Indice de masa corporal como factor de riesgo que afecta a la osteoartritis de rodilla de los ancianos / Body Mass Index as the Risk Factor Affecting Knee Osteoarthritis of the Elderly

Introducción: La osteoartritis es una enfermedad que progresa con el tiempo y culmina en la destrucción de articulaciones y ligaduras. La Investigación Básica de Salud (RISKESDAS) 2013 muestra que East Nusa Tenggara tiene la prevalencia más alta de la enfermedad reumática en Indonesia, alrededor del 33,1%. Método: Esta investigación es un estudio observacional-analítico con un diseño transversal. Esta investigación tiene como objetivo determinar los factores que afectan la osteoartritis de los ancianos en el Centro de Salud Comunitario de Sikumana, distrito de Maulafa, ciudad de Kupang durante el período de diciembre de 2018 a febrero de 2019. Resultado: En esta investigación, índice de masa corporal / IMC (PR = 1,21, p = 0,037) tiene una correlación significativa con la osteoartritis de los ancianos, sin embargo, el género (RP = 1,02, p = 0,839) y los antecedentes de trauma de rodilla (RP = 1,08, p = 0,453) no tienen una correlación significativa con la osteoartritis de los ancianos. Conclusión: un cuerpo con sobrepeso aumenta la presión mecánica de la articulación de la rodilla, lo que provoca la osteoartritis. En esta investigación, las mujeres tienen un mayor riesgo de sufrir osteoartritis en comparación con los hombres. Cuanto mayor sea el IMC, la prevalencia de la osteoartritis aumenta significativamente. Alrededor del 41% de los ancianos con osteoartritis tienen obesidad. Entre otros riesgos, la obesidad muestra una correlación con la prevalencia de osteoartritis. Se debe aumentar la conciencia de los pacientes sobre el índice de masa corporal (IMC) para reducir la prevalencia de la osteoartritis.

Introduction: Osteoarthritis is a disease that progresses over time and culminates in the destruction of articular and joints. Basic Health Research (RISKESDAS) 2013 shows that East Nusa Tenggara have the highest prevalence of the rheumatic disease in Indonesia, about 33,1 %. Method: This research is an observational-analytic study with a cross-sectional design. This research aims to determine the factors affecting Osteoarthritis of the Elderly at Sikumana Community Health Center, Maulafa District, Kupang City during the period of December 2018 to February 2019. Result: In this research, body mass index/BMI (PR=1,21, p=0,037) has a significant correlation to osteoarthritis of the elderly, yet gender (PR=1,02, p=0,839) and history of knee trauma (PR=1,08, p=0,453) have no significant correlation to osteoarthritis of the elderly. Conclusion: An overweight body increases the mechanical pressure of the knee joint, which causes osteoarthritis. In this research, women have a higher risk of osteoarthritis compared to men. The higher the BMI, the prevalence of osteoarthritis increases significantly. Around 41 % of the Elderly with Osteoarthritis have obesity. Amongst any other risks, obesity shows a correlation with the prevalence of Osteoarthritis. Patients' awareness of the body mass index (BMI) should be increased to reduce the prevalence of osteoarthritis.

Uso de bastones contralaterales en artrosis de rodilla / Contralateral canes for knee osteoarthritis

INTRODUCCIÓN La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

INTRODUCTION Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

Dolor en la artrosis de rodilla / Pain in knee osteoarthritis

El dolor constituye el síntoma fundamental de la artrosis, sus características e interpretación permiten el diagnóstico certero y también conocer la magnitud de esa entidad. El objetivo de este trabajo, es profundizar los conocimientos sobre los elementos más esenciales relacionados con el dolor en la artrosis de la rodilla. Se describen las causas mecánicas y bioquímicas del dolor, entre las que resaltan el dolor óseo, sinovial, así como los factores bioquímicos relacionados con ese síntoma. Se hace referencia a las principales estructuras anatómicas responsables del dolor y sus mecanismos de acción. Se mencionan la relación existente entre ese síntoma y las modalidades imagenológicas, así como los patrones del dolor. Para finalizar, se hace referencia a las escalas de dolor usadas.

Pain is the main symptom of osteoarthritis. Determining the distinctive features of pain in knee osteoarthritis allows for an accurate diagnosis. This article gives a review of the results from research work on the typical features of knee osteoarthritic pain. The mechanics and biochemical causes of pain are described including both bone and synovial biochemical symptom-related factors. The relationships between knee pain, various imaging techniques and pain mechanism are also identified. Finally, the used pain scales are presented.

Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: double blind, randomized comparative study / Efetividade do plasma rico em plaquetas no tratamento da dor em osteoartrite de joelho: estudo comparativo randômico e duplo-cego

Abstract Background: Intra-articular injections of platelet-rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet-rich plasma was administered in one knee and normal saline in another knee of same patient. Methods: 20 patients aged 30-65 years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet-rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6 months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study. Results: The baseline VAS score in platelet-rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6 months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6 month 7.00 ± 4.24 (p < 0.001) in platelet-rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet-rich plasma knee as compared to normal saline knee. Conclusion: The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra-articular platelet-rich plasma injection as compared to normal saline.

Resumo Justificativa e objetivos: Injeções intra-articulares de plasma rico em plaquetas têm sido usadas com sucesso para tratar os sintomas da osteoartrite de joelho em pacientes jovens. Porém, na maioria desses estudos, os joelhos de controle e teste estavam presentes em diferentes pacientes, o que incorporou uma grande quantidade de viés aos resultados. Portanto, o projeto do presente estudo incluiu pacientes com osteoartrite em ambos os joelhos, com a administração de plasma rico em plaquetas em um dos joelhos e de solução salina normal no outro joelho do mesmo paciente. Métodos: 20 pacientes, de ambos os sexos, com idades entre 30-65 anos e portadores de osteoartrite bilateral de joelho (classificação ASA I e II) foram incluídos no estudo. Os pacientes foram randomizados para receber plasma rico em plaquetas e solução salina normal em um dos dois joelhos. O desfecho primário foram os escores VAS e WOMAC seis meses após o procedimento. O desfecho secundário incluiu alterações na rigidez articular, função física e qualquere feito adverso observado durante o curso do estudo. Resultados: O escore VAS basal para o joelho que recebeu plasma rico em plaquetas foi 8,4 ± 0,88 e melhorou significativamente para 4,85 ± 2,48 (p < 0,001) após seis meses, comparado ao joelho que recebeu solução salina normal (p = 0,017). A intensidade da dor avaliada com o WOMAC também melhorou de 14,5 ± 1,3 na fase basal para 7,00 ± 4,24 após seis meses (p < 0,001) nos joelhos que receberam plasma rico em plaquetas, enquanto nenhuma mudança significativa ocorreu nos joelhos que receberam solução salina normal entre a fase basal e após seis meses (10,2 ± 1,2 a 10,05 ± 1,23). Além disso, houve uma diminuição significativa da rigidez e melhora da atividade física nos joelhos que receberam plasma rico em plaquetas, comparados aos joelhos que receberam salina normal. Conclusão: O presente estudo identificou uma diminuição significativa da dor e da rigidez e uma melhora das funções físicas da articulação do joelho com a injeção intra-articular de plasma rico em plaquetas, comparada à solução salina normal.

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.

Elderly with knee osteoarthritis should perform nutritional assessment: integrative literature review / Idosos com osteoartrite de joelhos devem realizar avaliação nutricional: revisão integrativa da literatura

ABSTRACT To review scientific literature to assess nutritional status of elderly patients with osteoarthritis in the last 16 years. This is an integrative literature review that included articles published in national and international journals indexed in PubMed, SciELO and BIREME. We selected 14 articles, and English language was predominant. The year of publication of articles ranged from 2006 to 2016, and most of papers were cross-sectional studies. To gather papers and for posterior evaluate, we used a validated data collection instrument and the included studies were critical analyzed by reading, gathering and analysis of articles. Studies suggested that there is a positive correlation between obesity and knee osteoarthritis. Obesity is one of the most important modifiable factors in worsening of osteoarthritis symptoms.

RESUMO O objetivo da pesquisa foi revisar a produção científica referente à avaliação do estado nutricional de idosos com osteoartrite nos últimos 16 anos. Assim, o estudo foi uma revisão integrativa da literatura, realizada com a busca de artigos publicados em periódicos nacionais e internacionais indexados no PubMed, na SciELO e na BIREME. Foram selecionados 14 artigos, e o idioma inglês foi preponderante. O período de publicação dos artigos variou de 2006 a 2016, com predominância de estudos do tipo transversais. Para reunir os artigos e para posterior avaliação, foi utilizado um instrumento de coleta de dados validado, e as análises críticas dos estudos incluídos foram realizadas por meio da leitura, do agrupamento e da análise dos artigos. As pesquisas sugeriram que existe correlação positiva entre obesidade e osteoartrite de joelhos. Além disto, a obesidade é um dos fatores mais significativos e modificáveis no agravamento dos sintomas da osteoartrite.

