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1.
Acta Ortop Mex ; 35(1): 85-91, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480446

RESUMO

The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain has been controversial; However, as knowledge about the joint increases, its role as a generator of chronic pain has become better elucidated. The literature states that sacroiliac joint is the cause of pain in up to 30% of patients. Clinically, diagnosing sacroiliac pain can be difficult to assess; However, pain semiology, patient posture/movement and manual testing are useful for making the presumptive diagnosis of sacroiliac dysfunction. The most effective diagnostic test is image-guided injection of anesthetic solutions into the joint, which is considered positive if there is at least 75% acute symptom relief. Treatment begins with physiotherapy and/or intra-articular infiltration of steroids. If these fails, a possible option is radiofrequency (rizotomy) denervation of the joint. If this does not provide adequate relief, surgery may be considered, in the form of fusion; various work supports favorable outcomes in selected patients.


Assuntos
Dor Lombar , Articulação Sacroilíaca , Humanos , Injeções Intra-Articulares , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Articulação Sacroilíaca/diagnóstico por imagem
2.
Medicine (Baltimore) ; 100(35): e27097, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477145

RESUMO

ABSTRACT: We retrospectively investigated the natural course of hemoglobin (Hb) level after total knee arthroplasty (TKA) and identified the benefit of tranexamic acid injection at the operation field for unilateral TKA patients who have not received blood transfusions.There were 115 cases conducted by a surgeon who performed TKA without injecting tranexamic acid and 62 cases by another surgeon with injection. During 2-weeks of hospitalization, Hb level was checked on the day of surgery and 1, 2, 3, 5, 7, 11 days after surgery.Regardless of whether whom the operator was and tranexamic acid was injected or not, the same natural course of Hb level after TKA was observed. The lowest value of Hb was shown at postoperative day 3, after which it tended to recover. In repeated measures analysis of variance test, mean difference from preoperative Hb level showed a statistically significant difference between tranexamic acid injected and noninjected groups (P = .01). In post hoc test, the differences from preoperative Hb levels were significantly lower at all measurements in surgeon with injection of tranexamic acid.When deciding whether to transfuse after TKA, it should be noted that the patient tends to show the lowest Hb level on postoperative day 3. Also, the authors emphasize that tranexamic acid injection in the joint at the operation field is an effective method to reduce the loss of Hb after TKA.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Hemoglobinas/análise , Ácido Tranexâmico/uso terapêutico , Idoso , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Injeções Intra-Articulares/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/fisiopatologia , Ácido Tranexâmico/administração & dosagem
3.
BMC Musculoskelet Disord ; 22(1): 703, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404381

RESUMO

BACKGROUND: The administration of an intra-articular injection (IAI) of tranexamic acid (TXA) has been demonstrated to be effective in reducing both blood loss and transfusion rate during total knee arthroplasty (TKA); however, few studies have reported the efficiency of a peri-articular injection (PAI) of TXA. We studied the efficiency of a PAI of TXA in reducing blood loss during TKA. METHODS: Fifty patients undergoing primary simultaneous bilateral TKA were enrolled in this retrospective study. The right knee received a PAI of 1 g of TXA (Group I), and the left knee received an IAI of 1 g of TXA (Group II). The clinical outcome measures were a change in blood loss from Hemovac drains and surgical time. RESULTS: The decrease in blood loss from the Hemovac was significantly lower in Group I (460.1 ± 36.79 vs. 576.0 ± 34.01, P < 0.001) than in Group II, and no significant difference in surgical times was observed. The blood transfusion rate in the present study was 16 %. CONCLUSIONS: A PAI of TXA may reduce blood loss more efficiently than an IAI of TXA during TKA without increased complications such as surgical site infection, poor wound healing, skin necrosis, pulmonary embolism, and deep vein thrombosis.


