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1.
Clin Oral Investig ; 24(1): 97-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31025193

RESUMO

OBJECTIVE: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis. METHODS: A study population (n = 300), randomly selected from the adult population in Västerbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome. RESULTS: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3-9.9). This association was confounded by concurrent myalgia (B = 1.737 → B = 0.996, 42.7%). CONCLUSION: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia. CLINICAL RELEVANCE: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.


Assuntos
Artralgia/diagnóstico , Mialgia/complicações , Transtornos da Articulação Temporomandibular , Adulto , Dor Facial , Humanos , Suécia , Articulação Temporomandibular
2.
BMC Musculoskelet Disord ; 20(1): 452, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31627723

RESUMO

BACKGROUND: Few studies have investigated the effects of mobilization with movement (MWM) in patients with knee osteoarthritis (OA) compared to other procedures. Sham procedures are generally more appropriate control than using no or usual treatments. Moreover, studies investigating the widespread hypoalgesic effects of MWM in patients with knee OA are lacking. The aim was to investigate the effect of MWM on function and pain in patients with knee OA compared to sham MWM. METHODS: This is a randomized double-blind (patients and assessor) controlled trial. Forty adult patients with knee OA of grade II and above were recruited to receive either MWM treatment or sham MWM for the knee. The outcome measures included the following: a visual analogue scale (VAS) for pain, the pressure pain threshold (PPT) test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the timed up and go (TUG) test, knee strength and knee range of motion (ROM). The measurements were taken at baseline, immediately after intervention and 2 days later. RESULTS: Compared with sham MWM, MWM resulted in greater immediate improvement in pain [mean difference (95% CI): - 2.2 (- 2.8, - 1.6)], PPT at both the knee [176 (97, 254)] and shoulder [212 (136, 288)], TUG time [- 1.6 (- 2.1, - 1.1)], knee flexor strength [2.0 (1.3, 2.7)] and extensor strength [5.7 (4.1, 7.2)] and knee flexion ROM [12.8 (9.6, 15.9)] (all, p < 0.001) but not knee extension ROM [- 0.8 (- 1.6, 0.1)] (p = 0.067). After 2 days of intervention, patients who received MWM also demonstrated a greater improvement in pain [- 1.0 (- 1.8, - 0.1)], PPT at the shoulder [107 (40, 175)], TUG time [- 0.9 (- 1.4, - 0.4)], knee flexor strength [0.9 (0.2, 1.7)] and extensor strength [2.9 (2.1, 3.9)] and knee flexion ROM [8.3 (4.7, 11.9)] (all, p ≤ 0.026). However, WOMAC scores and knee extension ROM showed no evidence of change at any stage after intervention (p ≥ 0.067). CONCLUSIONS: MWM provided superior benefits over sham MWM in terms of local and widespread pain, physical function (walking), knee flexion and extension muscle strength and knee flexion ROM for at least 2 days in patients with knee OA. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02865252 ), registered on August 12, 2016.


Assuntos
Artralgia/terapia , Articulação do Joelho/fisiopatologia , Manipulação Ortopédica/métodos , Osteoartrite do Joelho/terapia , Amplitude de Movimento Articular , Artralgia/diagnóstico , Artralgia/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 20(1): 428, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521136

