Daytime Functional Usage Versus Night-Time Wearing: Identifying the Optimal Wearing Regimen for a Custom-Made Orthosis in the Treatment of Trapeziometacarpal Osteoarthritis.

OBJECTIVE: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA). DESIGN: Randomized, controlled single-blind trial. SETTING: The rheumatology outpatient clinic of the University. PARTICIPANTS: Sixty participants diagnosed with trapeziometacarpal OA. INTERVENTIONS: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night. MAIN OUTCOMES MEASURES: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function. RESULTS: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006). CONCLUSIONS: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients.

The current insights of mitochondrial hormesis in the occurrence and treatment of bone and cartilage degeneration.

It is widely acknowledged that aging, mitochondrial dysfunction, and cellular phenotypic abnormalities are intricately associated with the degeneration of bone and cartilage. Consequently, gaining a comprehensive understanding of the regulatory patterns governing mitochondrial function and its underlying mechanisms holds promise for mitigating the progression of osteoarthritis, intervertebral disc degeneration, and osteoporosis. Mitochondrial hormesis, referred to as mitohormesis, represents a cellular adaptive stress response mechanism wherein mitochondria restore homeostasis and augment resistance capabilities against stimuli by generating reactive oxygen species (ROS), orchestrating unfolded protein reactions (UPRmt), inducing mitochondrial-derived peptides (MDP), instigating mitochondrial dynamic changes, and activating mitophagy, all prompted by low doses of stressors. The varying nature, intensity, and duration of stimulus sources elicit divergent degrees of mitochondrial stress responses, subsequently activating one or more signaling pathways to initiate mitohormesis. This review focuses specifically on the effector molecules and regulatory networks associated with mitohormesis, while also scrutinizing extant mechanisms of mitochondrial dysfunction contributing to bone and cartilage degeneration through oxidative stress damage. Additionally, it underscores the potential of mechanical stimulation, intermittent dietary restrictions, hypoxic preconditioning, and low-dose toxic compounds to trigger mitohormesis, thereby alleviating bone and cartilage degeneration.

The role of renin angiotensin system in the pathophysiology of rheumatoid arthritis.

BACKGROUND: In rheumatoid arthritis (RA) and osteoarthritis (OA), chronic inflammatory processes lead to progresive joint destruction. The renin-angiotensin system (RAS) is involved in the pathogenesis of RA and OA. The aim of this mini-review article is to summarize evidence on the role of RAS in RA and OA. METHODS: A non-systematic search in Pubmed included terms as "rheumatoid arthritis", "renin angiotensin system", "osteopenia", "RANKL", "DKK-1", "MMP", "inflammation", "angiogenesis", "local renin-angiotensin system", "angiotensin converting enzyme", "AT2 receptor", "Ang-(1-7)", "VEGF", "angiotensine receptor blocker", "angiotensin converting enzyme inhibitors", "renin inhibitors". RESULTS: Both RAS axes, the classical one, formed by angiotensin converting enzyme (ACE), angiotensin (Ang) II and AT1 receptor (AT1R) and the counter-regulatory one, composed by ACE2, Ang-(1-7) and the Mas receptor, modulate inflammation and tissue damage. Ang II activates pro-inflammatory mediators and oxidative stress. Conversely, Ang-(1-7) exerts anti-inflammatory actions, decreasing cytokine release, leukocyte attraction, density of vessels, tissue damage and fibrosis. Angiogenesis facilitates inflammatory cells invasion, while osteopenia causes joint dysfunction. Up-regulated osteoclastogenisis and down-regulated osteoblastogeneses were associaed with the activation of the classical RAS axis. Three different pathways, RANKL, DKK-1 and MMPs are enhanced by classical RAS activation. The treatment of RA included methotrexate and corticosteroids, which can cause side effects. Studies with angiotensin receptor blockers (ARBs), angiotensin converting enzyme inhibitors (ACEi) and renin inhibitors have been conducted in experimental and clinical RA with promising results. CONCLUSION: The classical RAS activation is an important mechanism in RA pathogenesis and the benefit of ARB and ACEi administration should be further investigated.

Initial stages of hand osteoarthritis do not affect the extrinsic muscles of the hand: a cross-sectional study.