Assuntos
Antifibrinolíticos , Artroplastia do Joelho , Ácido Tranexâmico , Administração Intravenosa , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Injeções Intra-Articulares , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos
4.
Arthroscopy ; 37(8): 2640-2641, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353566

RESUMO

With increasing life expectancy and an increased prevalence of osteoarthritis, the total number of individuals with symptomatic degenerative arthritis will most likely increase considerably. The current focus of nonoperative treatment is on weight loss, exercise, muscle strengthening, physical therapy, nonsteroidal anti-inflammatory drugs, intra-articular injection therapies with corticosteroids, hyaluronic acid, or platelet-rich plasma, and lately, disease-modifying drugs. Obviously, prevention is better than cure, but only 5% of all studies registered on ClinicalTrials.gov in the United States are intending to develop strategies for prevention. The overall majority of included studies (89%) will target symptom resolution, and 6% will investigate disease-modifying drugs.


Assuntos
Osteoartrite do Joelho , Plasma Rico em Plaquetas , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Prevenção Primária
5.
Int J Mol Sci ; 22(13)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34281278

RESUMO

Osteoarthritis (OA) is hallmarked by a progressive degradation of articular cartilage. One major driver of OA is inflammation, in which cytokines such as IL-6, TNF-α and IL-1ß are secreted by activated chondrocytes, as well as synovial cells-including macrophages. Intra-articular injection of blood products-such as citrate-anticoagulated plasma (CPRP), hyperacute serum (hypACT), and extracellular vesicles (EVs) isolated from blood products-is gaining increasing importance in regenerative medicine for the treatment of OA. A co-culture system of primary OA chondrocytes and activated M1 macrophages was developed to model an OA joint in order to observe the effects of EVs in modulating the inflammatory environment. Primary OA chondrocytes were obtained from patients undergoing total knee replacement. Primary monocytes obtained from voluntary healthy donors and the monocytic cell line THP-1 were differentiated and activated into proinflammatory M1 macrophages. EVs were isolated by ultracentrifugation and characterized by nanoparticle tracking analysis and Western blot. Gene expression analysis of chondrocytes by RT-qPCR revealed increased type II collagen expression, while cytokine profiling via ELISA showed lower TNF-α and IL-1ß levels associated with EV treatment. In conclusion, the inflammation model provides an accessible tool to investigate the effects of blood products and EVs in the inflammatory context of OA.


Assuntos
Condrócitos/imunologia , Vesículas Extracelulares/imunologia , Osteoartrite/terapia , Condrócitos/metabolismo , Técnicas de Cocultura , Feminino , Perfilação da Expressão Gênica , Humanos , Inflamação/imunologia , Inflamação/terapia , Injeções Intra-Articulares , Interleucina-1beta/metabolismo , Masculino , Modelos Biológicos , Monócitos/imunologia , Osteoartrite/genética , Osteoartrite/imunologia , Medicina Regenerativa/métodos , Fator de Necrose Tumoral alfa/metabolismo
6.
Arthroscopy ; 37(7): 2041-2042, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34225997

RESUMO

Multisite corticosteroid injection therapy is more effective in terms of pain relief, restoration of motion, and functional status than single intra-articular injection for the treatment of primary frozen shoulder (adhesive capsulitis).


Assuntos
Bursite , Articulação do Ombro , Corticosteroides/uso terapêutico , Bursite/tratamento farmacológico , Humanos , Injeções Intra-Articulares , Modalidades de Fisioterapia
7.
Arthroscopy ; 37(7): 2315-2317, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34226015

RESUMO

Injection therapy for knee osteoarthritis continues to be a controversial topic. Commonly accepted treatment options are corticosteroid and hyaluronic acid injections, but recently platelet-rich plasma also has been a promising biologic treatment option. Adipose and bone marrow-derived mesenchymal stem cells have been applied clinically, but there is no strong supporting evidence for their use. It is also currently unknown whether stem cells can regenerate cartilage. As there is no cure for painful knee osteoarthritis, injection therapy can provide symptom relief. Recent network meta-analyses suggest that platelet-rich plasma provides the best functional improvement and safety for knee osteoarthritis, and adipose-derived mesenchymal stem cells provide excellent pain relief. We must bear in mind that other network meta-analyses report different results, and a challenge of network meta-analysis is inconsistency that can lead to biased treatment effect estimates.


