Correlation between macrophage chemotaxis and disease severity in patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate the enhancement of macrophage chemotaxis in patients with knee osteoarthritis (KOA) and its correlation with the disease severity.@*METHODS@#Eighty patients with KOA admitted from July 2019 to June 2022 were enrolled as the observation group and divided into 29 cases of moderate group, 30 cases of severe group and 21 cases of extremely severe group. At the same time, 30 healthy subjects were included as the control group. The gene expressions of NF-κB, CXC chemokine receptor 7 (CXCR7) and CXC chemokine ligand 12 (CXCL12) in macrophages of each group were analyzed. Visual analogue scale(VAS) was used to evaluate the degree of joint pain. Joint function was evaluated by knee Joint Society Scoring system(KSS). Finally, data analysis was carried out.@*RESULTS@#The expression levels of NF-κB, CXCR7 and CXCL12 in moderate group, severe group and extreme recombination group were higher than those in control group. The VAS, the expression of NF-κB, CXCR7 and CXCL12 in the severe group and the extreme recombination group were higher than those in the moderate group, whereas KSS was lower than that in the moderate group. The VAS, expression levels of NF-κB, CXCR7 and CXCL12 in the extremely severe group were higher than those in the severe group, and KSS was lower than that in the severe group (all P<0.01). The expression levels of NF-κB, CXCR7 and CXCL12 in macrophages were positively correlated with VAS score, but negatively correlated with KSS(all P<0.01). The expression levels of NF-κB, CXCR7 and CXCL12 in macrophages were positively correlated with the severity of disease. After excluding the influence of traditional factors (gender, age and disease duration), multiple linear regression analysis further showed that the expression levels of NF-κB, CXCR7 and CXCL12 were still positively correlated with the severity of disease(all P<0.01).@*CONCLUSION@#The chemotaxis of macrophages in patients with KOA increased with the aggravation of the disease, and was related to the degree of pain and function impairment.

Association between matrix metalloproteinase-1 (MMP-1) protein level and the risk of rheumatoid arthritis and osteoarthritis: a meta-analysis

Recent publications have investigated the potential role of the protein level of matrix metalloproteinase-1 (MMP-1) in the susceptibility to rheumatoid arthritis (RA) and osteoarthritis (OA). However, no unanimous conclusion was obtained. Therefore, we carried out a meta-analysis to explore the association between MMP-1 expression and these two clinical disorders. After database searching and screening, we enrolled a total of eighteen articles for the pooled analysis. We observed a significant association between RA cases and controls in the whole population [SMD (standard mean difference)=1.01, P=0.017]. There were similar positive results in the subgroup analysis of "population-based control" (SMD=1.50, P=0.032) and "synovial fluid" (SMD=1.32, P=0.049). In addition, we observed an increased risk in OA cases, compared with controls, in the overall analysis (SMD=0.47, P=0.004) and subsequent subgroup analysis of "knee OA" (SMD=0.86, P<0.001), "Asian/China" (SMD=0.76, P=0.003), "cartilage-Asian/China" (SMD=1.21, P<0.001), and "synovial fluid-Asian/China" (SMD=0.73, P=0.004). In summary, a high protein level of MMP-1 in synovial fluid may be associated with the susceptibility to RA, and the high MMP-1 level in the cartilage tissue or synovial fluid may be related to the pathogenesis of knee OA in the Chinese population. This should be confirmed by larger sample sizes.

Genetic variation of aggrecanase-2 (ADAMTS5) in susceptibility to osteoarthritis

Aggrecanase-2 (ADAMTS5) gene is responsible for aggrecan degradation that may contribute to cartilage destruction in a mouse osteoarthritis (OA) model. We aimed to investigate the effects of ADAMTS5 gene polymorphisms on OA risk in a Chinese population. A total of 300 OA patients and 300 controls were recruited and their genotypes for ADAMTS5 gene rs226794 and rs2830585 polymorphisms were determined using a custom-by-design 48-Plex single nucleotide polymorphism Scan™ kit. ADAMTS5-associated genes were identified by co-expression analysis and their functions were investigated by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses. Bioinformatics analysis showed that ADAMTS5 was significantly related to the components, structural constituent, and organization of the extracellular matrix. The rs2830585 polymorphism, but not rs226794 polymorphism, was significantly associated with an increased risk of knee OA. Stratified analysis further confirmed this significant association in patients at age ≥55 years. In conclusion, the ADAMTS5 rs2830585 polymorphism may be involved in the development of knee OA by destroying the extracellular matrix, but this finding should be further confirmed by larger studies.