RESUMO

BACKGROUND: Knee osteoarthritis (OA) is a highly prevalent condition. People with knee OA often have other co-morbidities such as obesity. Exercise is advocated in all clinical guidelines for the management of knee OA. It is often undertaken as a home-based program, initially prescribed by a physiotherapist or other qualified health care provider. However, adherence to home-based exercise is often poor, limiting its ability to meaningfully change clinical symptoms of pain and/or physical function. While the efficacy of short message services (SMS) to promote adherence to a range of health behaviours has been demonstrated, its ability to promote home exercise adherence in people with knee OA has not been specifically evaluated. Hence, this trial is investigating whether the addition of an SMS intervention to support adherence to prescribed home-based exercise is more effective than no SMS on self-reported measures of exercise adherence. METHODS: We are conducting a two-arm parallel-design, assessor-and participant-blinded randomised controlled trial (ADHERE) in people with knee OA and obesity. The trial is enrolling participants exiting from another randomised controlled trial, the TARGET trial, where participants are prescribed a 12-week home-based exercise program (either weight bearing functional exercise or non-weight bearing quadriceps strengthening exercise) for their knee by a physiotherapist and seen five times over the 12 weeks for monitoring and supervision. Following completion of outcome measures for the TARGET trial, participants are immediately enrolled into the ADHERE trial. Participants are asked to continue their prescribed home exercise program unsupervised three times a week for 24-weeks and are randomly allocated to receive a behaviour change theory-informed SMS intervention to support home exercise adherence or to have no SMS intervention. Outcomes are measured at baseline and 24-weeks. Primary outcomes are self-reported adherence measures. Secondary outcomes include self-reported measures of knee pain, physical function, quality-of-life, physical activity, self-efficacy, kinesiophobia, pain catastrophising, participant-perceived global change and an additional adherence measure. DISCUSSION: Findings will provide new information into the potential of SMS to improve longer-term exercise adherence and ultimately enhance exercise outcomes in knee OA. TRIAL REGISTRATION: Prospectively registered with the Australian New Zealand Clinical Trials Registry. Reference: ACTR N12617001243303 Date/version: August 2019/two.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Sistemas de Alerta , Mensagem de Texto , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/reabilitação , Austrália , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/reabilitação , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/reabilitação , Manejo da Dor/métodos , Medição da Dor , Autorrelato/estatística & dados numéricos , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 20(1): 412, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488106

RESUMO

BACKGROUND: Age of onset in symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement syndrome (FAIS) varies. The purpose of this study was to investigate whether psychological factors, radiographic, and clinical variables were related to age of onset of hip pain in DDH and FAIS. METHODS: We collected demographic, clinical, and radiographic data on 56 DDH and 84 FAIS patients. Each was diagnosed based on radiographic findings and clinical history. Age of onset was operationalized by subtracting patient reported duration of symptoms from patient age at presentation. Pain catastrophizing (PCS) and depression were assessed with the pain catastrophizing scale and hospital anxiety and depression scale (HADS), respectively. Multiple linear regression modeling, with Lasso variable selection, was implemented. RESULTS: Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH onset (p-values > 0.27) or age of FAIS onset (p-values > 0.29). LASSO-penalized linear regression revealed alpha Dunn angle, Tonnis grade, prior hip surgery, WOMAC pain score, and iHOT total score were associated with age of onset in FAIS (Adjusted R2 = 0.3099). Lateral center edge angle (LCEA), alpha frog angle, Tonnis grade, SF12 physical functioning, and body mass index (BMI) were associated with age of DDH onset (Adjusted R2 = 0.3578). CONCLUSIONS: Psychological factors, as measured by PCS and HADS, were not associated with age of onset in DDH or FAIS. Functional impairment as measured by WOMAC pain and impaired active lifestyle as measured by iHOT were found to affect age of FAIS onset. For DDH, impaired physical functioning and increasing BMI were found to be associated with age of onset. Severity of the disease, as measured radiographically by LCEA and alpha Dunn angle, was also found to be associated with earlier age of onset in DDH and FAIS, respectively. A patient's radiographic severity may have more of a relationship to the onset of pain than physiologic factors.


