RESUMEN
INTRODUCTION: Atypical femoral fractures (AFFs) have been correlated with long-term use of bisphosphonates (BPs), glucocorticoids (GCs), and femoral geometry. We investigated the incidence and characteristics of subtrochanteric (ST) and diaphyseal (DP) AFFs in all institutes in a super-aging prefectural area. MATERIALS AND METHODS: We performed a blinded analysis of radiographic data in 87 patients with 98 AFFs in all institutes in Yamagata prefectural area from 2009 to 2014. Among the 98 AFFs, 57 AFFs comprising 11 ST fractures in 9 patients and 46 DP fractures in 41 patients with adequate medical records and X-rays were surveyed for time to bone healing and geometry. RESULTS: Of the 87 patients, 67 received BPs/denosumab (77%) and 10 received GCs (11%). Surgery was performed in 94 AFFs. Among 4 AFFs with conservative therapy, 3 required additional surgery. In univariate regression analyses for ST group versus DP group, male-to-female ratio was 2/7 versus 1/40, mean age at fracture was 58.2 (37-75) versus 78 (60-89) years, rheumatic diseases affected 55.5% (5/9) versus 4.9% (2/41), femoral lateral bowing angle was 1.7 (0-6) versus 11.8 (0.8-24)°, GC usage was 67% (6/9) versus 4.9% (2/41), and bone healing time was 12.1 (6-20) versus 8.1 (3-38) months (p < 0.05). In multivariate analyses, higher male-to-female ratio, younger age, greater proportion affected by rheumatic diseases, and higher GC usage remained significant (p < 0.05). CONCLUSIONS: The incidence of AFFs in our prefectural area was 1.43 cases/100,000 persons/year. This study suggests that the onset of ST AFFs have greater correlation with the worse bone quality, vice versa, the onset of DP AFFs correlated with the bone geometry. The developmental mechanisms of AFFs may differ significantly between ST and DP fractures.
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Envejecimiento/patología , Diáfisis/patología , Fracturas del Fémur/epidemiología , Fracturas de Cadera/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas de Cadera/diagnóstico por imagen , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Factores de RiesgoRESUMEN
Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p < 0.05). In conclusion, the incidence of AFFs in rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.
Asunto(s)
Fracturas del Fémur/complicaciones , Fracturas del Fémur/epidemiología , Enfermedades Reumáticas/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades Reumáticas/diagnóstico por imagen , Enfermedades Reumáticas/epidemiologíaAsunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Cabeza Femoral/patología , Granuloma de Células Plasmáticas/etiología , Prótesis de Cadera/efectos adversos , Trombosis de la Vena/etiología , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Biopsia con Aguja , Remoción de Dispositivos , Femenino , Estudios de Seguimiento , Granuloma de Células Plasmáticas/patología , Granuloma de Células Plasmáticas/cirugía , Humanos , Vena Ilíaca , Inmunohistoquímica , Metales , Polietileno , Diseño de Prótesis , Falla de Prótesis , Radiografía , Reoperación/métodos , Medición de Riesgo , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/cirugíaRESUMEN
BACKGROUNDS: Interstitial lung disease (ILD) is associated with rheumatoid arthritis (RA) itself and is also induced by biological and non-biological disease-modifying antirheumatic drugs. The glycoprotein Krebs von den Lungen-6 (KL-6) is reported to be a marker for the activity of ILD. OBJECTIVES: To elucidate the relationship between serum KL-6 levels in patients with RA treated with biological agents and pulmonary involvement on computed tomography of the chest. METHODS: The subjects were 307 patients with RA treated with infliximab, etanercept, adalimumab, or tocilizumab. Medical records were reviewed to investigate serum KL-6 levels, disease activity, and pulmonary imaging findings. RESULTS: Levels of KL-6 were abnormally elevated in 25 patients (8.1%): 15 patients (11.2%) treated with infliximab, 6 patients (4.4%) treated with etanercept, and 4 patients (22.2%) treated with adalimumab, but in no patients treated with tocilizumab. However, no clinical pulmonary events developed. Computed tomography of the chest showed the start or progression of interstitial fibrotic change in 5 of 25 (20%) patients with abnormal KL-6 values. The changes in disease activity did not differ significantly between patients who showed elevated KL-6 values and those who did not. CONCLUSIONS: Serum KL-6 levels were elevated in 8.1% of patients with RA treated with biological agents. Careful observation is necessary for these patients regarding lung fibrosis.