Ostectomía del peroné en el genu varo doloroso de rodilla. Resultados preliminares al año de operado / Fibula ostectomy in painful genu varum of the knee. Preliminary results after a year of the surgery

Introducción: la artrosis de rodilla puede llegar a ser una patología muy invalidante por sus síntomas, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa que ha aumentado su prevalencia en las últimas décadas, muy ligada al envejecimiento poblacional. Objetivo: validar la técnica de la ostectomía del peroné en el genu varo doloroso como nueva opción de tratamiento. Materiales y Métodos: se realizó un estudio, prospectivo y lineal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, desde abril del 2016 hasta agosto del 2017. Se aplicó la nueva técnica del Dr. Ying-Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China. En la actualidad ya existe una casuística de 75 pacientes, con 84 rodillas operadas de los cuales se presentan los resultados de los primeros 11 pacientes, posterior al año de operado. Resultados: el promedio de edad fue de 64,3 años, (45 años el menor y 84 años el mayor); de los cuales 8 eran hombres y 3 mujeres. Se aplicó la escala visual analógica para el dolor pre y post-operatorio en cuanto a la marcha y al subir escalones; estando todos los pacientes al caminar, por encima de 6 y al subir escaleras por encima de 7. Después de un año de operados 10 pacientes se encontraban evaluados al caminar entre 0 y 3 puntos, y al subir escalones 9 en igual puntuación; 1 en 5, y solamente 1 paciente mantuvo igual puntuación antes de operarse. Valorando estas puntuaciones se evaluaron 9 pacientes de bien, 2 de regular, y se presentaron 3 complicaciones. Conclusiones: al año de seguimiento ocurre gran mejoría del dolor, mejorando la seguridad del paciente durante la marcha (AU).

Introduction: the fibular osteoarthritis could be a very invalidating disease due to its symptoms, characterized by pain, insecurity and functional loss. It is a degenerative disease whose prevalence has increased during the last decades, tightly linked to population ageing. Objective: to validate the technique of fibular ostectomy in the painful genu varum as a new treatment option. Materials and Methods: a prospective, lineal study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy", of Matanzas, from April 2016 to August 2017. It was used the new technique of Dr. Ying-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of Hebei Medical University in Shijiazhuang, China. Currently there is a series of cases of 75 patients, with 84 operated knees; the results of the first 11 operated patients, are presented here after a year of the surgery. Results: the average age was 64.3 years, 45 years the youngest and 84 years the eldest; from them, 8 were men and 3 women. The analogical visual scale for the pre and post-surgical pain was applied during the gait and when going upstairs. During the gait all the patients were above 6, and when climbing upstairs above 7. After a year from the operation 10 patients got an evaluation between 0 and 3 points during the gait, and 9 got the same score when climbing steps; one got 5, and only 1 patient kept the same score than before the operation. Taking into account these scores, 9 patients were evaluated as good, 2 regular, and there were 3 complications. Conclusions: after a one-year follow-up, the pain greatly improves, improving patients' security during the gait (AU).

Association between tumor necrosis factor alpha rs1800629 polymorphism and risk of osteoarthritis in a Chinese population

Osteoarthritis (OA) is the most common degenerative disease affecting articular cartilage. Some studies indicate that tumor necrosis factor alpha (TNF-α) gene rs1800629 polymorphism was associated with OA risk among Caucasian populations. To examine the role of this candidate gene in Asian populations, we conducted a hospital-based case-control study involving 257 knee OA patients and 305 controls in a Chinese population. Genotyping was performed using a custom-by-design 48-Plex single nucleotide polymorphism (SNP) Scan™ kit. Our study indicated that the AA genotype of TNF-α rs1800629 polymorphism was associated with increased risk of OA. Subsequently, we conducted a meta-analysis and found that rs1800629 polymorphism increased the risk of OA in the recessive and homozygous models. Stratification analysis of ethnicity also obtained a significant association among Asian populations. In conclusion, TNF-α rs1800629 polymorphism confers susceptibility to OA, especially among Asians. Larger studies with more diverse ethnic populations are needed to confirm these results.