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.

Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty

PURPOSE: To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. MATERIALS AND METHODS: The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5degrees varus (Group 1, 351 cases), 5degrees to less than 10degrees varus (Group 2, 189 cases), 10degrees to less than 15degrees varus (Group 3, 59 cases), and 15degrees varus or more (Group 4, 28 cases). RESULTS: On average, the alignment of the tibial implant was 0.2+/-1.4degrees, 0.1+/-1.3degrees, 0.1+/-1.6degrees, and 0.3+/-1.7degrees varus, and the tibiofemoral alignment was 5.2+/-1.9degrees, 4.7+/-1.9degrees, 4.9+/-1.9degrees, and 5.1+/-2.0degrees valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0+/-3degrees varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p0.05). CONCLUSION: Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.

Investigação da ansiedade, depressão e qualidade de vida em pacientes portadores de osteoartrite no joelho: um estudo comparativo / Investigation of depression, anxiety and quality of life in patients with knee osteoarthritis: a comparative study

RESUMOIntrodução:A osteoartrite (OA), artrose ou osteoartrose acomete a cartilagem hialina e o osso subcondral e compromete a articulação como um todo. A articulação do joelho caracteriza-se como um dos principais sítios de acometimento da OA. O envelhecimento, o sobrepeso e o gênero (prevalência em mulheres) são os fatores de risco mais significativos para o desenvolvimento da doença. A OA é considerada uma das mais frequentes causas de incapacidade laborativa e pode afetar a qualidade de vida de seus portadores e favorecer a emergência de transtornos mentais.Objetivo:Avaliar se os sintomas de ansiedade e depressão são mais expressivos em mulheres com OA quando comparados com mulheres sem tal diagnóstico e o quanto essa doença reumática compromete a qualidade de vida desses pacientes.Métodos:Participaram deste estudo 75 mulheres, com média de 67 anos, 40 com diagnóstico de OA no joelho e 35 sem. Foram usados os seguintes instrumentos: Inventário de Ansiedade Traço e Estado, Inventário de Depressão de Beck e SF-36, questionário de qualidade de vida.Resultados:Mulheres portadoras de OA no joelho têm níveis maiores de depressão e ansiedade, além de apresentar qualidade de vida inferior em comparação com o grupo sem a doença.Conclusão:Acreditamos que o tratamento aos portadores de OA deveria considerar a combinação de farmacoterapia, psicoterapia, orientação e apoio por parte dos parentes e/ou pessoas próximas para que o paciente possa atingir melhor qualidade de vida.

ABSTRACTIntroduction:Osteoarthritis (OA) affects the articular cartilage and subchondral bone, compromising the joint as a whole. The knee joint is characterized as one of the main sites of involvement of OA and the most significant risk factors for developing the disease are aging, overweight and female gender. OA is considered one of the most frequent causes of disability, which may affect the quality of life of the patients, favoring the onset of mental disorders.Objective:To investigate whether anxiety and depression symptoms are more significant in women with OA, when compared with women without this diagnosis, and to what extent this rheumatic disease affects the quality of life of these patients.Methods:The study included 75 women, mean age 67 years; 40 were diagnosed with knee OA and 35 without this diagnosis. The following instruments were used: State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI) and SF-36, a quality of life questionnaire.Results:Women with knee OA have higher rates of depression and anxiety when compared to controls; in addition, they have a lower quality of life.Conclusion:We believe that the treatment of patients with OA should consider the combination of pharmacotherapy, psychotherapy, counseling and family support, in order to achieve a better quality of life.

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.

Evaluation of Femoral Neck Bone Mineral Density and Radiographic Hand and Knee Osteoarthritis in a Korean Elderly Population

