[Dietary inflammatory index related to knee osteoarthritis symptomatology]. / Índice inflamatorio dietético relacionado con la sintomatología de osteoartritis de rodilla.

Background: Proinflammatory diet contributes to greater symptomatology in patients with knee osteoarthritis (KOA); however, in Mexico there seems to be no evidence of the dietary inflammatory role, being a country with high prevalence of overweight and obesity with an inclination towards a Western diet. Objective: To analyze the relationship between dietary inflammatory index (DII) and KOA symptomatology in Mexican patients. Material and methods: Analytical cross-sectional study in 100 patients aged 40 to 70 years. Pain, stiffness, and functionality were evaluated with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the DII was calculated from the semi-quantitative food consumption frequency questionnaire (QFCFQ). For its analysis, linear regression was calculated. Results: DII was significantly associated with pain (p = 0.001, R² = 0.118), functionality (p = 0.003, R² = 0.087) and WOMAC score (p = 0.001, R² = 0.099). In the second linear regression model with the dependent variable functionality, waist circumference (WC) was adjusted obtaining an R² = 0.144 and higher significance p = 0.001. Conclusions: Proinflammatory DII was related to greater pain, lower functionality and a high WOMAC score, which is why the anti-inflammatory diet could be considered as a support for the treatment of the patient with KOA.

Introducción: la dieta proinflamatoria contribuye a una mayor sintomatología en pacientes con osteoartritis de rodilla (OAR); sin embargo, en México parece no existir evidencia del papel inflamatorio dietético, pues es un país con alta prevalencia de sobrepeso y obesidad con inclinación hacia una dieta occidental. Objetivo: analizar la relación del índice inflamatorio dietético (IID) con la sintomatología de OAR en pacientes mexicanos. Material y métodos: estudio transversal, analítico en 100 pacientes de 40 a 70 años. Se evaluó el dolor, la rigidez y la funcionalidad con el Western Ontario and McMaster Universities Arthritis Index (WOMAC) y el IID se calculó a partir del cuestionario semicuantitativo de frecuencia de consumo de alimentos (CSFC). Para su análisis, se calculó regresión lineal. Resultados: el IID se asoció significativamente con dolor (p = 0.001, R² = 0.118), funcionalidad (p = 0.003, R² = 0.087) y puntaje del WOMAC (p = 0.001, R² = 0.099). En el segundo modelo de regresión lineal con la variable dependiente funcionalidad, se ajustó la circunferencia de cintura (CC) y se obtuvo una R² = 0.144 y una mayor significación: p = 0.001. Conclusiones: el IID proinflamatorio se relacionó con un mayor dolor, una menor funcionalidad y un puntaje alto del WOMAC, por lo cual la dieta antiinflamatoria podría considerarse como un apoyo para el tratamiento del paciente con OAR.

Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort.

BACKGROUND/OBJECTIVE: Knee pain is an important health problem due to its high prevalence, negative impact on daily activities and quality of life, and societal burden. While the link between excess weight and knee pain has been well-documented in the literature, many studies are limited to patients with osteoarthritis or use cross-sectional data. This longitudinal study investigated whether overweight and obesity were associated with the frequency and severity of frequent knee pain (FKP) episodes over 4 years in civil servants enrolled in the ELSA-Brasil MSK cohort. METHODS: Knee pain was assessed during baseline face-to-face interviews (2012-2014) and four yearly telephone follow-ups (2015-2019). Disabling FKP episodes or those of moderate to very severe intensity were classified as severe. Multinomial logistic regression models adjusted for confounders were used to test for associations in two participant groups: those with knee pain at baseline (prognosis cohort) and those without knee pain (incidence cohort). RESULTS: A total of 2644 participants were included: 54.2% female, mean age 55.8 (SD 8.8) years. In the incidence cohort (n = 1896), obesity increased the risk of one (OR: 1.63; 95% CI 1.13-2.37) and multiple FKP episodes (OR: 2.61; 95% CI 1.71-3.97), as well as the risk of non-severe (OR: 1.72; 95% CI 1.04-2.84) and severe FKP episodes (OR: 2.10; 95% CI 1.50-2.95). In the prognosis cohort (n = 748), obesity increased the risk of multiple (OR: 2.54; 95% CI 1.60-4.05) and severe FKP episodes (OR: 2.31; 95% CI 1.49-3.59). Overweight presented the same trends but fell short of significance. CONCLUSIONS: These results provide further support that overweight and obesity are important contributors to the incidence and worsening of FKP, and that weight management must be prioritized in multidisciplinary knee pain prevention and treatment programs to reduce the burden of musculoskeletal disorders.