Assuntos
Artralgia/diagnóstico , Catastrofização/psicologia , Impacto Femoroacetabular/complicações , Luxação Congênita de Quadril/complicações , Adulto , Idade de Início , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/psicologia , Artralgia/etiologia , Artralgia/psicologia , Catastrofização/diagnóstico , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/psicologia , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/psicologia , Articulação do Quadril/anormalidades , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Testes Psicológicos , Autorrelato/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
6.
BMC Musculoskelet Disord ; 20(1): 365, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391043

RESUMO

BACKGROUND: This study describes how patients with knee or hip osteoarthritis (OA), scheduled for arthroplasty, characterize their pain qualitatively and quantitatively and investigates whether differences exist in pain expression between younger and older patients, and between men and women. METHODS: One hundred eight patients scheduled for a joint arthroplasty completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Hip Disability and Osteoarthritis Outcome Score (HOOS) and a health-related quality of life question. Pain was assessed using the visual analogue scale (VAS), KOOS/HOOS and the Pain-o-Meter (POM) consisting of 12 sensory and 11 affective words (POM-Words). Frequency of analgesics use was assessed and preoperative radiographs were graded. ANOVA was used to test differences in pain expression with age (< 65 vs. ≥65 years), sex, and affected joint as independent factors. RESULTS: Patients < 65 years of age used more affective words (POM) and words with higher affective intensity (median scores 8 (3-39), 5.5 (2-27) respectively), than older patients, despite having less radiographically advanced OA. They also reported more symptoms (KOOS/HOOS) than older patients. However, pain ratings, as measured by VAS and KOOS/HOOS pain, did not differ between younger and older adults. Women reported more frequent analgesics use (45.7 and 26.5% respectively) and rated their pain higher than men (mean POM-VAS = 42 (SD 24) and 31 (SD 19); respectively). No differences existed between sexes for sensory or affective POM-Words, or radiographic grade of OA. With age and sex as independent factors, a significant difference between knee and hip OA remained for sensory POM-words intensity scores. CONCLUSIONS: Younger adults scheduled for arthroplasty expressed pain using more affective words and words with higher intensity and had less radiographically advanced OA than older adults. However, VAS and KOOS/HOOS pain subscales could not distinguish the difference in pain expression. Thus, the POM may be a valuable tool for assessment of pain.


Assuntos
Artralgia/diagnóstico , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/métodos , Índice de Gravidade de Doença , Fatores Etários , Idoso , Artralgia/psicologia , Artroplastia de Quadril , Artroplastia do Joelho , Estudos Transversais , Estudos de Viabilidade , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medição da Dor/psicologia , Período Pré-Operatório , Qualidade de Vida , Fatores Sexuais , Inquéritos e Questionários
8.
Br J Hosp Med (Lond) ; 80(8): 456-460, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437039

RESUMO

Ulnar-sided wrist pain is often unfairly labelled as the 'back pain' of the wrist. This reputation comes from the complexity of diagnosing problems related to this area of the wrist. This article summarizes the anatomy and biomechanics of the wrist and presents a logical approach to diagnosing the aetiology of the pain. The problems are categorised based on the anatomical structure from which the pain arises: either bony, soft tissue-related or arising from nerves or vascular structures. The article also outlines the relevant examination findings and the most appropriate investigation that would yield a diagnosis with any given presentation. A linked article detailing the imaging of ulnar-sided wrist pain is included in this issue (10.12968/hmed.2019.80.8.461).


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Artralgia/diagnóstico , Dor/diagnóstico , Radiologia/métodos , Ulna/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Fenômenos Biomecânicos , Competência Clínica , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor , Exame Físico/métodos , Amplitude de Movimento Articular/fisiologia , Traumatismos do Punho/diagnóstico
9.
BMC Musculoskelet Disord ; 20(1): 376, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421686