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Artritis Reumatoide/sangre , Artritis Reumatoide/tratamiento farmacológico , Factores Biológicos/uso terapéutico , Pulmón/patología , Mucina-1/sangre , Artritis Reumatoide/diagnóstico por imagen , Demografía , Progresión de la Enfermedad , Fibrosis , Humanos , Pulmón/efectos de los fármacos , Metotrexato/uso terapéutico , Persona de Mediana Edad , Radiografía Torácica , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
AIM: To elucidate the pathophysiology of rheumatoid arthritis (RA) as well as osteoarthritis (OA), we analyzed protein profiles of bone marrow-derived adherent cells (BMACs) from patients with these diseases. METHODS: Proteins, extracted from BMACs from three RA and three OA patients, were comprehensively analyzed by 2-dimensional differential image gel electrophoresis (2D-DIGE). Then a part of the detected proteins, differently expressed between the two diseases, were identified by mass spectrometric analysis. RESULTS: 2D-DIGE analysis detected more than 1600 protein spots in both RA and OA BMACs. Out of these, expression of 340 spots was significantly altered between the diseases (more than 1.5-fold: RA > OA, 26 spots; OA > RA, 314 spots; P < 0.05). Eleven protein spots the intensity of which were significantly altered by more than 2.0-fold were identified, which included vimentin and annexin A5 as increased proteins in RA rather than in OA. As increased proteins in OA compared to RA, alpha chain of collagen VI, a membrane anchor for acetylcholine esterase, heat shock protein 27, caldesmon and cytoskeletal proteins, such as beta actin and alpha tubulin, were identified. CONCLUSIONS: We here report different protein profiles of BMACs between RA and OA for the first time. BMACs possessing differently expressed proteins may be involved in the pathophysiology of the two diseases.
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Artritis Reumatoide/metabolismo , Células de la Médula Ósea/metabolismo , Médula Ósea/metabolismo , Osteoartritis de la Cadera/metabolismo , Proteínas/metabolismo , Proteómica , Anciano , Artritis Reumatoide/patología , Artritis Reumatoide/fisiopatología , Médula Ósea/patología , Células de la Médula Ósea/patología , Adhesión Celular , Electroforesis en Gel Bidimensional , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/patología , Osteoartritis de la Cadera/fisiopatología , Mapeo Peptídico , Proteínas/química , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
We describe 3 cases of rheumatoid arthritis presenting with elevated serum KL-6 levels during treatment with adalimumab, which was discontinued because of suspected onset of complications. However, no complications were observed following discontinuation despite comprehensive assessments, and KL-6 levels subsequently returned to baseline levels. In our institutes, 3 out of 29 cases treated with adalimumab showed elevated KL-6 levels. The baseline levels were 445, 347, and 547 U/ml, while the peak levels were 1010, 546, and 2007 U/ml, respectively. The elevated KL-6 levels seem to have been innocuous; nevertheless, further careful observation is deemed necessary.
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Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/efectos adversos , Artritis Reumatoide/sangre , Mucina-1/sangre , Adalimumab , Anciano , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Enfermedades Transmisibles/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Persona de Mediana Edad , Privación de TratamientoRESUMEN
BACKGROUND: The clinical evidence of the efficacy of hyperthermia on osteoarthritis (OA) has not yet been clearly established. In addition, the application of a modality that can control the temperature inside the joints has not been reported. The purpose of this study was to investigate the effect of percutaneous radiofrequency hyperthermia, which could safely raise the temperature of the body core, in patients with OA knees. METHODS: Temperature changes inside the knee joint without OA were measured during exposure to radiofrequency. Radiofrequency hyperthermia was performed on 12 OA knees by exposure to 8 MHz and 200 W for 20 min, 3 times, at 1-week intervals. The clinical outcome was evaluated by use of the Lequesne index (LI) and the Japan Orthopaedic Association (JOA) scale. The osteoarthritis research society international (OARSI) responder criteria were also analyzed. RESULTS: Radiofrequency hyperthermia of 8 MHz and 200 W for 20 min increased the temperature inside the joint from 34.4 to 39.4°C. The LI decreased by 3.55 points from baseline during the 3 weeks. The JOA scale improved significantly during the period, reaching 86.25 points at the final examination from baseline of 67.5 points. 67% of patients had a response to the therapy according to OARSI criteria. No side effects were observed. CONCLUSIONS: Radiofrequency hyperthermia can safely increase the temperature inside the knee joint. Radiofrequency hyperthermia on OA knees provides a remarkable pain relief effect and can improve the patients' daily life. In the future, clinical studies should be performed with a protocol containing more cases, with appropriate control groups.
