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1.
Oral Maxillofac Surg ; 24(2): 211-215, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32323042

RESUMO

PURPOSE: Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that provides good clinical results such as the improvement of jaw movements. It also helps to balance the synovial liquid viscosity and relieve TMJ pain by the washout of inflammatory components from the upper compartment. The purpose of this study is to report a case series of patients submitted to a clinical-based protocol of diagnosis of TMJ joint open lock and treatment with arthrocentesis. MATERIAL AND METHODS: Patients suffering from a recurrent unilateral open lock of the TMJ were submitted to one arthrocentesis of the affected TMJ and all of them reported that the open lock was caused by daily stomatognathic activities. To decide the arthrocentesis as the initial treatment of these patients, the authors followed a rational protocol of diagnosis. RESULTS: Ten patients were included in the present study. No complications occurred during arthrocentesis. Immediately, 1 week, 1 month, and 6 months after arthrocentesis, patients did not suffer from open lock or disc click anymore. They also reported no more pain because it was strictly related to the disc click. CONCLUSIONS: All patients of the present study improved from the open lock and disc click of the affected TMJ for 6 months after arthrocentesis. The clinical-based protocol of diagnosis of TMJ open lock reported in the present study, followed by the treatment with arthrocentesis is a reasonable, low-cost, and safe method to treat patients with the acute open lock.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Paracentese , Amplitude de Movimento Articular , Articulação Temporomandibular , Resultado do Tratamento
4.
Int J Oral Maxillofac Surg ; 49(5): 621-627, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31540790

RESUMO

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n=15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P=0.016) and significant long-term differences in masticatory efficiency (P=0.046) and protrusive movement (P=0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P<0.001), disruption in daily activities (P=0.002), maximum mouth opening (P=0.008), and protrusive movement (P=0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.


Assuntos
Luxações Articulares , Osteoartrite , Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Injeções Intra-Articulares , Amplitude de Movimento Articular , Articulação Temporomandibular , Resultado do Tratamento
5.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31836615

RESUMO

OBJECTIVES: In Lyme disease endemic areas, initial management of children with arthritis can be challenging because diagnostic tests take several days to return results, leading to potentially unnecessary invasive procedures. Our objective was to examine the role of the C6 peptide enzyme immunoassay (EIA) test to guide initial management. METHODS: We enrolled children with acute arthritis undergoing evaluation for Lyme disease presenting to a participating Pedi Lyme Net emergency department (2015-2019) and performed a C6 EIA test. We defined Lyme arthritis with a positive or equivocal C6 EIA test result followed by a positive supplemental immunoblot result and defined septic arthritis as a positive synovial fluid culture result or a positive blood culture result with synovial fluid pleocytosis. Otherwise, children were considered to have inflammatory arthritis. We report the sensitivity and specificity of the C6 EIA for the diagnosis of Lyme arthritis. RESULTS: Of the 911 study patients, 211 children (23.2%) had Lyme arthritis, 11 (1.2%) had septic arthritis, and 689 (75.6%) had other inflammatory arthritis. A positive or equivocal C6 EIA result had a sensitivity of 100% (211 out of 211; 95% confidence interval [CI]: 98.2%-100%) and specificity of 94.2% (661 out of 700; 95% CI: 92.5%-95.9%) for Lyme arthritis. None of the 250 children with a positive or equivocal C6 EIA result had septic arthritis (0%; 95% CI: 0%-1.5%), although 75 children underwent diagnostic arthrocentesis and 27 underwent operative joint washout. CONCLUSIONS: In Lyme disease endemic areas, a C6 EIA result could be used to guide initial clinical decision-making, without misclassifying children with septic arthritis.


Assuntos
Ensaios Enzimáticos Clínicos/métodos , Doença de Lyme/diagnóstico , Doença Aguda , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Artrocentese/estatística & dados numéricos , Sedimentação Sanguínea , Borrelia burgdorferi/imunologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Immunoblotting , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Doença de Lyme/epidemiologia , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
6.
Int J Oral Maxillofac Surg ; 49(5): 628-635, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31547949

