[Identification of Osteoarthritis Inflamm-Aging Biomarkers by Integrating Bioinformatic Analysis and Machine Learning Strategies and the Clinical Validation]. / ç”Ÿç‰©ä¿¡æ¯å­¦å’Œæœºå™¨å­¦ä¹ ç­–ç•¥è¯†åˆ«éª¨å ³èŠ‚ç‚Žç‚Žæ€§è¡°è€ç”Ÿç‰©æ ‡å¿—ç‰©ä¸Žä¸´åºŠéªŒè¯.

Objective: To identify inflamm-aging related biomarkers in osteoarthritis (OA). Methods: Microarray gene profiles of young and aging OA patients were obtained from the Gene Expression Omnibus (GEO) database and aging-related genes (ARGs) were obtained from the Human Aging Genome Resource (HAGR) database. The differentially expressed genes of young OA and older OA patients were screened and then intersected with ARGs to obtain the aging-related genes of OA. Enrichment analysis was performed to reveal the potential mechanisms of aging-related markers in OA. Three machine learning methods were used to identify core senescence markers of OA and the receiver operating characteristic (ROC) curve was used to assess their diagnostic performance. Peripheral blood mononuclear cells were collected from clinical OA patients to verify the expression of senescence-associated secretory phenotype (SASP) factors and senescence markers. Results: A total of 45 senescence-related markers were obtained, which were mainly involved in the regulation of cellular senescence, the cell cycle, inflammatory response, etc. Through the screening with the three machine learning methods, 5 core senescence biomarkers, including FOXO3, MCL1, SIRT3, STAG1, and S100A13, were obtained. A total of 20 cases of normal controls and 40 cases of OA patients, including 20 cases in the young patient group and 20 in the elderly patient group, were enrolled. Compared with those of the young patient group, C-reactive protein (CRP), interleukin (IL)-6, and IL-1ß levels increased and IL-4 levels decreased in the elderly OA patient group (P<0.01); FOXO3, MCL1, and SIRT3 mRNA expression decreased and STAG1 and S100A13 mRNA expression increased (P<0.01). Pearson correlation analysis demonstrated that the selected markers were associated with some indicators, including erythrocyte sedimentation rate (ESR), IL-1ß, IL-4, CRP, and IL-6. The area under the ROC curve of the 5 core aging genes was always greater than 0.8 and the C-index of the calibration curve in the nomogram prediction model was 0.755, which suggested the good calibration ability of the model. Conclusion: FOXO3, MCL1, SIRT3, STAG1, and S100A13 may serve as novel diagnostic biomolecular markers and potential therapeutic targets for OA inflamm-aging.

Prevalence of diagnosed and undiagnosed osteoarthrosis and associated factors in the adult general Spanish population.

OBJECTIVE: To determine the prevalence and related factors of diagnosed osteoarthrosis (DO) and undiagnosed osteoarthrosis (UO) in the general Spanish adult population. SETTING: Cross-sectional study with data from the Spanish National Health Survey 2017. PARTICIPANTS: N=23,089 adults. Three groups of people were defined: DO, UO, and no osteoarthrosis (NO). MAIN MEASUREMENTS: Sociodemographic information, lifestyle (tobacco, alcohol, physical activity, body mass index) and health factors (intensity of pain, pain drug consumption, mental health, self-perceived health status, pain involvement in daily living) were collected. Descriptive and bivariate analyses were performed, and a multinomial logistic regression model for the factors associated with each group. RESULTS: The prevalence of DO was 22.4% (95%CI=21.8;22.9) and 0.9% (95%CI=0.8;1) of UO. With respect to NO, risk factors for DO and UO included higher pain levels and pain drug consumption. Better self-perceived health status was inversely related with both. More pain involvement in daily living was associated with increased risk of DO, but reduced risk of UO. CONCLUSIONS: The prevalence of DO and UO was similar to that reported in Europe, but slightly higher than in low/middle-income countries. It was more prevalent in females, older people, people with worse perceived health status and worse mental health. Higher pain levels and pain drug consumption were risk factors for DO and UO. Better self-perceived health status was protective. Pain involvement in daily living was a risk factor for DO, but protective for UO. Different public health strategies should be considered in view of this.

Identification of clinical characteristics biomarkers for rheumatoid arthritis through targeted DNA methylation sequencing.

