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1.
Med Clin North Am ; 104(2): 293-311, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32035570

RESUMEN

Osteoarthritis (OA) is a worldwide endemic and debilitating disease. Previously thought to simply be damaged from "wear and tear," OA is now understood to be a complex interaction of local and systemic factors. This article reviews the pathology, symptoms, diagnosis, and various conservative, surgical, and novel treatments of OA.


Asunto(s)
Osteoartritis , Manejo de Atención al Paciente/métodos , Humanos , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , Osteoartritis/terapia
2.
Clin Exp Rheumatol ; 37 Suppl 120(5): 48-56, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31621566

RESUMEN

Osteoarthritis (OA) is the most common age-related chronic and disabling joint disease. Long considered to be a "wear and tear" disease, OA is now seen as a low-grade inflammation disease that affects all tissues of the joint, involving cartilage degradation, bone remodelling, osteophytes, and synovitis. The process, called inflammaging, is characterised by the association of low-grade inflammation, profound changes in intra-cellular mechanisms, and the decreased efficiency of the immune system with ageing. The activation of innate immunity plays a critical role in the development and progression of OA. Innate immunity, including inflammasome activation, is triggered by small endogenous molecules called alarmins or damage-associated molecular patterns (DAMPs). These molecules are released in the extracellular media after cell stress or damage, bind to pathogen-recognition receptors (PRRs), such as Toll-like receptors (TLRs) and the receptor for advanced glycation end products (RAGE), and activate the secretion of pro-inflammatory factors, leading to joint inflammation. Moreover, such sterile inflammation triggers cell senescence, characterised by a senescence-associated secretory phenotype (SASP). Understanding the substantial age-related changes of joint tissues that influence the pathogenesis of OA is critical to improving the quality of life of elderly people in the context of increased life expectancy. This review will focus on age-related sterile inflammation in OA and highlight the various innovative and promising therapies targeting the mechanisms of aging.


Asunto(s)
Osteoartritis , Calidad de Vida , Anciano , Envejecimiento , Humanos , Inflamación/inmunología , Osteoartritis/inmunología , Osteoartritis/patología , Osteoartritis/terapia , Receptor para Productos Finales de Glicación Avanzada/metabolismo , Receptores Toll-Like/metabolismo
3.
Wiad Lek ; 72(9 cz 1): 1671-1675, 2019.
Artículo en Polaco | MEDLINE | ID: mdl-31586981

RESUMEN

Osteoarthritis is the disease connected with aging which is characterised by progressive degeneration of all elements building the joint but also influencing the muscles constituting motor unit with the affected joint. The effective and unified therapy has not been yet introduced despite the broad multi-site studies concentrating on metabolic pathways responsible for the development of the disease. The reason of which is probably its multifactorial aetiology. The treatment methods are based on decreasing of cartilage destruction activity, retardation of proinflammatory factors activity and fighting with pain. Physiotherapy, movement rehabilitation, painkillers, anti-inflammatory drugs, glucosamine sulphates and hyaluronic acids are used as therapeutic strategies. The methods recently introduced are platelet rich plasma concentrates and stem cells injected directly into the affected joint. The aim of this review article was the presentation of differential therapeutic options offered to patients in different stages of osteoarthritis.


Asunto(s)
Envejecimiento , Cartílago/patología , Osteoartritis/terapia , Analgésicos/uso terapéutico , Antiinflamatorios/uso terapéutico , Glucosamina/uso terapéutico , Humanos , Ácido Hialurónico/uso terapéutico
4.
Life Sci ; 236: 116861, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31513815

RESUMEN

Osteoarthritis is a prevalent worldwide joint disease, which demonstrates a remarkable adverse effect on the patients' life modality. Medicinal agents, exclusively nonsteroidal anti-inflammatory drugs (NSAIDs), have been routinely applied in the clinic. But, their effects are restricted to pain control with insignificant effects on cartilage renovation, which would finally lead to cartilage destruction. In the field of regenerative medicine, many researchers have tried to use stem cells to repair tissues and other human organs. However, in recent years, with the discovery of extracellular microvesicles, especially exosomes, researchers have been able to offer more exciting alternatives on the subject. Exosomes and microvesicles are derived from different types of bone cells such as mesenchymal stem cells, osteoblasts, and osteoclasts. They are also recognized to play substantial roles in bone remodeling processes including osteogenesis, osteoclastogenesis, and angiogenesis. Specifically, exosomes derived from a mesenchymal stem cell have shown a great potential for the desired purpose. Exosomal products include miRNA, DNA, proteins, and other factors. At present, if it is possible to extract exosomes from various stem cells effectively and load certain products or drugs into them, they can be used in diseases, such as rheumatoid arthritis, osteoarthritis, bone fractures, and other diseases. Of course, to achieve proper clinical use, advances have to be made to establish a promising regenerative ability for microvesicles for treatment purposes in the orthopedic disorders. In this review, we describe the exosomes biogenesis and bone cell derived exosomes in the regenerate process of bone and cartilage remodeling.