BACKGROUND: Reports on the relationship between osteoporosis and osteoarthritis (OA) have tended to disagree, especially in non-weight bearing joints such as the hand joints. We aimed to investigate the relationship between bone mineral density (BMD) and hand and knee OA in a general Korean elderly population. METHODS: We evaluated femur neck BMD and the hand and knee radiographs of 143 men and 123 women over 65 years of age who participated in a population-based cohort study. The Kellgren-Lawrence criteria for grading OA were implemented, and grade 2 or higher were categorized as radiographic OA. BMD was compared according to the existence of radiographic OA in the hand and knee using analysis of covariance, and correlation analyses were performed to explore the relationship between BMD and radiographic OA grade. RESULTS: After controlling for age and body mass index, there was no significant difference in BMD between participants with and without hand OA (p = 0.717 in male and p = 0.862 in female), between those with and without knee OA (p = 0.974 in male and p = 0.563 in female), and between those with only hand OA and those with only knee OA (p = 0.920 in male and p = 0.961 in female). Furthermore, there was no significant correlation between BMD and the radiographic OA grade of the hands (p = 0.182 in male and p = 0.897 in female) and knees (p = 0.245 in male and p = 0.098 in female). CONCLUSIONS: In our cohort of the general Korean elderly population, no association was found between osteoporosis and OA, regardless of the weight bearing status of the joints.

Autosomal Dominant Type I Osteopetrosis Is Related with Iatrogenic Fractures in Arthroplasty

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

Impacto del tratamiento con células madre adultas en la osteoartrosis de la rodilla / Impact of the treatment with adult stem cells in knee osteoarthrosis

Introducción: la osteoartrosis de la rodilla (OAR) es la causa más frecuente de artritis en la población por encima de los 55 años de edad. A menudo se asocia con discapacidad y deterioro variable de la calidad de vida. En la actualidad, el tratamiento con células madre ha abierto una alternativa más dentro del arsenal terapéutico con que se cuenta. Objetivo: evaluar la eficacia y seguridad del autotrasplante de células madre adultas en el tratamiento de la osteoartrosis de rodilla. Métodos: se realizó un estudio desde mayo 2009 hasta diciembre 2011, en el que se incluyeron 123 pacientes adultos con OAR atendidos en la consulta de medicina regenerativa, que no respondían a los tratamientos convencionales. Se les realizó el implante intrarticular de células mononucleares de sangre periférica (CMN-SP) autólogas, movilizadas mediante el factor estimulante de colonias granulocíticas. En todos los casos prevalecía el dolor y la dificultad a la marcha al inicio del tratamiento. Resultados: a los seis meses se observó mejoría clínica y radiológica en 117 pacientes (95,1 por ciento) y solo en seis enfermos (4,9 por ciento) no hubo la respuesta deseada, coincidiendo estos con los que presentaron trastornos de alineación marcados, en los cuales el dolor no desapareció, pero sí existió modificación de la intensidad. Conclusiones: el implante de CMN-SP es un método factible, simple, seguro y menos costoso para el tratamiento de OAR. Se recomienda que si existe deformidad angular acentuada marcada, esta debe corregirse antes del implante para que el proceder sea exitoso

Introduction: osteoarthrosis an every day more frequent degenerative disease affecting the quality of life of people over 55 years old and its treatment is a great challenge. The use of stem cells has open a new alternative in the available therapeutic arsenal. Objective: to assess the efficacy and safety of autologous adult stem cell transplantation in the treatment of knee osteoarthrosis. Methods: the study took place from May 2009 to December 2011 in 123 adult patients with OAR from the regenerative medicine outpatient service who had no response to conventional treatments. Intra-articular implantation of autologous peripheral blood mononuclear cells (MNC-SP) mobilized by granulocyte colony stimulating factor was performed. In all cases pain and gait difficulty at baseline prevailed. Results: after six months, clinical and radiological improvement in 117 patients (95,1 percent) were observed and only in six patients (4,9 percent) the expected response was not obtained. These last patients presented marked alignment disorders and the pain did not disappear, but there was a positive change in its intensity. Conclusions: the CMN-SP implant is a feasible, simple, safe and less expensive method for the treatment of knee osteoarthrosis. It is recommended that in cases with marked angular deformity, this disorder should be corrected prior to MNC-SP implantation so the procedure be successful

Síndrome metabólico en pacientes con osteoartritis primaria de rodillas en el Servicio de Reumatología del Hospital María Auxiliadora en el período Febrero - Abril del 2006 / Metabolic syndrome in patients with primary knee osteoarthritis in the Department of Rheumatology at the Hospital Maria Auxiliadora in the period February - April 2006

