Electroacupuncture Alleviates Pain by Suppressing P2Y12R-Dependent Microglial Activation in Monoarthritic Rats.

Electroacupuncture (EA) effectively improves arthritis-induced hyperalgesia and allodynia by repressing spinal microglial activation, which plays a crucial role in pain hypersensitivity following tissue inflammation. However, the mechanism by which EA suppresses spinal microglial activation in monoarthritis (MA) remains unclear. In the present study, a rat model of MA was established through unilateral ankle intra-articular injection of complete Freund's adjuvant (CFA). The relationship among P2Y12 receptor (P2Y12R) expression, spinal microglial activation, and EA analgesia was investigated using quantitative real-time PCR (qRT‒PCR), western blotting, immunofluorescence (IF), and behavioral testing. The results found that EA treatment at the ipsilateral "Huantiao" (GB30) and "Yanglingquan" (GB34) acupoints markedly attenuated pain and spinal microglia M1 polarization in MA rats. In particular, P2Y12R expression was significantly increased at the mRNA and protein levels in the spinal dorsal horn in MA rats, whereas EA treatment effectively repressed the MA-induced upregulation of P2Y12R. IF analysis further revealed that most P2Y12R was expressed in microglia in the spinal dorsal horn. Pharmacological inhibition of P2Y12R by its antagonist (AR-C69931MX) decreased MA-induced spinal microglial activation and subsequent proinflammatory cytokine production. Consequently, AR-C69931MX significantly intensified the anti-pain hypersensitive function of EA in MA rats. Taken together, these results demonstrate that EA alleviates MA-induced pain by suppressing P2Y12R-dependent microglial activation.

Reduction of Edema and Pain in Transcutaneous Electrical Nerve Stimulation Treated-Arthritic Rat.

Transcutaneous electrical nerve stimulation (TENS) has been used to reduce pain or improve motor function in musculoskeletal and neurological disorders in the clinic. Although some studies have suggested electrotherapy as an intervention for edema, the effects and mechanisms of TENS on inflammation-induced edema remain unclear. Thus, we aimed to investigate the effects of TENS on arthritic pain with edema. 1% carrageenan was injected into the right tibiofemoral joint of 69 male Sprague-Dawley rats (200-250 g). After the development of arthritic pain, low-frequency (4-Hz, Low-TENS, n = 25) and high-frequency (100-Hz, High-TENS, n = 25) TENS with sub-motor threshold or placebo-TENS (n = 19) was applied for 20-min to medio-lateral part of the ipsilateral side. Weight bearing and knee-bend tests were used to assess pain-like behaviors. Also, we examined the size of edema and measured tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1ß) levels in the synovium by western blot. Eight rats in each of the two TENS groups were injected with Naloxone. Edema was reduced in the low- and high-frequency TENS groups at 6-h. TENS-treated rats showed reduced pain in the knee-bend test at 6-h. We observed decreased weight load shifts on the ipsilateral side in TENS groups. Naloxone reduced these effects. TNF-α and IL-1ß expression decreased in the synovial membrane at 6-h. These results suggest that low- and high-frequency TENS have acutely positive effects on inflammatory edema, with the management of arthritic pain and reduction in pro-inflammatory mediators. Therefore, Low-TENS and High-TENS may be useful in treating acute inflammatory pain and edema.

Replenishing decoy extracellular vesicles inhibits phenotype remodeling of tissue-resident cells in inflammation-driven arthritis.

The interleukin 6 (IL6) signaling pathway plays pleiotropic roles in regulating the inflammatory milieu that contributes to arthritis development. Here, we show that activation of IL6 trans-signaling induces phenotypic transitions in tissue-resident cells toward an inflammatory state. The establishment of arthritis increases the serum number of extracellular vesicles (EVs), while these EVs express more IL6 signal transducer (IL6ST, also known as gp130) on their surface. Transferring these EVs can block IL6 trans-signaling in vitro by acting as decoys that trap hyper IL6 and prevent inflammatory amplification in recipient arthritic mice. By genetically fusing EV-sorting domains with extracellular domains of receptors, we engineered EVs that harbor a higher quantity of signaling-incompetent decoy receptors. These exogenous decoy EVs exhibit significant potential in eliciting efficient anti-inflammatory effects in vivo. Our findings suggest an inherent resistance of decoy EVs against inflammation, highlighting the therapeutic potential of efficient decoy EVs in treating inflammatory diseases.