RESUMO

BACKGROUND: Obesity and radiological severity have been identified to be independent predictors of a low rate of response to viscosupplementation (VS), in patients with knee osteoarthritis (OA). Is that enough to formally refute VS in such patients in whom surgery is sometimes contraindicated? OBJECTIVES: To compare pain and function scores before and 6 months after knee VS, according to the weight status (obese versus non obese), the radiological severity (mild/moderate versus severe) and both combined. METHODS: Post-hoc analysis of a prospective, double blind, randomized, multicentre trial, comparing 2 viscosupplements, in patients with symptomatic knee OA. Patients were classified according to body mass index (BMI < or ≥ 30 kg.- 2), OARSI radiological grade (1-2 versus 3) and OMERACT-OARSI response criteria (Yes/No). WOMAC between-group comparisons (obese versus non-obese, OARSI 1-2 versus 3, and both combined) in all patients and in OMERACT-OARSI Responders, were achieved using Mannn-Whitney U test. RESULTS: One-hundred and sixty-six patients were analyzed: 28.3% were obese, 44% were OARSI grade 3, 42,2% were neither obese nor OARSI 3, whereas 14.5% were obese and OARSI 3. At baseline WOMAC pain score did not differ according to the patients sub-groups (p > 0.05). Six months after VS, WOMAC pain decreased significantly in all patient sub-groups (all p < 0.01). At month 6, WOMAC pain sub-score was significantly lower in non-obese than in obese patients (4.9 ± 4.1 versus 7.1 ± 4.9; p = 0.008) and in patients OARSI 1-2 versus 3 (4.8 ± 4.3 versus 6.4 ± 4.5; p = 0.009). However, in responder patients there was no difference in pain score and pain decrease related to the weight status and the radiological score. CONCLUSION: These results do not confirm our previous conclusions that recommended not performing VS in obese patients with severe knee OA. Although the chances of being a responder were much reduced in these patients, the benefit of patients who respond to treatment was similar to that of subjects with normal weight and mild/moderate OA. Different pain phenotypes, more than overweight and advanced disease, might be the main reason for the success or failure of VS.


Assuntos
Artralgia/tratamento farmacológico , Articulação do Joelho/patologia , Obesidade/epidemiologia , Osteoartrite do Joelho/tratamento farmacológico , Viscossuplementos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Índice de Massa Corporal , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Viscossuplementação/métodos
10.
Trials ; 20(1): 394, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272488

RESUMO

BACKGROUND: Acupuncture is widely used for knee osteoarthritis (KOA), despite contradictory evidence. This study is designed to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA. METHODS/DESIGN: This is a multi-center three-arm randomized controlled trial. It will enroll 480 participants with KOA in China. Participants will be randomly assigned 1:1:1 to receive 24 sessions of electro-acupuncture, manual acupuncture, or sham acupuncture over 8 weeks. The primary outcome is the response rate, which is the proportion of patients who achieve the minimal clinically important improvement in pain and function at 8 weeks. The primary outcome will be analyzed using the Z-test with the intention-to-treat set. Secondary outcomes include pain, function, global patient assessment, and quality of life. Full details of the statistical analysis plan for the primary and secondary outcomes will be described in this article. The statistical analysis plan was written and submitted without knowledge of the study data. DISCUSSION: The data will be analyzed according to this pre-specified statistical analysis plan to avoid data-driven analysis and to enhance the transparency of the trial. The aim of the trial is to provide high-quality evidence on the efficacy of acupuncture for KOA. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03366363 . Registered on 20 November 2017.


Assuntos
Terapia por Acupuntura/métodos , Artralgia/terapia , Eletroacupuntura , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Terapia por Acupuntura/efeitos adversos , Artralgia/diagnóstico , Artralgia/fisiopatologia , China , Interpretação Estatística de Dados , Eletroacupuntura/efeitos adversos , Humanos , Modelos Estatísticos , Estudos Multicêntricos como Assunto , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
11.
Trials ; 20(1): 399, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272502