The objective of this study was to verify whether women in the initial stages of hand osteoarthritis (HOA) already have impaired grip strength and flexor and extensor torque of the wrist compared to healthy women. It also aimed to correlate these variables with pain, stiffness, and function of the hand. Twenty-six women were divided into a control group [CG, n = 13; 56 (51-61) years old] and a hand osteoarthritis group [HOAG, n = 13; 58 (53-63) years old]. Grades II and III were included in the HOA group according to the criteria of Kellgren and Lawrence. All volunteers answered an initial assessment form, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Australian/Canadian Hand Osteoarthritis Index (AUSCAN). The grip strength and isometric wrist flexor and extensor torque were evaluated by a hydraulic dynamometer. Comparisons between groups used Student's t test for independent samples and the Mann-Whitney test. Spearman's correlation was used to correlate grip strength and flexor and extensor wrist torque to the degree of disease and DASH and AUSCAN scores. There were no differences between the groups in grip strength or flexor and extensor torque values. In terms of the DASH and the AUSCAN, the HOA group had higher scores, indicating worse hand function. A strong negative correlation was found between grip strength and the degree of HOA (r = - 0.70, p = 0.008), and a moderate positive correlation was found between flexor torque and the degree of HOA (r = 0.53, p = 0.05). The pain (r = - 0.61, p = 0.02) and function (r = - 0.66, p = 0.01) sections of the AUSCAN correlated negatively with grip strength. Pain can be an important feature in the HOA rehabilitation process, as it can influence handgrip strength and function. It is important that rehabilitation is implemented as soon as possible to guarantee the maintenance of strength and function since with the severity of the disease, patients tend to have deficits in grip strength and function.

Resistance training decreases matrix metalloproteinase-2 activity in quadriceps tendon in a rat model of osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a degenerative disease that induces peri-articular tissue degradation. OA induces an imbalance between synthesis and degradation of the extracellular matrix components in favor of catabolic events, promoting pathological remodeling and involving degradative enzymes, such as matrix metalloproteinases (MMPs). OBJECTIVE: This study aimed to investigate the effects of 8-weeks resistance training (RT) on MMP-2 activity in the quadriceps tendon and patellar tendon in an OA model. METHODS: Twenty-four Wistar rats were randomly divided into six groups: Control, Exercise, Sham, Sham with Exercise, OA, and OA with Exercise (OAE). The OA model was performed by anterior cruciate ligament transection surgery on the left knee. The 8-week RT consisted of climbing a 1.1-m vertical ladder three times per week with progressive weights secured to the animals' tails. MMP-2 activity was analyzed by zymography. RESULTS: The OAE group displayed lower pro, intermediate, and active MMP-2 activity in the quadriceps tendon compared with the OA group (p<0.05). For the patellar tendon, there was no significant difference between the OAE group compared with the other groups (p>0.05) for pro, intermediate, and active MMP-2 activity. Moreover, MMP-2 activity differed between tissues, the OA and OAE groups presented lower pro, intermediate, and active MMP-2 activity in the quadriceps tendon compared to the patellar tendon. CONCLUSION: RT induced down-regulated MMP-2 activity in the quadriceps tendon. RT is a potential therapeutic approach to minimize the deleterious effects of extracellular matrix degeneration.

Functional index for hand osteoarthritis (FIHOA) is associated with pain, muscle strength, and EQ-5D in hand osteoarthritis

Abstract Background: This study identified whether Functional Index for Hand Osteoarthritis (FIHOA) is associated with pain, hand muscle strength, health-related quality of life, and radiographic severity in hand osteoarthritis (OA). Methods: We consecutively recruited 95 patients with hand OA. The FIHOA was used to assess questionnaire-based physical function in hand OA. Health-related quality of life was evaluated using EuroQol-5 dimension (EQ-5D). Radiographic changes of hand joints were measured by Kellgren-Lawrence (K-L) grade, which was determined based on total radiographic severity score and number of affected joints. Other measures included patient's visual analogue scale (VAS) score for pain and performance-based function indexes such as grip and pinch strength. Statistical analysis was performed using Mann-Whitney U test, Spearman's correlation analysis, and multivariate logistic regression analysis. Results: FIHOA score was negatively associated with grip and pinch hand strength and EQ-5D and positively correlated to VAS pain (p < 0.05 for all). There were significant differences of grip and pinch strength, VAS pain, EQ-5D index, and EQ-VAS between two FIHOA groups (≤ 4 vs. > 4) (p < 0.05 for all). Multivariate logistic regression analysis showed that higher FIHOA score (FIHOA > 4) was related with increased VAS pain and with lower EQ-5D index (p = 0.008 and p = 0.013, respectively). There was no association between FIHOA score and measures of total radiographic severity score and number of affected joints. Conclusion: This study observes that FIHOA score is associated with patient-reported VAS pain, hand muscle strength indexes, and EQ-5D but not radiographic severity in hand OA.