OBJECTIVES: Rheumatoid arthritis (RA) is a complex disease with a challenging diagnosis, especially in seronegative patients. The aim of this study is to investigate whether the methylation sites associated with the overall immune response in RA can assist in clinical diagnosis, using targeted methylation sequencing technology on peripheral venous blood samples. METHODS: The study enrolled 241 RA patients, 30 osteoarthritis patients (OA), and 30 healthy volunteers control (HC). Fifty significant cytosine guanine (CG) sites between undifferentiated arthritis and RA were selected and analyzed using targeted DNA methylation sequencing. Logistic regression models were used to establish diagnostic models for different clinical features of RA, and six machine learning methods (logit model, random forest, support vector machine, adaboost, naive bayes, and learning vector quantization) were used to construct clinical diagnostic models for different subtypes of RA. Least absolute shrinkage and selection operator regression and detrended correspondence analysis were utilized to screen for important CGs. Spearman correlation was used to calculate the correlation coefficient. RESULTS: The study identified 16 important CG sites, including tumor necrosis factort receptor associated factor 5 (TRAF5) (chr1:211500151), mothers against decapentaplegic homolog 3 (SMAD3) (chr15:67357339), tumor endothelial marker 1 (CD248) (chr11:66083766), lysosomal trafficking regulator (LYST) (chr1:235998714), PR domain zinc finger protein 16 (PRDM16) (chr1:3307069), A-kinase anchoring protein 10 (AKAP10) (chr17:19850460), G protein subunit gamma 7 (GNG7) (chr19:2546620), yes1 associated transcriptional regulator (YAP1) (chr11:101980632), PRDM16 (chr1:3163969), histone deacetylase complex subunit sin3a (SIN3A) (chr15:75747445), prenylated rab acceptor protein 2 (ARL6IP5) (chr3:69134502), mitogen-activated protein kinase kinase kinase 4 (MAP3K4) (chr6:161412392), wnt family member 7A (WNT7A) (chr3:13895991), inhibin subunit beta B (INHBB) (chr2:121107018), deoxyribonucleic acid replication helicase/nuclease 2 (DNA2) (chr10:70231628) and chromosome 14 open reading frame 180 (C14orf180) (chr14:105055171). Seven CG sites showed abnormal changes between the three groups (P < 0.05), and 16 CG sites were significantly correlated with common clinical indicators (P < 0.05). Diagnostic models constructed using different CG sites had an area under the receiver operating characteristic curve (AUC) range of 0.64-0.78 for high-level clinical indicators of high clinical value, with specificity ranging from 0.42 to 0.77 and sensitivity ranging from 0.57 to 0.88. The AUC range for low-level clinical indicators of high clinical value was 0.63-0.72, with specificity ranging from 0.48 to 0.74 and sensitivity ranging from 0.72 to 0.88. Diagnostic models constructed using different CG sites showed good overall diagnostic accuracy for the four subtypes of RA, with an accuracy range of 0.61-0.96, a balanced accuracy range of 0.46-0.94, and an AUC range of 0.46-0.94. CONCLUSIONS: This study identified potential clinical diagnostic biomarkers for RA and provided novel insights into the diagnosis and subtyping of RA. The use of targeted deoxyribonucleic acid (DNA) methylation sequencing and machine learning methods for establishing diagnostic models for different clinical features and subtypes of RA is innovative and can improve the accuracy and efficiency of RA diagnosis.

Lessons in clinical reasoning - pitfalls, myths, and pearls: a woman brought to a halt.

OBJECTIVES: Limitations in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. A metacognitive structured reflection on what clinical findings fit and/or do not fit with a diagnosis, as well as how discordance of data can help advance the reasoning process, may reduce such errors. CASE PRESENTATION: A 60-year-old woman with Hashimoto thyroiditis, diabetes, and generalized anxiety disorder presented with diffuse arthralgias and myalgias. She had been evaluated by physicians of various specialties and undergone multiple modalities of imaging, as well as a electromyography/nerve conduction study (EMG/NCS), leading to diagnoses of fibromyalgia, osteoarthritis, and lumbosacral plexopathy. Despite treatment for these conditions, she experienced persistent functional decline. The only definitive alleviation of her symptoms identified was in the few days following intra-articular steroid injections for osteoarthritis. On presentation to our institution, she appeared fit with a normal BMI. She was a long-time athlete and had been training consistently until her symptoms began. Prediabetes had been diagnosed the year prior and her A1c progressed despite lifestyle modifications and 10 pounds of intentional weight loss. She reported fatigue, intermittent nausea without emesis, and reduced appetite. Examination revealed intact strength and range of motion in both the shoulders and hips, though testing elicited pain. She had symmetric hyperreflexia as well as a slowed, rigid gait. Autoantibody testing revealed strongly positive serum GAD-65 antibodies which were confirmed in the CSF. A diagnosis of stiff-person syndrome was made. She had an incomplete response to first-line therapy with high-dose benzodiazepines. IVIg was initiated with excellent response and symptom resolution. CONCLUSIONS: Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts, this case underscores the importance of frequent assessment of fit along with explicit explanation of dissonant features in order to avoid misdiagnosis and halt diagnostic inertia. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. The case discussant demonstrates the power of iterative reasoning, case progression without commitment to a single diagnosis, and the dangers of both explicit and implicit bias. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl specific to overcoming diagnostic inertia.

Comparative study of 1H-NMR metabolomic profile of canine synovial fluid in patients affected by four progressive stages of spontaneous osteoarthritis.

