Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay.

Acute calcific periarthritis (ACP) is defined as periarticular inflammation associated with intra-articular deposits of hydroxyapatite and other basic calcium phosphate crystals. Patients with ACP present with a sudden onset of pain, together with localized swelling, as well as erythema, tenderness, and reduced range of motion. Familiarity with the clinical and radiological manifestations of ACP aids in the diagnosis and helps differentiate it from other conditions, particularly infectious or inflammatory pathologies such as septic arthritis and gout, thereby reducing the number of unnecessary diagnostic and therapeutic procedures. The objective of this pictorial essay is to illustrate the imaging findings of ACP in various joints, with an emphasis on the findings obtained by magnetic resonance imaging.

A periartrite cálcica aguda (PCA) é uma inflamação periarticular aguda associada a depósitos justa-articulares de hidroxiapatita e outros cristais básicos de fosfato de cálcio. Os pacientes apresentam início súbito de dor, edema localizado, eritema, sensibilidade e redução da amplitude de movimentos. A familiaridade com as manifestações clínicas e radiológicas da PCA facilita o diagnóstico e permite diferenciá-la de outras entidades, em particular, com doenças infecciosas ou inflamatórias, como artrite séptica e gota, reduzindo procedimentos diagnósticos e terapêuticos desnecessários. O objetivo deste ensaio iconográfico é ilustrar os achados de imagem de PCA em algumas articulações, com ênfase na ressonância magnética.

Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay / Achados de imagem da periartrite cálcica aguda, com ênfase na ressonância magnética: ensaio iconográfico

Abstract Acute calcific periarthritis (ACP) is defined as periarticular inflammation associated with intra-articular deposits of hydroxyapatite and other basic calcium phosphate crystals. Patients with ACP present with a sudden onset of pain, together with localized swelling, as well as erythema, tenderness, and reduced range of motion. Familiarity with the clinical and radiological manifestations of ACP aids in the diagnosis and helps differentiate it from other conditions, particularly infectious or inflammatory pathologies such as septic arthritis and gout, thereby reducing the number of unnecessary diagnostic and therapeutic procedures. The objective of this pictorial essay is to illustrate the imaging findings of ACP in various joints, with an emphasis on the findings obtained by magnetic resonance imaging.

Resumo A periartrite cálcica aguda (PCA) é uma inflamação periarticular aguda associada a depósitos justa-articulares de hidroxiapatita e outros cristais básicos de fosfato de cálcio. Os pacientes apresentam início súbito de dor, edema localizado, eritema, sensibilidade e redução da amplitude de movimentos. A familiaridade com as manifestações clínicas e radiológicas da PCA facilita o diagnóstico e permite diferenciá-la de outras entidades, em particular, com doenças infecciosas ou inflamatórias, como artrite séptica e gota, reduzindo procedimentos diagnósticos e terapêuticos desnecessários. O objetivo deste ensaio iconográfico é ilustrar os achados de imagem de PCA em algumas articulações, com ênfase na ressonância magnética.

Nuevas estrategias tecnológicas para la administración de fármacos en el tratamiento de patologías articulares / New technological strategies for drug administration in the treatment of joint pathologies

Despite the availability of drugs and pharmaceutical forms for the treatment of rheumatoid arthritis and osteoarthritis symptoms, their adverse effects and lack of response to therapy reinforces the need to search for new technological formulation strategies capable of delaying the progress of the disease, with better therapeutic results and prolonged control of arthropathy. The aim of this bibliographic review was to identify new reported therapeutic approaches for these diseases. The treatment of rheumatoid arthritis and osteoarthritis is an unresolved challenge, due to the complexity of these diseases. Thus, the new therapies aim to suppress inflammatory mediators and to reduce the degradation of the extracellular matrix. In addition, the use of nano and microtechnology takes advantage of the properties of polymers, lipids, peptides, and nucleic acids to develop controlled drug release systems, aiming to obtain highly effective precision therapies, whose usefulness should be evaluated in future clinical trials.

Sports yoga based on the prevention of joint injuries / Ioga esportiva baseada na prevenção de lesões articulares / Yoga deportivo basado en la prevención de lesiones articulares