Muscle function, physical function, and gait in older women with and without knee osteoarthritis

Abstract Aim: To compare muscle function of knee extensors, gait parameters, and physical function in older women with and without knee osteoarthritis (KOA) and to associate these parameters to the KOA incidence in this population. Methods: Sixteen older women with KOA (66.9 ± 5.5 years; 74.9 ± 10.0 kg; 157.9 ± 0.9 cm; 30.2 ± 5.0 kg/m2) and fourteen healthy counterparts (control group: CG; 68.8 ± 5.8 years; 68.9 ± 10.5 kg; 158 ± 0.06 cm; 27.4 ± 4.0 kg/m2) participated in this study. Muscle function, physical function, and gait parameters were evaluated in both groups. The Western Ontario and McMaster Index (WOMAC) questionnaire was answered only by the KOA group. A correlation was performed to verify if KOA incidence was associated with muscle function, physical function, and gait parameters. Results: KOA group showed lower peak torque at 60°/s (30%; p = 0.003) and 180°/s (37%; p < 0.001), greater acceleration time at 60°/s (382%; p < 0.001), lower cadence (12.2%; p = 0.002), slower gait speed (19.5%; p < 0.001) and greater stride time (12.5%; p = 0.001) than CG group. However, there was no difference between groups in physical function (p < 0.0045). The KOA incidence presented a negative correlation with peak torque (rho = −0.602; p < 0.001), cadence (rho = −0.533; p = 0.002), gait speed (rho = −0.633; p < 0.001), stride length (rho = −0.517; p = 0.003) and a positive correlation with stride time (rho = 0.533; p = 0.002) and acceleration time (rho = 0.655; p < 0.001). Conclusion: Our findings suggest that knee osteoarthritis may impair the function of the knee extensors muscles and gait parameters. An association between the ability to produce force rapidly and gait speed with the KOA incidence in older women was also observed.

Osteoarthrosis: Analyze of the Molar Bite Force, Thickness and Masticatory Efficiency.

Osteoarthrosis is a disorder of synovial joints, resulting from destruction of the cartilage and subchondral bone. The present study is aimed to investigate the molar bite force, thickness and efficiency of the masseter and temporalis muscles of subjects with osteoarthrosis. A total of forty-eight subjects participated in the study. They were distributed into two groups: with osteoarthrosis (n=24) and asymptomatic controls (n=24). Subjects were analyzed on the basis of maximal molar bite force (right and left side), thickness (mandibular rest and dental clenching in maximal voluntary contraction) and electromyographic activity of masticatory cycles through the linear envelope integral in habitual (raisins and peanuts) and non-habitual (Parafilm M) chewing of the masseter and temporalis muscles. All the data were analyzed statistically using t-test with a significance level of p≤0.05. There was no difference between groups in maximal molar bite force, muscle thickness and non-habitual chewing. Differences were found on the raisins (p=0.02) and peanuts (p=0.05) chewing for right temporal muscle, with reduced masticatory muscle efficiency in osteoarthrosis subjects. This study showed that osteoarthrosis induces negative changes in habitual chewing, highlighting the efficiency of the right temporalis muscles. The greater temporal muscle activity in subjects with osteoarthrosis may compromise chewing and consequently the nutritional status of adult subjects.