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Artralgia/terapia , Hipertermia Inducida/métodos , Osteoartritis de la Rodilla/terapia , Anciano , Anciano de 80 o más Años , Artralgia/etiología , Artralgia/fisiopatología , Radiación Electromagnética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Rango del Movimiento ArticularRESUMEN
The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.
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Artritis Reumatoide/cirugía , Ortopedia/tendencias , Humanos , JapónRESUMEN
We report herein the results of a retrospective study of 30 ankle arthrodesis procedures performed in 27 patients with rheumatoid arthritis from 1994 through 2001 using a novel design of intramedullary nail with fins. The surgical treatment, post-operative management and clinical evaluation are described. The clinical evaluation, at an average follow-up period of more than 10 years, was based on foot disease scores from the Japanese Orthopaedic Association and scores obtained preoperatively, postoperatively, and during follow-ups 1 (November 2001) and 2 (November 2007) were compared. These variables showed significant improvement between before surgery and at follow-up evaluations. Non-union was not observed and no marked changes of the Chopart joint were seen between before surgery and at follow-up evaluations. Delayed wound healing was seen in 9 of 30 joints. However, infection neuropathy or other complications were not found. We conclude that arthrodesis using an intramedullary nail with fins is an effective treatment for severe hindfoot deformities in patients with rheumatoid arthritis because no cases of non-union were observed and because clinical results over the mean 10-year follow-up period were good or satisfactory.
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Articulación del Tobillo/cirugía , Artritis Reumatoide/cirugía , Artrodesis/instrumentación , Artrodesis/métodos , Clavos Ortopédicos , Adulto , Anciano , Articulación del Tobillo/diagnóstico por imagen , Artritis Reumatoide/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/diagnóstico por imagen , Deformidades Adquiridas del Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Fractures of the distal humerus around the elbow joint are most often in supracondylar or condylar lesion. This article described the diagnosis, classification, treatment, progress, side-effect, after-treatment and rehabilitation of fractures of supracondylar, lateral condyle and medial epicondyle of the humerus in child, and also described these of supracondylar, epicondylar fractures of the humerus in adult. Physical therapy should include active and active-assisted exercises for joint mobilization as soon as soft tissue healing permits. To prevent the contracture and the loss of motion of the elbow, rehabilitation of the patient and upper extremity should begin immediately, depending on the fracture and soft tissue stability in these fractures.
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Fracturas del Húmero , Adulto , Niño , Articulación del Codo , Terapia por Ejercicio , Humanos , Fracturas del Húmero/clasificación , Fracturas del Húmero/diagnóstico , Fracturas del Húmero/rehabilitación , Fracturas del Húmero/terapia , Modalidades de Fisioterapia , Pronóstico , Rango del Movimiento ArticularRESUMEN
OBJECTIVE: To investigate the effects of vitamin K2 (Vit K2) alone or in combination with etidronate and risedronate on bone loss, osteoclast induction, and inflammation in patients with rheumatoid arthritis (RA). METHODS: Subjects comprised 79 patients with RA who were receiving prednisolone, divided into 3 groups: Group K, Vit K2 alone; Group KE, Vit K2 plus etidronate; and Group KR, Vit K2 plus risedronate. During a 24-month treatment and followup period, levels of N-terminal telopeptide of type I collagen (NTx) and bone alkaline phosphatase were measured. Bone mineral density (BMD) of the 3 groups was measured using dual-energy x-ray absorptiometry. Damage score to fingers on radiographic findings were measured according to the Larsen method. Serum levels of receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) were measured. RESULTS: Falls in rate of change of BMD decreased after 18 months in groups KR and KE. Larsen damage scores indicated a significant difference between Group KE and other groups. Significant decreases in serum NTx were observed in groups KE and KR at all timepoints, but not in Group K. Levels of RANKL decreased significantly in all 3 groups. CONCLUSION: Vit K2 alone or in combination with bisphosphonates for treatment of osteoporosis in patients with RA may inhibit osteoclast induction via decreases in levels of RANKL.