Asunto(s)
Cartílago Articular/citología , Exosomas/trasplante , Osteoartritis/terapia , Osteogénesis , Células Madre/citología , Humanos , Osteoartritis/complicaciones , Osteoartritis/patología , Medicina Regenerativa
5.
Biomed Res Int ; 2019: 4732654, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31428637

RESUMEN

Introduction: High levels of total cholesterol, triglycerides, and, connected with them, lipoprotein fractions may result in atherosclerosis. There are various forms of therapy used to prevent cardiovascular diseases, such as balneophysiotherapy, the effectiveness of which is confirmed by numerous scientific publications. Objective: The objective of this study was to assess the impact of balneophysiotherapeutic procedures on the systemic metabolism of lipids in patients suffering from osteoarthritis of the motor organ. Material and Methods: The study was conducted in the Health Resort Swieradów-Zdrój. Observation included patients undergoing radon water therapy. Before therapy and after 21 days of treatment, lipid profile was assessed with the use of standard colorimetric assay. Study group consisted of n=34 patients with degenerative joints and disc disease. The mean age of patients was 56.5l. The control group consisted of 17 people selected among the employees of the spa also suffering from osteoarthritis. The mean age was 54.2 years. Results: The results of the study are based on a single, 21-day health resort stay period in April/May. A statistically significant increase in HDL cholesterol levels was observed in female patients having undergone health resort treatment (P<0.01). Statistically significant drops in LDL cholesterol and TG levels were observed in the control group (P<0.01). An increase in HDL levels was observed in the male and female control subjects, with P<0.05. Conclusions: (1) After the end of therapy, there were no changes in lipid metabolism in men, while in the group of women an increase in HDL level was observed. (2) In the control group, statistically significant changes in the field of lipid metabolism may be related to lifestyle changes as a result of educational activities conducted prior to the research. (3) Due to the divergent results, it is advisable to conduct randomized studies in a larger population. This trial is registered with NCT03274128.


Asunto(s)
Balneología , Degeneración del Disco Intervertebral , Lípidos/sangre , Osteoartritis , Caracteres Sexuales , Anciano , Femenino , Humanos , Degeneración del Disco Intervertebral/sangre , Degeneración del Disco Intervertebral/fisiopatología , Degeneración del Disco Intervertebral/terapia , Masculino , Persona de Mediana Edad , Osteoartritis/sangre , Osteoartritis/fisiopatología , Osteoartritis/terapia
6.
Orthop Clin North Am ; 50(4): 433-443, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466660

RESUMEN

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.


Asunto(s)
Cartílago Articular/lesiones , Fracturas Intraarticulares/complicaciones , Osteoartritis/terapia , Artroplastia , Difosfonatos/uso terapéutico , Progresión de la Enfermedad , Glucocorticoides/uso terapéutico , Humanos , Ácido Hialurónico/uso terapéutico , Trasplante de Células Madre Mesenquimatosas , Osteoartritis/etiología
7.
Orthopade ; 48(9): 795-808, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31432200

RESUMEN

Primary osteoarthritis of the shoulder represents a destructive joint disease with associated synovitis, which in the first line seems to be genetically determined. Clinically, patients suffer from shoulder pain with progressive impairment of both active and passive range of motion. The diagnostics include a clinical examination, imaging by native radiography and magnetic resonance imaging (MRI) for assessment of the rotator cuff. Current classification systems consider the formation of humeral osteophytes, glenoid morphology and loss of humeral sphericity. Non-surgical measures include, apart from topical and oral analgesics, injection of corticosteroids and hyaluronic acid supported by physiotherapeutic measures. After failure of non-surgical therapeutic measures, arthroscopic joint-preserving arthroplasty in terms of the comprehensive arthroscopic management (CAM) procedure can be performed in young patients with early stage osteoarthritis, whereas in advanced stages endoprosthetic joint replacement is indicated.