RESUMO

The purpose of this study was to clinically evaluate the efficacies of three treatment methods and to compare their outcomes in patients with painful disc displacement. The study group comprised 45 patients with unilateral temporomandibular disorders who fell into Axis I group II (with limited mouth opening) of the Research Diagnostic Criteria for Temporomandibular Disorders. Magnetic resonance imaging was used for definitive diagnosis. The patients were divided randomly into three groups according to the treatment method: splint therapy, splint therapy with ultrasound-guided arthrocentesis, and splint therapy with low-level laser therapy. Patients were followed up after treatment for 6 months. The groups were compared in terms of pain and functional jaw movements (unassisted mouth opening without pain, maximum unassisted mouth opening, and contralateral movements). At the end of treatment, functional jaw movements were significantly increased while pain values were significantly decreased in all groups (P<0.05). Group 2 had a quicker improvement in terms of mouth opening scores at the end of the first month, and unassisted mouth opening without pain was found to be more than 35 millimetres in all groups at the end of 6 months. All treatment modalities showed effective results on pain and functional jaw movements in the treatment of temporomandibular disorders.


Assuntos
Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Dor , Medição da Dor , Amplitude de Movimento Articular , Resultado do Tratamento
7.
J Oral Rehabil ; 47(3): 307-312, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31557342

RESUMO

The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Adulto , Artrocentese , Feminino , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Contenções , Articulação Temporomandibular , Resultado do Tratamento
8.
Cranio ; 38(2): 122-127, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30048223

RESUMO

Objective: This study evaluated the clinical efficacy of arthrocentesis when varying the irrigation volume in patients with disc displacement without reduction (DDWOR). Methods: Thirty DDWOR patients were equally divided into two groups: G1 (50 mL) and G2 (200 mL). Information was compared for pain, the maximum interincisal distance (MID), protrusion, and right and left laterality. Results: Arthrocentesis was able to reduce the pain and increase the MID, protrusion, and both laterality values significantly one year after the procedure (p < 0.001) in both groups. However, comparisons between the groups revealed no significant difference (p > 0.05). Furthermore, changes in volume did not affect the arthrocentesis results (p = 0.626, odds ratio = 1.625; 95% confidence interval = 0.230-11.461). Conclusion: Arthrocentesis techniques using 50- and 200-mL irrigation volumes were both effective, with no significant differences between techniques observed after one year of follow-up.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Artrocentese , Seguimentos , Humanos , Medição da Dor , Amplitude de Movimento Articular , Resultado do Tratamento
9.
J Craniomaxillofac Surg ; 48(1): 9-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31870713

RESUMO

PURPOSE: Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. MATERIAL AND METHODS: An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. RESULTS: Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. CONCLUSION: The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.


Assuntos
Transtornos da Articulação Temporomandibular/terapia , Artrocentese , Humanos , Injeções Intra-Articulares , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
J Craniomaxillofac Surg ; 47(11): 1728-1738, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31601466

RESUMO

OBJECTIVE: to assess the reliability of bone marrow nucleated cell (BMNc) intra-articular injection in patients with degenerative temporomandibular joint disorders (TMDs), and to compare its efficacy with that of hyaluronic acid (HA). MATERIALS AND METHODS: this study was designed as a randomized, controlled trial of parallel groups. Patients affected by degenerative joint mandibular disorders were enrolled in this prospective clinical trial and randomly divided into two groups. The HA group underwent temporomandibular joint (TMJ) arthrocentesis and HA injection, whilst patients in the BMNc group were inoculated with BMNc inside the joint after lavage. Outcome measures were: assessing pain at rest and during motion, joint noises, chewing efficiency, and maximum interincisal opening. A postoperative MRI scan was performed and compared with the preoperative one, while examining for cartilage regeneration. Clinical and radiological data were collected from baseline to 12 months follow-up. RESULTS: Thirty patients, 15 for each group, complaining of different degrees of unilateral TMD with internal derangement, were enrolled and treated. In both groups, significant clinical improvements were detected after the procedure up to 1 year postoperatively. The BMNc group presented significantly better pain relief than the HA group after 6 months (p = 0.028) and 12 months (p = 0.000). No significant differences were observed in terms of joint noises. In terms of chewing efficiency, the BMNc group showed positive significant differences after 12 months (p = 0.000). Maximum interincisal opening presented significantly better values in the BMNc group after 6 months (p = 0.001) and 12 months (p = 0.000). No MRI evidence of cartilage regeneration was reported. CONCLUSION: intra-articular TMJ BMNc injection improved clinical outcomes in TMD treatment. The Results of this first human-model study are promising but further studies are needed to determine whether BMNc can represent the best treatment for TMDs.


