Efficacy and safety of a centrally acting analgesic flupirtine in primary knee osteoarthritis in comparison to tramadol: a randomized controlled trial

Background: Osteoarthritis (OA) is a chronic, degenerative joint disorder responsible for considerable morbidity, particularly in old age. Flupirtine, a new centrally acting analgesic, is devoid of the adverse effects of NSAIDs and opioid analgesics. In this study author compared the effectiveness and safety of flupirtine with tramadol in knee OA.Methods: An open label, randomized, controlled trial was done with patients of primary knee OA of both sexes, age >50 years. Patients were recruited from Rheumatology OPD of SSKM Hospital. A minimum WOMAC score of 35 was essential for recruitment. Patients with serious comorbidities were excluded. They were treated orally with either flupirtine (100mg thrice daily) or tramadol (50mg thrice daily) for 12 weeks.Results: Ninety patients were recruited and data of 42 on flupirtine and 41 on tramadol were analysed. There was significant improvement in pain, stiffness and physical function compared to baseline in both the groups. However, there was no significant difference between groups at 4, 8 and 12 weeks. Responder rate (50% reduction in pain score from baseline) was 66.67% with flupirtine and 48.78% with tramadol (p = 0.122). Flupirtine caused 4 adverse events compared to 16 with tramadol. However, both the drugs were well-tolerated.Conclusions: The effectiveness of flupirtine in knee OA is comparable to tramadol, while causing minimal adverse effects. Long-term benefits need to be explored.

Effect of arthroscopic arthroplasty on short-term efficacy and stress factors in patients with primary primary osteoarthritis of the elbow / 中国综合临床

Objective To investigate the effect of arthroscopic arthroplasty on the short-term efficacy and stress factors in patients with primary osteoarthritis of the elbow and to guide the clinical application.Methods From February 2013 to February 2016,32 patients with primary primary osteoarthritis of the elbow underwent arthroscopic arthroplasty in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology.The levels of serum TNF-α,IL-6,IL-10,adrenocorticotrophic hormone(ACTH) and other stress factors were measured before and after the operation.The ROM,MEPS and VAS were used to evaluate the curative effect before,3 months and 6 months after operation.Results All patients were followed up successfully.The excellent rate was 96.9%(31/32) 1 year after the operation.Preoperative ROM,MEPS score,VAS score were (83.2±18.6) °,(63.2±14.5) points,(3.2±1.8) points;3 months,6 months postoperative ROM were (102.3±18.9) °,(124.3±15.4) °,and MEPS scores were (75.4±16.8) points and (89.5±14.3) points respectively,which were significantly higher than those before operation (ROM F value of 43.19,P0.05).Conclusion For the modest primary osteoarthritis of the elbow,arthroscopy arthroplasty can achieve good therapeutic effect,improve the patient′s motor function and life quality,and minimally invasive surgical approach is conducive to relieve systemic stress.

Clinical study on treatment of primary attack of knee osteoarthritis with bushen Huoxuetongluo decoction / 中国生化药物杂志

Objective To investigate the clinical effect of Bushen Huoxue Tongluo Recipe in the treatment of acute attack of primary knee osteoarthritis, so as to enrich the treatment method and improve the curative effect. Methods 94 cases of primary knee osteoarthritis acute attack were randomly divided into 2 groups, 47 cases in the control group were treated with conventional western medicine treatment, the observation group of 47 cases, treated with Bushen Huoxue Tongluo Decoction, were observed after treatment in the improvement of the safety index, serum indexes and related score. Results The two groups at the end of the pain, stiffness, ADL, tenderness, swelling, joint activities are significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment, the observation group in the above six indicators were significantly better than the control group (P<0.05); group MMP-3, two at the end of treatment CRP, IL-1, TNF- were significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment observation group above index was significantly better than the control group (P<0.05). Conclusion: Bushen Huoxue Tongluo Decoction can improve the primary acute exacerbation of knee osteoarthritis clinical symptoms, reduce inflammation, and high safety.