ABSTRACT Introduction During sports, the athletes' joints bear a strong overload, causing joint injuries, which have a strong impact on the sports level and shorten the sports athletes' careers. Objective Explore the preventive effect of yoga practice on joint injuries. Methods In this study, an experimental protocol was tested. The experimental group adopted the yoga teaching method, and the control group adopted traditional massage. The interventions were performed three times a week, lasting one hour for a total of 6 months. The scores of the VAS and the Oswestry functional disorder index questionnaire were collected and compared, and the joint activity before and after the experiment was also collected and analyzed. Results Both methods can effectively improve the overall joint condition and prevent joint injury, but the effect of the yoga teaching group was superior to the massage group. Conclusion Compared to traditional massage, sport-oriented yoga training proved superior, better adapted to the actual situation of athletes, and more cost-effective. Further studies are recommended for its promotion. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Durante os esportes, as articulações dos atletas suportam uma forte sobrecarga, ocasionando lesões articulares, ocasionando um forte impacto no nível esportivo e abreviando a carreira dos atletas esportivos. Objetivo Explorar o efeito preventivo da prática de ioga sobre as lesões articulares. Métodos Neste trabalho, foi testado um protocolo experimental. O grupo experimental adotou o método de ensino de ioga, e o grupo de controle adotou a massagem tradicional. As intervenções foram realizadas três vezes por semana, com duração de uma hora num total de 6 meses. As pontuações do VAS e do questionário do índice de desordem funcional Oswestry foram coletadas e comparadas, e a atividade conjunta antes e depois do experimento também foi coletada e analisada. Resultados Ambos os métodos podem efetivamente melhorar a condição articular geral e prevenir lesões articulares, porém o efeito do grupo de ensino de ioga demonstrou-se superior ao grupo de massagem. Conclusão Em comparação com a massagem tradicional, o treinamento de ioga voltado para o esporte demonstrou-se superior, adaptando-se melhor à situação real dos atletas, além de ser mais econômico. Recomenda-se maiores estudos para a sua promoção. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Durante la práctica deportiva, las articulaciones de los atletas soportan una fuerte sobrecarga, provocando lesiones articulares, causando un fuerte impacto en el nivel deportivo y acortando la carrera deportiva de los atletas. Objetivo Explorar el efecto preventivo de la práctica del yoga en las lesiones articulares. Métodos En este trabajo se ha probado un protocolo experimental. El grupo experimental adoptó el método de enseñanza del yoga, y el grupo de control adoptó el masaje tradicional. Las intervenciones se realizaron tres veces por semana, con una duración de una hora, durante un total de 6 meses. Se recogieron y compararon las puntuaciones del VAS y del cuestionario del índice de trastornos funcionales de Oswestry, y también se recogió y analizó la actividad articular antes y después del experimento. Resultados Ambos métodos pueden mejorar eficazmente el estado general de las articulaciones y prevenir las lesiones articulares, pero el efecto del grupo de enseñanza de yoga demostró ser superior al del grupo de masaje. Conclusión En comparación con el masaje tradicional, el entrenamiento de yoga orientado al deporte demostró ser superior, adaptándose mejor a la situación real de los atletas, además de ser más rentable. Se recomienda realizar más estudios para su promoción. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Jaccoud-type lupus arthropathy.

BACKGROUND: Jaccoud's arthropathy (JA) is a condition characterized by joint deformities that have a "reducible" pattern, that is, they return to the normal appearance with a passive manoeuvre. JA was described in patients with rheumatic fever (RF) more than a century ago, and presently, the majority of the patients have systemic lupus erythematosus (SLE). PURPOSE: The aim of this review is to draw one attention to the epidemiology, pathogenesis, histopathology, clinical features, imaging, and management of JA in patients with SLE (Jaccoud-type lupus arthropathy). DATA COLLECTION: The search strategy included articles retrieved from PubMed utilizing the terms "lupus arthropathy", "lupus deforming arthropathy", "lupus hand", "lupus foot", "chronic postrheumatic arthropathy", "Jaccoud's" and "Jaccoud" from 1950 until March 2021, with no language restriction. RESULTS: The prevalence of Jaccoud-type arthropathy in SLE is approximately 5%. The aetiopathogenic mechanisms of JA are not yet known. The most common joint deformities of JA, are ulnar deviation, swan neck, and the "z" of the thumb. Unfortunately, none of the proposed classification criteria for JA have been validated so far. Characteristically, there is no bone erosion on plain radiographs of the joints, but more sensitive imaging methods, magnetic resonance imaging or high-performance ultrasound may reveal small bone erosions. There is no preventive measure against JA development, specific clinical treatment or convincing surgical approach for correcting the deformities. CONCLUSION: As daily activities and quality of life are compromised in patients with JA, other studies are urgently needed in this area.

Evaluation of bone erosion in rheumatoid arthritis patients by high-resolution peripheral quantitative computed tomography scans: Comparison between two semi-automated programs in a three-dimensional setting.

AIM: The aim of this study was to compare OsiriX software with the previous published Medical Image Analysis Framework (MIAF) method to assess the volume of erosion in patients with rheumatoid arthritis (RA). METHODS: Forty RA patients underwent high-resolution peripheral quantitative computed tomography scans of the second and third metacarpophalangeal joints, and thirty-four patients with any bone erosion were enrolled. Two techniques were applied to erosion evaluation: (a) semi-automated MIAF software, and (b) semi-automated segmentation by free open-source Digital Imaging and Communications in Medicine viewer, OsiriX software. MIAF has been published before, but this is the first time that OsiriX has been used in this way in rheumatology. Bland & Altman plots described agreement between methods. RESULTS: Forty-eight erosions from 34 patients were analyzed. Mean age was 40.74 ± 5.32 years and mean disease duration was 10.68 ± 4.96 years. Both methods demonstrated a strong correlation regarding erosion volume (r = 0.96, P < 0.001). Median (interquartile range) of erosion volume was 12.14 (4.5-36.07) when MIAF was considered, and 11.80 (3.45-29.42) when the OsiriX tool was used (P = 0.139). MIAF and OsiriX showed good agreement when the Bland & Altman plot was performed. Evaluation by MIAF took 22.69 ± 6.71 minutes, whereas OsiriX took only 2.62 ± 1.09 minutes (P < 0.001). CONCLUSION: The three-dimensional segmentation of bone erosions can be done by both MIAF and OsiriX software with good agreement. However, because OsiriX is a widespread tool and faster, its method seems to be more feasible for evaluating peripheral bone damage, especially bone erosions.

