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1.
Clin Podiatr Med Surg ; 37(1): 117-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735263

RESUMO

This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.


Assuntos
Artrodese/efeitos adversos , Articulações do Pé/cirurgia , Artropatias/etiologia , Complicações Pós-Operatórias/etiologia , Fenômenos Biomecânicos , Articulações do Pé/fisiopatologia , Humanos , Artropatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
2.
Orv Hetil ; 160(44): 1727-1734, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657254

RESUMO

Authors discuss the musculoskeletal aspects of obesity by applying a novel approach. Biochemical changes associated with obesity and especially metabolic syndrome, may have a great impact on the function of bones, joints and muscles. Therefore we need a new view and new strategies in rheumatic diseases. Obesity-associated metabolic changes should be considered during the progress of as well as the selection of treatment in inflammatory rheumatic diseases. Individualised treatment is necessary due to associated comorbidities as well. Orv Hetil. 2019; 160(44): 1727-1734.


Assuntos
Artropatias/etiologia , Artropatias/fisiopatologia , Síndrome Metabólica , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/fisiopatologia , Obesidade/complicações , Obesidade/fisiopatologia , Doenças Reumáticas , Adipocinas/metabolismo , Artrite , Humanos , Artropatias/metabolismo , Leptina/metabolismo , Doenças Musculoesqueléticas/metabolismo , Obesidade/metabolismo , Osteoartrite/etiologia , Osteoartrite/metabolismo , Osteoartrite/fisiopatologia , Doenças Reumáticas/etiologia , Doenças Reumáticas/metabolismo , Doenças Reumáticas/fisiopatologia
4.
Blood Coagul Fibrinolysis ; 30(1S Suppl 1): S11-S13, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517710

RESUMO

: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within the context of a multidisciplinary team. Muscle hematomas must be diagnosed as early as possible and be subjected to continuous treatment until full resolution, as they are associated with the risk of severe complications (compartment syndromes and pseudotumors). Arthrocentesis (extraction of intra-articular blood) is recommended in cases of acute and profuse hemarthrosis. Synovectomy is mandatory in the case of synovitis. Radiosynovectomy plays a key role as it has been shown to reduce bleeding by 65%. Our department uses Yttrium-90 in knees and Rhenium-186 in elbows and ankles. Radiosynovectomy is our treatment of choice for synovitis whereas arthroscopic synovectomy is resorted to as second-line treatment. Total knee replacement (TKR) has shown itself to be effective for treating severe hemophilic arthropathy, although the infection risk in patients with hemophilia is higher than in patients with osteoarthritis (1-2 vs. 7%).


Assuntos
Hemofilia A/complicações , Artropatias/etiologia , Artropatias/cirurgia , Artroplastia do Joelho/métodos , Hemartrose/etiologia , Hemartrose/cirurgia , Humanos , Radioisótopos/uso terapêutico , Rênio/uso terapêutico , Sinovectomia/métodos , Sinovite/etiologia , Sinovite/cirurgia , Radioisótopos de Ítrio/uso terapêutico
5.
Iowa Orthop J ; 39(1): 63-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413676

RESUMO

Background: The primary indication for reverse shoulder arthroplasty (RSA) is rotator cuff arthropathy caused by a deficient rotator cuff. Cuff deficiency in patients is highly variable in its distribution and extent, with mechanical implications that may significantly affect post-operative recovery. This study investigated the effects of variable cuff deficiency on the propensity for impingement between the scapula and humeral component and resulting subluxation, the source of two common complications (scapular notching and instability). Methods: Five different finite element models of an RSA were analyzed with varying degrees of rotator cuff deficiency: (1) baseline, with intact subscapularis, infraspinatus and teres minor, (2) no subscapularis, (3) no subscapularis or infraspinatus, (4) no infraspinatus, and (5) no infraspinatus or teres minor. The supraspinatus was not included in any models, as it is absent in rotator cuff arthropathy. Each model was moved through a prescribed arc of 45° internal/ external rotation originating from neutral. Results: Greater rotator cuff deficiency was associated with more impingement and larger magnitudes of subluxation. The largest subluxation (7.5 mm) and highest impingement-related contact stress (479 MPa) was in the model lacking all rotator cuff muscle groups. Posterior subluxation was present in most models lacking the infraspinatus, while anterior subluxation was present in all models lacking the subscapularis. Conclusions: This study helps clarify how different rotator cuff deficiencies influence shoulder stability following RSA and can ultimately help predict which patients may be at greater risk for impingement-related scapular notching and subluxation. Clinical Relevance: Surgeons should carefully consider the nature of the rotator cuff deficiency and its influence on impingement and instability when planning for RSA.Level of Evidence: V.