The study aimed to assess the metabolomic profile of the synovial fluid (SF) of dogs affected by spontaneous osteoarthritis (OA) and compare any differences based on disease progression. Sixty client-owned dogs affected by spontaneous OA underwent clinical, radiographic, and cytologic evaluations to confirm the diagnosis. The affected joints were divided into four study groups based on the Kallgreen-Lawrence classification: OA1 (mild), OA2 (moderate), OA3 (severe), and OA4 (extremely severe/deforming). The osteoarthritic joint's SF was subjected to cytologic examination and 1H-NMR analysis. The metabolomic profiles of the study groups' SF samples were statistically compared using one-way ANOVA. Sixty osteoarthritic joints (45 stifles, 10 shoulders and 5 elbows) were included in the study. Fourteen, 28, and 18 joints were included in the OA1, OA2, and OA3 groups, respectively (0 joints in the OA4 group). Metabolomic analysis identified 48 metabolites, five of which were significantly different between study groups: Mannose and betaine were elevated in the OA1 group compared with the OA2 group, and the 2-hydroxyisobutyrate concentration decreased with OA progression; in contrast, isoleucine was less concentrated in mild vs. moderate OA, and lactate increased in severe OA. This study identified different 1H-NMR metabolomic profiles of canine SF in patients with progressive degrees of spontaneous OA, suggesting 1H-NMR metabolomic analysis as a potential alternative method for monitoring OA progression. In addition, the results suggest the therapeutic potentials of the metabolomic pathways that involve mannose, betaine, 2-hydroxyisobutyrate, isoleucine, and lactate.

Co-development and testing of an extended community pharmacy model of service delivery for managing osteoarthritis: protocol for a sequential, multi-methods study (PharmOA).

BACKGROUND: Osteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss. Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis. METHODS: Informed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases: 1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain. 2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care. 3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools). 4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams. 5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation. DISCUSSION: This novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies.

Exploring m6A-linked aging genes in osteoarthritis and broad cancer spectrum: Prospects for diagnostic and therapeutic advancements.

Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts individuals and healthcare systems worldwide. However, the exploration of N6-methyladenosine (m6A)-related aging genes in OA pathogenesis remains largely underexplored. This study aimed to elucidate the role of m6A-related aging genes in OA and to develop a robust diagnostic model based on their expression profiles. Leveraging publicly available gene expression datasets, we conducted consensus clustering to categorize OA into distinct subtypes, guided by the expression patterns of m6A-related aging genes. Utilizing XGBoost, a cutting-edge machine learning approach, we identified key diagnostic genes and constructed a predictive model. Our investigation extended to the immune functions of these genes, shedding light on potential therapeutic targets and underlying regulatory mechanisms. Our analysis unveiled specific OA subtypes, each marked by unique expression profiles of m6A-related aging genes. We pinpointed a set of pivotal diagnostic genes, offering potential therapeutic avenues. The developed diagnostic model exhibited exceptional capability in distinguishing OA patients from healthy controls. To corroborate our computational findings, we performed quantitative real-time polymerase chain reaction analyses on two cell lines: HC-OA (representing adult osteoarthritis cells) and C-28/I2 (representative of normal human chondrocytes). The gene expression patterns observed were consistent with our bioinformatics predictions, further validating our initial results. In conclusion, this study underscores the significance of m6A-related aging genes as promising biomarkers for diagnosis and prognosis, as well as potential therapeutic targets in OA. Although these findings are encouraging, further validation and functional analyses are crucial for their clinical application.

Is it possible to predict which patients are most likely to benefit from intra-articular corticosteroid injections? A systematic review.

AIM: Intra-articular corticosteroid injections (IACIs) can reduce osteoarthritis-related pain, with differing levels of response across patient groups. This systematic review investigates what is known about the positive and negative predictors of outcomes in patients with osteoarthritis who undergo IACIs. METHODS: We systematically searched the Medline, Embase, and Cochrane databases to May 2023 for studies that evaluated patients undergoing IACIs for osteoarthritis and reported on predictors of outcomes in these patients. RESULTS: Eight studies were included. Two were placebo-controlled trials, six were observational studies. Due to the heterogeneity of outcomes and variables between the studies, it was not possible to pool the results for formal meta-analysis. Higher baseline pain, older age, higher BMI, lower range of movement, higher Kellgren-Lawrence radiographic score, joint effusion, and aspiration were shown to be predictors of a positive response to IACIs in some of the included studies. However, other studies showed no difference in response with these variables, or a negative correlation with response. Sex, smoking, mental health status, hypertension/ischaemic heart disease, diabetes mellitus, duration of symptoms, and socioeconomic status did not demonstrate any correlation with the prediction of positive or negative outcomes after IACIs. CONCLUSION: Several patient features have been identified as positive predictors of outcomes following IACIs. However, this systematic review has identified inconsistent and variable findings across the existing literature. Further research with standardization of IACI administration and outcome measures is required to facilitate further analysis of the reliability and significance of predictive factors for response to IACIs.

Ankle Osteoarthritis / Osteoartrite do tornozelo

Abstract Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing posttraumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.