El Profesor Doctor Hernán Alessandri Rodríguez (1900-1980) / Professor Hernán Alessandri, M.D. (1900-1980)

Hernán Alessandri M.D. was an astounding clinician and a leading medical educator, born in Santiago in 1900 where he died in 1980. He received his medical degree at the University of Chile in 1923, became Professor of Clinical Medicine in 1932, Full Professor and Chair of Internal Medicine in 1944. At the Hospital del Salvador, in Santiago, he chaired a teaching Department and a Clinical Service that was an example for its academic environment and dedication to patients and students. From 1958 to 1962 he was Dean of the University of Chile Faculty of Medicine, conducting a reform of teaching curricula and organizing medical residency programs for the training of specialists, originally started in his own Service in 1952. The American College of Physicians awarded him the first foreign Honorary Membership. He was a founding Member of the Chilean Academy of Medicine (1964). In 1973 the University of Chile awarded him the Emeritus Professor status. He was considered by his peers, alumni and patients a brilliant clinician and an exceptional medical educator. Since 1980 a Social and Teaching Foundation bears his name and in 2014, with the occasion of the XXXV Chilean Congress of Internal Medicine, the Sociedad Médica de Santiago-Chilean Society of Internal Medicine created an annual lecture to render tribute to distinguished physicians and his name was one of the two selected to inaugurate them.

Polimorfismo del D repetido en gen ASPN en osteoartritis de rodilla en mujeres de Torreón, Coahuila: Estudio de casos y controles / D-repeat polymorphism in the ASPN gene in knee osteoarthritis in females in Torreón, Coahuila: Case-control study

La osteoartritis de rodilla (OA) es uno de los trastornos articulares más comunes e incapacitantes del sistema musculoesquelético, que afecta a cualquier grupo étnico y ocasiona grados variables de discapacidad. Diversos factores de riesgo se han relacionado con el desarrollo y progresión de la enfermedad como son: la edad, factores genéticos, factores ocupacionales, traumatismos, menopausia, diabetes mellitus, obesidad, género, entre otros más. La distinción de estos factores en forma individual o conjunta es importante con el fin de prevenir o diagnosticar y tratar en forma temprana la enfermedad. Métodos: Se llevó a cabo un estudio de casos y controles en 260 mujeres de Torreón, Coahuila, analizando la asociación entre la osteoartritis primaria de rodilla y el polimorfismo del repetido D del gen ASPN (asporina). Se incluyeron 130 mujeres con osteoartritis de rodilla y 130 mujeres controles sanos. Resultados: En este estudio, la menopausia y la variante alélica D16 se asociaron como factores de riesgo significativos para el desarrollo de osteoartritis de rodilla (p = 0.002, OR 2.656, IC 95% 1.412-4.998; p = 0.026, OR 2.418, IC 95% 1.111-5.263, respectivamente). La variable D12 mostró significancia como alelo de protección. Conclusiones: Hasta nuestro conocimiento, este es el primer estudio de casos y controles en mujeres mexicanas en el que se sugiere a la menopausia y el polimorfismo del repetido D del gen ASPN asociados a la OA de rodilla...

Knee osteoarthritis (OA) is one of the most common and disabling disorders of the musculoskeletal system. It may affect any ethnic group and causes variable degrees of disability. Various risk factors have been associated with the development and progression of this condition, such as: age, genetic and occupational factors, trauma, menopause, diabetes mellitus, obesity, and gender, among others. Distinguishing these factors, whether individually or altogether, is important to prevent or diagnose and treat the disease early on. Methods: A case-control study was conducted in 260 females in Torreón, Coahuila, to analyze the relationship between primary knee osteoarthritis and the D-repeat polymorphism in the ASPN gene (asporin). 130 females with knee osteoarthritis and 130 healthy female controls were included. Results: In this study, menopause and the D16 allele variant were found to be significant risk factors for knee osteoarthritis (p = 0.002, OR 2.656, CI 95% 1.412-4.998; p = 0.026, OR 2.418, CI 95% 1.111-5.263, respectively). The D12 variant was found to be a significant protective allele. Conclusions: As far as we know, this is the first case-control study in Mexican women that suggests that menopause and the D-repeat polymorphism in the ASPN gene are associated with knee OA...