No Difference in Perioperative Complications for Bilateral Total Knee Arthroplasty Staged at 1 Week Compared With Delayed Staging.

INTRODUCTION: Controversy exists regarding the safety of simultaneous bilateral total knee arthroplasty (TKA) versus two TKA procedures staged months apart in patients with bilateral knee arthritis. Here, we investigated a third option: bilateral TKA staged 1 week apart. In this study, we examined the rate of complications in patients undergoing bilateral TKA staged at 1 week compared with longer time intervals. METHODS: A retrospective review of 351 consecutive patients undergoing bilateral TKA at our institution was conducted. Patients underwent a 1-week staged bilateral procedure with planned interim transfer to a subacute rehabilitation facility (short-staged) or two separate unilateral TKA procedures within 1 year (long-staged). Binary logistic regression was used to compare outcomes while controlling for year of surgery, patient age, body mass index, and Charlson Comorbidity Index. RESULTS: Two hundred four short-staged and 147 long-staged bilateral TKA patients were included. The average interval between procedures in long-staged patients was 200.9 ± 95.9 days. Patients undergoing short-staged TKA had a higher Charlson Comorbidity Index (3.0 ± 1.5 versus 2.6 ± 1.5, P = 0.017) with no difference in preoperative hemoglobin ( P = 0.285) or body mass index ( P = 0.486). Regression analysis demonstrated that short-staged patients had a higher likelihood of requiring a blood transfusion (odds ratio 4.015, P = 0.005) but were less likely to return to the emergency department within 90 days (odds ratio 0.247, P = 0.001). No difference was observed in short-term complications ( P = 0.100), 90-day readmissions ( P = 0.250), or 1-year complications ( P = 0.418) between the groups. CONCLUSION: Bilateral TKA staged at a 1-week interval is safe with a comparable complication rate with delayed staged TKA, but allows for a faster total recovery time. LEVEL OF EVIDENCE: Level III.

[Risk factors for the development of osteoarthritis in middle-aged women]. / Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas.

BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. AIM: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.

[Maximum isometric force of the quadriceps and hamstrings and functionality after total knee arthroplasty]. / Fuerza isométrica máxima de cuádriceps e isquiotibiales y funcionalidad luego de la artroplastia total de rodilla.

Gonarthrosis is a highly prevalent disease in older adults. The objective of this research was to identify changes in quadriceps muscle strength and their impact on the functionality of total knee replacement (TKA) operated patients undergoing kinesitherapy at Hospital El Carmen de Maipú (HEC). All TKA operated patients were measured, pre and post intervention, maximum isometric strength (MIF), Time Up and Go, Standing and sitting test, Unipodal support and the WOMAC scale. The operated and contralateral MIF is higher in flexion and extension when comparing both genders (p < 0.0001; p < 0.0001, respectively). In the up and go and the standing and sitting test, performance was significantly higher for males than for females (p = 0.001; p = 0.007, respectively). In the WOMAC, there were significant differences before and after the intervention in men and women (p < 0.0001; p < 0.0001, respectively). Patients with a body mass index (BMI) > 30 kg/m2 are 3 times less likely [OR = -3.498; CI (0.062-1.067)] to receive treatment in a period of less than 50 days. On the other hand, injuries to the non-dominant (left) knee have a 4 times greater chance of stay in treatment in less than 50 days [(OR = 2.71; CI (1.000-16.252)]. There was an increase in MIF of the knee treated post-intervention, in both genders. Functionality increased in men and women, after the intervention.