Regenerative Therapies for Basal Thumb Arthritis-A Systematic Review.

Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.

[Non-pharmacological management for inflammatory rheumatic diseases]. / Traitements non médicamenteux des rhumatismes inflammatoires chroniques.

Chronic inflammatory arthritis are conditioners with many drug treatments available. However, many patients still suffer from symptoms impairing their quality of life. It seems necessary to propose complementary therapies favoring patients' involvement in their management. We detail several axes: nutrition and micronutrition, physical activity, management of comorbidities such as obesity, smoking and periodontitis as well as physical therapies with cryotherapy and occupational therapy.

Les rhumatismes inflammatoires chroniques sont des maladies fréquentes avec de nombreux traitements médicamenteux à disposition. Toutefois, un nombre significatif de patients conservent des symptômes qui altèrent leur qualité de vie. Il paraît nécessaire de proposer des thérapies complémentaires adaptées à chaque patient en l'impliquant dans sa prise en charge. Nous détaillons ainsi plusieurs axes : la nutrition et la micronutrition, l'activité physique, la prise en charge des comorbidités telles que l'obésité, le tabagisme et la parodontite, ainsi que les thérapies physiques avec la cryothérapie et l'ergothérapie.

A "Gold Standard" in the Management of Arthritis.

ABSTRACT: Hand radiographs show gold thread used as part of acupuncture treatment for arthritis.

Utilização da fisioterapia na reabilitação de bezerro com poliartrite e paresia neuromuscular: relato de caso / Use of physiotherapy in the rehabilitation of calves with polyarthritis and neuromuscular paresis: case report / Uso de la fisioterapia en la rehabilitación de un ternero con poliartritis y parisia neuromuscular: reporte de caso

A reabilitação animal na medicina veterinária é um campo recente, porém crescente a cada dia. Neste sentido, a fisioterapia veterinária atua trazendo inúmeros benefícios, como melhoria dos movimentos, redução da dor, edema e outras. Interfere ainda no tempo de recuperação, redução de custos para o proprietário, podendo ser hoje utilizada como um tratamento na recuperação pós-cirúrgica. Desta forma, objetivou-se relatar o uso da fisioterapia em uma bezerra com poliartrite e paresia neuromuscular. O animal apresentou um aumento de volume nas articulações cárpicas e társicas após histórico de onfalite, permanecendo em decúbito esternal por vários dias. O proprietário resolveu aplicar ferro dextrano na região glútea do animal, o que causou uma lesão de nervo isquiático. Foram instituídos protocolos medicamentosos e fisioterápicos, que culminaram no estímulo da marcha, propriocepção, além de hipertrofia muscular. Porém, em virtude de complicações resultantes de onfalite, o animal veio a óbito.(AU)

Animal rehabilitation in veterinary medicine is a recent field, but growing every day. In this sense, veterinary physiotherapy works bringing numerous benefits, such as improved movements, reduced pain, edema and others. Reducing the recovery time, reducing costs for the owner, and today it can be used as a treatment in post-surgical recovery. In this sense, the objective was to report the use of physiotherapy in a heifer with polyarthritis and neuromuscular paresis. The animal showed an increase in volume in the carpal and tarsal joints after a history of omphalitis, remaining in sternal decubitus for several days. The owner decided to apply iron dextran to the animal's gluteal region, which caused an injury to the sciatic nerve. Medicinal and physical therapy protocols were instituted, which culminated in the stimulation of gait, proprioception, in addition to muscle hypertrophy. However, due to complications resulting from omphalitis, the animal died.(AU)

La rehabilitación animal en medicina veterinaria es un campo reciente, pero en crecimiento cada día. En este sentido, la fisioterapia veterinaria actúa aportando numerosos beneficios, como mejora de los movimientos, reducción del dolor, edemas y otros. Disminución del tiempo de recuperación, reducción de costos para el propietario, pudiendo ser utilizado hoy en día como tratamiento en la recuperación posquirúrgica. En ese sentido, el objetivo fue reportar el uso de fisioterapia en una vaquilla con poliartritis y paresia neuromuscular. El animal presentó un aumento de volumen en las articulaciones del carpo y del tarso tras un antecedente de onfalitis, permaneciendo en decúbito esternal durante varios días. El propietario decidió aplicar hierro dextrano en la región glútea del animal, lo que provocó una lesión en el nervio ciático. Se instauraron protocolos farmacológicos y de fisioterapia, que culminaron con estimulación de la marcha, propiocepción, además de hipertrofia muscular. Sin embargo, debido a complicaciones derivadas de la onfalitis, el animal falleció.(AU)

Successful Delayed Hyperbaric Oxygen Therapy and Iloprost Treatment on Severe Frostbite at High Altitude.