Association between joint diseases and common mental disorders in women at ages related to menopause: Data from the São Paulo City Health Survey, SP, Brazil.

OBJECTIVES: To investigate the association between joint diseases (JD) and common mental disorders (CMD) in women at ages related to menopause. STUDY DESIGN: Cross-sectional, population-based study (São Paulo City Health Survey, SP, Brazil). The sample was composed of 1191 women, 40 years and older. MAIN PARAMETERS INVESTIGATED: Dependent variable (outcome): Presence of CMD, investigated by the Self Reporting Questionnaire-20 (SRQ-20). INDEPENDENT VARIABLES: Presence of JD; other self-reported chronic conditions different from JD (OCC); age categories (40-45, 46-50, 51-55, 56-60, 61+ years old); Adjusting variables: years of formal education and ethnicity (skin color), used as proxies of socioeconomic status. The associations were investigated using simple and multiple logistic regression models. MAIN RESULTS: The prevalence of CMD was 30.4%, and JD was 21.4%. Considering only the women presenting CMD, the prevalence of JD was 31.6%. The final regression model showed an independent association between JD and CMD (OR = 1.998; p < 0.001), age between 56 and 60 years (OR = 0.542; p = 0.018), and having three OCC (OR = 2.696; p = 0.027). CONCLUSIONS: Our data showed that JD in women of the ages related to menopause was significantly and independently associated with CMD. Interestingly, the 56 to 60 years' age interval showed a very particular feature, with opposite association's direction, which demands further investigations.

Functional and joint evaluation in a prospective cohort of patients with severe haemophilia.

INTRODUCTION: Arthropathy is the main morbidity of haemophilia. Periodic joint health assessment enables a better understanding of the limitations of these patients. OBJECTIVE: To evaluate the functional and joint performance in patients with haemophilia at one-year follow-up, as well as its association with prophylactic treatment and attendance at scheduled consultations at a haemophilia treatment centre. METHODS: This prospective cohort study included patients with severe haemophilia aged 7 years or more and treated at Fundação Hemocentro de Brasília, Brazil, from January 2014 to December 2018. The Hemophilia Joint Health Score and Functional Independence Score in Hemophilia were assessed at the first consultation and after a one-year follow-up. RESULTS: The study included 69 patients. The mean age at study recruitment was 22.5 ± 4.5 years, 62.3% of patients aged 18 years or older, and 29 patients were receiving primary prophylaxis (38.0%). There was a positive correlation between HJHS and age and a negative correlation between FISH and age. The worsening HJHS was associated with non-primary prophylaxis and non-attendance at scheduled multidisciplinary consultations. The worsening FISH was associated with non-primary prophylaxis. The correlation between FISH and treatment adherence was significant for the delta. CONCLUSION: The older the patient with haemophilia, the higher the probability of a worsening of the HJHS. In the presence of more arthropathies, the older the patient, the worse the FISH. Patients receiving primary prophylaxis show better results in the HJHS and FISH when compared to patients receiving secondary prophylaxis and/or on-demand treatment.

Photobiomodulation (λ=808nm) and Platelet-Rich Plasma (PRP) for the Treatment of Acute Rheumatoid Arthritis in Wistar Rats.

Introduction: Rheumatoid arthritis (RA) causes inflammation, pain, edema, and articular degradation and its treatment can be based on anti-inflammatory drugs, photobiomodulation (PBM) and/or platelet-rich plasma (PRP) that can decrease cell flow and promote local healing. In the present study, we evaluate the effects of PBM and PRP on acute arthritis in Wistar rats through inflammatory and oxidative stress parameters. Methods: Thirty female Wistar rats were assigned to five groups (n=6, each group): Control, Sham, PRP, Laser, and PRP+Laser. For arthritis induction, all animals of groups Sham, PRP, Laser and PRP+Laser received an intraarticular injection of Zymosan® (200µg) in the right knee. Twenty-four hours post-arthritis induction, PRP was prepared and injected (8 × 105 of platelets) in animals of PRP and PRP+Laser groups. PBM was performed in Laser and PRP+Laser groups by single-dose therapy with the GaAlAs laser (λ=808 nm, P=25 mW, fluence=30 J/cm2, beam area=0.02 mm2, t=33 seconds, E=0.825 J, punctual application). After seven days of induction, serum samples were collected and thiobarbituric acid reactive substances (TBARS), nitric oxide (NO) and catalase activity were analysed. Morphological parameters were measured for inflammation areas, cartilage thickness, and C3 protein expression in knee samples. Statistical analysis was performed with an ANOVA test and Tukey's post-hoc test with a significance level of 5% (P<0.05). Results: NO was lower in the treated groups compared to the Sham group, and TBARS did not show any differences, while catalase showed greater activity between PRP+Laser versus PRP (P<0.05). Inflammatory areas and cartilage thickness were lower in the treated groups compared to Sham (P<0.05), while no differences in C3 protein expression was observed. Conclusion: PBM associated with PRP is better for anti-inflammatory and joint preservation by morphological aspects and NO levels that concern a potential clinical application.