Ejercicio en ratas con osteoartritis: aspectos morfológicos y una revisión de la literatura / Exercise in rats osteoarthritis: morphological aspects and literature review

La osteoartritis (OA) es una enfermedad crónica, degenerativa, muy invalidante, que destruye en forma gradual y progresiva el cartílago articular en diversas regiones: rodillas, caderas, hombros, manos, tobillos y columna vertebral. En este sentido, el ejercicio ha sido descrito como la intervención no farmacológica más recomendada para pacientes con OA. La práctica regular de ejercicio es considerada un componente integral del estilo de vida saludable; sin embargo, su efecto en el cartílago se mantiene como objeto de debate y especulaciones, así como la relación del ejercicio con el desarrollo de OA. Algunos estudios de modelos animales sugieren que el ejercicio puede ser beneficioso para la salud del cartílago, mientras otros demuestran su efecto nocivo. Una explicación general a estos resultados inconsistentes es que el correr a intensidad moderada tiene efectos beneficiosos, mientras que correr "vigorosamente" o de manera "extenuante" lleva a un efecto nocivo. El objetivo de este trabajo consistió en realizar una revisión de la literatura acerca de los efectos del ejercicio sobre el cartílago artícular, especialmente enfocado a modelos animales experimentales con ratas.

Osteoarthritis (OA) is a chronic, degenerative, and very disabling disease that gradually and progressively destroys articular cartilage in various regions: knees, hips, shoulders, hands, ankles and spine. In this sense, exercise has been described as the most recommended non-pharmacological intervention for patients with OA. Regular exercise is considered an integral component of the healthy lifestyle. However, its effect on cartilage remains the subject of debate and speculation, as well as the relationship between exercise and the development of OA. Some animal model studies suggest that exercise may be beneficial for cartilage health, while others demonstrate its harmful effect. A general explanation for these inconsistent results is that running at moderate intensity has beneficial effects, while running "vigorously" or "strenuously" leads to a harmful effect. The aim of this work was to make a literature review about the effects of exercise on cartilage, especially focused on experimental animal models with rats.

Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations

Abstract Background: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. Methods: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. Results: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. Conclusions: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.(AU)

Hylan G-F20 and galactomannan joint flares are associated to acute synovitis and release of inflammatory cytokines

Abstract Background: Injection of Hylan G-F20 (HY) into joints may provoke local flares, which mechanisms may involve reaction to protein contaminants. We have previously developed a protein-free saline-soluble galactomannan derived from guar gum (GM) that displays both analgesia and chondroprotection in experimental osteoarthritis (OA). We now demonstrate that both GM and Hylan G-F20 (HY) promote mild synovitis with cytokine release after intra-articular injection. Methods: Mice received 100 μg/25 μL GM or HY or saline into the knees. Joint pain was evaluated using von Frey test; cell influx, interleukin (IL)-1, IL-6, and CXCL-1 (pg/mL) levels were assessed in joint lavage at 6 h. Synovia were excised for histopathology. Results: Neither GM nor HY after being given into mice knee joints induced pain albeit promoting mild cell influx into joint washings as well as mild synovitis at histology, with no damage to the underlying cartilage. HY but not GM promoted IL-1 release into mice joints. Both compounds induced IL-6 and CXCL-1 release. Conclusion: Intra-articular injection of HY or GM promote acute transient synovitis whilst not provoking detectable significant joint damage. Local administration of these polysaccharides induces acute intra-articular release of inflammatory cytokines, which may account for joint flares following viscosupplementation.(AU)

Functional status and severity of osteoarthritis in elderly is associated to the polymorphism of TNFA gene.