Fadiga óssea: causa de dor em joelhos na osteoartrite / Bone attrition: a cause of knee pain in osteoarthritis

A dor no joelho é o sintoma mais comum na osteoartrite, sendo a principal causa de incapacidade crônica em idosos e uma das principais fontes de morbidade atribuível à osteoartrite em geral. As causas de dor no joelho em pessoas com osteoartrite não são facilmente entendidas e o conhecimento sobre as causas da dor é fundamental para que futuramente sejam realizadas intervenções específicas. A fadiga óssea representa o remodelamento do osso subcondral na osteoartrite, levando a uma consequente alteração na forma do osso e/ou perda óssea. No entanto, a fadiga óssea não é algo facilmente interpretado, pois é de difícil detecção na ausência de defeitos claros da cortical e pela sobreposição de estruturas ósseas nas radiografias convencionais. A fadiga óssea está associada não apenas a dor no joelho, mas também a rigidez e incapacidade. Se a fadiga ocorre antes da osteoartrite avançada, isso sugere que alterações no osso subcondral podem ocorrer simultaneamente a alterações da cartilagem e que tratamentos visando sua preservação podem não ser eficazes. Lesões com padrão de edema ósseo estão associadas e são fatores preditivos para fadiga óssea. Este trabalho tem por objetivo rever a literatura mostrando a importância da fadiga óssea e de como diagnosticar esta alteração nos exames de imagem.

Knee pain is the most frequent symptom in osteoarthritis, a condition that is the leading cause of chronic disability in the elderly and one of the main sources of morbidity attributable to osteoarthritis in general. The causes of knee pain in individuals with osteoarthritis cannot be easily understood, and the knowledge of such causes is critical for determining future specific interventions. Bone attrition represents remodelling of the subchondral bone envelope in osteoarthritis, leading to a consequential change in bone shape and/or bone loss. However, bone attrition is not a feature that can be easily read, since it is hardly detected in the absence of clear defects of cortical bone integrity and because of overlap of bone structures at radiography. Bone attrition is associated not only with knee pain, but also with stiffness and disability. If attrition occurs prior to advanced osteoarthritis, this would suggest that changes in subchondral bone occur concurrently with cartilage loss and that treatments targeting cartilage loss alone are unlikely to be effective. Association with edema-like bone marrow lesions may be observed and constitute predictive factors for subchondral bone attrition. The present study was aimed at reviewing the literature, demonstrating the relevance of bone attrition and explaining how to diagnose this entity on imaging studies.

Angiotensin converting enzyme gene polym orphism in Korean patients with primary knee osteoarthritis

Angiotensin converting enzyme (ACE) plays an important role in the physiology of vasculature, blood pressure and inflammation. ACE gene, known to have insertion/deletion (I/D) polymorphism, has been widely investigated in its relation with cardiovascular and neurodegenerative diseases and longevity. ACE gene polymorphism in an inflammation associated osteoarthritis (OA) patients is not known. Here we have investigated ACE gene polymorphism in 142 Korean primary knee OA patients and 135 healthy volunteers to establish any clinical correlates between ACE polymorphism and knee osteoarthritis. Clinical parameters such as disease onset age, Kellgren-Lawrence grade and Lequesne's functional index provided additional analysis of the relationship of ACE polymorphism and clinical features of OA. Early onset OA showed significantly higher allele frequency and carriage rate of I than late onset OA. Radiographically severe and functionally poor OA showed higher carriage rate of I allele than radiographically mild and functionally good OA, respectively. This study first reports ACE gene polymorphism to be a risk factor for early onset, severe form primary knee OA.