Cost analysis of hemophilia treatment in a Brazilian public blood center / Custo-análise do tratamento da hemofilia em um hemocentro público brasileiro

Abstract Background hemophilia is a rare coagulopathy, treated by replacing the missing blood clotting factor. Objective to assess the direct costs of hemophilia treatment from the perspective of the Unified Health System, highlighting the impact costs of new therapeutic modalities. Method partial economic assessment of the direct costs of hemophilia, in which were collected data from patient records from 2011 to 2015, at the Blood Center in the city of Juiz de Fora. Costs were assigned to consultations, exams, hospitalizations, and medications according to the price list of the National Health Surveillance Agency (in Portuguese ANVISA) and the Table of Procedures, and Medications. Results among 98 patients evaluated, 76 had hemophilia A, and 43.3% presented severe hemophilia. The number of consultations and the consumption of Clotting Factor Concentrates (CFCs) were higher in severe hemophilia. Hospitalizations were rare. Direct costs increased 286.8% from 2011 to 2015. The mean annual cost per patient was R$57,416.43, with no significant difference between hemophilia A and B. The expenditures for factor concentrates amounted to 99.46% of total costs. The actual impact cost was more than R$6,000,000.00. Conclusion the direct costs of hemophilia were high, mainly due to factor concentrates. There was an increase in costs with the incorporation of technologies, although there are some areas with potential inefficiencies.

Resumo Introdução hemofilia é uma coagulopatia rara, tratada com reposição do fator de coagulação deficiente. Objetivo avaliar custos diretos do tratamento da hemofilia pela perspectiva do Sistema Único de Saúde brasileiro, destacando o impacto nos custos das novas modalidades terapêuticas. Método análise econômica parcial dos custos diretos da hemofilia. Foram coletados dados de prontuários de pacientes do Hemocentro de Juiz de Fora de 2011-2015. Aos atendimentos, exames, hospitalizações e medicamentos, foram atribuídos custos conforme as Tabelas de Preços da Agência de Vigilância Sanitária e de Procedimentos e Medicamentos do SUS. Resultados entre 98 pacientes avaliados, 76 tinham hemofilia A e 43,3%, hemofilia grave. O número de consultas e o consumo de concentrados de fatores da coagulação foram mais altos na hemofilia grave. Hospitalizações foram raras. Os custos diretos aumentaram 286,8% entre 2011-2015. O custo anual médio por paciente foi R$57.416,43 sem diferença significativa entre hemofilia A e B. Os concentrados de fator corresponderam a 99,46% dos custos totais. O impacto nos custos foi de mais de R$6.000.000,00. Conclusão custos diretos da hemofilia são altos, principalmente devido aos concentrados de fator. O aumento nos custos com as novas tecnologias foi muito elevado embora ainda haja áreas com ineficiências no tratamento da hemofilia.

Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations.

PURPOSE: The purpose of this study was to use cone-beam computed tomography (CBCT) images to determine the prevalence of calcifications in the temporomandibular joint (TMJ) and to evaluate any associations between the presence of such calcifications and degenerative bone alterations of the TMJ, sex, or age. MATERIALS AND METHODS: In this retrospective study, 1,058 CBCT exams were analyzed, and data regarding the presence and quantity of calcifications, the affected side, any degenerative alterations of the condyle, sex, and age were collected. To evaluate associations between the presence of calcifications and sex or age, the Fisher exact test or the Spearman correlation coefficient, respectively, was used. To assess the association between the presence of calcifications and joint bone alterations, the chi-square and Fisher exact tests were used. The significance level adopted was 5% (P<0.05). RESULTS: Twenty-eight patients (2.7%) presented with TMJ calcifications, including 23 women (82.1%) and 5 men (17.9%). Significant correlations were found between the presence of calcifications and age (P<0.05) and between the presence of calcifications and the presence of condylar alterations (P<0.05), with 73.2% of patients with bone alterations having TMJ calcifications. CONCLUSION: It may be concluded that, although rare (with a prevalence of only 2.7%), intra-articular calcifications are associated with both degenerative bone alterations and age.

PRE-PLANNING ANKLE ARTHRODESIS USING 3D RECONSTRUCTED TOMOGRAPHIES.

OBJECTIVE: To implement one analysis method of the ankle bone contour that could make a more precise ankle arthrodesis. METHODS: Twenty tomographies were submitted to 3D reconstruction. Seven points of anatomic interest for ankle arthrodesis with the three screws technique were marked with a triplannar marker. The median of the position of markers was estimated, and the union of the seven median points allow the construction of one median ankle for that population. Using this median ankle, sizes and angles for the screws position were determined. RESULTS: Two median ankles were reconstructed, left and right. The position of the screw passage were determined considering the anatomical parameters. In the right ankle the lateral to medial screw should enter 4.56 cm and 0.79 above and posterior to lateral malleolus, with one inclination of 17.34° in relation to tibial longitudinal axis; and 0° in relation to tibial axial plane. The position for the other two screws is also described. CONCLUSION: Our article is the first to presents one precise guide for ankle arthrodesis based on a populational assessment. Level of evidence II, Diagnostic Studies.