BACKGROUND: Osteoarthritis (OA) is a major musculoskeletal disease with high prevalence in the elderly. The study of genetic polymorphisms of inflammatory mediators involved in OA may contribute to the elucidation of the complex pathophysiology of this disease and identification of susceptibility individuals. AIM: This study aimed to evaluate the association between polymorphism at tumor necrosis factor alpha gene (SNP - 308 G/A TNFA) with presence, severity and functional status of osteoarthritis in elderly. METHODS: This study was characterized as case-control and encompassed 257 physically independent elderly (Mean Age: 68.55 ± 5.2; Minimum age: 60 and Maximum age: 82) were recruited. After this selection, the groups were divided in: 92 elderly individuals with osteoarthritis (case group) and 165 without the disease (control group). METHODS: The individuals were genotyped by the TaqMan real-time PCR system. The subjects were classified based on the degree of radiological impairment according to the criteria of Kellgren-Laurence and regarding functional impairment using the WOMAC and LEQUESNE questionnaires. RESULTS: TNFA gene polymorphic individuals (subjects harboring allele A) are more affected by OA (χ2 = 8.7, p = 0.003), once they have major radiological lesion both in hip (Fisher-Freeman-Halton Test = 3.9, p = 0.04) and knee (Fisher-Freeman-Halton Test = 4.0, p = 0.04) as well as worse functional status assessed by the Lequesne questionnaire (Mann-Whitney, p = 0.04). At the multivariate analysis, after adjustment for age, gender, body mass index, the presence of rare allele for TNFA (allele A) increases the susceptibility to OA development [OR: 1.87 (95% CI: 1.1-3.2)]. CONCLUSION: We conclude that the SNP - 308 G/A of TNFA gene may affect osteoarthritis susceptibility, severity and functional status of individuals with osteoarthritis.

The effect of concomitant hand osteoarthritis on pain and disease activity in patients with rheumatoid arthritis.

INTRODUCTION: Pain is a core complaint among rheumatoid arthritis (RA) patients, and persistent pain requires treatment adjustments according to current strategies. We aimed to quantify the impact of hand osteoarthritis (OA) on health status and residual pain in patients with RA. METHODS: This cross-sectional survey compared RA patients with and without osteoarthritis of the hand. The main outcome was pain intensity. Other measurements included disease activity scores (the Disease Activity Score 28-joints; the Simplified Disease Activity Index, SDAI; the Clinical Disease Activity Index, CDAI), functional disability and self-reported quality of life, and the proportion of patients with residual pain (Patient Acceptable Symptom State, PASS). RESULTS: Eighty-one patients were analyzed, including 39 with RA and OA and 42 with RA only. The patients were mainly women (94%), with a median disease duration of 13 years. This group also reported a higher intensity of pain (visual analogue scale, VAS 70 mm vs. 30 mm; p = 0.003), higher disease activity (3.89 vs. 2.88; p = 0.001), and greater functional disability irrespective of treatment and comorbidities. A strong correlation (r2 = 0.69; p < 0.001) between pain and disease activity was observed, although no differences in pain were observed between groups according to disease activity categories. Patients with RA and OA had a higher proportion of residual pain (59% vs. 29%; p = 0.006) even in the absence of clinical inflammation. CONCLUSION: The coexistence of RA and hand OA is associated with distorted disease activity measurements in RA. Osteoarthritis contributes to persistent pain and greater disability in patients with RA.

Biophysical Stimuli: A Review of Electrical and Mechanical Stimulation in Hyaline Cartilage.

OBJECTIVE: Hyaline cartilage degenerative pathologies induce morphologic and biomechanical changes resulting in cartilage tissue damage. In pursuit of therapeutic options, electrical and mechanical stimulation have been proposed for improving tissue engineering approaches for cartilage repair. The purpose of this review was to highlight the effect of electrical stimulation and mechanical stimuli in chondrocyte behavior. DESIGN: Different information sources and the MEDLINE database were systematically revised to summarize the different contributions for the past 40 years. RESULTS: It has been shown that electric stimulation may increase cell proliferation and stimulate the synthesis of molecules associated with the extracellular matrix of the articular cartilage, such as collagen type II, aggrecan and glycosaminoglycans, while mechanical loads trigger anabolic and catabolic responses in chondrocytes. CONCLUSION: The biophysical stimuli can increase cell proliferation and stimulate molecules associated with hyaline cartilage extracellular matrix maintenance.