Assuntos
Artrocentese , Autoenxertos , Medula Óssea , Ácido Hialurônico/administração & dosagem , Transtornos da Articulação Temporomandibular/terapia , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Medição da Dor , Estudos Prospectivos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Articulação Temporomandibular , Resultado do Tratamento
12.
Dent Med Probl ; 56(3): 265-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577070

RESUMO

BACKGROUND: Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. OBJECTIVES: The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. MATERIAL AND METHODS: A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. RESULTS: The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. CONCLUSIONS: Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.


Assuntos
Artrocentese , Ácido Hialurônico , Plasma Rico em Plaquetas , Transtornos da Articulação Temporomandibular , Adulto , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
13.
J Craniomaxillofac Surg ; 47(11): 1720-1727, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31451342

RESUMO

The aim of the study was to compare the effectiveness of hyaluronic acid (HA) injection and arthrocentesis plus HA injection for treating disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR). In this randomized clinical trial, patients were divided into 2 main groups: group I (DDwR) and group II (DDwoR). Sub-groups were made depending on allocated treatment: group Ia (arthrocentesis plus HA), group Ib (single HA), group Ic (control), group IIa (arthrocentesis plus HA), group IIb (single HA), and group IIc (control). The primary outcome variable was maximum pain on chewing, while maximum pain at rest, maximum non-assisted and assisted mouth opening, chewing efficiency, temporomandibular joint (TMJ) sounds, quality of life, treatment tolerability, and treatment effectiveness were secondary outcomes. The influences of individual study variables (gender, involved side, and duration of symptoms) on clinical outcomes were also examined. The study consisted of 116 TMJs of 90 patients (n = 45 in both main groups, TMJs = 58) aged 15-82 years. At the 6-month follow-up, improvement in all parameters, except for TMJ sounds, was recorded in all treatment groups, with no improvements in control groups. Notably, arthrocentesis plus HA showed superior improvement in chewing efficiency (p = 0.041) and quality of life (p = 0.047) of group I and quality of life (p = 0.004) in group II, compared to single HA. Furthermore, the duration of symptoms correlated with clinical outcomes. Both procedures successfully improved the symptoms of DDwR and DDwoR patients, but arthrocentesis plus HA injection seemed superior.


Assuntos
Artrocentese , Ácido Hialurônico/uso terapêutico , Transtornos da Articulação Temporomandibular/terapia , Viscossuplementos/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Humanos , Injeções Intra-Articulares , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Amplitude de Movimento Articular , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento , Adulto Jovem
14.
Pol J Vet Sci ; 22(2): 321-326, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31269338

RESUMO

INTRODUCTION: Arthrocentesis has been used in the temporomandibular joint (TMJ) to analyze components of the synovial fluid or as a therapeutic procedure associated or not with the administration of a drug. The rabbit is one of the most commonly used animal species as a model for pathologies that affect the TMJ. The aim of this study was to propose a specific technique to perform arthrocentesis on the rabbit TMJ, emphasizing descriptions of reference points and measurements for a successful puncture without complications. MATERIALS AND METHODS: Fourteen adult rabbits (Oryctolagus cuniculus) were used. The project was approved by the Scientific Ethics Committee of the Universidad de La Frontera (File Nº083/2016). RESULTS: The description of the technique was divided into three steps: 1) Location of the rabbit TMJ, 2) Positioning of the needles in the TMJ, and 3) Passage of fluid through the TMJ. CONCLUSIONS: This arthrocentesis technique could help to simplify the procedure and give the investigator a guide for joint washing and extraction of synovial fluid in the rabbit TMJ.