Asunto(s)
Osteoartritis/diagnóstico , Articulación del Hombro , Artroplastia de Reemplazo , Humanos , Osteoartritis/terapia , Rango del Movimiento Articular , Hombro , Resultado del Tratamiento
8.
Implement Sci ; 14(1): 74, 2019 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337394

RESUMEN

BACKGROUND: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years. METHODS: Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics. RESULTS: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013. CONCLUSIONS: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.


Asunto(s)
Conducta Cooperativa , Insuficiencia Cardíaca/terapia , Osteoartritis/terapia , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad/organización & administración , Sistema de Registros , Humanos , Evaluación de Programas y Proyectos de Salud , Suecia , Factores de Tiempo
9.
BMC Musculoskelet Disord ; 20(1): 335, 2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31324245

RESUMEN

BACKGROUND: Previous basic research and clinical studies examined the effects of mesenchymal stem cells (MSCs) on regeneration and maintenance of articular cartilage. However, our pilot study suggested that MSCs are more effective at suppressing inflammation and pain rather than promoting cartilage regeneration in osteoarthritis. Adipose tissue is considered a useful source of MSCs; it can be harvested easily in larger quantities compared with the bone marrow. The present study was designed to evaluate the anti-inflammatory, analgesic, and regenerative effects of intra-articularly injected processed lipoaspirate (PLA) cells (containing adipose-derived MSCs) on degenerative cartilage in a rat osteoarthritis model. METHODS: PLA cells were isolated from subcutaneous adipose tissue of 12-week-old female Sprague-Dawley rats. Osteoarthritis was induced by injection of monoiodoacetate (MIA). Each rat received 1 × 106 MSCs into the joint at day 7 (early injection group) and day 14 (late injection group) post-MIA injection. At 7, 14, 21 days after MIA administration, pain was assessed by immunostaining and western blotting of dorsal root ganglion (DRG). Cartilage quality was assessed macroscopically and by safranin-O and H&E staining, and joint inflammation was assessed by western blotting of the synovium. RESULTS: The early injection group showed less cartilage degradation, whereas the late injection group showed cartilage damage similar to untreated OA group. The relative expression level of CGRP protein in DRG neurons was significantly lower in the two treatment groups, compared with the untreated group. CONCLUSIONS: Intra-articular injection of PLA cells prevented degenerative changes in the early injection group, but had little effect in promoting cartilage repair in the late injection group. Interestingly, intra-articular injection of PLA cells resulted in suppression of inflammation and pain in both OA groups. Further studies are needed to determine the long-term effects of intra-articular injection of PLA cells in osteoarthritis.


Asunto(s)
Artralgia/terapia , Artritis Experimental/terapia , Cartílago Articular/patología , Trasplante de Células Madre Mesenquimatosas/métodos , Osteoartritis/terapia , Tejido Adiposo/citología , Animales , Artralgia/diagnóstico , Artralgia/etiología , Artritis Experimental/inducido químicamente , Biomarcadores/análisis , Femenino , Ganglios Espinales/patología , Humanos , Inyecciones Intraarticulares , Ácido Yodoacético/toxicidad , Articulación de la Rodilla/inervación , Articulación de la Rodilla/patología , Osteoartritis/inducido químicamente , Osteoartritis/patología , Dimensión del Dolor/métodos , Ratas , Ratas Sprague-Dawley , Resultado del Tratamiento
10.
Z Rheumatol ; 78(Suppl 2): 73-79, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31342161

RESUMEN

BACKGROUND: The objective of the research consortium PROCLAIR was to gain population level knowledge on the treatment of patients with rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and osteoarthritis (OA) in Germany. AIMS: A main question of the consortium was whether it is possible to identify groups of people who were exposed to a particular risk of undersupply or oversupply of treatment. In addition, the study investigated the validity of claims data for these diseases as a basis for further studies. PATIENTS AND METHODS: Cross-sectional surveys were carried out among insurees of the BARMER statutory health insurance fund whose claims data included RA, axSpA and OA diagnoses. The questionnaire data were linked with the claims data of the insured persons if they agreed. RESULTS: In all three diseases risk groups for care deficits could be identified. Persons with RA who are not treated by a specialist have less access to drug treatment. Physical therapy is prescribed for all three diagnoses at a low level, even for people undergoing joint replacement surgery. A connection between depressive symptoms and disease activity or function in axSpA was shown. In addition to the results relevant to care, the PROCLAIR network has also made contributions to critically assess the quality of health insurance data. DISCUSSION: The combination of billing data with survey data enables a comprehensive description of the treatment of musculoskeletal diseases. Particularly relevant factors are the specialization of the physician, sociodemographic parameters of the patients and the region of residence. In particular, access to treatment cannot be investigated in randomized clinical trials.