RESUMO

BACKGROUND: The morbidity of knee arthritis is increasing among aged people and total knee arthroplasty has been its mainstream treatment to date. Postoperative rehabilitation is an important part of the procedure. However, the intense pain during the functional exercise involved has always been a challenge for both patients and health care professionals. The aim of this study is to test the analgesic effect of a mixture of nitrous oxide/oxygeb (1:1) inhalation for patients who are doing functional exercise 1 month after total knee arthroplasty. METHODS/DESIGN: This double-blind, randomized, placebo-controlled study will be implemented in the Rehabilitation Department in the General Hospital of Ningxia Medical University. Patients aged between 50 and 75 years who underwent a primary unilateral total knee arthroplasty are eligible for inclusion. The key exclusion criteria include: epilepsy, pulmonary embolism, intestinal obstruction, aerothorax. The treatment group (A) will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesics), and the control group (B) will receive oxygen plus conventional treatment (no analgesics). Patients, physicians, therapists, and data collectors are all blind to the experiment. Assessments will be taken immediately after functional exercise begins (T0), 5 min (T1) after functional exercise begins, and 5 min after functional exercise has finished (T2). Patients will be randomly allocated between a treatment group (A) and a control group (B) in a ratio of 1:1. Primary outcome, including pain severity in the procedure, will be taken for each group. Secondary outcomes include blood pressure, heart rate, oxygen saturation, side effects, knee joint range of motion, Knee Society Score (KSS), rescue analgesia need, and satisfaction from both therapists and patients. DISCUSSION: This study will focus on exploring a fast and efficient analgesic for patients who are doing functional exercise after total knee arthroplasty. Our previous studies suggested that the prefixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burn-dressing pain and breakthrough cancer pain. The results of this study should provide a more in-depth insight into the effects of this analgesic method. If this treatment proves successful, it could be implemented widely for patients doing functional exercise in the rehabilitation department. TRIAL REGISTRATION: ChiCTR-INR-17012891 . Registered on 6 October 2017.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Artralgia/prevenção & controle , Artrite/cirurgia , Artroplastia do Joelho/reabilitação , Terapia por Exercício , Articulação do Joelho/cirurgia , Óxido Nitroso/administração & dosagem , Oxigenoterapia , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Artrite/diagnóstico , Artrite/fisiopatologia , Artroplastia do Joelho/efeitos adversos , China , Método Duplo-Cego , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Oxigenoterapia/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
12.
BMC Musculoskelet Disord ; 20(1): 335, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324245

RESUMO

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.


Assuntos
Artralgia/terapia , Artrite Experimental/terapia , Cartilagem Articular/patologia , Transplante de Células-Tronco Mesenquimais/métodos , Osteoartrite/terapia , Tecido Adiposo/citologia , Animais , Artralgia/diagnóstico , Artralgia/etiologia , Artrite Experimental/induzido quimicamente , Biomarcadores/análise , Feminino , Gânglios Espinais/patologia , Humanos , Injeções Intra-Articulares , Ácido Iodoacético/toxicidade , Articulação do Joelho/inervação , Articulação do Joelho/patologia , Osteoartrite/induzido quimicamente , Osteoartrite/patologia , Medição da Dor/métodos , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 28(8): 1431-1440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327393

RESUMO

BACKGROUND: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. METHODS: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. RESULTS: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. CONCLUSIONS: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.


Assuntos
Adaptação Psicológica/fisiologia , Artralgia/psicologia , Articulação do Cotovelo/lesões , Fraturas Ósseas/psicologia , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Articulação do Cotovelo/fisiopatologia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
14.
Int J Med Sci ; 16(6): 845-853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31337958

RESUMO

Background: Knee joint pain is the most common reason for physical disability which associates with age. TamaFlexTM (NXT15906F6) is a synergistic anti-inflammatory formulation which contains ethanol/aqueous extracts of Tamarindus indica seeds and ethanol extract of Curcuma longa rhizome. Methods: In a 90-day randomized, double-blind, placebo-controlled study, we evaluated efficacy of NXT15906F6 in relieving pain and improving joint function in non-arthritic adults. Ninety non-arthritic subjects who experienced knee pain and joint discomfort following a six-minute walk test (SMWT) and Stair climb test (SCT) participated in the present trial. Subjects received either 250 mg (n=30) or 400 mg (n=30) of NXT15906F6 or matched placebo (PL: n=30) daily for 90 days. Improvement from baseline six-minute walk distance (SMWD) in NXT15906F6 groups, compared with placebo (PL) was the primary outcome of the study. Results: At post-intervention, subjects in NXT15906F6-250 (p<0.001) and NXT15906F6-400 (p<0.0001) groups showed substantial improvements in mean changes of SMWD from baseline compared to placebo. The 250 mg and 400 mg NXT15906F6 groups also improved average walking speed from baseline by 0.08±0.07 m/s (p=0.0010) and 0.11±0.08 m/s (p<0.0001), respectively. The NXT15906F6 groups experienced significant improvement in SMWT performances as early as 14 days. NXT15906F6-supplemented participants showed a consistent benefit of pain relief and improved musculoskeletal functions, compared to placebo. Conclusion: NXT15906F6 provided substantial relief from knee pain after physical activity and improved joint function in non-arthritic adults. Study participants did not show any major adverse events, and they tolerated well this novel herbal formulation.