Resumo A osteoartrite (OA) é caracterizada por uma degradação crônica, progressiva e irreversível da superfície articular, associada a inflamação articular. A principal etiologia da OA do tornozelo é pós-traumática e sua prevalência é maior entre os jovens e obesos. Apesar dos avanços no tratamento das fraturas ao redor do tornozelo, o risco geral de desenvolver OA pós-traumática do tornozelo após 20 anos do trauma é de quase 40%; especialmente nas fraturas bimaleolares de Weber tipo B e C e fraturas envolvendo a borda tibial posterior. Nas fraturas do tálus, essa prevalência se aproxima de 100%, dependendo da gravidade da lesão e do tempo de seguimento. Nesse cenário, é fundamental a compreensão atual das vias de sinalização moleculares envolvidas na senescência e apoptose dos condrócitos. O tratamento da OA do tornozelo é estagiado e guiado pelos sistemas de classificação, condições locais e do paciente. Os principais problemas são a limitada capacidade de regeneração da cartilagem articular, o baixo suprimento de sangue e a escassez de células-tronco progenitoras. A presente atualização resume evidências científicas básicas recentes da OA póstraumática do tornozelo, com foco principal nas alterações metabólicas da sinóvia, da cartilagem e do líquido sinovial. Epidemiologia, fisiopatologia, implicações clínicas, e opções de tratamento são também discutidas.

Medial Knee Arthrosis: A Pathology with a Progressive Evolution / Artrose medial do joelho: Uma patologia de evolução progressiva

Abstract Medial arthrosis of the knee is an evolutionary pathology that occurs due to progressive muscle imbalance. The muscles of the knee region have a large imbalance caused by the difference of power and lever arm. With the progression of life, this imbalance manifests itself more importantly, especially due to the loss of muscle strength due to aging. Pathological postures begin to occur and determine areas of support and pressure harmful to the joint. Meniscal injury is typical in the evolution of this pathology, as well as cartilage injury. The recognition of this pathology enables good results with less aggressive treatments, such as correction of muscle imbalance and consequent reeducation of joint support. Economic and partial meniscectomy brings good results in the early stages of the degenerative process. Progressive evolution leads to knee degeneration and the consequent need for broader surgeries.

Resumo A artrose medial do joelho é uma patologia evolutiva que ocorre em decorrência de desequilíbrio muscular progressivo. Os músculos da região do joelho têm um grande desequilíbrio, provocado pela diferença de potência e braço de alavanca. Com a progressão da vida, este desequilíbrio se manifesta de forma mais importante, especialmente em decorrência da perda de força muscular em função do envelhecimento. Posturas patológicas passam a ocorrer e determinar zonas de apoio e pressão lesivas para a articulação. A lesão meniscal é típica na evolução desta patologia, assim como a lesão da cartilagem. O reconhecimento desta patologia possibilita resultados bons com tratamentos menos agressivos, como a correção do desequilíbrio muscular e consequente reeducação do apoio da articulação. A meniscectomia econômica e parcial traz bons resultados nas fases iniciais do processo degenerativo. A evolução progressiva leva à degeneração do joelho e à consequente necessidade de cirurgias mais amplas.

Ozonoterapia rectal en pacientes con osteoartritis / Rectal ozone therapy in patients with osteoarthritis

Introducción: La osteoartritis es una de las principales causas de dolor y discapacidad en el mundo. La ozonoterapia actúa como medio terapéutico, mejora la calidad del cartílago articular, disminuye la inflamación producida y presenta propiedades moduladoras del sistema inmune. Objetivo: Evaluar los resultados de la ozonoterapia rectal en pacientes con osteoartritis. Método: Se realizó un estudio descriptivo prospectivo, en el Servicio de Reumatología del Hospital Clínico Quirúrgico Lucía Iñiguez Landín, de Holguín en el período comprendido de julio de 2017 a febrero de 2019. La población del estudio quedó conformada por 101 pacientes. La muestra fue de 60 pacientes, seleccionada según un muestreo aleatorio simple. Resultados: La articulación más afectada fue la rodilla en 100 por ciento de los pacientes estudiados. El mayor número de pacientes presentaba discapacidad física moderada (53,3 por ciento) al inicio del tratamiento y a los 3 meses predominó la discapacidad ligera (26,6 (por ciento). Se logra reducir el uso de analgésicos de forma ocasional al concluir tratamiento. Conclusiones: En los pacientes con discapacidad funcional por osteoartritis tratados con ozonoterapia transrectal el efecto terapéutico fue muy bueno(AU)

Introduction: Osteoarthritis is one of the main causes of pain and disability worldwide. Ozone therapy acts as a therapeutic means, improves the quality of articular cartilage, reduces the resulting inflammation and has modulating properties of the immune system. Objective: To evaluate the results of rectal ozone therapy in patients with osteoarthritis. Method: A prospective descriptive study was carried out in the Rheumatology Service of Lucía Iñiguez Landín Surgical Clinical Hospital, in Holguín from July 2017 to February 2019. One hundred one patients consisted the study population. Sixty patients formed the sample, selected according to a simple random sampling. Results: The most affected joint was the knee in 100 percent of the studied patients. The highest number of patients had moderate physical disability (53.3 percent) at the start of treatment and at 3 months later, mild disability predominated (26.6 percent). It was possible to reduce the use of pain relievers occasionally at the end of treatment. Conclusions: The therapeutic effect of transrectal ozone therapy was very good in patients with functional disability due to osteoarthritis(AU)

Matriz de recomendações para farmacoterapia da osteoporose e da osteoartrite: recurso para subsidiar a adaptação de guias de prática clínica / Matrix of recommendations for osteoporosis and osteoarthritis pharmacotherapy: A resource to subsidize the adaptation process of clinical practice guidelines for the treatment of osteoporosis and osteoarthritis