OBJETIVO: Implementar método de análise do contorno e alinhamento ósseos no tornozelo de uma população normal, possibilitando uma artrodese tibiotársica mais precisa. MÉTODOS: Tomografias de vinte tornozelos foram submetidas à reconstrução 3D. Nesses exames, 7 pontos anatômicos de interesse para a técnica de fixação com 3 parafusos foram identificados e marcados com indicadores da posição triplanar. As médias das localizações de cada ponto foram calculadas. A união dessas médias permitiu a reconstrução de um tornozelo padrão daquela população. Nesses tornozelos médios estudou-se os comprimentos e ângulos para a passagem dos parafusos. RESULTADOS: Dois tornozelos, direito e esquerdo, foram reconstruídos. A posição para a passagem dos parafusos em relação a parâmetros anatômicos foi determinada. Para o tornozelo direito, a passagem do parafuso de lateral para medial deve ocorrer com o ponto de entrada 4,56 cm acima e 0,79 cm posterior à ponta do maléolo lateral, com inclinação de 17,34° em relação ao eixo longitudinal e 0° em relação ao eixo axial da tíbia. As posições dos outros dois parafusos também estão descritas. CONCLUSÃO: Esse é o primeiro trabalho que apresenta um guia preciso para realização da artrodese do tornozelo, baseado em um estudo populacional. Nível de evidência II, Estudos Diagnósticos.

Pre-planning ankle arthrodesis using 3d reconstructed tomographies / Desenvolvimento da artrodese do tornozelo baseada na tomografia com reconstrução 3d

ABSTRACT Objective: To implement one analysis method of the ankle bone contour that could make a more precise ankle arthrodesis. Methods: Twenty tomographies were submitted to 3D reconstruction. Seven points of anatomic interest for ankle arthrodesis with the three screws technique were marked with a triplannar marker. The median of the position of markers was estimated, and the union of the seven median points allow the construction of one median ankle for that population. Using this median ankle, sizes and angles for the screws position were determined. Results: Two median ankles were reconstructed, left and right. The position of the screw passage were determined considering the anatomical parameters. In the right ankle the lateral to medial screw should enter 4.56 cm and 0.79 above and posterior to lateral malleolus, with one inclination of 17.34° in relation to tibial longitudinal axis; and 0° in relation to tibial axial plane. The position for the other two screws is also described. Conclusion: Our article is the first to presents one precise guide for ankle arthrodesis based on a populational assessment. Level of evidence II, Diagnostic Studies.

RESUMO Objetivo: Implementar método de análise do contorno e alinhamento ósseos no tornozelo de uma população normal, possibilitando uma artrodese tibiotársica mais precisa. Métodos: Tomografias de vinte tornozelos foram submetidas à reconstrução 3D. Nesses exames, 7 pontos anatômicos de interesse para a técnica de fixação com 3 parafusos foram identificados e marcados com indicadores da posição triplanar. As médias das localizações de cada ponto foram calculadas. A união dessas médias permitiu a reconstrução de um tornozelo padrão daquela população. Nesses tornozelos médios estudou-se os comprimentos e ângulos para a passagem dos parafusos. Resultados: Dois tornozelos, direito e esquerdo, foram reconstruídos. A posição para a passagem dos parafusos em relação a parâmetros anatômicos foi determinada. Para o tornozelo direito, a passagem do parafuso de lateral para medial deve ocorrer com o ponto de entrada 4,56 cm acima e 0,79 cm posterior à ponta do maléolo lateral, com inclinação de 17,34° em relação ao eixo longitudinal e 0° em relação ao eixo axial da tíbia. As posições dos outros dois parafusos também estão descritas. Conclusão: Esse é o primeiro trabalho que apresenta um guia preciso para realização da artrodese do tornozelo, baseado em um estudo populacional. Nível de evidência II, Estudos Diagnósticos.

Os benefícios da laserterapia de baixa intensidade associados a exercícios domiciliares em idosos com osteoartrite de joelho / The benefits of low-intensity laser therapy associated with home exercises in elderly knee osteoarthritis