La gonartrosis es una enfermedad de alta prevalencia en adultos mayores. El objetivo de esta investigación fue identificar los cambios en la fuerza muscular del cuádriceps y su efecto en la funcionalidad de los pacientes operados de artroplastia total de rodilla (ATR) sometidos a kinesiterapia en el Hospital El Carmen de Maipú (HEC). A todos los operados de ATR se les midió, pre y post intervención, fuerza isométrica máxima (FIM), Time Up and Go, test de pararse y sentarse, apoyo unipodal y la escala WOMAC. La FIM de la rodilla operada y la no operada, es mayor en flexión y extensión al comparar ambos géneros (p < 0.0001; p < 0.0001, respectivamente). En el up and go y la prueba pararse y sentarse el rendimiento fue significativamente superior para el género masculino en relación al femenino (p = 0.001; p = 0.007, respectivamente). En el WOMAC, existieron diferencias significativas pre y post intervención en hombres y mujeres (p < 0.0001; p < 0.0001, respectivamente). Los pacientes con un índice de masa corporal (IMC) > 30 kg/m2 tienen 3 veces menos posibilidades [OR = -3.498; IC (0.062-1.067)] de permanecer en tratamiento en un plazo menor a 50 días. Por otra parte, las lesiones en la rodilla no dominante (izquierda) tiene 4 veces más posibilidades de tratamiento inferior a 50 días [(OR = 2.71; IC (1.000-16.252)]. Existió un aumento de la FIM de la rodilla tratada post intervención, en ambos géneros. La funcionalidad aumentó en hombres y mujeres, posterior a la intervención.

Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Causes of knee pain evaluated by arthroscopy after knee arthroplasty: a case series.

BACKGROUND: The origin of persistent pain and joint limitation after knee arthroplasty are controversial and difficult to diagnose. Knee arthroscopy is indicated when the results of routine evaluation tests are not clear. The purpose of this study was to determine through arthroscopy the cause of post-knee-arthroplasty pain symptoms in patients without a prior diagnosis of cause of pain. METHODS: This prospective case series study described the outcomes of 34 patients (35 knees) with pain and limited function in the arthroplastic joint, who underwent diagnostic and therapeutic arthroscopy. Patients were clinically evaluated using range-of-motion tests and the Lysholm, Hospital for Special Surgery (HSS) and Knee Society Score (KSS) scales. RESULTS: The procedure found cyclops in 17 knees, synovitis in 9 knees, arthrofibrosis in 6 knees, polyethylene wear with debris in two knees, and polyethylene bouncing in one knee with unicompartmental arthroplasty with a mobile polyethylene platform. It was effective for the relief of pain symptoms, with excellent or good outcomes in 80% of cases; there was a poor outcome in 11.43%, which maintained the presentation of pain and underwent revision arthroplasty, and, in 8.57%, did not undergo another surgery despite symptom persistence. CONCLUSIONS: Post-arthroplasty knee arthroscopy seems beneficial in patients with pain and without a pre-established diagnosis and who had already undergone conservative treatment unsuccessfully.

Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas / Risk factors for the development of osteoarthritis in middle-aged women

BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. Aim: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction.

The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

Inhibition of diabetes mellitus-induced knee joint injury in rats by a combination of metformin and captopril / Inhibición de la lesión de la articulación de la rodilla inducida por diabetes mellitus en ratas mediante una combinación de metformina y captopril