A osteoporose e a osteoartrite são doenças crônicas não transmissíveis (DCNT), multifatoriais, de longa duração e que tem na idade um fator agravante. Não possuem cura, somente tratamentos não farmacológicos e farmacológicos para amenizar suas consequências. Para auxiliar os profissionais na assistência desses pacientes, são elaborados guias de prática clínica (GPC), que precisam ser preparados respeitando preceitos de alto rigor científico e para tanto, requerem tempo, suporte financeiro e participação de equipe multiprofissional. Uma opção é a adaptação desses documentos a partir de documentos existentes. Este trabalho teve como o objetivo criar matrizes de recomendações baseadas em GPC de alta qualidade. Para a elaboração das matrizes, utilizou-se as duas primeiras fases do método ADAPTE: Configuração e Adaptação. A fase de Configuração foi planejada e registrada pelo grupo de pesquisa Chronic Diseases and Informed Decisions (CHRONIDE), Brasil, no Próspero. Para a fase de Adaptação, realizou-se uma busca sistemática, utilizando os seguintes critérios de elegibilidade: documentos que continham recomendações para o tratamento farmacológico da osteoporose (OP) e da osteoartrite (OA) em atenção primária, publicados em português, espanhol ou inglês e publicados no período de 01/2011 a 12/2016, todas as etapas do processo foram avaliadas por três avaliadores de forma independente. Foram encontrados 43 GPC de OP e 23 GPC de OA, analisados quanto à qualidade por meio do instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II), sendo considerados de alta qualidade os GPC que apresentaram 60% ou mais no domínio 3. Apenas 10 GPC de OP e 07 GPC de OA considerados de alta qualidade, foram utilizados para a elaboração das matrizes das duas doenças. A matriz para OP permitiu evidenciar que a alternativa mais sugerida de tratamento são os bifosfonatos e para OA, os antiinflamatórios não esteroidias (AINEs), especialmente o acetaminofeno. Os achados também mostraram que a maioria dos GPC apresentou limitações, principalmente, quanto à qualidade, implementação, participação de outros profissionais, assim como de pacientes, e independência editorial, indicando a necessidade de aprimoramento no momento da elaboração, adoção ou adaptação dos GPC. Todavia, foi possível identificar GPC de alta qualidade suficientes para elaborar as duas matrizes, o que pode subsidiar possíveis elaborações de futuros protocolos locais e cuidados aos pacientes

Osteoporosis (OP) and osteoarthritis (OA) are chronic non-communicable diseases (CNCDs), i.e., multifactorial, long-lasting and with age as an aggravating factor. None has cure, and only non-pharmacological and pharmacological treatments to mitigate their effects. In order to support health professionals in terms of the best treatments for both diseases, Clinical Practice Guidelines (CPG) contains recommendations that must be elaborated with high methodological rigor, requiring time, financial support and multiprofessional team. An option is to adapt existing CPG that have been rigorously developed. This study aimed to create a matrix of recommendations based on high quality CPG. The ADAPTE process was used, but only the first two phases: Configuration and Adaptation. The Configuration phase was planned and registered by the Chronic Diseases and Informed Decisions group (CHRONIDE), Brazil, in PROSPERO. For the Adaptation phase, a systematic search was performed using the following eligibility criteria: documents that contained recommendations for the pharmacological treatment of OP and OA in primary care, published in Portuguese, Spanish or English, from 01/01/2011 to 12/31/2016, all stages of the processes were assessed by three independent reviewers. 43 CPG OP and 23 CPG of OA were retrieved and had their quality assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Only ten CPG for OP treatment, and seven GPC for OA treatment were considered high quality and had their recommendations extracted and synthesized in two separate matrices. Biphosphonates were the most suggested pharmacological treatment for OP and non-steroidal anti-inflammatory drugs (NSAIDs), especially acetaminophen, for OA. Findings also showed that the majority of CPG had limitations, mainly regarding their quality, implementation, multiprofessional team, as weel as patients, and editorial independence, indicating the need for improvement. However, the findings made it possible to create two matrices to support future elaboration of local protocols and patient care.

Relation between osteoarthritis and HLA-A in Iraqui patients

Relación entre osteoartritis y HLA - A en pacientes iraquíes. (HLA: acrónimo inglés de antcígenos leucocitarios humanos - Human Leucocyte Antigens). La osteoartritis e la afección más común que involucra el aparato osteo-articular. Representa a un grupo heterogéneo de condiciones resultante de cambios comunes histopatológicos y radiológicos. Existen múltiples factores de riesgo para la osteoartritis: edad, obesidad, y el antígeno genético. El leococitario humano (HLA) como parte del sistema inmune, teniendo un rol en el proceso nosológico. Diversos estudios han determinado la diferente asociación entre la clase HLA - I y la II. El objetivo de esta investigación fue el de determinar la eventualidad de una relación entre el HLA-I y el II en la osteocondritis. Los resultados obtenidos se discuten en el artículo.