La osteoartritis de rodillas y la enfermedad cardiovascular son dos patologías prevalentes a nivel mundial, que pueden producir discapacidad importante. Se ha encontrado evidencia que sugeriría que la osteoartritis estaría vinculada al síndrome metabólico. Objetivos: Describir la frecuencia de síndrome metabólico, en pacientes con osteoartritis de rodillas que se atendieron en el servicio de Reumatología del Hospital María Auxiliadora, Lima-Perú, entre febrero a abril del año 2006. Material y Métodos: Se revisaron las historias clínicas de los pacientes con osteoartritis primaria de rodillas, que acudieron a la consulta externa de reumatología del Hospital María Auxiliadora en el período febrero-abril 2006, para determinar la frecuencia del síndrome metabólico en estos pacientes. Resultados: 61,7 por ciento de pacientes con osteoartritis primaria de rodillas presentaban síndrome metabólico. El mayor porcentaje (39,2 por ciento) perteneció al grupo de 61 a 70 años. El 92 por ciento fue de sexo femenino y 8 por ciento masculino. La circunferencia abdominal aumentada fue el componente más frecuente (87,5 por ciento). La hiperglucemia fue más frecuente en varones y la circunferencia abdominal aumentada, HDL disminuido y triglicéridos aumentados en mujeres. Conclusiones: 61.7 por ciento de pacientes con osteoartritis de rodillas presentaban síndrome metabólico, 92 por ciento eran mujeres y 8 por ciento varones. Un 50 por ciento presentó tres componentes y 10 por ciento cinco. Se encontró la circunferencia abdominal aumentada en 87.5 por ciento, hipertensión arterial en 66.7 por ciento, HDL disminuido en 50.8 por ciento, elevación de triglicéridos en 46.7 por ciento e hiperglucemia en 41.7 por ciento.

Knee Pain and Its Severity in Elderly Koreans: Prevalence, Risk Factors and Impact on Quality of Life

This study investigated the epidemiology (prevalence, risk factors, and impact on quality of life) of knee pain and its severity in elderly Koreans. The subjects (n=3,054) were participants aged > or =50 yr from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. Knee pain was defined as pain in the knee lasting > or =30 days during the most recent 3 months; severity was categorized as mild, moderate, or severe. EQ-5D was used to measure quality of life. The prevalence of knee pain was 23.1% (11.7% in men, 31.9% in women). The prevalences of mild, moderate, and severe knee pain were 4.3%, 9.1%, and 9.7%, respectively (2.8%, 5.4%, and 3.5% in men and 5.4%, 12.0%, and 14.4% in women). Old age, female gender, a low level of education, a manual occupation, obesity, and radiographic osteoarthritis were risk factors for knee pain, and were associated with increased severity of knee pain. Excluding men with mild knee pain, people with knee pain had significantly lower quality of life than those without knee pain. Early interventional approaches are needed to reduce the medical, social, and economic burden of knee pain in elderly Koreans.

Impacto dos exercícios na capacidade funcional e dor em pacientes com osteoartrite de joelhos: ensaio clínico randomizado / Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis: a randomized clinical trial

INTRODUÇÃO: A fraqueza muscular, especialmente do quadríceps, é uma das principais repercussões osteomusculares da osteoartrite de joelho, e os exercícios são considerados uma das principais intervenções no tratamento conservador da doença. OBJETIVO: Avaliar o efeito do fortalecimento do quadríceps femural na capacidade funcional e nos sintomas relacionados à osteoartrite de joelho utilizando o teste Timed Up and Go (TUG), o questionário Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e o Índice de Lequesne. MÉTODOS: Foram randomizados 100 pacientes, divididos em dois grupos: 1) Grupo Exercício (n = 50), o qual incluiu bicicleta estacionária, alongamento dos músculos isquiotibiais e fortalecimento do músculo quadríceps, e 2) Grupo Orientação (n = 50), que recebeu um manual de orientações a fim de descrever a osteoartrite de joelho e instruir os pacientes a como ajustar o dia a dia de acordo com os sintomas. Os pacientes foram informados sobre os sinais e sintomas da doença e os cuidados durante as atividades de vida diária. O manual não incluiu orientação de exercícios. RESULTADOS: O Grupo Exercício apresentou melhora estatisticamente significante no teste TUG, nos aspectos dor, função e rigidez do questionário WOMAC e no índice Lequesne, quando comparado ao Grupo Orientação. CONCLUSÃO: Exercícios para fortalecimento do quadríceps com duração de oito semanas são efetivos na melhora de dor, função e rigidez em pacientes com osteoartrite de joelho.