Assuntos
Anti-Inflamatórios/administração & dosagem , Artralgia/tratamento farmacológico , Articulação do Joelho/efeitos dos fármacos , Extratos Vegetais/administração & dosagem , Tamarindus/química , Adulto , Anti-Inflamatórios/efeitos adversos , Artralgia/diagnóstico , Artralgia/etiologia , Curcuma/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Exercício/fisiologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Placebos/administração & dosagem , Placebos/efeitos adversos , Extratos Vegetais/efeitos adversos , Rizoma/química , Sementes/química , Resultado do Tratamento , Teste de Caminhada
15.
BMC Musculoskelet Disord ; 20(1): 342, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31351449

RESUMO

BACKGROUND: Knee osteoarthritis (OA) is a prevalent and chronic condition with no known cure. Exercise is advocated in all clinical guidelines due to its positive effects on symptoms. Despite this, exercise participation is often poor in people with knee OA with access to exercise treatments a known barrier. Internet-delivered exercise interventions have the potential to improve access to evidence-based exercise treatments and can benefit OA outcomes, although non-usage and low adherence potentially limit their effectiveness. Short message services (SMS) show promise in facilitating exercise adherence and may be one solution to improve adherence to internet-delivered exercise interventions. The combination of internet-delivered exercise and SMS adherence support has not been specifically evaluated in people with knee OA. METHODS: This protocol reports a two-arm parallel-design, assessor- and participant-blinded randomised controlled trial. This trial is recruiting 206 people aged 45 years and older, with a clinical diagnosis of knee OA from the Australian-wide community. Eligible and consenting participants are enrolled and randomised to receive access to either i) 'My Knee Education', an education control website containing OA and exercise information only or ii) a combined intervention that includes a website, 'My Knee Exercise', containing the same educational information as the control, guidance to increase general physical activity, and the prescription of a 24-week self-directed home-based lower-limb strengthening program in addition to a 24-week behaviour change SMS exercise adherence program. Outcome measures are being collected at baseline and 24-weeks. Primary outcomes are self-reported knee pain and physical function. Secondary outcomes include another self-reported measure of knee pain, function in sport and recreation, quality-of-life, physical activity, self-efficacy, participant satisfaction and perceived global change. DISCUSSION: This randomised controlled trial will provide evidence about the effectiveness of a combined intervention of internet-delivered OA and exercise education, physical activity guidance and prescription of a 24-week lower-limb strengthening exercise program supported by a behaviour change SMS program compared to internet delivered OA and exercise education alone. TRIAL REGISTRATION: ACTRN12618001167257/13th July 2018.


Assuntos
Artralgia/terapia , Terapia Comportamental/métodos , Osteoartrite do Joelho/terapia , Educação de Pacientes como Assunto/métodos , Treinamento de Resistência/métodos , Artralgia/diagnóstico , Artralgia/etiologia , Austrália , Terapia Combinada , Medicina Baseada em Evidências , Feminino , Humanos , Internet , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Ensaios Clínicos Pragmáticos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato/estatística & dados numéricos , Telemedicina , Mensagem de Texto , Resultado do Tratamento
16.
BMC Res Notes ; 12(1): 326, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182146