INTRODUÇÃO: A Osteoartrite (OA) é uma doença musculoesquelética com predomínio na população idosa. O tratamento com Laserterapia tem sido um dos métodos seguros e não invasivos para o tratamento da OA. OBJETIVO: Observar a influência na dor, rigidez e função em idosos antes e depois da aplicação da laserterapia associados a exercícios domiciliares. MÉTODOS: Dez pacientes idosos com OA de joelho, submetidos a 12 sessões de Laserterapia, 3 vezes por semana e orientados a realizarem exercícios domiciliares durante o período do estudo. Foi utilizado o Laser de baixa potência Class 3B Chattanooga, com energia total de 36J (divididos em 6 pontos- 6J por ponto) conforme a dosagem da World Association of Laser Therapy (WALT). Para mensuração do quadro álgico foi utilizados a Escala Visual Analógica (EVA); Índice de Osteoartrite de Western Ontario (WOMAC) e Índice de Lequesne para dor, rigidez e funcionalidade. Os exercícios domiciliares foram explicados e demonstrados pelo avaliador e orientado a realizar 3 vezes por semana durante 12 sessões. RESULTADOS: Observamos que após aplicações de Laserterapia e exercícios domiciliares, não houve melhora na EVA, porém com melhora significativa nos quesitos WOMAC geral (p=0,01) e função (p=0,001) enquanto os demais não houve significância (p>0,5) quando avaliados por meio do t-test, já na comparação entre questionários houve correlação forte em WOMAC e LEQUESNE com a Correlação de Pearson. CONCLUSÃO: Pode-se concluir que a Laserterapia associada a exercícios domiciliares não evidencia melhora significativa do quadro álgico através da EVA, podendo ser uma resposta subjetiva com dificuldade de compreensão pelos pacientes, porém foi observado melhora significativa na evolução funcional do paciente medidas pelos questionários WOMAC e LEQUESNE nos pacientes com OA de joelho.

INTRODUCTION: Osteoarthritis (OA) is a musculoskeletal disease with predominance in the elderly population. Laser therapy has been one of the safe and non-invasive methods for treating OA. OBJECTIVE: To observe the influence on pain, stiffness and function in the elderly before and after the application of home exercise laser therapy. METHODS: Ten elderly patients with knee OA who underwent 12 laser therapy sessions 3 times a week. The Chattanooga Class 3B Low Power Laser was used, with a total energy of 36J (divided into 6 points - 6J per point) according to the dosage of the World Association of Laser Therapy (WALT). We used the Visual Analog Scale (VAS) for pain; Western Ontario Osteoarthritis Index (WOMAC) and Lequesne Index for pain, stiffness and functionality. Home exercises were explained and demonstrated by the evaluator and instructed to perform 3 times a week during 12 sessions. RESULTS: We observed that after laser therapy and home exercises, there was no improvement in VAS but there was significant improvement in the general WOMAC (p = 0.01) and function (p = 0.001), while the others were not significant (p> 0, 5), when compared to the t-test, when compared to the Pearson correlation, there was an improvement in the WOMAC and LEQUESNE questionnaires. CONCLUSION: It can be concluded that after applying home exercise laser therapy, there was no significant improvement in pain through VAS, which may be a subjective response with difficulty for patients to understand, but there was a significant improvement in the patient's functional evolution measured by the questionnaires. WOMAC and LEQUESNE in patients with knee OA.

Destructive psoriatic arthritis of the temporomandibular joint: a clinical case, an overview of the pathophysiology and its differential diagnoses.

Background Clinical assessments and uniplanar images in temporomandibular disorders are not always entirely reliable. This predicament is especially important when clinicians need to determine the nature of temporomandibular joint disease, particularly when clinical features are not helpful in determining the diagnosis.Clinical presentation A 63-year-old female patient presented with mild pain in her right TMJ. During routine imaging exams, a destructive monoarticular arthritis was noticed, producing multiple erosions of the mandibular and temporal condyles. In addition, attrition of the ceiling of the glenoid fossa was observed, generating a communication with the endocranium. Only the presumptive biological behavior revealed on TMJ imaging and the appearance of the psoriatic plaques later during follow-up helped the authors to narrow the differential diagnosis.Conclusion The clinical case presented illustrates the difficulties in diagnosing an erosive, seronegative TMJ destruction, suggestive of a systemic arthritis.

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis / Comparação biomecânica da força de fixação de parafuso com orientação de plantar para dorsal e vice-versa para artrodese subtalar

ABSTRACT Objective To compare screw fixation strength for subtalar arthrodesis. Methods Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. Results Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.

RESUMO Objetivo Comparar a força de fixação dos parafusos para artrodese subtalar. Métodos Oito pares de pés de cadáveres frescos foram submetidos à artrodese da articulação subtalar com dois parafusos canulados de 7,3mm. A randomização foi usada para atribuir a orientação do parafuso, de modo que um pé em cada par foi designado com orientação de dorsal para plantar (Grupo DP), e o outro pé com orientação de plantar para dorsal (Grupo PD). Técnica cirúrgica padrão com radioscopia foi usada para os procedimentos. Após a fixação, cada amostra foi testada até a falha com um dispositivo Bionix®858 MTS, aplicando força axial descendente a uma distância para criar torque. O torque de falha foi comparado entre os Grupos DP e PD, usando o teste t de Student, com p=0,05 usado para determinar significância estatística. Resultados A análise estatística demonstrou que a média do torque até a falha favoreceu ligeiramente o Grupo DP (37,3Nm) em relação ao PD (32,2Nm). No entanto, a diferença entre os dois grupos não foi estatisticamente significativa (p=0,55). Conclusão Na artrodese subtalar, não há diferença significativa na força de compressão entre as orientações dos parafusos dorsal-plantar e plantar-dorsal. A abordagem escolhida pelo cirurgião deve ser baseada em outros fatores, sem preocupação com a força biomecânica da orientação dos parafusos.