Assuntos
Artroplastia do Ombro/métodos , Instabilidade Articular/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Lesões do Manguito Rotador/complicações , Síndrome de Colisão do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Artropatias/etiologia , Artropatias/cirurgia , Instabilidade Articular/fisiopatologia , Pontuação de Propensão , Medição de Risco , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia
6.
Appl Ergon ; 80: 193-199, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31280805

RESUMO

Workers who kneel or squat frequently are at a high risk of developing knee pathologies. Knee Savers® are wedge-shaped pads, worn on the lower calf by baseball catchers that aim to reduce this risk. This study examined how Knee Savers® change the bilateral quadriceps muscle activity during dorsiflexed kneeling, and heels-up and flat-foot squatting. For twenty participants, integrated and peak electromyography (EMG) during descent and ascent phases, mean EMG during a 10-s static phase, and participants' subjective perception of muscle fatigue were compared between equipment conditions (with (W) and without (WO) Knee Savers®). Knee Savers® did not significantly reduce integrated or peak EMG during transitions into and out of the postures; however, they significantly reduced (p < .03) mean EMG in five of six muscles during the static phase. These findings indicate potential for Knee Savers® to reduce cumulative muscular effort and fatigue in applications where prolonged static kneeling or squatting are required.


Assuntos
Braquetes , Artropatias/prevenção & controle , Doenças Profissionais/prevenção & controle , Postura/fisiologia , Músculo Quadríceps/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Artropatias/etiologia , Joelho/fisiopatologia , Masculino , Fadiga Muscular , Doenças Profissionais/etiologia
7.
Ortop Traumatol Rehabil ; 21(2): 95-106, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31180035

RESUMO

The objective of the paper is to highlight the interdisciplinary problem of arthrofibrosis (AF) and to present this problem from the physiotherapy angle based on a literature review and the authors' experience. Arthrofi-brosis is a pain-ful condition limiting joint mobility due to pathological fibrosis involving scarring. The limited mobility is often ac-companied by pain. Arthrofibrosis may result in limited locomotion in everyday life or at work and withdrawal from physical activity. In severe cases, Severe AF can lead to patients' unemployability due to their inability to perform certain work-related activities. The problem is important from the clinical point of view, and therefore treatment of AF involves specialists, physiotherapists and psychologists. Our paper presents the definitions of AF, the most fre-quent causes and epidemiology of the dysfunction. This is followed by a classification of arthrofibrosis. Special attention is paid to problems connected with AF-related terminology. The consequences of the disease, such as pain, inflammation and impairment of joint function, especially joint range of motion limitation, are also presented. The relationship between AF and decreased muscle strength is discussed as well as the ways of muscle strength genera-tion and the issue of limited locomotion in patients with this condition. Some emphasis is given to the role of con-servative and surgical treatment as well as physiotherapy for the prevention or reduction of AF consequences. The next section presents the main guidelines for early physiotherapy. The goal of early physiotherapeutic intervention is to prevent excessive fibrosis within the knee joint and enable safe recovery of joint mobility. The conclusions high-light the need to conduct further research and develop a standard for physiotherapeutic intervention within a com-prehensive evidence-based treatment approach to arthrofibrosis.


Assuntos
Artropatias/etiologia , Artropatias/patologia , Artropatias/terapia , Articulação do Joelho/patologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Terapia Combinada , Fibrose , Humanos , Força Muscular , Modalidades de Fisioterapia , Amplitude de Movimento Articular
8.
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S10-S13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169640

RESUMO

BACKGROUND: The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies. METHODS: A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb length discrepancies. Papers reporting only expert opinion or case reports were excluded. RESULTS: Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb length discrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb length discrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis. CONCLUSIONS: There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.