Background: Osteoarthritis (OA) is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. There are multiples risk factors for osteoarthritis includes the following: Age, Obesity and Genetics. Human leukocyte antigen (HLA) as part of immune system has a role in the disease process. Many reported studies have pointted to different HLA classs I and II association. Aim: To investigate whether there is an association between HLA class II and OA. Patients and methods: A cross sectional comparatives study including patient with primary osteoarthritis attending the department of orthopedic in Al-Kindy teaching hospital Baghdad, Iraq between September 2016-September 2017. Patient's selection was done by the orthopaedics. The HLA-A tuping was performed in HLA research unit at Al-Kindy College of Medicine using PCR-SSO according to the manufacturer instruction using both Amplification and Hybridization kit by Automated method using Autolipa - 48Innogenities-Belgium. The results ewre interepted using LIRAS version 5.0 software innogenetics - Belgium, odds ratio were used to test signifcant differences. Results: Thirty five Iraqi Arab Muslims patients with primary osteoarthritis. The control group was comprised from 75 healtht unrelated sex and age matched volunteers among the staff of Al-Kindey college of medicine that didn't have a history of osteoarthritis. There was an increased frequencies of HLA-A*0101,0202,6802 in patients with osteoarthritis compared with healthy controls (P value=0.001,<0.001,<0.001 respectively)

Infecciones osteoarticulares en un hospital pediátrico de alta complejidad: epidemiología y características clínicas asociadas con bacteriemia / Osteoarticular infections in a tertiary care children's hospital: Epidemiology and clinical characteristics in association with bacteremia

Introducción. Las infecciones osteoarticulares son una importante causa de morbilidad y pueden presentar bacteriemia. La epidemiología de estas infecciones se ha modificado en los últimos años. Objetivos. Describir las características epidemiológicas, clínicas y evolutivas de los niños con infecciones osteoarticulares y comparar los pacientes con bacteriemia con los que no la presentaron. Población y métodos. Cohorte retrospectiva. Se incluyeron pacientes menores de 18 años, admitidos en el Hospital Juan P. Garrahan entre el 1/1/2016 y el 31/12/2016 con sospecha de infecciones osteoarticulares en quienes se hubiese realizado artrocentesis y/o biopsia articular. Se excluyeron niños con patología previa. Se compararon las características clínicas y de laboratorio según tuvieran bacteriemia o no. Se utilizó Stata 10. Resultados. N: 62. La mediana de edad fue 59.5 meses (rango intercuartilo -RIC- 24-84). Presentaron fiebre 44 pacientes (70%). Predominaron las artritis (54 pacientes, 87%). Se identificó un agente etiológico en 29 pacientes (47%). Predominó Staphylococcus aureus (n: 20, 32%). Tuvieron bacteriemia 15 de ellos (24%). Recibieron clindamicina como tratamiento empírico 56 pacientes (90%). La mediana de tratamiento endovenoso fue 7 días (RIC 5-11) y de internación, 7 días (RIC 4-12). Los pacientes con bacteriemia tuvieron menor edad (26 meses vs. 60, p < 0,05), mayor valor de proteína C reactiva inicial (101 vs. 33 U/L, p < 0,05), menor valor de hemoglobina al ingresar (10,8 g/dl vs. 12.5 g/dl, p 0,04) y mayor frecuencia de fiebre (100% vs. 57%, p < 0,05). Conclusiones. Predominó Staphylococcus aureus. Los niños con bacteriemia tuvieron menor edad, mayor valor de proteína C reactiva, menos hemoglobina al ingresar y, más frecuentemente, fiebre.

Introduction. Osteoarticular infections are an important cause of morbidity and may present with bacteremia. The epidemiology has changed in recent years. Objectives. To describe the epidemiological, clinical, and evolutionary characteristics of children with osteoarticular infections and compare patients with and without bacteremia. Population and methods. Retrospective cohort. Patients younger than 18 years admitted between January 1st, 2016 and December 31st, 2016 suspected of osteoarticular infections who had undergone an arthrocentesis and/or joint biopsy were included. Clinical and laboratory characteristics were compared between patients with and without bacteremia. The Stata 10 software was used.Results. N: 62. Patients' median age was 59.5 months (interquartile range [IQR]: 24-84). Fever developed in 44 patients (70%). Arthritis predominated (54 patients, 87%). An etiologic agent was identified in 29 patients (47%). Staphylococcus aureus was prevalent (n: 20, 32%). Among these, 15 developed bacteremia (24%). Clindamycin was administered to 56 patients (90%) as empirical therapy. The median intravenous treatment duration was 7 days (IQR: 5-11) and the median length of stay, 7 days (IQR: 4-12). Patients with bacteremia were younger (26 months versus 60 months, p < 0.05), had a higher baseline C-reactive protein level (101 U/L versus 33 U/L, p < 0.05), a lower hemoglobin level at the time of admission (10.8 g/dL versus 12.5 g/dL, p = 0.04), and a higher frequency of fever (100% versus 57%, p < 0.05).Conclusions. Staphylococcus aureus was prevalent. Children with bacteremia were younger, had a higher C-reactive protein level, a lower hemoglobin level at the time of admission, and 100% presented fever