Caracterización clínica, imagenológica y quirúrgica de la discopexia en pacientes con artropatía discal de la art iculación temporomandibular. Estudio de serie de casos / Clinical, imagenological and surgical characterization of discopexia in patients with discal arthropathy of the temporomandibular articulation. Case series study

Introducción: El desplazamiento discal es la artropatía temporomandibular más común. Los desplazamientos discales sin Reducción (DDSR) constituyen una condición clínica en la cual en boca cerrada el disco articular se encuentra desplazado completamente, sin contacto con la vertiente anterior de la cabeza mandibular y en boca abierta el disco no es recapturado. El tratamiento quirúrgico realizado es la discopexia. A pesar de toda la información presente en la bibliografía aún existe controversia entre la elección de tratamiento del DDSR. Objetivo: Presentar la experiencia clínica, quirúrgica e imagenológica de la discopexia en DDSR mediante la presentación de una serie de casos. Metodología: Se realizó un estudio retrospectivo de las historias clínicas del Servicio de Cirugía Bucal y Maxilofacial del hospital General del Oeste "Dr. José Gregorio Hernández", Distrito Capital, Venezuela, entre 2014-2018; se seleccionaron seis casos clínicos que presentaban DDSR, los cuales fueron intervenidos con discopexia, posteriormente se evaluaron clínica e imagenológicamente. Resultados: Los seis casos presentaron particularidades en el transcurso del tratamiento desde la fase inicial y en la postoperatoria. Se evidenció una franca mejoría en las manifestaciones clínicas, en contraste, la resonancia magnética postoperatoria, el cual reveló el desplazamiento discal nuevamente. Conclusiones: La estabilidad en la reubicación discal postoperatoria depende de múltiples factores, tales como la estabilidad oclusal, muscular y presencia de hábitos parafuncionales. El aumento en la apertura bucal fue la característica común en todos los pacientes de este estudio así como la disminución de la sintomatología dolorosa.

Introduction: Disc displacement is the most common temporomandibular arthropathy. The displacements without reduction (DDSR) become a clinical practice in the closed mouth the articular disc is completely displaced, without contact with the anterior vertical of the mandibular head and in the open mouth the disc is not recaptured. The surgical treatment performed is discopexy. Despite all the information present in the literature there is still controversy between the choice of treatment of the DDSR. Objective: To present the clinical, surgical and imaging experience of discopexy in DDSR by presenting a series of cases. Methodology: A retrospective study of the clinical records of the Oral and Maxillofacial Surgery Service of the General del Oeste Hospital "Dr. José Gregorio Hernández ", Capital District, Venezuela, between 2014-2018; Six clinical cases were selected that presented DDSR, which were operated on with discopexy, and then evaluated clinically and imaging. Results: The six cases present particularities in the course of the treatment from the initial phase and in the postoperative period. The evidence is improved in the clinical manifestations, in contrast, in the postoperative magnetic resonance, in the articular disc it moved again. Conclusions: Stability in postoperative disc relocation depends on multiple factors, such as occlusal stability, muscle stability and the presence of parafunctional habits. The increase in oral opening was the common feature in all the patients for this study, as well as the decrease in painful symptoms.

Cartílago y gonartrosis / Cartilage and knee osteoarthritis

RESUMEN Fundamento: el cartílago articular es un tejido avascular, aneural y alinfático que desempeña un importante papel en la articulación, su afección más frecuente es la de tipo degenerativa. Objetivo: actualizar los conocimientos sobre el cartílago articular normal, envejecido y con cambios degenerativos. Métodos: la búsqueda y análisis de la información se realizó en un periodo de tres meses (primero de octubre al 31 de diciembre de 2018) y se emplearon las siguientes palabras: cartilage AND osteoarthritis, cartilage AND knee osteoarthritis, cartilage a partir de la información obtenida se realizó una revisión bibliográfica de un total de 164 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 50 citas seleccionadas para realizar la revisión, de ellas 48 de los últimos cinco años. Resultados: se mencionan los aspectos macro y microscópicos del tejido, así como su organización por zonas y áreas. Se describen los cambios que ocurren en el proceso degenerativo a diferentes niveles y en el envejecimiento. Conclusiones: el cartílago articular es la estructura anatómica más afectada en la articulación por el proceso degenerativo. Se encuentra organizado por zonas y áreas, las que se afectan a medida que avanza la enfermedad. El origen de la destrucción del cartílago es enzimático y repercute en las demás estructuras como el tejido sinovial y hueso subcondral. Es importante conocer las diferencias entre el envejecimiento y la afección degenerativa de este tejido.

ABSTRACT Background: articular cartilage is an important avascular, alinphatic and aneural tissue in joints, it is mainly affected by degenerative disease. Objective: to update knowledge about normal, aging and degenerative articular cartilage. Methods: a three months research and analysis were conducted from October 1st, 2018 to December 31th, 2018. Our review included 164 articles published in PubMed, Hinari, SciELO and Medline databases by using EndNote. The words used were cartilage AND osteoarthritis, cartilage AND knee osteoarthritis, cartilage. Fifty citations were selected, 48 of all them within the last five years, were used to write the present paper. Results: macro and microscopic features of articular cartilage were mentioned as well as its organization in zones and areas. Degenerative process was described at different levels, and in aging. Conclusions: articular cartilage is the most affected tissue in osteoarthritis. Cartilage is organized by zones and areas which are affected as degenerative disease progresses. The start point of osteoarthritis is enzymatic and gradually affects synovial tissue and sub-chondral bone. It is important to know the main differences between aging and degenerative cartilages.