Functional status and severity of osteoarthritis in elderly is associated to the polymorphism of TNFA gene

Abstract Background: Osteoarthritis (OA) is a major musculoskeletal disease with high prevalence in the elderly. The study of genetic polymorphisms of inflammatory mediators involved in OA may contribute to the elucidation of the complex pathophysiology of this disease and identification of susceptibility individuals. Aim: This study aimed to evaluate the association between polymorphism at tumor necrosis factor alpha gene (SNP - 308 G/A TNFA) with presence, severity and functional status of osteoarthritis in elderly. Methods: This study was characterized as case-control and encompassed 257 physically independent elderly (Mean Age: 68.55 ± 5.2; Minimum age: 60 and Maximum age: 82) were recruited. After this selection, the groups were divided in: 92 elderly individuals with osteoarthritis (case group) and 165 without the disease (control group). Methods: The individuals were genotyped by the TaqMan real-time PCR system. The subjects were classified based on the degree of radiological impairment according to the criteria of Kellgren-Laurence and regarding functional impairment using the WOMAC and LEQUESNE questionnaires. Results: TNFA gene polymorphic individuals (subjects harboring allele A) are more affected by OA (χ2 = 8.7, p = 0.003), once they have major radiological lesion both in hip (Fisher-Freeman-Halton Test = 3.9, p = 0.04) and knee (Fisher- Freeman-Halton Test = 4.0, p = 0.04) as well as worse functional status assessed by the Lequesne questionnaire (Mann- Whitney, p = 0.04). At the multivariate analysis, after adjustment for age, gender, body mass index, the presence of rare allele for TNFA (allele A) increases the susceptibility to OA development [OR: 1.87 (95% CI: 1.1 —3.2)]. Conclusion: We conclude that the SNP - 308 G/A of TNFA gene may affect osteoarthritis susceptibility, severity and functional status of individuals with osteoarthritis.

Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis.

BACKGROUND: Pellegrini's surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). METHODS: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton's classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1-2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. RESULTS: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. CONCLUSIONS: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

Análise das internações por osteoartrite em mulheres em idade menopausal / Analysis of hospitalizations for osteoarthritis of women in menopausal

OBJETIVO: Identificar e avaliar dados epidemiológicos referentes à osteoartrite em mulheres em idade menopausal. MÉ- TODOS: Pesquisa e análise de informações de saúde disponibilizadas pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), utilizando-se as variáveis artrose, sexo feminino, faixa etária de 40 a 59 anos, período de janeiro de 2012 a dezembro de 2016. RESULTADOS: Nos 5 anos estudados, notificaram-se 13.077 internações por osteoartrite em mulheres em idade menopausal, 2.180 delas (16,67%) em 2012, 2.557 (19,55%) em 2013, 2.686 (20,53%) em 2014, 2.792 (21,35%) em 2015 e 2.862 (21,88%) em 2016. A Região Sudeste se destacou, com 54,84% do total de internações, das quais 1.983 se deram de 40 a 49 anos e 5.313, de 50 a 59 anos. Nas outras regiões, o número de internações, de 40 a 49 anos, foi de 94 pacientes no Norte, 370 no Nordeste, 955 no Sul e 214 no Centro-Oeste; já de 50 a 59 anos, o Norte notificou 182 internações; Nordeste, 684; Sul, 2.827; e Centro-Oeste, 455. O Nordeste apresentou maior média de permanência hospitalar (5,9 dias), porém teve o segundo menor gasto por internação (R$2.836,00); já o Sudeste foi responsável pelo montante de R$22.640.928,14 em gastos totais. CONCLUSÃO: De 2012 a 2016, o índice de internações por osteoartrite em mulheres de 40 a 59 anos no território brasileiro mostrou ligeiro aumento. Isso é um dado preocupante, pois esta é uma afecção de manejo predominantemente ambulatorial; logo, infere-se que são necessárias mais ações de prevenção, tratamento e reabilitação, principalmente, na Região Sudeste, que detém mais de 50% das internações. (AU)