BACKGROUND: Muscle weakness, especially of the quadriceps muscle, is one of the major musculoskeletal effects of knee osteoarthritis. Exercises are considered one of the main interventions in the conservative treatment of those patients. OBJECTIVE: To assess the effectiveness of quadriceps strengthening exercises on functional capacity and symptoms related of knee osteoarthritis by use of the Timed Up and Go test (TUG), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lequesne Index. METHODS: One hundred patients were randomized into two groups: 1) Exercise Group (n = 50), which included stationary bicycle, hamstrings stretching, and quadriceps strengthening; 2) Instruction Group (n = 50), which received a manual with information about knee osteoarthritis and instructions on how to deal with knee symptoms in daily activities. The manual did not include exercise instructions. RESULTS: The Exercise Group showed statistically significant improvement regarding the TUG test, the WOMAC aspects of pain, function, and stiffness, and the Lequesne Index, as compared with the Instruction Group. CONCLUSION: Quadriceps strengthening exercises for eight weeks are effective to improve pain, function, and stiffness in patients with knee osteoarthritis.

Parâmetros do controle postural em mulheres idosas com ou sem histórico de quedas associadas ou não à osteoartrite de joelhos / Postural control parameters in elderly female fallers and non-fallers diagnosed or not with knee osteoarthritis

OBJETIVOS: Comparar parâmetros estabilométricos de mulheres idosas com ou sem histórico de quedas associadas ou não à osteoartrite (OA) de joelhos. MÉTODOS: Cinquenta e seis idosas apresentando ou não histórico de quedas (Q) e OA de joelho unilateral e bilateral foram distribuídas da seguinte maneira: grupo QOA (n = 10), idosas com histórico de queda e OA de joelho; grupo QSOA (n = 11), idosas com histórico de queda e sem OA de joelho; grupo SQOA (n = 14), idosas sem histórico de quedas (SQ) e com OA de joelho; e grupo SQSOA (n = 21), idosas sem histórico de quedas e sem OA de joelho. Para análise do equilíbrio semiestático usando uma plataforma de força, foram avaliados os deslocamentos anteroposterior (DAP) e mediolateral (DML), as velocidades de oscilação anteroposterior (VAP) e mediolateral (VML) em quatro situações na postura ereta. As situações avaliadas foram as seguintes: 1) PFOA: sobre superfície fixa e olhos abertos; 2) PFOF: sobre superfície fixa e olhos fechados; 3) PIOA: sobre superfície instável e olhos abertos; 4) PIOF: sobre superfície instável e os olhos fechados. RESULTADOS: As idosas com OA de joelho apresentaram maior DAP em todas as situações analisadas (P < 0,05), ao passo que idosas com histórico de quedas apresentaram maior DML (P < 0,05). Não houve diferenças entre os grupos para VAP e VML (P > 0,05). CONCLUSÕES: A OA de joelho, por si, é um fator prejudicial no aumento de oscilação do centro de pressão (COP) na direção anteroposterior, enquanto o histórico de quedas, independente da presença de OA de joelhos, traz prejuízos ao controle postural na direção mediolateral.

OBJECTIVES: To compare stabilometric parameters of elderly female fallers and non-fallers associated or not with knee osteoarthritis (OA). METHODS: Fifty-six elderly female fallers and non-fallers diagnosed or not with unilateral or bilateral knee OA were divided into the following groups: FOA (n = 10), elderly female fallers with knee OA; FNOA (n = 11), elderly female fallers without knee OA; NFOA (n = 14), elderly female non-fallers with knee OA; and NFNOA (n = 21), elderly female non-fallers without knee OA. For analyzing semi-static balance on a force platform with the elderly females standing, the following parameters were assessed in four conditions: center of pressure (COP), anterior-posterior and mediolateral displacements (APD and MLD, respectively); and COP anterior-posterior and mediolateral displacement velocities (APV and MLV, respectively). The following conditions were assessed: 1) standing on a firm wooden surface with eyes open (WSEO); 2) standing on a firm wooden surface with eyes closed (WSEC); 3) standing on a foam surface with eyes open (FSEO); 4) standing on a foam surface with eyes closed (FSEC). RESULTS: The elderly females with knee OA showed greater APD in all four conditions assessed (P < 0.05), while the elderly female fallers showed greater MLD (P < 0.05). No difference between the groups was observed for APV and MLV (P > 0.05). CONCLUSIONS: Knee OA per se increases APD of the COP, while the history of falls, regardless of the presence of knee OA, hinders postural control in the ML direction.