RESUMO

OBJECTIVE: Increase in the evidence of global occurrence of Zika viral infection suggests that in Africa the circulation of the virus which causes 80% of asymptomatic infection could be undetected and/or overlooked. We sought to serologically detect Zika virus infection in febrile patients at Greater Accra Regional Hospital, Ghana. RESULTS: Of the 160 patient serum samples analyzed, 33 were found to have antibodies against Zika virus infection. Among the sero-positives 30 (91%) of the cases were anti-Zika virus IgM with the 21-30-year age group recording the highest number of 8 (26%) and 2 (7%) cases being the least for the 61 years and above age group. All sero-positive febrile patients developed at least one symptom consistent with Zika virus infection: 33 (100%) fever, 25 (76%) muscle pain, 24 (73%) joint pain, and conjunctivitis 2 (6%). Digestive symptoms recorded include 16 (49%) nausea, 12 (36%) vomiting and diarrhea 18 (55%). In addition, 28 (85%) loss of appetite, 14 (75%) rapid respiration and chest pain 15 (42%) were reported by seropositive febrile patients. Our data indicates exposure to Zika virus which suggests the possible circulation of the virus among febrile patients in Ghana with a sero-prevalence rate of 20.6%.


Assuntos
Anticorpos Antivirais/sangue , Artralgia/imunologia , Febre/imunologia , Mialgia/imunologia , Infecção por Zika virus/imunologia , Zika virus/imunologia , Adolescente , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/epidemiologia , Artralgia/fisiopatologia , Criança , Pré-Escolar , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Conjuntivite Viral/imunologia , Conjuntivite Viral/fisiopatologia , Estudos Transversais , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/imunologia , Diarreia/fisiopatologia , Feminino , Febre/diagnóstico , Febre/epidemiologia , Febre/fisiopatologia , Gana/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Mialgia/diagnóstico , Mialgia/epidemiologia , Mialgia/fisiopatologia , Náusea/diagnóstico , Náusea/epidemiologia , Náusea/imunologia , Náusea/fisiopatologia , Estudos Soroepidemiológicos , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/imunologia , Vômito/fisiopatologia , Zika virus/crescimento & desenvolvimento , Zika virus/patogenicidade , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/fisiopatologia
17.
Breast Cancer Res Treat ; 177(2): 427-435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31218477

RESUMO

PURPOSE: Half of hormone receptor-positive (HR+) breast cancer patients will develop joint pain, termed aromatase inhibitor-induced arthralgia (AIA), while taking aromatase inhibitor therapy. Though there is no universally accepted effective treatment for AIA, there has been some evidence to support high-dose vitamin D as a treatment. METHODS: We randomized post-menopausal women who were beginning adjuvant AI therapy to receive standard-dose vitamin D3 (800 IU daily for 52 weeks), or high-dose vitamin D3 (50,000 IU weekly for 12 weeks, followed by 2000 IU daily for 40 weeks). The primary end point was development of AIA. The trial was designed to enroll 184 patients. This futility analysis was performed after 93 patients were enrolled. RESULTS: The high-dose vitamin D regimen was effective in raising serum vitamin D levels, but there was no significant difference in development of AIA between the two arms. In the high-dose arm, 25 patients (54%) developed AIA, compared to 27 patients (57%) in the standard-dose arm. The planned futility analysis was positive; thus, the study was terminated. Neither baseline vitamin D nor 12-week vitamin D level was predictive of AIA development. CONCLUSION: Although vitamin D levels were increased in the high-dose arm, there was no significant signal for benefit of high-dose vitamin D supplementation for AIA prevention in this unblinded trial. This study, along with several others, implies that vitamin D likely does not play a significant role in AIA for the majority of patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Artralgia/etiologia , Artralgia/prevenção & controle , Neoplasias da Mama/complicações , Colecalciferol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Artralgia/diagnóstico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Suplementos Nutricionais , Feminino , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fatores de Risco , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 20(1): 291, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31208435