Avaliação funcional de pacientes submetidos à artroplastia total do joelho utilizando implantes com estabilização posterior e implantes bloqueados / Functional outcome after total knee arthroplasty using cruciate-substituing implants and hinged implants

A artroplastia total do joelho (ATJ) é uma das cirurgias ortopédicas eletivas mais realizadas no mundo e é o procedimento de escolha para o tratamento de pacientes nos estágios finais de osteoartrite. Os implantes são divididos segundo o grau de estabilidade em sem bloqueio, com bloqueio parcial e implantes bloqueados. Os implantes bloqueados são reservados para os pacientes com insuficiência ligamentar grave do joelho. O objetivo do presente estudo foi comparar a função e a força do joelho entre pacientes submetidos à ATJ utilizando implantes bloqueados e aqueles que utilizaram implantes com estabilização posterior (sem bloqueio). A função foi avaliada através do questionário da sociedade do joelho (KSS) e a força foi avaliada através do pico de torque da musculatura extensora e flexora no teste isocinético. Os pacientes que utilizaram implantes bloqueados foram também subdivididos segundo o procedimento cirúrgico em artroplastias primárias e artroplastias de revisão (séptica ou asséptica). Após aplicação dos critérios de exclusão permaneceram no estudo 24 pacientes (25 ATJ) que utilizaram prótese bloqueada e 19 pacientes (26 ATJ) que realizaram ATJ primária utilizando implante com estabilização posterior sem bloqueio (grupo controle). Não houve diferença em relação à idade, peso, altura, índice de massa corpórea (IMC) e distribuição de sexo entre os dois grupos. O subgrupo de pacientes que realizaram revisão séptica e utilizou implante bloqueado tinha IMC maior do que o subgrupo revisão asséptica. Não houve diferença em relação à pontuação do KSS, função, força isocinética, dor e arco de movimento entre os grupos prótese bloqueada e controle. Também não foi observada diferença entre os subgrupos que utilizaram prótese bloqueada na pontuação do KSS, dor, arco de movimento e pico de torque extensor. Dos parâmetros avaliados, apenas a mediana do pico de torque flexor do subgrupo revisão séptica (0,24 Nm/kg) foi menor do que a do subgrupo ATJ primária (0,65 Nm/kg) (p < 0,05). Concluímos que o uso de implantes bloqueados promove função e força comparáveis a dos pacientes que realizaram artroplastia primária utilizando implantes com estabilização posterior, sem comprometer o arco de movimento e o nível de dor. No entanto, quando utilizado em revisão séptica, ocorre perda da força da musculatura flexora quando comparada a ATJ primária com implante bloqueado. Por fim, são necessários estudos complementares com um grupo maior de pacientes a fim de avaliar com maior precisão o desempenho funcional dos subgrupos de pacientes que utilizaram implantes bloqueados na substituição da articulação do joelho

Total knee arthroplasty (TKA) is one of the most widely performed elective orthopedic surgery in the world and is the procedure of choice for the treatment of patients in the end stages of osteoarthritis. The implants can be classified according to the levels of constraint in unconstrained, with varus-valgus constrained implant and hinged implants. Hinged implants are reserved for patients with severe knee ligament insufficiency. The aim of the present study was to compare the function and strength of the knee between patients submitted to TKA using hinged implants with patients treated with cruciate-substituting implants (unconstrained). The function was evaluated through the knee society score (KSS) and the strength was evaluated through the peak torque of the extensor and flexor muscles in the isokinetic test. Patients of hinged group were also subdivided according to the surgical procedure in primary arthroplasty and revision arthroplasty (septic or aseptic). After applying the exclusion criteria, 24 patients (25 TKA) who used a hinged prosthesis and 19 patients (26 TKA) who underwent primary TKA using cruciate-substituting implant (control group) remained in the study. There was no difference on age, weight, height, body mass index (BMI) and gender distribution between the two groups. The hinge subgroup of patients who underwent septic revision had a higher BMI than the aseptic revision hinge subgroup. There was no difference on the KSS score, function, isokinetic strength, pain and range of motion between the hinged prosthesis and the control group. Also, no difference was observed between the subgroups that used a hinged prosthesis in the KSS score, pain, range of motion and peak of extensor torque. Only the median peak flexor torque of the septic revision subgroup (0.24 Nm / kg) was lower than that of the primary ATJ subgroup (0.65 Nm / kg) (p

Metabolomics as a promising tool for early osteoarthritis diagnosis

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

Pinzamiento femoroacetabular, causa de dolor en la cadera en el adulto joven / Femoroacetabular impingement causing hip pain in young adults / Le pincement fémoro-acétabulaire à l'origine de la douleur aux hanches chez le sujet jeune

El dolor de la cadera en adultos ha sido tradicionalmente asociado con osteoartritis en dicha articulación. Sin embargo, vemos a muchos pacientes jóvenes con dolor en la cadera, sin artritis, en nuestras consultas. Recientemente, un anormal contacto entre el acetábulo y la unión de cabeza-cuello femoral, conocido como síndrome de pinzamiento femoroacetabular se ha reconocido como una causa preartrítica relativamente común de estos síntomas. Se realizó una amplia revisión bibliográfica con la finalidad de conocer la incidencia de pinzamiento femoroacetabular reportada en la literatura internacional así como todo lo relacionado con el diagnóstico clínico-radiológico y el tratamiento de esta afección. El pinzamiento femoroacetabular es una de las principales causas de dolor en la cadera del adulto joven así como de osteoartritis; la artroscopia de cadera va tomando un papel cada vez más preponderante en el tratamiento de esta afección.