Clinical study on treatment of primary attack of knee osteoarthritis with bushen Huoxuetongluo decoction / 中国生化药物杂志

Objective To investigate the clinical effect of Bushen Huoxue Tongluo Recipe in the treatment of acute attack of primary knee osteoarthritis, so as to enrich the treatment method and improve the curative effect. Methods 94 cases of primary knee osteoarthritis acute attack were randomly divided into 2 groups, 47 cases in the control group were treated with conventional western medicine treatment, the observation group of 47 cases, treated with Bushen Huoxue Tongluo Decoction, were observed after treatment in the improvement of the safety index, serum indexes and related score. Results The two groups at the end of the pain, stiffness, ADL, tenderness, swelling, joint activities are significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment, the observation group in the above six indicators were significantly better than the control group (P<0.05); group MMP-3, two at the end of treatment CRP, IL-1, TNF- were significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment observation group above index was significantly better than the control group (P<0.05). Conclusion: Bushen Huoxue Tongluo Decoction can improve the primary acute exacerbation of knee osteoarthritis clinical symptoms, reduce inflammation, and high safety.

Determination of oxidant stress in plasma of rheumatoid arthritis and primary osteoarthritis patients.

Determination of oxidant stress in plasma of rheumatoid arthritis (RA) and primary osteoarthritis (POA) patients is important in understanding the pathogenesis of these diseases. In this study, we examined the relationship between oxidant stress and inflammation by measuring protein carbonyl content, thiol levels and plasma protein fractions as the oxidation markers and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) tests as inflammation markers. Protein carbonyls content was higher in RA and POA patients, as compared to controls (p<0.0001), while the plasma thiol levels in both groups of patients were significantly lower than controls (p<0.0001). Increased levels of proteins under 40 kDa molecular mass were detected in the RA and POA patients compared to that of controls (p<0.0001) both in HPLC and SDS-PAGE analysis. Total protein concentration in plasma of RA patients was higher than the controls (p<0.001), while in POA patients was lower than that of controls (p<0.001). ESR and CRP levels were higher in both the patient groups than the normal group (p<0.001). These results suggested that alterations in the oxidant stress markers could be the cause of inflammation in these diseases. Thus, while working for RA/POA treatment strategies, consideration of the relationship between oxidant stress and inflammation would be worth evaluating.

A Case of Primary Osteoarthritis of Both Elbow Joints in a Worker Using Sledge-hammers / 대한산업의학회지

BACKGROUND: The incidence of primary osteoarthritis of elbow is very low in individuals without work-related risk factors, and primary osteoarthritis of the elbow is rarely symptomatic. Because it is difficult to prove these conditions are work-related, the patients with work-related elbow osteoarthritis don't tend to be compensated in Korea. CASE REPORT: The patient was a 51-year old male, with an occupational history as a sledgehammer user for 23 years. He has been complaining of pain for 3 years. Physical examination of the elbow showed painful end-range motion and the radiographs showed osteophytes and, loose bodies, but relatively-preserved joint spaces, which were typical characteristic of primary osteoarthritis. CONCLUSION: The authors report on a case of primary osteoarthritis of both elbows that was associated with repetitive high shear force due to long-term use of the sledgehammer.

Debridement Arthroplasty Through a Medial Approach for Primary Osteoarthritis of the Elbow

PURPOSE: To analyze the clinical results of debridement arthroplasty through a medial approach for primary osteoarthritis of the elbow. MATERIALS AND METHODS: Ten patients with primary osteoarthritis treated with debridement arthroplasty trough a medial approach were investigated. The ulnar nerve was transposed anteriorly in all patients. The mean duration of follow-up was 20.8 months. The clinical results were evaluated by measuring the preoperative and postoperative range of motion (ROM) of the elbow and using Mayo Elbow Performance Score (MEPS). RESULTS: The mean flexion contracture of the elbow joint was reduced from 23 degrees preoperatively to 10 degrees, postoperatively and the mean further flexion was improved from 93 degrees preoperatively to 131 degrees postoperatively. The mean MEPS improved from 55.3 points preoperatively to 86.9 points postoperatively. CONCLUSION: Debridement arthroplasty through a medial approach is considered as an useful method for primary osteoarthritis of the elbow.

Debridement Arthroplasty for Primary Elbow Osteoarthritis / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze clinical and radiological results after debridement arthroplasty during primary elbow arthroplasty. MATERIALS AND METHODS: This study involved 25 primary elbow osteoarthritis cases that were treated by debridement arthroplasty from January 1996 to December 2004 with at least a 2 year follow up (mean: 41.3 months). Mean patient age was 45.5 years. Clinical outcomes were analyzed using preoperative and postoperative ranges of motion, Mayo Elbow Performance Scores (MEPS), and Visual Analogue Scale scores. Radiologic analysis was based on plain radiographs. RESULTS: Average flexion-extension arc improved from 72degrees ROM preoperatively to 110.5degrees postoperatively (p<0.001). Mean MEPS was 89.5 points preoperatively and increased postoperatively (p<0.05). Humeral fenestration size decreased from 27% to 20.5%. Bony spurs of the olecranon and coronoid process recurred in 8 cases. Postoperative LOM was found to be associated with spur recurrence (p<0.05). CONCLUSION: Debridement arthroplasty may be recommendable for primary elbow osteoarthritis as it reduces pain and improves functional outcomes, including range of motion. Spur recurrence was found to be associated with a reduced range of motion.