Magnan, Dre Marie-Anne, Marco Gelsomino, Pierre Louge, and Rodrigue Pignel. Successful delayed hyperbaric oxygen therapy and iloprost treatment on severe frostbite at high altitude. High Alt Med Biol. 23:294-297, 2022.-Frostbite is an injury caused when tissues freeze. Severe frostbite can result in amputation. Hyperbaric oxygen therapy (HBO) may improve frostbite outcome. The patient, a 36-year-old man, was climbing above 6,000 m in Kyrgystan when he fell into a crevasse and lost his gloves. The outside temperature was -30°C. He sustained grade 3 frostbite of both hands, which carries a high amputation risk. He was rescued by local responders and transported to the local hospital: neither rapid rewarming in warm water nor other specific frostbite treatment was given. The patient was repatriated to Geneva (day 2). On day 3, he received medical care including iloprost infusion for 7 days and daily HBO for 3 weeks. His hands healed in <1 month. He suffered no amputation. At 6-month follow-up, no early arthritis was found. Three years later he was able to climb again and play volleyball. He still does not have any clinical arthritis at 4-year follow-up. Iloprost is less effective when initiated longer than 48 hours after frostbite injury. Despite the delay, the patient did not require amputation, as might have been predicted by the injury. The combination of HBO and iloprost may have contributed to this favorable outcome.

Critical Role of Synovial Tissue-Resident Macrophage and Fibroblast Subsets in the Persistence of Joint Inflammation.

Rheumatoid arthritis (RA) is a chronic prototypic immune-mediated inflammatory disease which is characterized by persistent synovial inflammation, leading to progressive joint destruction. Whilst the introduction of targeted biological drugs has led to a step change in the management of RA, 30-40% of patients do not respond adequately to these treatments, regardless of the mechanism of action of the drug used (ceiling of therapeutic response). In addition, many patients who acheive clinical remission, quickly relapse following the withdrawal of treatment. These observations suggest the existence of additional pathways of disease persistence that remain to be identified and targeted therapeutically. A major barrier for the identification of therapeutic targets and successful clinical translation is the limited understanding of the cellular mechanisms that operate within the synovial microenvironment to sustain joint inflammation. Recent insights into the heterogeneity of tissue resident synovial cells, including macropahges and fibroblasts has revealed distinct subsets of these cells that differentially regulate specific aspects of inflammatory joint pathology, paving the way for targeted interventions to specifically modulate the behaviour of these cells. In this review, we will discuss the phenotypic and functional heterogeneity of tissue resident synovial cells and how this cellular diversity contributes to joint inflammation. We discuss how critical interactions between tissue resident cell types regulate the disease state by establishing critical cellular checkpoints within the synovium designed to suppress inflammation and restore joint homeostasis. We propose that failure of these cellular checkpoints leads to the emergence of imprinted pathogenic fibroblast cell states that drive the persistence of joint inflammation. Finally, we discuss therapeutic strategies that could be employed to specifically target pathogenic subsets of fibroblasts in RA.

From traditional to novel treatment of arthritis: a review of recent advances in nanotechnology-based thermal therapy.

Arthritis has been a heavy burden on the economy and society at large. Recently, nanomaterials that can convert near-infrared light into localized heat have demonstrated better targeting to arthritic joints, fewer side effects, ease of combined application with current therapeutics and enhanced efficacy for arthritis treatment. In this review, the authors summarize traditional thermal therapies for arthritis treatment and their molecular mechanisms and discuss the advantages and applications of nanotechnology-based thermal therapies for arthritis treatment. In conclusion, nanotechnology-based thermal therapies are effective alternatives or adjuvant strategies to the current pharmacological treatment of arthritis. Future clinical translation of thermal therapies could benefit from research elucidating their mechanisms and standardizing their parameters to optimize efficacy.

The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: A randomized controlled pilot study.