Assuntos
Células-Tronco Mesenquimais , Osteoartrite do Joelho , Plasma Rico em Plaquetas , Medula Óssea , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Osteoartrite do Joelho/terapia
8.
Altern Ther Health Med ; 27(4): 8-13, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34324435

RESUMO

Introduction: Knee pain, a common complaint in primary care, has many causes, the most common of which is osteoarthritis (OA). Other common causes are meniscus tears, tendinosis, ligament tears or sprains, rheumatoid arthritis, lupus and septic arthritis. Also, referred pain from hip joint pathology like slipped capital femoral epiphysis can result in knee pain.1 The use of peptides BPC157 and thymosin-beta-4 (TB4) has not been studied in the treatment of knee pain. Methods: A retrospective study was done at the Institute for Hormonal Balance in Orlando, Florida, USA to see whether intra-articular injection of the peptide BPC 157, alone or combined with TB4, helped relieve knee pain. A 1-year chart review from 2019 to 2020 was performed. Since this was a retrospective study, patient follow-up varied, with most patients having had an injection of peptide into their knee 6 months to 1 year prior to the study. Of the 17 patients in the study, 16 were contacted by phone to follow up on the status of their knee pain. Only 1 patient could not be reached for the survey. Patients were asked to rate their pain prior to injection, the length of time the peptides helped ease the pain and the degree to which the injection helped them. No specific tools were used to measure their improvement in function, quality of life, stiffness or activities of daily living. The survey's main goal was to determine whether BPC157 helped with multiple types of knee pain in a primary care setting. Results: Of the 16 patients, 12 had received only BPC 157 as an intra-articular injection. In this group, 11 of the 12 patients (91.6%) had significant improvement in knee pain, whereas 1 patient (8.3 %) had no improvement. The other 4 patients received a combination of 2 peptide injections of BPC 157 and TB4. Of the patients who received both peptides, 75% showed significant improvement, but 25% had no relief of their knee pain. Overall, 14 of 16 patients (87.5%) had relief of their knee pain when BPC 157 or a combination of BPC 157 and TB4 was used. Conclusion: This small study suggests that intra-articular injection of BPC-157 helps with multiple types of knee pain. Clinical Implications: BPC157 is a peptide with regenerative properties that can be used to relieve multiple types of knee pain.2,3 Future studies are needed to look at the different causes of knee pain with follow-up magnetic resonance imaging scans (MRIs) to document the peptide's benefits. BPC157 has the potential to repair tears, build cartilage and reduce the number of knee surgeries. Because of its reparative properties, treatment with BPC157 offers advantages over the use of steroids. Results: BPC157 is a peptide with regenerative properties that can be used to relieve multiple types of knee pain.2,3 Future studies are needed to look at the different causes of knee pain with follow-up MRIs to document the peptide's benefits. BPC157 has the potential to repair tears, build cartilage and reduce the number of knee surgeries. Because of its reparative properties, treatment with BPC157 offers advantages over the use of steroids.


Assuntos
Osteoartrite do Joelho , Qualidade de Vida , Atividades Cotidianas , Humanos , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Dor , Fragmentos de Peptídeos , Proteínas , Estudos Retrospectivos , Resultado do Tratamento
11.
Int J Mol Sci ; 22(14)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34299024

RESUMO

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.


Assuntos
Corticosteroides/uso terapêutico , Ácido Hialurônico/uso terapêutico , Osteoartrite/tratamento farmacológico , Plasma Rico em Plaquetas/metabolismo , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adolescente , Corticosteroides/farmacologia , Adulto , Humanos , Ácido Hialurônico/farmacologia , Injeções Intra-Articulares , Osteoartrite/fisiopatologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Transtornos da Articulação Temporomandibular/metabolismo , Transtornos da Articulação Temporomandibular/fisiopatologia
12.
Am J Sports Med ; 49(10): 2795-2809, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34213976