Results of Arthroscopic Debridement of the Elbow Osteoarthritis

PURPOSE: Primary osteoarthritis on the elbow is the result of the growth of osteophytes and contracture of the capsule. It often causes disability on joint motion and pain while exercising. As arthroscopy has developed, the arthroscopic diagnosis and treatment of the elbow have recently become more generalized as well. Therefore, we like to report on arthroscopy for treating elbow arthritis and its results. MATERIALS AND METHODS: This study includes 23 cases of elbow arthritis that were seen between 2005 June to 2007 June and these patients didn't response to conservative treatment. From this we excluded 18 cases that underwent arthroscopic surgery and among these 18 cases, 6 cases underwent ulnar nerve transfer. The average observation time was 21.3 months and the average age was 48.4 years (range: 22-66 years). The pre and post operative pain was evaluated with using the Visual Analogue Scale (VAS) and functional evaluation was done with using the Mayo elbow Performance Score (MEPS) with the range of joint motion. RESULTS: The VAS score at the last follow up was significantly decreased from 3.4 to 1.9 compare to the preoperative score. The range of joint motion was improved by 25 (0-40) to 8.5 (0-20) in extension and 101.7 (80-140) to 125.2 (85-140) in flexion (p<0.05). The MEPS always showed significant improvement by showing an increase from 65.4 (40-85) to 87.9 (55-100). However, 3 cases showed a decreased range of motion after the operation. One case showed ulnar nerve symptoms after surgery. CONCLUSION: An arthroscopic procedure can treat the pathologic processes associated with arthritis of the elbow and it was safe and effective in this series.

Differences between Koreans and Americans undergoing Total Knee Replacement Arthroplasty for Primary Osteoarthritis

BACKGROUND: Total knee arthroplasty is a reliable and durable procedure in the treatment of knee arthritis. Patient selection is one scientific aspect of total knee replacement and the surgeon must develop knowledge about those patients who will benefit from total knee replacement. Authors tried to find any differences in preoperative status for Koreans and Americans undergoing total knee replacement arthroplasty(TKRA) for primary osteoarthritis(OA). Another goal of this study was to determine whether Koreans undergoing elective TKIRA for primary OA had more advanced disease preoperatively than Americans undergoing the same procedure. METHODS: Preoperative clinical and radiographic severity of knee OA was determined between Koreans who underwent TKRA at the National Medical Center in Seoul, Korea and Americans who underwent the same procedure at the Hospital of the University of Pennsylvania in Philadelphia, USA. RESULTS: There were 62 women and five men included in the group I(Koreans) compared to 60 women and thirty men in the group II(Americans). The mean age for the patients in the group I was 64.0 years and for the group II 69.5 years. The average weight for the group I was 63.8 Kg(range, 46-85 kg) with an average height of 152.4 cm(range, 133-168 cm). The corresponding data in the group II was 86.6 kg(range, 54-170 kg) and 167.4 cm(range, 147-196 cm). The mean preoperative knee score(developed by The Knee Society) for the group I was 32.7 points and the mean preoperative function score was 42.0 points. The mean preoperative knee and function scores for the group II were 38.1 and 46.2 points, respectively. The mean preoperative flexion contracture and further flexion were 11.7degrees(range, 0-40degrees) and 124.8degrees(range, 70-140degrees), respectively. The corresponding data in the group II were 4.0degrees(range, 0-15degrees) and 107.7degrees(range, 80-130degrees), respectively. The group I knees had a mean preoperative tibiofemoral angle of 4.8degrees(+/-6.0degrees) varus. For the group H knees, the preoperative tibiofemoral angle was 0.83degrees(+/-7.80degrees) valgus. Lateral FT(femorotibial) osteoarthritis was not found in any Korean patients but seen in 18 cases(17.8%) of American patients. CONCLUSION: The observed differences in the status prior to TKRA indicate that Koreans are operated on at a more advanced stage in the course of their disease than Americans. A number of important issues remain to be addressed in future research, such as the role of patient preference and different access to TKRA and the differences of their clinical presentation.