OBJECTIVE: To identify and evaluate epidemiological data regarding osteoarthritis in menopausal women. METHODS: Research and analysis of health information provided by the Department of Informatics of the Unified Health System (DATASUS), using the variables osteoarthritis, female gender, age range of 40-59 years, from January 2012 to December 2016. RESULTS: In the 5 years studied, 13,077 hospitalizations for osteoarthritis were reported in menopausal women, 2180 of them (16.67%) in 2012; 2557 (19.55%) in 2013; 2686 (20.53%) in 2014; 2792 (21.35%) in 2015; and 2862 (21.88%) in 2016. The Southeast region stands out with 54.84% of the total hospitalizations, of which 1983 were reported between 40-49 years old, and 5313, from 50 to 59 years. In the other regions, the number of hospitalizations between 40-49 years old was of 94 patients in the North, 370 in the Northeast, 955 in the South, and 214 in the Midwest; from 50-59 years old, the North reported 182 hospitalizations; Northeast, 684; South, 2827; and Center-West, 455. The Northeast had the highest average hospital stay (5.9 days), but had the second lowest hospitalization cost (R$ 2,836); on the other hand, the Southeast accounted for the amount of R$22,640,928.14 in total expenses. CONCLUSION: From 2012 to 2016, the rate of hospitalizations for osteoarthritis in women aged 40-59 years in Brazil showed a slight increase. These data are worrying, because it is predominantly a condition for outpatient management; therefore, it is inferred that more actions of prevention, treatment and rehabilitation are necessary, mainly in the Southeast, which is responsible for >50% of hospitalizations. (AU)

Multicomponent Exercise Improves Physical Functioning but Not Cognition and Hemodynamic Parameters in Elderly Osteoarthritis Patients Regardless of Hypertension.

The present study aimed to investigate the impact of a 6-month multicomponent exercise program (MCEP) on physical function, cognition, and hemodynamic parameters of elderly normotensive (NTS) and hypertensive (HTS) osteoarthritis patients. A total of 99 elderly osteoarthritis patients (44 NTS and 55 HTS) were recruited and submitted to functional, cognitive, and hemodynamic evaluations before and after six months of a MCEP. The program of exercise was performed twice a week at moderate intensity. The physical exercises aggregated functional and walking exercises. Results indicate that 6 months of MCEP were able to improve one-leg stand and mobility (walking speeds) of osteoarthritis patients regardless of hypertension. On the other hand, cognitive and hemodynamic parameters were not altered after the MCEP. The findings of the present study demonstrate that 6 months of MCEP were able to improve the physical functioning (i.e., usual and maximal walking speed and balance) of osteoarthritis patients regardless of hypertensive condition.

Th1/Th17/Th22 immune response and their association with joint pain, imagenological bone loss, RANKL expression and osteoclast activity in temporomandibular joint osteoarthritis: A preliminary report.

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno-inflammatory response in the joint environment, such as IL-1ß, IL-17 and IL-22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ-OA), IL-1ß and IL-17 have been implicated in the inflammation and resorption of sub-chondral bone; however, the role of Th22 response in the TMJ-OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22-type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ-OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast-induced bone resorption. Higher levels of IL-1ß, IL-17 and IL-22 were expressed in TMJ-OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL-1ß, IL-17 and IL-22-producing cells, were over-expressed in TMJ-OA compared with DDWR subjects. Osteoclastogenesis and osteoclast-induced bone resorption were significantly greater in presence of synovial fluid from TMJ-OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno-inflammatory response are involved in TMJ-OA pathogenesis. These findings suggest that IL-22 is involved in the RANKL expression in TMJ-OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub-chondral bone.

Effects of glucosamine supplements on painful temporomandibular joint osteoarthritis: A systematic review.

The purpose of this study was to systematically review the literature for studies that assessed the effects of glucosamine supplements (GS) on pain and maximum mouth opening (MMO) restriction compared to other therapies, placebo or no intervention on painful temporomandibular joint osteoarthritis (TMJ OA). Randomised controlled trials were selected in a two-phase process. Seven electronic databases, in addition to three grey literature databases, were searched. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Twelve potentially eligible studies were identified, from which three were finally included. Furthermore, two were categorised at low risk and one at high risk of bias. Intervention groups were treated with glucosamine-sulphate, while controls were treated with placebo or ibuprofen. In two studies, GS were equally effective regarding pain reduction and mouth opening improvement compared to ibuprofen taken two or three times a day over 12 weeks; however, one study did not find significant differences in follow-up evaluations concerning these clinical variables in both glucosamine and placebo groups administered over six weeks. There is very low evidence regarding GS therapeutic effects on TMJ OA. Considering a follow-up of 12 weeks, GS were as effective as ibuprofen taken two or three times a day. However, over six weeks of medication intake, GS were not superior to placebo. Still, included studies presented major drawbacks, and therefore, conclusions must be interpreted with caution.