Assuntos
Artrocentese/veterinária , Coelhos , Animais , Artrocentese/métodos , Masculino
15.
Oral Maxillofac Surg ; 23(4): 415-421, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31264124

RESUMO

BACKGROUND: Temporomandibular dysfunction is a generic term that covers a large number of clinical problems affecting not only temporomandibular joint but also the masticatory musculature and related structures. Arthrocentesis is used in patients with joint pathology in which conservative treatment has failed. METHODS: A prospective, observational, analytical cohort study has been carried out to evaluate the results of 111 arthrocentesis. We have performed an inferential statistics study between the variables: improvement of pain and improvement in the oral opening with the variables and access joint, washing joint, hyaluronic acid infiltration, and type of joint pathology. RESULTS: Joint washing and intra-articular hyaluronic acid injection significantly improved the pain at 1-week, 1-month, and 3-month postarthrocentesis, although this improvement was limited in time, at 6 months, joint washing and hyaluronic acid infiltration are no longer significant. Only the joint access (p = 0.014) and the type of joint pathology (p = 0.028) are significant. CONCLUSIONS: The effectiveness of joint access in the arthrocentesis at 6 months is high, although less than at 1-month and 3-month postarthrocentesis. The type of joint pathology is another important factor. Patients with degenerative pathology worsen the most after 6-month postarthrocentesis. Arthrocentesis could avoid the evolution of acute pathology.


Assuntos
Artrocentese , Ácido Hialurônico , Estudos de Coortes , Humanos , Estudos Prospectivos , Amplitude de Movimento Articular , Articulação Temporomandibular , Resultado do Tratamento
16.
Scand J Rheumatol ; 48(5): 393-397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31146626

RESUMO

Objective: The aim of this study was to evaluate the risk of septic arthritis (SA) in patients who received an intra-articular (IA) glucocorticoid (GC) injection and to describe the characteristics of these patients. Methods: All patients undergoing IA procedures at the orthopaedic and rheumatological departments on the Danish island of Funen from January 2006 to December 2013 were identified in the central database and included by register extraction. Patients who developed a clinically inflamed joint and positive synovial fluid culture within 14 days after IA GC injection were considered as having SA. Retrospectively, data on age, gender, affected joint location, bacterial agent, pre-existing inflammatory disorder, and death within 30 days were extracted from the patient files. According to local recommendations, a non-touch sterile technique was used for IA procedures. Patients were informed about the risk of SA and advised to seek medical attention on suspicion of infection or lack of improvement. Results: In total, 22 370 IA procedures were performed. Among these, 14 118 GC injections and 8252 arthrocenteses were undertaken. Only 11 patients were diagnosed with SA (0.08%, 95% confidence interval 0.03-0.12). Risk factors for SA were male gender, age, and pre-existing joint disease. Conclusion: We found a low frequency of SA subsequent to IA GC injections. Older patients with pre-existing joint disease are at higher risk of developing SA.


Assuntos
Artrite Infecciosa/epidemiologia , Artrocentese/efeitos adversos , Glucocorticoides/efeitos adversos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Artrite Reumatoide/terapia , Dinamarca/epidemiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares/efeitos adversos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
17.
J Oral Rehabil ; 46(8): 699-703, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31044441

RESUMO

BACKGROUND: Temporomandibular disorder (TMD) is a group of disease which affects the temporomandibular joint (TMJ) and supporting tissues of the musculoskeletal structures. Arthrocentesis is an effective treatment modality for TMD, especially in patients who suffer from pain and limited mouth opening. OBJECTIVE: The aim of this study was to investigate the effects of pre-operative and intra-operative variables on the clinical outcome of arthrocentesis therapy. METHODS: The records of 83 patients diagnosed as disc displacement (DD) without reduction according to DC/TMD, and treated with arthrocentesis were selected. Sex, age, bruxism history, pain intensity and maximum mouth opening (MMO) were recorded as pre-operative variables. Extravasation and the amount of irrigation were recorded as intra-operative variables. The success of the arthrocentesis procedure was determined as MMO <35 mm and pain intensity lower than 3, at third-month follow-up. RESULTS: At 3-month follow-up, clinical evaluation showed a significant reduction in TMJ pain and an increase in MMO (P < 0.05). It was found that patients with an unsuccessful outcome are those who had a more restricted MMO and severe pain before the procedure. Extravasation was found to be a significant factor that affects the success of the procedure. CONCLUSION: The success of arthrocentesis in TMJ DD without reduction is adversely affected by the severity of the pre-operative clinical symptoms. Extravasation is also a factor that has a negative effect on the success of the procedure.