Assuntos
Articulação do Quadril , Artropatias/etiologia , Articulação do Joelho , Desigualdade de Membros Inferiores/complicações , Desigualdade de Membros Inferiores/fisiopatologia , Dor Lombar/etiologia , Fenômenos Biomecânicos , Marcha , Humanos
9.
BMC Musculoskelet Disord ; 20(1): 285, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31200682

RESUMO

BACKGROUND: Primary purpose of this study is to compare the clinical outcomes of patients undergoing arthroscopic arthrolysis in posttraumatic and non-traumatic elbow stiffness. Secondary aims are to compare the level of satisfaction and complications. METHODS: We retrospectively evaluated the patients undergoing arthroscopic elbow arthrolysis between January 2008 and September 2015 and have completed a minimum 2-year follow-up. Total of 141 patients (male = 90; female = 51) with 143 elbows (posttraumatic, n = 75; non-traumatic, n = 68) with an average age of 33 years were available for final evaluation. The average follow-up period was 44 months. We used the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), Visual Analogue Scale (VAS) to measure clinical outcomes. The level of satisfaction was measured by a self-constructed questionnaire. RESULTS: All parameters were significantly improved postoperatively (P < 0.01). However, statistically significant differences were not present in the rate of postoperative improvement of elbow ROM (P = 0.08) and MEPI (P = 0.21) in both groups. According to MEPI, 72(96%) elbows in posttraumatic and 60(88%) elbows in non-traumatic group were rated as good to excellent. No statistically significant differences were observed in the level of satisfaction (P = 0.76) and rate of complications (P = 0.91). CONCLUSIONS: Arthroscopic arthrolysis is an effective tool and a good option for the treatment of patients with posttraumatic and non-traumatic elbow stiffness. The rate of elbow ROM and MEPI score improvements were significant and comparable postoperatively with a high level of patient's satisfaction. However, postoperative rehabilitation is equally essential to maintain intraoperative elbow ROM, to attain optimal outcome and to prevent complications.


Assuntos
Artroscopia , Articulação do Cotovelo/cirurgia , Artropatias/cirurgia , Satisfação do Paciente , Adolescente , Adulto , Criança , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Haemophilia ; 25(5): 867-875, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31115111

RESUMO

INTRODUCTION: The Joint Outcome Study (JOS) demonstrated that previously untreated children with severe haemophilia A treated with prophylactic factor VIII (FVIII) concentrate had superior joint outcomes at age 6 years compared to those children treated episodically for bleeding. However, variation in joint outcome within each treatment arm was not well explained. AIM: In this study, we sought to better understand variation in joint outcomes at age 6 years in participants of the JOS. METHODS: We evaluated the influence of FVIII half-life, treatment adherence, constitutional coagulant and anticoagulant proteins, and global assays on joint outcomes (number of joint bleeds, total number of bleeds, total MRI score and joint physical exam score). Logistic regression was used to evaluate the association of variables with joint failure status on MRI, defined as presence of subchondral cyst, surface erosion or joint-space narrowing. Each parameter was also correlated with each joint outcome using Spearman correlations. RESULTS: Prophylaxis treatment arm and FVIII trough were each found to reduce risk of joint failure on univariate logistic regression analysis. When controlling for treatment arm, FVIII trough was no longer significant, likely because of the high level of covariation between these variables. We found no consistent correlation between any laboratory assay performed and any joint outcome parameter measured. CONCLUSION: In the JOS, the effect of prescribed prophylactic FVIII infusions on joint outcome overshadowed the contribution of treatment adherence, FVIII half-life, global assays of coagulation and constitutional coagulation proteins. (ClinicalTrials.gov number, NCT00207597).