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function / Homens com graus iniciais de osteoartrite apresentam correlação entre torque extensor do joelho e dor, rigidez e função

BACKGROUND: Osteoarthritis (OA) is a chronic-degenerative disease. The knee is the most commonly affected joint and the symptoms are generally attributed to quadriceps muscle weakness. However, few studies have evaluated this relationship in a population with early stages of knee OA. OBJECTIVE: To investigate whether a correlation among the knee extensor torque and the three subscales of the WOMAC questionnaire in men with early stages of knee OA exists. METHOD: Twenty-one men with knee OA grades I or II (according to Kellgren and Lawrence criteria) participated in this study. The concentric and eccentric knee extensor torque were assessed using a Biodex System 3 Pro® isokinetic dynamometer, at a speed of 90º/s. Self-reported symptoms and disability were assessed using the WOMAC questionnaire. Spearman's correlation coefficient was used to test the relationship between the dependent variables (three subscales of WOMAC questionnaire) and the independent variables (average knee extensor peak torque). RESULTS: We found a strong negative correlation between the concentric extensor torque and pain (r=-0.7, p<0.001) and a moderate and negative correlation among the concentric extensor torque and stiffness (r=-0.62, p=0.002) and physical function (r=-0.54, p=0.011). Eccentric extensor torque presented a moderate and negative correlation with the three subscales of the WOMAC (r=-0.40 to 0.69, p<0.05). CONCLUSIONS: The concentric and eccentric knee extensor torque is significantly correlated with self-report symptoms of patients in initial stages of knee OA. Therefore, the strengthening of the quadriceps muscles, through concentric and eccentric exercise is indicated for these patients in order to minimize these symptoms.

CONTEXTUALIZAÇÃO: A osteoartrite (OA) é uma doença crônico-degenerativa. O joelho é a articulação mais afetada, e os sintomas geralmente são atribuídos à fraqueza do músculo quadríceps. Entretanto, poucos estudos têm avaliado essa relação em indivíduos com graus iniciais de OA. OBJETIVO: Verificar se existe correlação entre o torque extensor do joelho e as seções dor, rigidez e função física do questionário WOMAC de homens com OA de joelho nos graus iniciais. MÉTODO: Participaram deste estudo 21 homens com OA de joelho graus I ou II (segundo critérios de Kelgren e Lawrence). Foi avaliado o torque extensor concêntrico e o excêntrico do joelho por meio do dinamômetro isocinético (Biodex System 3 Pro®), na velocidade de 90º/s. O autorrelato de sintomas e incapacidades foi avaliado por meio do questionário WOMAC. O Coeficiente de Correlação de Spearman foi utilizado para detectar a relação entre as variáveis dependentes (três seções do questionário WOMAC) e as variáveis independentes (média dos picos de torque). RESULTADOS: Encontrou-se correlação forte e negativa do torque extensor concêntrico com a seção dor (r=-0,7, p<0,001) e moderada e negativa com as seções rigidez (r=-0,62, p=0,002) e função física (r=-0,54, p=0,011). O torque extensor excêntrico correlacionou-se moderada e negativamente com as três seções do questionário (r=-0,40 a -0,69, p<0,05). CONCLUSÕES: Os torques extensores concêntrico e excêntrico correlacionaram-se com os sintomas autorrelatados pelos indivíduos com graus iniciais de OA de joelho. Assim, o fortalecimento do músculo quadríceps, por meio de exercícios concêntricos e excêntricos, é indicado para esses pacientes para minimizar tais sintomas.

Lesiones de menisco en pacientes con osteoartritis de la rodilla / Meniscus lesions in patients with osteoarthritis of knee

Las lesiones de los meniscos de rodilla en pacientes con osteoartritis son muy frecuentes, se manifiesta por la triada de Henderson, lo que limita aún más el movimiento de la articulación de la rodilla. Desarrollo: se realizó una revisión bibliográfica con relación a los siguientes aspectos: composición bioquímica normal de los meniscos, alteraciones que sufren durante el proceso degenerativo articular de la rodilla, relación causa-efecto entre menisco y presencia de osteoartritis. Por último se hace mención al tratamiento mediante vía artroscópica y los resultados propios del los autores con referencia a citas de autores internacionales. Conclusiones: las lesiones de los meniscos tienen un comportamiento divergente en pacientes con osteoartritis de rodilla. El resultado del tratamiento quirúrgico vía artroscópica constituye una fuente de buen pronóstico y la ausencia o disminución del tejido meniscal aumenta el progreso de la enfermedad degenerativa articular de la rodilla