INTRODUCTION: Effective physiotherapy interventions are required for haemophilic arthropathy (HA) of the elbow due to its biomechanical differences and contribution to upper limb functionality. AIM: To investigate the effects of manual therapy & exercises on bleeding frequency, pain, range of motion (ROM), strength, joint health, functionality and quality of life (QoL) in HA of the elbow. METHODS: Seventeen participants with HA of the elbow were randomized as Manual Therapy & Exercises Group (MTEG = 9) and Home Exercises Group (HEG = 8). Soft tissue mobilization, joint traction (grade I-II) and Mulligan's mobilization with movement as manual therapy, and stretching/strengthening exercises were applied to MTEG, while HEG had only same exercises as home programme. The interventions lasted 3 days/weekly for 5 weeks. Bleeding frequency was evaluated with patients' records; pain with Numeric Pain Scale; ROM with goniometer; strength with digital dynamometer; joint health with HJHS; functionality with Quick-Disability of Arm, Shoulder and Hand questionnaire; and QoL with Oxford Elbow Score. RESULTS: Bleeding frequency and activity pain were decreased, while elbow ROMs and flexor strength were increased in MTEG (P Ë‚ 0.05). Also significantly improvements were seen in joint health, functionality and QoL in MTEG. HEG showed improvements in activity pain, QoL and some ROMs. MTEG had better results in ROMs, joint health and functionality (P Ë‚ 0.05). CONCLUSION: Manual therapy & exercises may be used without causing bleeding and pain to increase the functionality, joint health and QoL, and is superior to home exercise for joint health and functionality. Home exercises may be ameliorated in pain, QoL and some ROMs.

The quality of online consumer health information at the intersection of complementary and alternative medicine and arthritis.

BACKGROUND: Complementary and alternative medicine (CAM) use is prevalent among patients living with arthritis. Such patients often seek information online, for the purpose of gaining a second opinion to their healthcare provider or even self-medication. Little is known about the quality of web-based consumer health information at the intersection of CAM and arthritis; thus, investigating the quality of websites containing this information was the purpose of this study. METHODS: Four unique search terms were searched on Google across four English-speaking countries. We assessed the first 20 results of each search, including them if they contained CAM consumer health information for the treatment and/or management of arthritis. Eligible websites were assessed in duplicate using the DISCERN instrument, which consists of 16-items designed to assess quality. RESULTS: Of total of 320 webpages, 239 were duplicates, and a total of 38 unique websites were deemed eligible and assessed using the DISCERN instrument. The mean summed  DISCERN scores across all websites was 55.53 (SD = 9.37). The mean score of the overall quality of each website was 3.71 (SD = 0.63), thus the majority of websites are ranked as slightly above 'fair' quality. CONCLUSION: Eligible websites generally received scores better than 'moderate' in terms of overall quality. Several shortcomings included a lack of transparency surrounding references used and underreporting of risks associated with treatment options. These results suggest that health providers should be vigilant of the variable quality of information their patients may be accessing online and educate them on how to identify high quality resources.

Innate Lymphocytes in Inflammatory Arthritis.

Inflammatory arthritis (IA) refers to a group of chronic diseases, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and other spondyloarthritis (SpA). IA is characterized by autoimmune-mediated joint inflammation and is associated with inflammatory cytokine networks. Innate lymphocytes, including innate-like lymphocytes (ILLs) expressing T or B cell receptors and innate lymphoid cells (ILCs), play important roles in the initiation of host immune responses against self-antigens and rapidly produce large amounts of cytokines upon stimulation. TNF (Tumor Necrosis Factor)-α, IFN (Interferon)-γ, Th2-related cytokines (IL-4, IL-9, IL-10, and IL-13), IL-17A, IL-22, and GM-CSF are involved in IA and are secreted by ILLs and ILCs. In this review, we focus on the current knowledge of ILL and ILC phenotypes, cytokine production and functions in IA. A better understanding of the roles of ILLs and ILCs in IA initiation and development will ultimately provide insights into developing effective strategies for the clinical treatment of IA patients.

[Clinical observation of acupuncture at tendon blockage point of quadriceps femoris muscle belly for patella femoral arthritis].