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Conservadores de la Densidad Ósea/farmacología , Densidad Ósea/efectos de los fármacos , Ácido Etidrónico/análogos & derivados , Ácido Etidrónico/farmacología , Osteoporosis/tratamiento farmacológico , Vitamina K 2/farmacología , Anciano , Fosfatasa Alcalina/efectos de los fármacos , Artritis Reumatoide/tratamiento farmacológico , Estudios de Cohortes , Colágeno Tipo I/efectos de los fármacos , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoclastos/efectos de los fármacos , Osteoporosis/inducido químicamente , Osteoprotegerina/efectos de los fármacos , Péptidos/efectos de los fármacos , Prednisolona/efectos adversos , Estudios Prospectivos , Ligando RANK/efectos de los fármacos , Ácido RisedrónicoRESUMEN
To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy or shortening of lesser toe deformities. Forty-seven RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads and painful HV deformities. The HV and intermetatarsal (M1M2) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. Visual analogue scales were studied preoperatively, postoperatively, and in the follow-up period. HV and M1M2 angles significantly improved compared between the pre- and postoperative conditions. Out of the 47 patients, 78.9% were satisfied with the results of the operation, 8.9% were unsatisfied, and 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of the 90 feet. A modified Hohmann method and abductor hallucis muscle correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.
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Artritis Reumatoide/complicaciones , Deformidades Adquiridas del Pie/cirugía , Hallux Valgus/cirugía , Osteotomía/métodos , Articulación del Dedo del Pie/cirugía , Adulto , Anciano , Femenino , Deformidades Adquiridas del Pie/etiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy of lesser toe deformities instead of fusion of HV or resection of all metatarsal heads. From October 1995 through March 2001, 47 RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads, painful HV deformities, and the severe deviation of the sesamoid complex diagnosed by the basis of X-ray images. The HV and intermetatarsal (M1M2 and M1M5) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. According to the results of a questionnaire survey, the patients were divided into three groups using the visual analogue scale; group 1: satisfied, group 2: fair and or no pain, group 3: dissatisfied. HV and M1M2 angles significantly improved compared between pre- and postoperative or preoperative and the follow-up periods. Out of the 47 patients, 78.9% were satisfied with the results of the operation and 8.9% were dissatisfied. Of these patients, 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of 90 feet. A modified Hohmann method and abductor hallucis correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.
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Artritis Reumatoide/cirugía , Deformidades Adquiridas del Pie/cirugía , Hallux Valgus/cirugía , Osteotomía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We report herein a retrospective study of 25 cases of ankle arthrodesis performed in 23 patients with rheumatoid arthritis (RA) using an intramedullary nail with fins, developed in 1994. Surgical treatment, postoperative management, and clinical evaluation are described. Clinical evaluation, at an average follow-up period of 7 years 1 month, was based on foot disease scores from the Japanese Orthopedic Association; we compared these scores pre- and postoperatively, and during follow-up. These parameters showed a significant difference between preoperation and the follow-up period. However, instability only significantly improved when compared between pre- and postoperation. Arthrodesis using an intramedullary nail with fins was effective for the treatment of severe deformity of the hind foot. Nonunion was not observed and no remarkable changes of the Chopart joint were recognized between preoperation and the follow-up period. In our series, delayed wound healing was recognized in 6 of 25 joints. However, infection or neuropathy and other complications were not found. Arthrodesis using an intramedullary nail with fins is a viable treatment option for severe deformity of the hind foot in RA patients, because nonunion was not recognized and the clinical results over an average 7-year follow-up period were good or satisfactory.