SUMMARY: Osteoarthritis (OA) is an inflammatory disease that damages the joints and affects millions of people worldwide. The potential inhibitory effects of the antidiabetic drug metformin combined with captopril, the angiotensin-converting enzyme inhibitor, on diabetes-induced damage to the knee joint articular cartilage associated with the inhibition of glycemia, dyslipidemia, and inflammation has not been investigated before. Therefore, we induced diabetes in rats using high carbohydrate and fat diets and a single injection of streptozotocin (50 mg/kg). The protective group of rats was pre-treated with combined daily doses of metformin (Met; 200 mg/kg body weight) and captopril (Cap; 150 mg/kg body weight) for 14 days before diabetic induction and continued on metformin and resveratrol until the end of the experiment at week 12. Harvested tissues obtained from knee joints were prepared for basic histology staining with haematoxylin and eosin (H&E) and examined under light microscopy. Representative H&E images showed that OA was developed in the diabetic rats as demonstrated by a profound damage to the knee joints such as irregular eroded and a sharp decrease in the thickness of the articular cartilage surface and abnormal remodeling of the subchondral bone that were substantially ameliorated by Met+Cap. Met+Cap also significantly (p< 0.05) reduced blood levels of glucose, glycated hemoglobin (HbA1c), dyslipidemia, and the inflammatory biomarkers, high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) induced by diabetes. In addition, a significant (p≤ 0.0014) correlation between the articular cartilage thickness and the blood levels of glucose, HbA1c, triglyceride (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein- cholesterol (HDL-C), and hs-CRP were observed. Thus, we demonstrate that Met+Cap effectively protect the knee joint against injuries induced secondary to diabetes in rats, possibly due to the inhibition of glycemia, dyslipidemia, and biomarkers of inflammation.

RESUMEN: La osteoartritis (OA) es una enfermedad inflamatoria que daña las articulaciones y afecta a millones de per- sonas en todo el mundo. No se han investigado los posibles efectos inhibidores del fármaco antidiabético metformina combinado con captopril, el inhibidor de la enzima convertidora de angiotensina, sobre el daño inducido por la diabetes en el cartílago articular de la articulación de la rodilla asociado con la inhibición de la glucemia, dislipidemia e inflamación. En este estudio fue inducida la diabetes en ratas con dietas altas en carbohidratos y grasas y una sola inyección de estreptozotocina (50 mg / kg). El grupo protector de ratas se pretrató con dosis diarias combinadas de metformina (Met; 200 mg / kg de peso corporal) y captopril (Cap; 150 mg / kg de peso corporal) durante 14 días antes de la inducción diabética. El tratamiento se continuó con metformina y resveratrol hasta el final del experimento en la semana 12. Los tejidos obtenidos de las articulaciones de la rodilla se prepararon para la tinción de histología básica con hematoxilina y eosina (H&E) y se examinaron con microscopía óptica. Imágenes representativas de H&E mostraron que la OA se desarrolló en las ratas diabéticas, como lo evidencia un daño profundo en las articulaciones de la rodilla, como la erosión irregular y una fuerte disminución en el grosor de la superficie del cartílago articular y remodelación anor- mal del hueso subcondral que fueron mejorados sustancialmente por Met + Cap. Met + Cap. También redujo significativamente (p <0.05) los niveles sanguíneos de glucosa, hemoglobina glicosilada (HbA1c), dislipidemia y los biomarcadores inflamatorios, proteína C reactiva de alta sensibilidad (hs-CRP), interleucina-6 (IL-6), y factor de necrosis tumoral alfa (TNF-α) inducido por diabetes. Además, una correlación significativa (p≤ 0,0014) entre el grosor del cartílago articular y los niveles sanguíneos de glucosa, HbA1c, triglicéridos (TG), lipoproteínas-colesterol de baja densidad (LDL- C), lipoproteínas de alta densidad-colesterol (HDL-C) ) y hs-CRP. Así, demostramos que Met + Cap protege eficazmente la articulación de la rodilla contra lesiones inducidas por diabetes en ratas, posiblemente debido a la inhibición de la glicemia, dislipidemia y biomarcadores de inflamación.

Thirty days after anterior cruciate ligament transection is sufficient to induce signs of knee osteoarthritis in rats: pain, functional impairment, and synovial inflammation.