Assuntos
Fator VIII/uso terapêutico , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Artropatias/etiologia , Fator VIII/farmacologia , Feminino , Hemofilia A/patologia , Hemostasia , Humanos , Masculino
11.
Dermatol Online J ; 25(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31046911

RESUMO

Endogenous ochronosis (EO) or alkaptonuria is an inherited autosomal recessive disease caused by the insufficiency of the enzyme homogentisic acid dioxygenase. This disturbance causes an accumulation and increased renal excretion of homogentisic acid (AHG), which manifests as dark urine when it oxidizes on contact with air. Other clinical manifestations of OE are the result of the deposit of AHG in the form of ochronotic pigment at the level of collagen in the skin and cartilage, where it causes blue-gray cutaneous hyperpigmentation, degenerative arthropathy, valvular disease, and other multisystem effects. Despite the progressive and irreversible nature of OE and the lack of a curative treatment, the life expectancy is preserved. We report a new case of EO with cutaneous and joint involvement, in which a high clinical suspicion, confirmed by elevated AHG in urine was the key in the diagnosis.


Assuntos
Alcaptonúria/diagnóstico , Ácido Homogentísico/urina , Hiperpigmentação/etiologia , Artropatias/etiologia , Ocronose/diagnóstico , Alcaptonúria/complicações , Alcaptonúria/urina , Feminino , Humanos , Pessoa de Meia-Idade , Ocronose/etiologia
12.
Orv Hetil ; 160(17): 679-682, 2019 Apr.
Artigo em Húngaro | MEDLINE | ID: mdl-31010304

RESUMO

The authors report the case of a 19-year-old male patient with inhibitor-positive factor VIII deficiency. The patient had painful, limited range of motion and swelling in the left toe, due to haemarthrosis 1-2 times a month. The MR images depicted a bone cyst penetrating into the tibiotalar joint space at the distal end of the left tibia. Due to the size and localisation of the cyst, there was a high chance of a pathological fracture with a potential intraarticular component. The clinical scenario was complicated by the high level of antifactor VIII antibodies. To prevent pathological fracture and stop the recurrence of haemarthrosis, the authors decided to debride the cavity and fill it with bone chips. During the operation and the postoperative period the patient recieved recombinant clotting factor substitution and standard thromboprophylaxis. Despite the high risk of bleeding complication, the patient had neither bleeding nor thomboembolic complication. Further bleeding into the joint space has not been reported by the patient since the surgery. The authors aim to draw attention to this rare, but significant disease, the role of the haemophilia centers and the importance of the coordinated multidisciplinary treatment. Orv Hetil. 2019; 160(17): 679-682.


Assuntos
Anticoagulantes/administração & dosagem , Cistos Ósseos/cirurgia , Hemartrose/etiologia , Hemofilia A/complicações , Artropatias/cirurgia , Tromboembolia Venosa/prevenção & controle , Articulação do Tornozelo , Cistos Ósseos/diagnóstico por imagem , Desbridamento , Humanos , Artropatias/etiologia , Imagem por Ressonância Magnética , Masculino , Resultado do Tratamento , Adulto Jovem
14.
Am J Otolaryngol ; 40(3): 459-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30948137

RESUMO

Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.


Assuntos
Abscesso/etiologia , Abscesso/cirurgia , Artrite Reumatoide/complicações , Cartilagem Aritenoide/cirurgia , Cartilagem Cricoide/cirurgia , Drenagem/métodos , Artropatias/etiologia , Artropatias/cirurgia , Abscesso/diagnóstico por imagem , Idoso , Cartilagem Aritenoide/diagnóstico por imagem , Doença Crônica , Cartilagem Cricoide/diagnóstico por imagem , Feminino , Humanos , Artropatias/diagnóstico por imagem , Laringoscopia , Traqueotomia , Resultado do Tratamento
15.
J Shoulder Elbow Surg ; 28(7): 1232-1240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30878278