Hip pain in adults has traditionally been associated with osteoarthritis in that joint. However, in our consultations we see many young patients with hip pain, with no arthritis. Recently, an abnormal contact between the acetabulum and the femoral head-neck union, known as femoroacetabular impingement syndrome has been recognized as a relatively common pre-arthritis cause of these symptoms. An extensive literature review was conducted in order to determine the incidence of femoroacetabular impingement reported in international literature and all related to the clinical and radiological diagnosis and treatment of this condition. Femoroacetabular impingement is a major cause of hip pain in adult and osteoarthritis; hip arthroscopy is taking an increasingly prominent role in the treatment of this condition.

Chez les adultes, la douleur de hanche a été d’habitude associée à une ostéoarthrite de cette dite articulation. Néanmoins, on peut voir dans nos cabinets pas mal de jeunes patients souffrant d’une douleur de hanche, sans arthrite. Un contact anormal entre l’acétabulum et la jonction tête et col du fémur, aussi appelé conflit fémoro-acétabulaire, a été récemment décrit comme une cause pré-arthritique relativement commune de ces symptômes. Une large analyse bibliographique a été réalisée afin de connaître l’incidence du conflit fémoro-acétabulaire rapportée dans la littérature internationale, ainsi que tout ce qui est en relation avec le diagnostic clinique et radiologique et le traitement de ce trouble. Le pincement fémoro-acétabulaire est l’une des principales causes de douleur de hanche, ainsi que d’ostéoarthrite, chez le sujet jeune; l’arthroscopie joue un rôle de plus en plus prépondérant dans le traitement de cette affection.

Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES / Assessing the magnitude of osteoarthritis disadvantage on people's lives: the MOVES study

Introdução A osteoartrite (OA) é uma das dez doenças mais incapacitantes nos países desenvolvidos e uma das principais causas de dor e incapacitação no mundo. O diagnóstico precoce aumenta a probabilidade de prevenção da progressão da doença. Objetivos Estimar a prevalência de osteoartrite auto-referida e a qualidade de vida em adultos portugueses com 45 ou mais anos de idade. Métodos Estudo observacional, transversal, implementado em domicílios por entrevista interpessoal. Resultados Foram incluídos no estudo 1039 indivíduos com idade média de 62 anos, sendo 54,2% do gênero feminino. A prevalência de osteoartrite auto-referida foi de 9,9%. Os joelhos e as mãos foram o local mais freqüente da doença. A prevalência de OA foi maior em mulheres e em participantes sem atividade profissional. A presença de OA foi maior em participantes com comorbidades. A maioria dos indivíduos já tinham passado por algum tratamento em alguma ocasião de suas vidas para esta doença: 94,5% tiveram tratamento farmacológico, 49,5% fisioterapia, e 19,8% atividade física. A dor estava associada com a estatura, com alguns locais da doença, especificamente pescoço, coluna lombar e ombros, pontuação do SF12 para qualidade de vida, e medidas de impacto no cotidiano dos participantes, gravidade da doença e incapacitação. O impacto da OA no dia-a-dia foi maior em indivíduos que tinham gozado licença por doença ou que pararam de trabalhar por causa da OA, apresentavam-se com pior saúde física e mental, e exibiam maior gravidade da doença. Conclusão Este estudo confirmou que a osteoartrite é uma doença muito relevante, com impacto potencial elevado na qualidade de vida, no funcionamento e na capacidade para o trabalho e, por causa de sua prevalência, exerce um impacto social muito elevado e crescente. .

Introduction Osteoarthritis (OA) is one of the ten most disabling diseases in developed countries and one of the leading causes of pain and disability over the world. Early diagnosis increases the likelihood of preventing disease progression. Objectives To estimate the prevalence of self-reported osteoarthritis and quality of life in Portuguese adults with 45 or more years old. Methods Observational, cross-sectional study, implemented in households by face-to-face interview. Results 1039 subjects with mean age of 62 years and 54.2% female were included. The prevalence of self-reported osteoarthritis was 9.9%. Knees and hands were the most frequent site of disease. The prevalence of OA was higher in women and in participants without professional activity. Presence of OA was higher in participants with comorbidities. Most subjects have done some treatment at some point in time for this disease: 94.5% had drug therapy, 49.5% physiotherapy, and 19.8% physical activity. Pain was associated with height, with some disease locations specifically neck, lower spine and shoulders, SF12 scores of quality of life, and measurements of impact in daily living, severity of disease and disability. The impact of OA in daily living was greater in subjects that had been on sick leave or stopped working due to OA, had worse physical and mental health, and with more severe of disease. Conclusion This study confirmed that osteoarthritis is a very relevant disease with a high potential impact on quality of life, function and work ability and because of its prevalence with a very high growing social impact. .