OBJECTIVE: To compare the unilateral signs of knee osteoarthritis (KOA) 30 and 60 days after anterior cruciate ligament transection (ACLT). Pain, gait function, synovial fluid inflammation, and histopathological changes in the synovial membrane were analyzed, as well as the interaction between the variables. MATERIALS AND METHODS: Male Wistar rats (n = 32; 219.2 ± 18.6 g) were randomly distributed into four groups of eight animals each. Two groups were submitted to unilateral ACLT surgery to induce KOA and analyzed after 30 (KOA30) and 60 days (KOA60). Two control groups (without surgery) were also assessed after the same time periods (C30 and C60). All the groups were evaluated before ACLT from the least to most stressful tests (skin temperature, mechanical response threshold, gait test, thermal response threshold, and joint swelling), as well as 30 and 60 days after surgery. After euthanasia, the synovial fluid and synovial membrane were collected. RESULTS: Thirty days after ACLT, KOA30 showed decrease paw print area and mechanical response threshold, higher joint swelling, skin temperature, leukocyte count, cytokine levels, and synovitis score. No differences were found between KOA30 and KOA60. CONCLUSION: Our data showed that 30 days after ACLT is sufficient to induce signs of KOA in rats, such as pain, functional impairment, and synovial inflammation, suggesting that a shorter time period can be used as an experimental model.

Therapeutic Use of Scoparia dulcis Reduces the Progression of Experimental Osteoarthritis.

Pain is recognized as one of the main symptoms in knee osteoarthritis and is the main reason why patients seek medical attention. Scoparia dulcis has been popularly used to relieve discomfort caused by various painful conditions. The objective of the study is to evaluate the analgesic and anti-inflammatory effect of the crude extract of S. dulcis, in an experimental model of osteoarthritis. The experiment was performed with Wistar rats divided into 4 groups with 5 animals each: healthy, saline, crude extract, and meloxicam groups. Knee osteoarthritis was induced by intra-articular injection of sodium mono-iodoacetate. First, clinical parameters of pain were assessed at days 0, 5, 10, 15, and 20 after induction. Second, the potential cyclooxygenase inhibition was evaluated, and the cytokines of the synovial fluid were quantified. An in silico test and Molecular Docking tests were performed. A histopathological evaluation was made on articular cartilage with safranin O staining. The results showed that a 15-day treatment with crude extract reduced edema, spontaneous pain, peripheral nociceptive activity, and proinflammatory cytokines in the synovial fluid. The highest inhibition of cyclooxygenase 2 in the crude extract occurred at 50 µg/mL. The crude extract of S. dulcis presents therapeutic potential for the treatment of osteoarthritis due to its anti-inflammatory and anti-nociceptive action.

Knee osteoarthritis risk in non-industrial societies undergoing an energy balance transition: evidence from the indigenous Tarahumara of Mexico.

Non-industrial societies with low energy balance levels are expected to be less vulnerable than industrial societies to diseases associated with obesity including knee osteoarthritis. However, as non-industrial societies undergo rapid lifestyle changes that promote positive energy balance, individuals whose metabolisms are adapted to energetic scarcity are encountering greater energy abundance, increasing their propensity to accumulate abdominal adipose tissue and thus potentially their sensitivity to obesity-related diseases. OBJECTIVES: Here, we propose that knee osteoarthritis is one such disease for which susceptibility is amplified by this energy balance transition. METHODS: Support for our hypothesis comes from comparisons of knee radiographs, knee pain and anthropometry among men aged ≥40 years in two populations: Tarahumara subsistence farmers in Mexico undergoing the energy balance transition and urban Americans from Framingham, Massachusetts. RESULTS: We show that despite having markedly lower obesity levels than the Americans, the Tarahumara appear predisposed to accrue greater abdominal adiposity (ie, larger abdomens) for a given body weight, and are more vulnerable to radiographic and symptomatic knee osteoarthritis at lower levels of body mass index. Also, proportionate increases in abdomen size in the two groups are associated with greater increases in radiographic knee osteoarthritis risk among the Tarahumara than the Americans, implying that the abdominal adipose tissue of the Tarahumara is a more potent stimulus for knee degeneration. CONCLUSIONS: Heightened vulnerability to knee osteoarthritis among non-industrial societies experiencing rapid lifestyle changes is a concern that warrants further investigation since such groups represent a large but understudied fraction of the global population.

