermore, intra-articular injection of MCP-1 in mouse knees induced cartilage degradation and the CCR2 antagonist did not impede cartilage destroy in rats knees of monosodium iodoacetate (MIA) model. CONCLUSIONS: The results of this study demonstrate that the MCP-1-CCR2 ligand-receptor axis plays a special role in the initiation and progression of OA pathology. Patients with ambiguous etiology can gain some insight from the MCP-1-CCR2 ligand-receptor axis.

Influência da velocidade da marcha sobre a pressão plantar em sujeitos com osteoartrite unilateral de joelho / Influence of gait speed on plantar pressure in subjects with unilateral knee osteoarthritis

Objetivos Alterar a velocidade da marcha é uma estratégia comum para manipular a intensidade de exercício de caminhada, mas pode repercutir em maiores forças de impacto e consequente sobrecarga articular. Neste estudo analisamos os efeitos do aumento da velocidade da marcha sobre a pressão plantar e assimetrias na marcha em idosos com osteoartrite (OA) unilateral de joelho. A hipótese do estudo era de que o membro acometido receberia maior sobrecarga que o acometido durante o andar nas diferentes velocidades. Métodos Doze idosos com OA unilateral de joelho caminharam por um corredor de 10 m onde pisavam em um tapete instrumentado para medidas de pressão plantar. Cada participante caminhou cinco vezes em três diferentes velocidades autosselecionadas (preferida, lenta e rápida). Os resultados foram comparados entre as velocidades e entre os membros inferiores. Resultados As velocidades avaliadas diferiram entre si (p<0,05). A pressão média e o pico de pressão aumentaram com as mudanças entre as velocidades lenta e rápida (p<0,05); a velocidade do centro de pressão aumentou e o tempo de apoio simples diminuiu com o aumento da velocidade (p<0,05). Assimetrias não foram observadas entre o membro acometido e o contralateral. Conclusões O aumento na velocidade da marcha lenta para rápida em sujeitos com OA unilateral afeta a pressão plantar tanto no membro acometido quanto no contralateral, sem a observação de assimetrias. .

Objective Changing gait speed is a common strategy to manipulate exercise intensity during physical exercise, but may elicit higher impact forces and consequent joint loading. Here we analyzed the effects of increasing walking velocity on plantar pressure and asymmetries in elderly with knee osteoarthritis (OA). Our hypothesis was that the contralateral limb could receive higher loading compared to the OA limb in the different walking speeds tested. Methods Twelve elderly with unilateral knee OA walked at different self-selected speeds along a 10 m pass way stepping on an instrumented mat for measurement of plantar pressure at preferred, slow and fast gait speeds. Five steps were recorded for each speed. Plantar pressure data were compared between the speeds and legs. Results speeds were significantly different between them (p<0.05). Mean and peak plantar pressure increased when speed changed from slow to fast (p<0.05). Velocity of the center of pressure increased and the single stance time decreased when walk speed was increased (p<0.05). Any asymmetries were observed. Conclusion Increasing gait speed from slow to fast in subjects with unilateral knee OA significantly affected variables of plantar pressure, but asymmetries between committed and contralateral leg were not detected. .

Artrosis patelofemoral: tratamiento quirúrgico no protésico / Patellofemoral osteoarthritis. Non-prosthetic surgical treatment

La artrosis patelofemoral es una entidad clínica frecuente y muy incapacitante. Numerosos tratamientos han sido propuestos para el tratamiento quirúrgico de esta patología cuando fracasa el tratamiento ortopédico. Los hemos dividido en tratamientos quirúrgicos menores (liberación retináculo lateral- resección osteofito lateral y resección de la faceta lateral) y mayores (osteotomía de la TAT-cultivo de condrocitos- remplazos articulares). El objetivo de este trabajo es realizar una actualización de esta entidad clínica, y presentar una serie de casos mostrando la experiencia personal en el manejo de esta patología. Nivel de Evidencia: V

Patellofemoral osteoarthritis is a common and very disabling clinical entity. Several treatments have been proposed for the surgical treatment of this disease when the orthopedic one fails We’ve divided these treatments into minor surgery (lateral retinaculum release- laterally osteophyte resection and resection of the lateral facet) and major (osteotomy TAT-ACI- joint replacements). The aim of this work is an update of this clinical entity, and presents a series of cases showing personal experience in the management of this condition. Evidence Level: V

Avaliação do controle postural e da qualidade de vida em idosas com osteoartrite de joelho / Evaluation of postural control and quality of life in elderly women with knee osteoarthritis

Objetivo: Avaliar o equilíbrio em tarefas dinâmicas e a qualidade de vida em idosas com e sem osteoartrite no joelho. Métodos: As idosas foram divididas em: Grupo 1 (n = 12), consistindo de idosas com osteoartrite bilateral no joelho (Grau Kellgreen-Lawrence 1 e 2); e Grupo 2 (n = 12), consistindo de controles. Foi empregada uma plataforma de força (EMG System do Brasil) para avaliar a oscilação postural em tarefas dinâmicas; já a qualidade de vida foi avaliada mediante a aplicação do questionário WHOQOL-Bref. Resultados: O teste t de Student não demonstrou diferença estatística durante as ações de ficar de pé e sentar em uma cadeira (p > 0,05). Contudo, a tarefa de subir escadas revelou diferença na velocidade de deslocamento (p < 0,05), enquanto a tarefa de descer escadas demonstrou diferenças tanto na velocidade como na amplitude do deslocamento (p < 0,05). No questionário, o Grupo 1 demonstrou valores mais baixos do que os obtidos no Grupo de controle, no que diz respeito ao domínio físico (p < 0,05). Conclusão: Aparentemente, idosas com osteoartrite no joelho tiveram mais dificuldade na tarefa de descer escadas e pior percepção de domínio físico. Esses achados foram observados no grupo com OA, mesmo nos estágios iniciais da doença, o que demonstra a importância de intervenções ainda mais precoces. .