RESUMO

BACKGROUND: Clinical guidelines recommend exercise as a core treatment for individuals with knee osteoarthritis (OA). However, the best type of exercise for clinical benefits is not clear, particularly in different OA subgroups. Obesity is a common co-morbidity in people with knee OA. There is some evidence suggesting that non-weight bearing exercise may be more effective than weight bearing exercise in patients with medial knee OA and obesity. METHODS: To compare the efficacy of two different exercise programs (weight bearing functional exercise and non-weight bearing quadriceps strengthening) on pain and physical function for people ≥50 years with painful medial knee OA and obesity (body mass index ≥30 kg/m2) 128 people in Melbourne, Australia will be recruited for a two group parallel-design, assessor- and participant-blinded randomised controlled trial. Participants will be randomly allocated to undertake a program of either weight bearing functional exercise or non-weight bearing quadriceps strengthening exercise. Both groups will attend five individual sessions with a physiotherapist who will teach, monitor and progress the exercise program. Participants will be asked to perform the exercises at home four times per week for 12 weeks. Outcomes will be measured at baseline and 12 weeks. Primary outcomes are self-reported knee pain and physical function. Secondary outcomes include other measures of knee pain, physical function, quality-of-life, participant-perceived global change, physical performance, and lower limb muscle strength. DISCUSSION: This study will compare the efficacy of two different 12-week physiotherapist-prescribed, home-based exercise programs for people with medial knee OA and obesity. Findings will provide valuable information to help inform exercise prescription in this common OA patient subgroup. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12617001013358 , 14/7/2017.


Assuntos
Artralgia/diagnóstico , Terapia por Exercício/métodos , Obesidade/terapia , Osteoartrite do Joelho/terapia , Suporte de Carga , Artralgia/etiologia , Austrália , Comorbidade , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Obesidade/epidemiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/epidemiologia , Medição da Dor , Desempenho Físico Funcional , Músculo Quadríceps/fisiopatologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
Nat Rev Rheumatol ; 15(7): 438-448, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31201386

RESUMO

The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.


Assuntos
Artralgia/etiologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Artralgia/diagnóstico , Artralgia/fisiopatologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Prognóstico
20.
Scand J Rheumatol ; 48(5): 408-414, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31170850

RESUMO

Objective: Pain is a common and distressing feature of juvenile idiopathic arthritis (JIA). Pain interference (PI) is underexplored in long-term conditions such as JIA. The aim of this study was to explore the factors associated with PI in young adults with JIA. Methods: All consecutive JIA patients aged 18-30 years in three tertiary rheumatology and rehabilitation centres in Finland between September 2015 and April 2016 were included. The patients completed questionnaires addressing demographics, disability, depressive symptoms, pain anxiety, pain intensity, and PI. PI was measured with a single item from the RAND-36 questionnaire. Five response categories were coded into three groups: patients reporting 'extremely', 'quite a bit' or 'moderate' were classified as having significant PI; 'a little bit' as having minor PI; and 'not at all' as having no PI. A leisure-time physical activity metabolic equivalent of task (LTPA MET) was calculated. Statistical comparisons between PI and categorical variables were made using chi-squared or Fisher-Freeman-Halton tests. Results: Of the total 195 patients, 97 (50%) patients reported PI. PI was associated with a wide spectrum of sociodemographic and disease-related variables. Pain intensity scores were higher in patients expressing greater PI (p < 0.001). Greater PI was associated with higher disability (p < 0.001), higher pain anxiety scores (p < 0.001), lower LTPA MET (p = 0.027), and poorer leisure-time activity (p < 0.001). Conclusions: PI is common in young adults with JIA. We suggest that PI should be taken into account in future outcome studies exploring the impact of pain in children and young adults with JIA.


Assuntos
Artralgia/epidemiologia , Artrite Juvenil/complicações , Nível de Saúde , Atividade Motora/fisiologia , Medição da Dor/métodos , Adolescente , Adulto , Artralgia/diagnóstico , Artralgia/etiologia , Artrite Juvenil/diagnóstico , Artrite Juvenil/fisiopatologia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Prognóstico , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
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