Asunto(s)
Artritis Reumatoide , Accesibilidad a los Servicios de Salud , Osteoartritis , Espondiloartritis , Artritis Reumatoide/terapia , Estudios Transversales , Alemania , Humanos , Osteoartritis/terapia , Espondiloartritis/terapia
11.
Medicine (Baltimore) ; 98(29): e16367, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31335683

RESUMEN

RATIONALE: Kashin-Beck disease (KBD) is known for some typical characters like finger joint enlargement, shortened fingers, and dwarfism. However, Avascular necrosis (AVN) of the talus in KBD has rarely been reported in the literature. Here, we reported on a KBD patient presented with partial AVN of the talus in conjunction with ankle and subtalar arthritis. PATIENT CONCERNS: A 50-year-old woman presented with severe pain and limited range of motion in her left ankle and subtalar joint while walking for 2 years. She had been walking with the aid of crutches for many years. Conservative treatment with rigid orthosis and activity restriction could not help reduce the pain in the left foot. DIAGNOSES: Radiographs demonstrated that partial AVN was developed in the body of the talus and arthritis was viewed in the left ankle and subtalar joint. Hence, we established the diagnosis of partial talar AVN in conjunction with ankle and subtalar arthritis. INTERVENTIONS: A conservative tibiotalocalcaneal fusion attempting to preserve as much viable talar body as possible was performed using a humeral locking plate and 2 cannulated compression screws. OUTCOMES: Bone union proved by CT scan and a good alignment of the left limb were achieved at 4-month follow-up postoperatively. LESSONS: Partial AVN of the talus along with ankle and subtalar arthritis in KBD patients has rarely been reported as it is not a common characteristic of KBD in clinical practice. Conservative tibiotalocalcaneal fusion could help preserving much more viable talar body, maintaining most structural integrity of the ankle joint, and achieving a stable and plantigrade foot postoperatively.


Asunto(s)
Articulación del Tobillo , Enfermedad de Kashin-Beck , Procedimientos Ortopédicos , Osteoartritis , Articulación Talocalcánea , Astrágalo , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/patología , Placas Óseas , Tornillos Óseos , China , Femenino , Humanos , Enfermedad de Kashin-Beck/diagnóstico , Enfermedad de Kashin-Beck/fisiopatología , Persona de Mediana Edad , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Osteoartritis/diagnóstico , Osteoartritis/etiología , Osteoartritis/fisiopatología , Osteoartritis/terapia , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Osteonecrosis/fisiopatología , Osteonecrosis/terapia , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/patología , Astrágalo/diagnóstico por imagen , Astrágalo/patología , Resultado del Tratamiento
12.
BMC Musculoskelet Disord ; 20(1): 316, 2019 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-31279341

RESUMEN

BACKGROUND: Synovial mesenchymal stem cells (MSCs) are an attractive cell source for cartilage and meniscus regeneration. The optimum cryopreservation medium has not been determined, but dimethylsulfoxide (DMSO) should be excluded, if possible, because of its toxicity. The purposes of our study were to examine the possible benefits of higher concentrations of serum and the effectiveness of 100% serum (without DMSO) for the cryopreservation of synovial MSCs. METHODS: Human synovium was harvested from the knees of four donors with osteoarthritis during total knee arthroplasty. Synovial MSCs (8 × 105 cells) were suspended in 400 µL medium and used as a Time 0 control. The same number of synovial MSCs was also suspended in 400 µL α-MEM medium containing 10% fetal bovine serum (FBS) (5% DMSO, and 1% antibiotic), 95% FBS (and 5% DMSO), or 100% FBS (no DMSO) and cryopreserved at - 80 °C for 7 days. After thawing, the cell suspensions (1.5 µL; 3 × 103 cells) were cultured in 60 cm2 dishes for 14 days for colony formation assays. Additional 62.5 µL samples of cell suspensions (1.25 × 105 cells) were added to tubes and cultured for 21 days for chondrogenesis assays. RESULTS: Colony numbers were significantly higher in the Time 0 and 95% FBS groups than in the 10% FBS group (n = 24). Colony numbers were much lower in the 100% FBS group than in the other three groups. The cell numbers per dish reflected the colony numbers. Cartilage pellet weights were significantly heavier in the 95% FBS group than in the 10% FBS group, whereas no difference was observed between the Time 0 and the 95% FBS groups (n = 24). No cartilage pellets formed at all in the 100% FBS group. CONCLUSION: Synovial MSCs cryopreserved in 95% FBS with 5% DMSO maintained their colony formation and chondrogenic abilities to the same levels as observed in the cells before cryopreservation. Synovial MSCs cryopreserved in 100% FBS lost their colony formation and chondrogenic abilities.