El índice de masa corporal como fenotipo en el perfil clínico y funcional en mujeres con osteoartritis de rodilla / Association between the functional impact of osteoarthritis and body mass index in women

Background: Obesity is associated with pain, reduction of function and quality of life in patients with osteoarthritis (OA). Aim: To describe the clinical profile of women with knee OA according to their body mass index (BMI). Material and Methods: Observational study in 308 women with knee OA. According to their BMI, they were classified as normal-weight, overweight and obese. The primary outcome measure was functionality evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI) and quality of life assessed with the European Quality of Life Five Dimension (EuroQol-5D). Results: WOMAC, PSQI and EuroQol-5D scores were significantly higher in obese women. Conclusions: Overweight and obese women with OA have more sleep disorders, reduction on functionality and quality of life compared to their normal weight counterparts.

PREVALENCE OF JOINT PAIN AND OSTEOARTHRITIS IN OBESE BRAZILIAN POPULATION.

BACKGROUND: High body mass index, as well as maintaining this condition for a long period of time, are important risk factors for the development of osteoarthritis. AIM: To determine joint pain and osteoarthritis prevalence in patients referred to bariatric surgery. METHODS: Morbidly obese patients referred to bariatric surgery responded to the visual analogue pain scale (VAS) and the WOMAC questionnaire. X-rays of the hips and knees were evaluated. The primary endpoints were self-reported joint pain and the diagnosis of osteoarthritis by clinical and radiological criteria of the American College of Rheumatology. RESULTS: 141 patients were interviewed (85.1% women) with a mean age of 40 years. The mean body mass index was 46. The lumbar spine and knee joint were the most commonly reported as painful (77.9% and 73.2% respectively). Prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8%. Age, mean VAS and WOMAC scores were higher in the osteoarthritic individuals. CONCLUSION: There is prevalence of 90.1% of pain symptoms in morbidly obese patients referred to bariatric surgery. The prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8% in this sample.

Ostectomía del peroné en el genu varo doloroso de rodilla. Resultados preliminares al año de operado / Fibula ostectomy in painful genu varum of the knee. Preliminary results after a year of the surgery

Introducción: la artrosis de rodilla puede llegar a ser una patología muy invalidante por sus síntomas, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa que ha aumentado su prevalencia en las últimas décadas, muy ligada al envejecimiento poblacional. Objetivo: validar la técnica de la ostectomía del peroné en el genu varo doloroso como nueva opción de tratamiento. Materiales y Métodos: se realizó un estudio, prospectivo y lineal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, desde abril del 2016 hasta agosto del 2017. Se aplicó la nueva técnica del Dr. Ying-Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China. En la actualidad ya existe una casuística de 75 pacientes, con 84 rodillas operadas de los cuales se presentan los resultados de los primeros 11 pacientes, posterior al año de operado. Resultados: el promedio de edad fue de 64,3 años, (45 años el menor y 84 años el mayor); de los cuales 8 eran hombres y 3 mujeres. Se aplicó la escala visual analógica para el dolor pre y post-operatorio en cuanto a la marcha y al subir escalones; estando todos los pacientes al caminar, por encima de 6 y al subir escaleras por encima de 7. Después de un año de operados 10 pacientes se encontraban evaluados al caminar entre 0 y 3 puntos, y al subir escalones 9 en igual puntuación; 1 en 5, y solamente 1 paciente mantuvo igual puntuación antes de operarse. Valorando estas puntuaciones se evaluaron 9 pacientes de bien, 2 de regular, y se presentaron 3 complicaciones. Conclusiones: al año de seguimiento ocurre gran mejoría del dolor, mejorando la seguridad del paciente durante la marcha (AU).