Meniscus lesions of knee in patients with osteoarthritis are very common, showed by Henderson´s triad, thereby further limiting the movement of knee joint. Development: a literature review was conducted with regard to the following aspects: normal biochemical composition of meniscus, alterations that suffer during the degenerative joint process of knee, cause-effect relationship between meniscus and presence of osteoarthritis. Finally it is mentioned the treatment via arthroscopy and authors´ own outcomes with reference to citations from international authors.Conclusions: meniscus lesions have different behavior in patients with osteoarthritis of knee. The result of surgical treatment via arthroscopy constitutes a source of good prognosis and the absence or decrease of meniscal tissue increases the progression of degenerative joint disease of knee

Síndrome da fragilidade no idoso comunitário com osteoartrite / Frailty syndrome in the community-dwelling elderly with osteoarthritis

OBJETIVO: Caracterizar e comparar idosos comunitários com osteoartrite (OA) de joelhos e/ou quadris, com enfoque na síndrome da fragilidade. MéTODO: Estudo transversal com avaliação de características sociodemográficas, comorbidades, medicamentos, depressão, antropometria, quedas, dor, rigidez, função, fragilidade e avaliação subjetiva da saúde em idosos com OA de joelhos e/ou quadris a partir de subamostra do estudo sobre fragilidade em idosos brasileiros (FIBRA). RESULTADOS: A amostra final foi composta de 58 idosos (74 ± 5,50 anos), como segue: 17 (29,31%) não frágeis, 28 (48,28%) pré-frágeis e 13 (22,41%) frágeis. O número de medicamentos foi maior no grupo frágil em comparação ao não frágil (7,00 ± 2,00 e 4,00 ± 2,00, respectivamente; P = 0,001). O Índice de Massa Corporal foi menor nos idosos não frágeis em comparação aos pré-frágeis e frágeis (média de 27,00 ± 4,50 kg/m², 30,00 ± 4,00 kg/m² e 34,00 ± 8,00 kg/m², respectivamente; P = 0,018). Depressão foi mais prevalente no grupo frágil. Em relação à saúde comparada ao ano anterior, houve diferença: 64,3% dos pré-frágeis e 46,2% dos frágeis acreditavam que sua saúde piorou; entre os não frágeis, 52,9% consideraram que a saúde permaneceu igual (P = 0,016). Quanto ao nível de atividade em relação ao ano anterior, pré-frágeis e frágeis relataram que houve piora (P = 0,010). Quanto à função e à autoeficácia para quedas, os frágeis mostraram-se piores que os demais (P = 0,023 e 0,017, respectivamente). Os outros itens avaliados não apresentaram diferenças significativas entre os grupos. CONCLUSÃO: Idosos com OA e fragilidade usam maior número de medicamentos, são mais obesos e mais deprimidos, têm pior percepção da saúde e do nível de atividade em relação ao ano anterior e pior autoeficácia para quedas e para função física.

OBJECTIVE: To characterize and compare community-dwelling elderly with knee and/or hip osteoarthritis (OA), focusing on the frailty syndrome. METHOD: Cross-sectional study of the elderly with knee and/or hip OA, using a subsample from the study of frailty in the Brazilian elderly (FIBRA), assessing the following: sociodemographic characteristics, comorbidity, medications, depression, anthropomorphic data, falls, pain, stiffness, physical function, and frailty. The subjective assessment of health was also performed. RESULTS: The final sample comprised 58 elderly (mean age, 74 ± 5.5 years) as follows: 17 (29.31%) non-frail, 28 (48.28%) pre-frail, and 13 (22.41%) frail. The frail elderly received more medications than the non-frail ones (7.00 ± 2.00 and 4.00 ± 2.00, respectively; P = 0.001). The mean Body Mass Index was lower in the non-frail elderly as compared with those of the pre-frail and frail ones (27.00 ± 4.50 kg/m², 30.00 ± 4.00 kg/m², and 34.00 ± 8.00 kg/m², respectively; P = 0.018). Depression was more prevalent in the frail group. Compared to the previous year, there was a difference in the health status of the groups as follows: 64.3% of the pre-frail elderly and 46.2% of the frail ones believed their health deteriorated, and 52.9% of the non-frail elderly considered that their health status remained unchanged (P = 0.016). When comparing the current physical activity levels with those of the previous year, the pre-frail and frail elderly reported a worsening (P = 0.010). Regarding physical function and fall-related self-efficacy, the frail elderly were worse than the others (P = 0.023 and 0.017, respectively). There were no significant differences between the groups for the remaining items analyzed. CONCLUSION: The elderly with OA and frailty use more medications, are more obese and depressed, have a poorer perception of their own health and of their level of activity as compared with that of the previous year, have a worse fall-related self-efficacy, and worse physical function.