Objective: To assess the balance in dynamic tasks and in the quality of life in elderly women with and without knee osteoarthritis. Methods: Elderly women were divided into Group 1 (n = 12), consisting of participants with bilateral knee osteoarthritis (Kellgreen-Lawrence grade 1 and 2), and Group 2 (n = 12), consisting of controls. A force plate (EMG System do Brazil) was used to assess postural sway in dynamic tasks, whereas the quality of life was assessed by using the WHOQOL-Bref questionnaire. Results: Student's t-test showed no statistical difference during sitting down and standing up from the chair (p > 0.05). However, stair ascent revealed difference in displacement speed (p < 0.05), whereas stair descent showed differences in both displacement speed and amplitude (p < 0.05). In the questionnaire, Group 1 showed values lower than those in the control group regarding physical domain (p < 0.05). Conclusion: Elderly women with knee osteoarthritis seemed to have more difficulty on stair descent task and had perception of worst physical domain. These findings were observed in OA group, even in the early stages of the disease, which shows the importance of even earlier interventions. .

Biomechanics of Hyperflexion and Kneeling before and after Total Knee Arthroplasty

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90degrees, 105degrees, 120degrees, and 135degrees. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135degrees). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120degrees of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.

The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

BACKGROUND: The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. METHODS: One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. RESULTS: There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. CONCLUSIONS: The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).

Conceitos atuais em osteoartrite / Current concepts in osteoarthritis

A osteoartrite (OA), forma mais comum de doença articular, afeta principalmente quadris, joelhos, mãos e pés, levando a grande incapacidade e perda de qualidade de vida, sobretudo na população idosa. A importância desta doença cresce a cada ano, na medida em que observamos uma tendência de envelhecimento da população brasileira, com grande aumento da população idosa em relação aos mais jovens. O progressivo entendimento da fisiopatologia da OA, a percepção de que o processo não é puramente mecânico e/ou de envelhecimento, e o esclarecimento das vias inflamatórias envolvidas levaram, recentemente, à aplicação clínica de vários outros medicamentos e medidas. Esta atualização tem como objetivo expor os mais recentes conceitos sobre a fisiopatologia e tratamento da OA.

Osteoarthritis (OA), the most common form of joint disease, affects mainly the hips, knees, hands and feet, leading to severe disability and loss of quality of life, particularly in the elderly population. Its importance grows every year with the aging of the population, with a large increase in the elderly population compared to younger patients. The progressive understanding of the pathophysiology of OA, the perception that the process is not purely mechanical and/or aging, and clarification of the inflammatory pathways involved led recently to the clinical application of various drugs and other measures. This update aims to expose the current concepts on the pathophysiology and treatment of OA.

Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial / A estimulação elétrica neuromuscular é efetiva na melhora da dor, função e atividades de vida diária de pacientes com osteoartrite do joelho? Ensaio clínico randomizado

CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459. .

CONTEXTO E OBJETIVO A estimulação elétrica neuromuscular (EENM) tem sido incluída em protocolos de reabilitação de pacientes com fraqueza muscular decorrente da osteoartrite do joelho. O objetivo do presente estudo foi determinar a efetividade de um tratamento de oito semanas de EENM combinado com exercícios na melhora da dor e função em pacientes com osteoartrite do joelho. TIPO DE ESTUDO E LOCAL Ensaio clínico randomizado realizado no Ambulatório de Especialidades de Interlagos, São Paulo, Brasil. MÉTODOS Cem pacientes foram randomizados em dois grupos: Grupo EENM (GEENM) e grupo controle (GC). As medidas de avaliação utilizadas foram: escala numérica de dor (END) 0 a 10, teste timed up and go (TUG), índice de Lequesne e escala de atividades de vida diária (EAVD). RESULTADOS Oitenta e dois pacientes completaram a pesquisa. Por meio da análise por intenção de tratar, na comparação entre grupos, o GEENM apresentou melhora estatisticamente significante em comparação ao GC na redução da dor (diferença entre as médias: 1,67 [0,31; 3,02], P = 0,01), no índice de Lequesne (diferença entre as médias: 1,98 [0,15; 3,79] e na EAVD (diferença entre as médias: -11,23 [-19,88; -2,57], P = 0,01). CONCLUSÃO A EENM, quando inserida em um protocolo de reabilitação para pacientes com osteoartrite do joelho, é efetiva na redução da dor, melhora da função e das atividades de vida diária quando comparada a um grupo submetido a programa de orientação. REGISTRO DE ENSAIO CLÍNICO ACTRN012607000357459. .