Asunto(s)
Condrogénesis/efectos de los fármacos , Criopreservación/métodos , Crioprotectores/farmacología , Células Madre Mesenquimatosas , Membrana Sinovial/citología , Anciano , Técnicas de Cultivo de Célula , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Crioprotectores/química , Dimetilsulfóxido/química , Dimetilsulfóxido/farmacología , Femenino , Humanos , Articulación de la Rodilla/citología , Trasplante de Células Madre Mesenquimatosas , Osteoartritis/terapia , Suero/química
13.
Artículo en Alemán | MEDLINE | ID: mdl-31273415

RESUMEN

BACKGROUND: Little is known about the utilization of individual health services performed by a physician (IGeL) and the services and supplements provided outside a doctor's office (MuPaP) for osteoarthritis patients. OBJECTIVES: The aims of this study are to analyze the use of osteoarthritis-specific IGeL and MuPaP as well as predictors for their utilization. MATERIALS AND METHODS: For this cross-sectional study, claims data was used to identify all persons with hip, knee, or polyarticular osteoarthritis in 2014 (n = 657,807). A random sample (n = 8995) was sent a questionnaire about their usage of IGeL and MuPaP. Furthermore, the type of physicians conducting or recommending services was evaluated. Applying multivariable logistic regression, predictors associated with the utilization of IGeL, MuPaP, and overall individual health services were analyzed. RESULTS: After validating the data and osteoarthritis diagnosis, 2363 persons were enrolled (mean age: 65.5 years, 72% female). In the last 12 months, 39% of patients had used at least one IGeL (MuPaP: 76%), with 86% being primarily performed by orthopedists (MuPaP: 88% patient self-motivated). Knee osteoarthritis was associated with increased utilization of IGeL. Having female gender, higher income, residence in Western Germany, higher disease burden, and lower satisfaction with the healthcare system were influences on the use of overall individual health services. CONCLUSIONS: Since patients with high disease burden in particular tend to use these therapies with varying treatment success, detailed information, especially about the risks and existing evidence, should be a prerequisite for trustworthy doctor-patient relationships.


Asunto(s)
Costo de Enfermedad , Gastos en Salud/estadística & datos numéricos , Formulario de Reclamación de Seguro/estadística & datos numéricos , Osteoartritis de la Cadera/terapia , Osteoartritis de la Rodilla/terapia , Osteoartritis/terapia , Reclamos Administrativos en el Cuidado de la Salud , Anciano , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Estudios Transversales , Femenino , Alemania , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Masculino , Osteoartritis/diagnóstico , Clase Social , Encuestas y Cuestionarios
14.
Z Rheumatol ; 78(8): 713-721, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31273459

RESUMEN

BACKGROUND: The objective of the research consortium PROCLAIR was to gain population level knowledge on the treatment of patients with rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and osteoarthritis (OA) in Germany. AIMS: A main question of the consortium was whether it is possible to identify groups of people who were exposed to a particular risk of undersupply or oversupply of treatment. In addition, the study investigated the validity of claims data for these diseases as a basis for further studies. PATIENTS AND METHODS: Cross-sectional surveys were carried out among insurees of the BARMER statutory health insurance fund whose claims data included RA, axSpA and OA diagnoses. The questionnaire data were linked with the claims data of the insured persons if they agreed. RESULTS: In all three diseases risk groups for care deficits could be identified. Persons with RA who are not treated by a specialist have less access to drug treatment. Physical therapy is prescribed for all three diagnoses at a low level, even for people undergoing joint replacement surgery. A connection between depressive symptoms and disease activity or function in axSpA was shown. In addition to the results relevant to care, the PROCLAIR network has also made contributions to critically assess the quality of health insurance data. DISCUSSION: The combination of billing data with survey data enables a comprehensive description of the treatment of musculoskeletal diseases. Particularly relevant factors are the specialization of the physician, sociodemographic parameters of the patients and the region of residence. In particular, access to treatment cannot be investigated in randomized clinical trials.