Retrospective study of radiographic changes in athletic bulls with orthopedic disorders / Estudo retrospectivo das alterações radiográficas de touros atletas com doenças ortopédicas

The objectives of this study were to demonstrate the lesions that affect athlete bulls and to correlate the disorders with weight, age, affected limb and region of the limb. The present study was accomplished using radiographic images of athletic rodeo bulls collected from the medical and surgical records of the large animal service at the veterinary hospital. Radiographic images were evaluated for 136 bulls that were taken care of at the Veterinary Hospital, ranging in age from 4 to 13 years, with an average weight of 800kg and proven prior physical activity through participation in rodeos. The chi-square or Fisher's exact test was used to assess the association between the studied variables. It was observed that 71.6% of the bulls studied and suffering from lameness had radiographic lesions, predominantly in experienced animals. Enthesopathy in starter and experienced bulls, septic arthritis in starter bulls, and fractures and degenerative joint disease in experienced bulls were the most frequent radiographic lesions diagnosed. The region of limb where the majority of radiographic changes occurred was the digits. Risk factors and occurrence of diseases of the locomotor system in athletic bulls are similar to those in sport equines.(AU)

O objetivo desse trabalho foi demostrar quais lesões acometem touros atletas, correlacionando as desordens com peso, idade, membro e região afetada. O presente estudo foi realizado utilizando radiografias de touros atletas de rodeio, após levantamento dos prontuários clínicos e cirúrgicos do serviço de grandes animais de um hospital veterinário. Foram avaliadas radiografias de 136 touros que haviam sido atendidos em tal hospital, com idade variando de quatro a 13 anos, com média de peso de 800kg e realizavam participação em rodeios. Para avaliar a associação entre as variáveis estudadas foi utilizado o teste exato de Fischer e o Qui-quadrado. Observou-se que 71,6% dos touros estudados que claudicavam, apresentavam lesões radiográficas, predominantemente em animais mais experientes. A entesiopatia em todos os animais, artrite séptica nos touros iniciantes, fraturas e doença articular degenerativa nos touros mais experientes, foram as alterações radiográficas mais frequentes. As regiões com maior ocorrência de lesões radiográficas foram os dígitos. Os fatores de risco para ocorrência de doenças no sistema locomotor de touros atletas são diversos, similares aos que ocorrem nos equinos atletas.(AU)

Retrospective study of radiographic changes in athletic bulls with orthopedic disorders / Estudo retrospectivo das alterações radiográficas de touros atletas com doenças ortopédicas

The objectives of this study were to demonstrate the lesions that affect athlete bulls and to correlate the disorders with weight, age, affected limb and region of the limb. The present study was accomplished using radiographic images of athletic rodeo bulls collected from the medical and surgical records of the large animal service at the veterinary hospital. Radiographic images were evaluated for 136 bulls that were taken care of at the Veterinary Hospital, ranging in age from 4 to 13 years, with an average weight of 800kg and proven prior physical activity through participation in rodeos. The chi-square or Fisher's exact test was used to assess the association between the studied variables. It was observed that 71.6% of the bulls studied and suffering from lameness had radiographic lesions, predominantly in experienced animals. Enthesopathy in starter and experienced bulls, septic arthritis in starter bulls, and fractures and degenerative joint disease in experienced bulls were the most frequent radiographic lesions diagnosed. The region of limb where the majority of radiographic changes occurred was the digits. Risk factors and occurrence of diseases of the locomotor system in athletic bulls are similar to those in sport equines.(AU)

O objetivo desse trabalho foi demostrar quais lesões acometem touros atletas, correlacionando as desordens com peso, idade, membro e região afetada. O presente estudo foi realizado utilizando radiografias de touros atletas de rodeio, após levantamento dos prontuários clínicos e cirúrgicos do serviço de grandes animais de um hospital veterinário. Foram avaliadas radiografias de 136 touros que haviam sido atendidos em tal hospital, com idade variando de quatro a 13 anos, com média de peso de 800kg e realizavam participação em rodeios. Para avaliar a associação entre as variáveis estudadas foi utilizado o teste exato de Fischer e o Qui-quadrado. Observou-se que 71,6% dos touros estudados que claudicavam, apresentavam lesões radiográficas, predominantemente em animais mais experientes. A entesiopatia em todos os animais, artrite séptica nos touros iniciantes, fraturas e doença articular degenerativa nos touros mais experientes, foram as alterações radiográficas mais frequentes. As regiões com maior ocorrência de lesões radiográficas foram os dígitos. Os fatores de risco para ocorrência de doenças no sistema locomotor de touros atletas são diversos, similares aos que ocorrem nos equinos atletas.(AU)