OBJECTIVE: To evaluate the clinical effect of acupuncture at tendon blockage point of quadriceps femoris muscle belly for mild to moderate patella femoral arthritis. METHODS: A total of 76 patients with mild to moderate patella femoral arthritis were randomly divided into an observation group and a control group, 38 cases in each group. The patients in the observation group were treated with acupuncture at tendon blockage point of quadriceps femoris muscle belly, and the needles were stayed for 20 min each time for twice a week; while the patients in the control group were treated with sodium hyaluronate injection into articular cavity, once a week, and both groups were treated for 4 weeks. The pain symptoms and joint function of the patients were evaluated with pain visual analogue scale (VAS) score, tenderness value of the most obvious pain point in front of the knee, and Lysholm knee function score before and one week after treatment, and the clinical effect was observed. RESULTS: After treatment, VAS scores, tenderness value of the most obvious pain point in front of the knee and Lysholm knee function scores of the two groups were improved compared with before treatment (P<0.05); the improvement of VAS score and tenderness value of the most obvious pain point in front of the knee in the observation group was more obvious than that in the control group (P<0.05). The total effective rate in the observation group was 94.7% (36/38), which was higher than 81.6% (31/38) in the control group (P<0.05). CONCLUSION: Acupuncture at tendon blockage point of quadriceps femoris muscle belly can relieve pain and improve the function of patella femoral joint for patients with patella femoral arthritis, and the clinical effect is better than that of sodium hyaluronate injected into articular cavity.

Molecular and Cellular Mechanisms of Arthritis in Children and Adults: New Perspectives on Applied Photobiomodulation.

Juvenile idiopathic arthritis and adult rheumatoid arthritis are two major groups with chronic joint pain and inflammation, extra-articular manifestations, and high risk of comorbidities, which can cause physical and ocular disability, as well as create great socio-economic pressure worldwide. The pathogenesis of arthritis manifested in childhood and adulthood is multifactorial, unclear, and overly complex, in which immunity plays an important role. Although there are more and more biological agents with different mechanisms of action for the treatment of arthritis, the results are not as expected, because there are partial responses or non-responsive patients to these compounds, high therapeutic costs, side effects, and so on; therefore, we must turn our attention to other therapeutic modalities. Updating knowledge on molecular and cellular mechanisms in the comparative pathogenesis of chronic arthritis in both children and adults is necessary in the early and correct approach to treatment. Photobiomodulation (PBM) represents a good option, offering cost-effective advantages over drug therapy, with a quicker, more positive response to treatment and no side effects. The successful management of PBM in arthritis is based on the clinician's ability to evaluate correctly the inflammatory status of the patient, to seek the optimal solution, to choose the best technology with the best physical parameters, and to select the mode of action to target very precisely the immune system and the molecular signaling pathways at the molecular level with the exact amount of quantum light energy in order to obtain the desired immune modulation and the remission of the disease. Light is a very powerful tool in medicine because it can simultaneously target many cascades of immune system activation in comparison with drugs, so PBM can perform very delicate tasks inside our cells to modulate cellular dysfunctions, helping to initiate self-organization phenomena and finally, healing the disease. Interdisciplinary teams should work diligently to meet these needs by also using single-cell imaging devices for multispectral laser photobiomodulation on immune cells.

Hirudotherapy attenuates arthritic pain in patients with various chronic pain syndromes: A retrospective analysis.

OBJECTIVE: Osteoarthritis is a degenerative disease that affects synovial joints. Micro-injuries of articular structures initiate inflammatory processes, leading to persistent pain. Due to various risk factors, osteoarthritis is often diagnosed in multimorbid patients. This makes pain management one of the key challenges, with a consistent need for new therapeutic strategies. Hence, complementary and integrative methods such as hirudotherapy have become increasingly important, even though their mechanisms of action are not entirely understood. METHODS: We retrospectively analyzed the longitudinal effect of a single leech application on osteoarthritic joints in a heterogenic cohort of 24 cases with various chronic pain syndromes. We assessed articular pain intensity ratings and movability of the treated joint after one-time leeching for up to 12 months. We further investigated the effect of hirudotherapy on the systemic pain status and multimodal treatment strategies of the patients. RESULTS: There was a significant reduction in pain intensity ratings at the joint of leech application for up to 12 months after treatment. The improvements in pain intensities were independent of the form of osteoarthritis treated. In addition, we saw a considerable enhancement in local movability of the treated joint. Hirudotherapy did not seem to influence the systemic pain status as well as the previously established individualized multimodal treatment model of the patients. CONCLUSION: Leeching as an adjuvant therapy has a great potential especially in terms of safety and long-term outcome.