Introduction: the fibular osteoarthritis could be a very invalidating disease due to its symptoms, characterized by pain, insecurity and functional loss. It is a degenerative disease whose prevalence has increased during the last decades, tightly linked to population ageing. Objective: to validate the technique of fibular ostectomy in the painful genu varum as a new treatment option. Materials and Methods: a prospective, lineal study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy", of Matanzas, from April 2016 to August 2017. It was used the new technique of Dr. Ying-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of Hebei Medical University in Shijiazhuang, China. Currently there is a series of cases of 75 patients, with 84 operated knees; the results of the first 11 operated patients, are presented here after a year of the surgery. Results: the average age was 64.3 years, 45 years the youngest and 84 years the eldest; from them, 8 were men and 3 women. The analogical visual scale for the pre and post-surgical pain was applied during the gait and when going upstairs. During the gait all the patients were above 6, and when climbing upstairs above 7. After a year from the operation 10 patients got an evaluation between 0 and 3 points during the gait, and 9 got the same score when climbing steps; one got 5, and only 1 patient kept the same score than before the operation. Taking into account these scores, 9 patients were evaluated as good, 2 regular, and there were 3 complications. Conclusions: after a one-year follow-up, the pain greatly improves, improving patients' security during the gait (AU).

[Association between the functional impact of osteoarthritis and body mass index in women]. / El índice de masa corporal como fenotipo en el perfil clínico y funcional en mujeres con osteoartritis de rodilla.

BACKGROUND: Obesity is associated with pain, reduction of function and quality of life in patients with osteoarthritis (OA). AIM: To describe the clinical profile of women with knee OA according to their body mass index (BMI). MATERIAL AND METHODS: Observational study in 308 women with knee OA. According to their BMI, they were classified as normal-weight, overweight and obese. The primary outcome measure was functionality evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI) and quality of life assessed with the European Quality of Life Five Dimension (EuroQol-5D). RESULTS: WOMAC, PSQI and EuroQol-5D scores were significantly higher in obese women. CONCLUSIONS: Overweight and obese women with OA have more sleep disorders, reduction on functionality and quality of life compared to their normal weight counterparts.

Prevalence of joint pain and osteoarthritis in obese brazilian population / Prevalência de dor articular e osteoartrite na população obesa brasileira

ABSTRACT Background: High body mass index, as well as maintaining this condition for a long period of time, are important risk factors for the development of osteoarthritis. Aim: To determine joint pain and osteoarthritis prevalence in patients referred to bariatric surgery. Methods: Morbidly obese patients referred to bariatric surgery responded to the visual analogue pain scale (VAS) and the WOMAC questionnaire. X-rays of the hips and knees were evaluated. The primary endpoints were self-reported joint pain and the diagnosis of osteoarthritis by clinical and radiological criteria of the American College of Rheumatology. Results: 141 patients were interviewed (85.1% women) with a mean age of 40 years. The mean body mass index was 46. The lumbar spine and knee joint were the most commonly reported as painful (77.9% and 73.2% respectively). Prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8%. Age, mean VAS and WOMAC scores were higher in the osteoarthritic individuals. Conclusion: There is prevalence of 90.1% of pain symptoms in morbidly obese patients referred to bariatric surgery. The prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8% in this sample.

RESUMO Racional: Alto índice de massa corpórea, assim como a manutenção desta condição por longo período de tempo, são importantes fatores de risco para o desenvolvimento de osteoartrite. Objetivo: Determinar a prevalência de dor articular e osteoartrite em pacientes aguardando cirurgia bariátrica. Métodos: Pacientes obesos mórbidos responderam à escala e questionário (VAS e WOMAC) de dor e função. Radiografias dos quadris e joelhos foram avaliadas. Os desfechos primários foram dor articular referida nos questionários e o diagnóstico de osteoartrite feito através dos critérios clinicoradiológicos do Colégio Americano de Reumatologia. Resultados: Cento e quarenta e um pacientes foram entrevistados (85,1% mulheres) com idade média de 40 anos. A média do índice de massa corpórea foi de 46. Coluna lombar e joelhos foram as regiões mais comumente referidas com dor (77,9% e 73,2% respectivamente). A prevalência de osteoartrite dos joelhos foi de 63,1% e dos quadris foi de 40,8%. Idade, média da escala visual de dor e resultados do questionário de WOMAC foram maiores nos indivíduos com osteoartrite. Conclusão: Há prevalência de 90,1% de sintomas dolorosos nos pacientes obesos mórbidos encaminhados para cirurgia bariátrica. A osteoartrite dos joelhos foi de 63,1% e de quadris de 40,8%.