RESUMO

BACKGROUND: Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. We hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA). METHODS: We identified patients aged 50 years or older who underwent TSA in the American College of Surgeons National Surgical Quality Improvement Program database. Pearson χ2 analysis and linear regression were used to determine the association of the mFI score with 30-day postoperative complications, reoperation, readmission, length of stay (LOS), adverse hospital discharge, and mortality rate. RESULTS: The study included 9861 patients with a mean age of 70 years. As the mFI score increased from 0 to 2 or greater, the following rates increased: postoperative complications from 4.2% to 9.4%, readmission from 1.6% to 4.4%, adverse hospital discharge from 6.3% to 19.6%, and LOS from 1.88 days to 2.43 days (P < .001). Multivariate analysis showed that patients with an mFI score of 2 or greater were over twice as likely to sustain a postoperative complication (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.86-3.10), readmission (OR, 2.80; 95% CI, 1.88-4.17), reoperation (OR, 1.82; 95% CI, 1.02-3.25), and adverse hospital discharge (OR, 3.14; 95% CI, 2.51-3.92). These effects were all significantly higher compared with age. CONCLUSION: Frailty is associated with increased rates of 30-day postoperative complications, readmission, reoperation, adverse hospital discharge, and hospital LOS after TSA. Use of a simple frailty evaluation may help inform decision making and risk assessment when considering TSA.


Assuntos
Artroplastia do Ombro/efeitos adversos , Fragilidade/complicações , Fragilidade/diagnóstico , Artropatias/cirurgia , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Alta do Paciente , Melhoria de Qualidade , Reoperação/efeitos adversos , Medição de Risco , Fatores de Risco
16.
Clin Orthop Surg ; 11(1): 112-119, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838115

RESUMO

Background: Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population. Methods: We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014. Results: In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores. Conclusions: Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.


Assuntos
Artroplastia do Ombro , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prognóstico , Radiografia , Amplitude de Movimento Articular , República da Coreia , Rotação , Lesões do Manguito Rotador/complicações , Dor de Ombro/cirurgia , Resultado do Tratamento
17.
J Spec Oper Med ; 19(1): 113-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30859538

RESUMO

Osteoarthritis (OA) is a disorder involving the deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. In military personnel, the incidence of OA has increased between 2000 and 2012 and was the first or second leading cause of medical separations in this period. It has been suggested that consumption of chondroitin sulfate (CS) may reduce the pain and joint deterioration associated with OA. This article reports on a systematic review and meta-analysis of the effectiveness of CS on reducing OA-related pain and joint deterioration. PubMed and Ovid Embase databases and other sources were searched to find randomized, double-blind, placebo-controlled trials on the effects of orally consumed CS on pain and/or joint structure. The outcome measure was the standardized mean difference (SMD) which was the improvement in the placebo groups minus the improvement in the CS groups divided by the pooled standard deviation. There were 18 trials meeting the review criteria for pain with SMD -0.41, 95% confidence interval (95% CI) -0.57 to -0.25 (negative SMD favors CS). Six studies met the review criteria for joint space narrowing with SMD -0.30, 95% CI -0.61 to +0.00. Two studies meet the review criteria for cartilage volume with SMD -0.11, 95% CI -0.48 to +0.26. Larger dosages (1200mg/d) had greater pain reduction efficacy than lower dosages (≤ 1000mg/d). These data suggest that CS has small to moderate effectiveness in reducing OA-related pain but minimal effects on joint space narrowing and no effect on cartilage volume. It is important that clinicians recommend pharmaceutical-grade CS to their patients due to the variability in the amount of CS in dietary supplements purporting to contain CS.


Assuntos
Sulfatos de Condroitina/administração & dosagem , Artropatias/tratamento farmacológico , Osteoartrite/complicações , Dor/tratamento farmacológico , Administração Oral , Método Duplo-Cego , Humanos , Artropatias/etiologia , Militares/estatística & dados numéricos , Osteoartrite/epidemiologia , Dor/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Bone Joint J ; 101-B(3): 317-324, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30813798