In Vitro and In Vivo Anti-inflammatory Activity of Bovine Milkfat Globule (MFGM)-derived Complex Lipid Fractions.

Numerous health related properties have been reported for bovine milk fat globule membrane (MFGM) and its components. Here we present novel data on the in vitro and in vivo anti-inflammatory activity of various MFGM preparations which confirm and extend the concept of MFGM as a dietary anti-inflammatory agent. Cell-based assays were used to test the ability of MFGM preparations to modulate levels of the inflammatory mediators IL-1ß, nitric oxide, superoxide anion, cyclo-oxygenase-2, and neutrophil elastase. In rat models of arthritis, using MFGM fractions as dietary interventions, the phospholipid-enriched MFGM isolates were effective in reducing adjuvant-induced paw swelling while there was a tendency for the ganglioside-enriched isolate to reduce carrageenan-induced rat paw oedema. These results indicate that the anti-inflammatory activity of MFGM, rather than residing in a single component, is contributed to by an array of components acting in concert against various inflammatory targets. This confirms the potential of MFGM as a nutritional intervention for the mitigation of chronic and acute inflammatory conditions.

Anti-Inflammatory Activity of Miodesin™: Modulation of Inflammatory Markers and Epigenetic Evidence.

PURPOSE: To investigate the effects of a combined herbal medicine Miodesin™ on the inflammatory response of key cells involved in the acute and chronic inflammatory processes as well as the possible epigenetic involvement. METHODS: After the establishment of the IC50 dose, the chondrocyte, keratinocyte, and macrophage cell lines were pretreated for 2 hours with Miodesin™ (200 µg/mL) and stimulated with LPS (1 µg/mL) for 24 hours. The supernatant was used to measure the levels of cytokines (IL-1ß, IL-6, IL-8, and TNF-α) and chemokines (CCL2, CCL3, and CCL5), and the cells were used to extract the mRNA for the transcription factor (NF-κß), inflammatory enzymes (COX-1, COX-2, PLA2, and iNOS), and chemokines (CCL2, CCL3, and CCL5). RESULTS: Miodesin™ inhibited the release of LPS-induced cytokines (IL-1ß, IL-6, IL-8, and TNF-α; p < 0.01) and chemokines (CCL2, CCL3, and CCL5; p < 0.01) and the expression of the transcription factor (NF-κß; p < 0.01), inflammatory enzymes (COX-1, COX-2, PLA2, iNOS; p < 0.01), and chemokines (CCL2, CCL3, and CCL5; p < 0.01). In addition, the evaluation of epigenetic mechanism revealed that Miodesin™ did not induce changes in DNA methylation, assuring the genetic safeness of the compound in terms of the inflammatory response. CONCLUSIONS: Miodesin™ presents anti-inflammatory properties, inhibiting hyperactivation of chondrocytes, keratinocytes, and macrophages, involving epigenetics in such effects.

A randomized controlled trial of real versus sham acupuncture for basal thumb joint arthritis.

We report a single-blinded randomized controlled trial comparing acupuncture to sham (non-penetrating) needling for relief of symptoms of basal thumb joint arthritis. Seventy acupuncture naive patients with basal thumb joint arthritis were randomized to receive true acupuncture or sham needling with 35 patients in each arm. Blinded baseline and post-treatment assessments included visual analogue pain scores for different grips and movement. Function was assessed using the Nelson questionnaire. Both groups showed statistically and clinically significant improvements in pain at week one post-treatment compared with baseline, but there was no difference between the treatment groups. The pain relief was comparable with published data for some standard treatments. Acupuncture did not perform better than sham needling in this study, indicating that pain relief may have been achieved through non-specific mechanisms. Level of evidence: I.

Does Instructor Experience Impact Balance and Health-Related Quality of Life in Healthy Older Adult Participants following a Tai Chi for Arthritis Program?

Tai chi improves balance in older adults; however, the level of instructor expertise on balance outcomes is not known. Older adults (mean age 72.6 ± 4.2 yrs.) were taught for 6 months by experienced (n = 15) or novice (n = 11) instructors. Both groups had large standardized response means (SRM) for the Four-Square-Step-Test. Only the experienced group had moderate to large SRMs (range 0.439-0.741) in all sway measures under challenge (standing with eyes closed on foam). Participants taught by experienced instructors had greater balance gains; the experience of instructors should be considered in future studies and community referrals.