Assuntos
Artrocentese , Transtornos da Articulação Temporomandibular , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação Temporomandibular , Resultado do Tratamento
19.
Blood Coagul Fibrinolysis ; 30(3): 111-119, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30958454

RESUMO

: Arthrocentesis of an acute hemarthrosis in hemophilia remains a controversial issue. The purpose of this study is to define the role that joint aspiration can play in the recovery from acute hemarthrosis in patients with hemophilia. The study sample included 33 hemophilic patients (55 joints) with acute elbow, knee, and ankle hemarthrosis as confirmed by ultrasonography. Patients were distributed into a treatment group and a control group. Patients in the first group were subjected to joint aspiration, whereas patients in the second were not. Arthrocentesis was carried out immediately after diagnosis of acute hemarthrosis in liquid phase. Patients were infused with the deficient coagulation factor and were instructed to observe relative rest until resolution of hemarthrosis. The following parameters were analyzed: time to full resolution of hemarthrosis (determined by ultrasonography), duration of treatment with the deficient coagulation factor, time to pain relief, time to recovery of prebleed range of motion, and time to resumption of school/work (all of these measured in days). The joints treated with joint aspiration exhibited a significantly faster resolution of bleeding (fewer days). In addition, this group required fewer days of pharmacological treatment, with faster achievement of functional recovery and resumption of school/work activities. No complications were observed. This study shows that joint aspiration under hemostatic cover and in strictly aseptic conditions is a well-tolerated technique that makes the recovery of acute hemarthrosis of hemophilic patients faster.


Assuntos
Artrocentese/métodos , Hemartrose/terapia , Hemofilia A/complicações , Articulações/patologia , Doença Aguda , Adulto , Articulação do Tornozelo , Articulação do Cotovelo , Feminino , Hemartrose/cirurgia , Humanos , Articulação do Joelho , Masculino , Fatores de Tempo , Resultado do Tratamento
20.
Clin Rheumatol ; 38(8): 2255-2263, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30953230

RESUMO

INTRODUCTION/OBJECTIVES: We hypothesized that mechanical compression of the knee in rheumatoid arthritis (RA) would mobilize occult extractable fluid and improve arthrocentesis success. METHODS: Sixty-seven consecutive knees with RA and 186 knees with OA and were included. Conventional arthrocentesis was performed and success and volume (milliliters) determined; the needle was left intraarticularly, and mechanical compression was applied with an elastomeric knee brace. Arthrocentesis was then resumed until fluid return ceased. Fluid was characterized as to volume and cell counts. RESULTS: In the RA, knee mechanical compression decreased failed diagnostic arthrocentesis from 56.7% (38/67) to 26.9% (18/67) (- 47.4%, p = 0.003) and increased absolute arthrocentesis yield from 4.7 ± 10.3 ml to 9.8 ± 9.8 ml (108% increase, 95% CI - 8.5 < - 5.1 < - 1.7 p = 0.0038). Total extractable fluid yield was 96% greater in RA (9.8 ± 9.8 ml) than OA (5.0 ± 9.4 ml, p = 0.0008), and occult extractable fluid was 77% greater in RA than OA (RA 5.3 ± 8.7 ml, OA 3.0 ± 5.5 ml, p = 0.046). Large effusions versus small effusions in RA demonstrated increased neutrophils in synovial fluid (p = 0.04) but no difference in radiologic arthritis grade (p = 0.87). In contrast, large effusions versus small effusions in OA demonstrated no difference in neutrophils in synovial fluid (p = 0.87) but significant different radiologic arthritis grade (p = 0.04). CONCLUSION: Mechanical compression improves the success of diagnostic and therapeutic knee arthrocentesis in both RA and OA. Large effusions in RA are associated with increased neutrophil counts but not arthritis grade; in contrast, large effusions in OA are associated with more severe arthritis grades but not increased neutrophil counts. Key points• Mechanical compression of the painful knee improves arthrocentesis success and fluid yield in both rheumatoid arthritis and osteoarthritis.• The painful rheumatoid knee contains approximately 100% more fluid than the osteoarthritic knee.• Large effusions in the osteoarthritic knee are characterized by higher grades of mechanical destruction but not increased neutrophil counts.• In contrast, large effusions in the rheumatoid knee are characterized by higher synovial fluid neutrophil counts but not the grade of mechanical destruction, indicating different mechanisms of effusion formation in rheumatoid arthritis versus osteoarthritis.


Assuntos
Artrite Reumatoide/terapia , Braquetes , Inflamação/terapia , Osteoartrite do Joelho/terapia , Líquido Sinovial , Idoso , Artrocentese , Feminino , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Estresse Mecânico
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