Asunto(s)
Artritis Reumatoide , Osteoartritis , Espondiloartritis , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/terapia , Productos Biológicos/uso terapéutico , Estudios Transversales , Alemania , Humanos , Osteoartritis/diagnóstico , Osteoartritis/terapia , Modalidades de Fisioterapia , Espondiloartritis/diagnóstico , Espondiloartritis/terapia , Encuestas y Cuestionarios
15.
Vet Anaesth Analg ; 46(5): 689-698, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31358392

RESUMEN

OBJECTIVE: Thermal radiofrequency (TRF) of the saphenous nerve (a sensory nerve) combined with pulsed radiofrequency (PRF) of the sciatic nerve (a sensory and motor nerve) might relieve intractable stifle osteoarthritis (OA) pain in dogs. The objective was to determine if saphenous nerve TRF induces Wallerian degeneration and if sciatic nerve PRF induces degeneration or dysfunction. STUDY DESIGN: Blinded, controlled, randomized, preclinical study. ANIMALS: A group of six intact, female Beagle dogs aged 14-16 months. METHODS: In each dog, one pelvic limb was assigned randomly to the control group and the other to the treatment group. Dogs were anesthetized and, using ultrasonography, radiofrequency electrodes were positioned adjacent to saphenous and sciatic nerves bilaterally; TRF and PRF were performed only in the treatment limb. Motor nerve conduction velocity (MNCV) was measured in both sciatic nerves 2 weeks later, and the dogs were euthanized. Hematoxylin and eosin-stained sections of saphenous and sciatic nerves were examined using light microscopy. Degeneration and inflammation were scored 0 (none) to 3 (severe). A one-tailed, paired Wilcoxon signed-rank test was used to test for differences in scores and MNCV between control and treatment nerves. RESULTS: Degeneration and inflammation scores were higher in treatment saphenous nerves in 5/6 dogs [83%; 95% confidence interval (CI), 36%, 99%]; however, after Bonferroni correction only degeneration score was higher (p = 0.0313). Degeneration, inflammation or decreased MNCV were not observed in sciatic nerves (each outcome: 0/6 nerves, 0%; 95% CI, 0%, 48%). No dogs experienced postprocedural pain or neurological deficits. CONCLUSIONS AND CLINICAL RELEVANCE: The degeneration in TRF-treated saphenous nerves appears sufficient to impair transmission. Sciatic nerve PRF did not cause degeneration with attendant motor deficits, consistent with a proposed neuromodulatory mechanism. A clinical trial is needed to confirm the combined techniques produce analgesia without motor deficits in dogs with stifle OA.


Asunto(s)
Dolor Crónico/veterinaria , Enfermedades de los Perros/terapia , Osteoartritis/veterinaria , Terapia por Radiofrecuencia/veterinaria , Rodilla de Cuadrúpedos/inervación , Animales , Dolor Crónico/terapia , Perros , Femenino , Osteoartritis/terapia , Dimensión del Dolor/veterinaria , Nervio Ciático/anatomía & histología , Nervio Ciático/fisiología , Método Simple Ciego , Nervios Espinales/anatomía & histología , Nervios Espinales/fisiología
16.
J Craniofac Surg ; 30(4): 1144-1148, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31166260

RESUMEN

There are few studies in the literature that comparatively evaluate the use of intra-articular orticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). In this study, the authors aimed to compare the clinical results of intra-articular CS, HA, and PRP injections in patients who presented to the authors' clinic with temporomandibular joint (TMJ) pain and clinically diagnosed with TMJ-osteoarthritis. Patients were evaluated in 2 groups as those patients who felt pain on lateral (n = 31), and posterior (n = 43) palpation. Patients who were evaluated in the study were randomly assigned to 3 different treatment groups as Group 1 (PRP), Group 2 (HA), and Group 3 (CS). Pain felt on the TMJ on lateral and posterior palpation was assessed before treatment and every month for 3 months using a 5-point pain scale. Presence of crepitation, loss of function, and loss of strength were assessed before treatment and every month for 3 months. Significant changes were observed in the PRP and HA groups when the patients were evaluated according to the VAS scores evaluated at different follow-up times for TMJ pain on lateral palpation. Significant changes were observed in the PRP, HA, and CS groups when VAS scores were evaluated according to the patients' follow-up times for TMJ pain on lateral palpation. In conclusion, the findings of this study have shown that intra-articular PRP injections decreased TMJ palpation pain more effectively compared with the HA and CS groups.