RESUMO

AIMS: The present study investigated the five-year interval changes in pseudotumours and measured serum metal ions at long-term follow-up of a previous report of 28 mm diameter metal-on-metal (MoM) total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 72 patients (mean age 46.6 years (37 to 55); 43 men, 29 women; 91 hips) who underwent cementless primary MoM THA with a 28 mm modular head were included. The mean follow-up duration was 20.3 years (18 to 24). All patients had CT scans at a mean 15.1 years (13 to 19) after the index operation and subsequent follow-up at a mean of 20.2 years (18 to 24). Pseudotumour volume, type of mass, and new-onset pseudotumours were evaluated using CT scanning. Clinical outcomes were assessed by Harris Hip Score (HHS) and the presence of groin pain. Serum metal ion (cobalt (Co) and chromium (Cr)) levels were measured at the latest follow-up. RESULTS: At final follow-up, pseudotumours were observed in 26/91 hips (28.6%). There was an increase in volume of the pseudotumour in four hips (15.4%), no change in volume in 21 hips (80.8%), and a decrease in volume in one hip (3.8%). There were no new-onset pseudotumours. There was no significant difference in HHS between patients with and without pseudotumours. At final follow-up, mean serum Co ion levels and median Co:Cr ratios were significantly greater in patients with pseudotumours, but the serum Cr ion levels were not significantly different. CONCLUSION: At a mean 20 years of follow-up, pseudotumours were observed in 26/91 hips (28.6%) with no new-onset pseudotumours during subsequent follow-up. Most pseudotumours in small-head MoM THA were static in volume and asymptomatic with normal serum metal ion levels. Cite this article: Bone Joint J 2019;101-B:317-324.


Assuntos
Artroplastia de Quadril/efeitos adversos , Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Artropatias/diagnóstico por imagem , Próteses Articulares Metal-Metal/efeitos adversos , Adulto , Artroplastia de Quadril/instrumentação , Cromo/sangue , Cobalto/sangue , Progressão da Doença , Feminino , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Íons/sangue , Artropatias/sangue , Artropatias/etiologia , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prevalência , Desenho de Prótese , Falha de Prótese , Reoperação , Tomografia Computadorizada por Raios X
19.
Clin Rheumatol ; 38(3): 927-932, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30712127

RESUMO

OBJECTIVES: The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups. METHOD: The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH). RESULTS: Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x2 = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16-9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61-9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00-1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021). CONCLUSION: High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.


Assuntos
Contratura/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Articulação da Mão/fisiopatologia , Artropatias/etiologia , Estado Pré-Diabético/complicações , Dermatopatias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Contratura/epidemiologia , Contratura/fisiopatologia , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Feminino , Mãos/fisiopatologia , Humanos , Artropatias/epidemiologia , Artropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/metabolismo , Fatores de Risco , Dermatopatias/epidemiologia , Dermatopatias/fisiopatologia , Adulto Jovem
20.
BMJ Case Rep ; 12(1)2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30635304

RESUMO

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA). A 59-year-old man presented with a 10-day history of right-sided frontal headache and a 7-day history of subacute left-sided weakness. He had no history of RA. He was febrile (38.2°C). Left ankle dorsiflexion and plantarflexion were graded at 4+/5. He developed focal onset motor seizures. He was intermittently febrile with minimal improvement despite intravenous antivirals and antimicrobials. Serology revealed elevated rheumatoid factor 88.2 IU/mL and anti-cyclic citrullinated peptide (anti-CCP) IgG >340 AU/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672 mg/L and normal glucose 3.4 mmol/L. Interval CSF revealed newly low glucose 2.6 mmol/L. Extensive CSF microbiology tests were negative. CSF cytology confirmed reactive lymphocytes. MRI brain revealed right frontoparietal leptomeningeal enhancement. Brain and leptomeningeal biopsy demonstrated florid leptomeningeal mixed inflammatory infiltrate without granulomas. The combination of elevated anti-CCP IgG, erosive arthropathy, CSF lymphocytosis, asymmetrical leptomeningeal enhancement and biopsy findings confirmed RM.


Assuntos
Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Meningite/sangue , Meningite/líquido cefalorraquidiano , Administração Intravenosa , Administração Oral , Assistência ao Convalescente , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Biópsia , Encéfalo/diagnóstico por imagem , Glucocorticoides/uso terapêutico , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Linfocitose/líquido cefalorraquidiano , Imagem por Ressonância Magnética/métodos , Masculino , Meningite/diagnóstico , Meningite/diagnóstico por imagem , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Doenças Raras , Fator Reumatoide/sangue , Convulsões/diagnóstico , Convulsões/etiologia , Resultado do Tratamento
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