Asunto(s)
Glucocorticoides/uso terapéutico , Ácido Hialurónico/uso terapéutico , Osteoartritis/terapia , Plasma Rico en Plaquetas , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Triamcinolona Acetonida/uso terapéutico , Viscosuplementos/uso terapéutico , Escala Visual Analógica
18.
Surg Technol Int ; 35: 280-294, 2019 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-31237341

RESUMEN

Ankle osteoarthritis constitutes a large burden to society and is a leading cause of chronic disability in the United States. Most commonly, it is post-traumatic, occurs in younger individuals, and is associated with obesity. This entity presents similarly to osteoarthritis of the other joints, with the typical nonspecific symptoms of stiffness, swelling, and pain. Radiographic investigation includes four weight-bearing standard views: antero-posterior and lateral foot, mortise view of the ankle, and a specialized view of the hindfoot. In this review, we covered epidemiology, anatomy and biomechanics, etiology, pathology, differential diagnoses, symptoms, physical examination, appropriate radiological investigation, as well as current treatment options and algorithms. Non-operative treatment options include weight loss, physical therapy, bracing, orthoses, pharmacologic treatments, corticosteroid injections, viscosupplementation, and biologic modalities. Viscosupplementation with hyaluronic acid has the most evidence-based support and has been shown to be safe and efficacious. For patients who have moderate to severe disease, surgery may be indicated. However, current surgical options are either associated with high rates of complications or restrict ankle range of motion (ROM). Early stages of the ankle osteoarthritis should be treated with the above-mentioned non-surgical methods, and once the disease progresses, surgical options can be utilized.


Asunto(s)
Osteoartritis , Viscosuplementación , Tobillo , Articulación del Tobillo , Humanos , Ácido Hialurónico , Osteoartritis/terapia
20.
Rev. cient. odontol ; 7(1): 121-131, ene.-jun. 2019.
Artículo en Español | LILACS | ID: biblio-1005981

RESUMEN

Este artículo involucra una revisión de los factores etiológicos asociados a la osteoartritis (OA) de la articulación temporomandibular (ATM), así como los hallazgos imagenológicos, los cuales son indispensables para el diagnóstico y la determinación de la etapa de evolución de esta patología. Además, se discuten los métodos de tratamiento invasivos y no invasivos. Los objetivos del presente artículo fueron describir los métodos de diagnóstico y tratamiento más actuales y eficientes para la osteoartritis de la articulación temporomandibular, y determinar la existencia de la correlación clínica e imagenológica en las diferentes etapas de esta patología. A partir de una revisión de la literatura, se encontró que el método de diagnóstico más relevante para la OA de la ATM es la tomografía computarizada de haz cónico (TCHC), por sus múltiples ventajas. El método de tratamiento más eficiente durante la etapa sintomatológica de la enfermedad es la artrocentesis sinergizada con ácido hialurónico o plasma rico en plaquetas. Cabe resaltar que no se encontraron correlaciones directas suficientes entre los cambios óseos y la sintomatología clínica de la OA de ATM empleando la TCHC. (AU)


The objectives of this article were to describe the most current and efficient diagnostic and treatment methods for osteoarthritis of the temporomandibular joint (TMJ) and to determine the correlation of clinical and imaging in the different stages of this pathology. We review the etiological factors associated with osteoarthritis (OA) of the TMJ as well as the imaging findings, which are essential for the diagnosis and determination of the stage of evolution of this pathology. In addition, invasive and noninvasive treatment methods are discussed. Based on review of the literature, the most relevant diagnostic method for OA of the TMJ is conic beam computed tomography (CBCT), due to its multiple advantages. The most efficient treatment method during the symptomatic stage of the disease is arthrocentesis synergized with hyaluronic acid or plateletrich plasma. It was of note that no direct correlation was found between bone changes and the clinical symptomatology of TMJ OA using CBCT. (AU)


Asunto(s)
Humanos , Osteoartritis/terapia , Osteoartritis/diagnóstico por imagen , Articulación Temporomandibular , Espectroscopía de Resonancia Magnética , Tomografía Computarizada de Haz Cónico , Artrocentesis
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