RESUMO

BACKGROUND: In this study, we investigated the in vitro and in vivo chondrogenic capacity of kartogenin (KGN)-enhanced bone marrow-derived mesenchymal stem cells (BMSCs) for cartilage regeneration. PURPOSE: To determine (1) whether functionalized nanographene oxide (NGO) can effectively deliver KGN into BMSCs and (2) whether KGN would enhance BMSCs during chondrogenesis in vitro and in vivo in an animal model. STUDY DESIGN: Controlled laboratory study. METHODS: Functionalized NGO with line chain amine-terminated polyethylene glycol (PEG) and branched polyethylenimine (BPEI) were used to synthesize biocompatible NGO-PEG-BPEI (PPG) and for loading hydrophobic KGN molecules noncovalently via π-π stacking and hydrophobic interactions (PPG-KGN). Then, PPG-KGN was used for the intracellular delivery of hydrophobic KGN by simple mixing and co-incubation with BMSCs to acquire KGN-enhanced BMSCs. The chondrogenic efficacy of KGN-enhanced BMSCs was evaluated in vitro. In vivo, osteoarthritis (OA) was induced by anterior cruciate ligament transection in rats. A total of 5 groups were established: normal (OA treated with nothing), phosphate-buffered saline (PBS; intra-articular injection of PBS), PPG-KGN (intra-articular injection of PPG-KGN), BMSCs (intra-articular injection of BMSCs), and BMSCs + PPG-KGN (intra-articular injection of PPG-KGN-preconditioned BMSCs). At 6 and 9 weeks after the surgical induction of OA, the rats received intra-articular injections of PPG-KGN, BMSCs, or KGN-enhanced BMSCs. At 14 weeks after the surgical induction of OA, radiographic and behavioral evaluations as well as histological analysis of the knee joints were performed. RESULTS: The in vitro study showed that PPG could be rapidly uptaken in the first 4 hours after incubation, reaching saturation at 12 hours and accumulating in the lysosome and cytoplasm of BMSCs. Thus, PPG-KGN could enhance the efficiency of the intracellular delivery of KGN, which showed a remarkably high chondrogenic differentiation capacity of BMSCs. When applied to an OA model of cartilage injuries in rats, PPG-KGN-preconditioned BMSCs contributed to protection from joint space narrowing, pathological mineralization, OA development, and OA-induced pain, as well as improved tissue regeneration, as evidenced by radiographic, weightbearing, and histological findings. CONCLUSION: Our results demonstrate that KGN-enhanced BMSCs showed markedly improved capacities for chondrogenesis and articular cartilage repair. We believe that this work demonstrates that a multifunctional nanoparticle-based drug delivery system could be beneficial for stem cell therapy. Our results present an opportunity to reverse the symptoms and pathophysiology of OA. CLINICAL RELEVANCE: The intracellular delivery of KGN to produce BMSCs with enhanced chondrogenic potential may offer a new approach for the treatment of OA.


Assuntos
Cartilagem Articular , Células-Tronco Mesenquimais , Osteoartrite do Joelho , Anilidas , Animais , Medula Óssea , Condrogênese , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Ácidos Ftálicos , Ratos
13.
Lancet ; 398(10298): 416-428, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34265255

RESUMO

BACKGROUND: Corticosteroid injections and physiotherapy exercise programmes are commonly used to treat rotator cuff disorders but the treatments' effectiveness is uncertain. We aimed to compare the clinical effectiveness and cost-effectiveness of a progressive exercise programme with a single session of best practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. METHODS: In this pragmatic, multicentre, superiority, randomised controlled trial (2 × 2 factorial), we recruited patients from 20 UK National Health Service trusts. We included patients aged 18 years or older with a rotator cuff disorder (new episode within the past 6 months). Patients were excluded if they had a history of significant shoulder trauma (eg, dislocation, fracture, or full-thickness tear requiring surgery), neurological disease affecting the shoulder, other shoulder conditions (eg, inflammatory arthritis, frozen shoulder, or glenohumeral joint instability), received corticosteroid injection or physiotherapy for shoulder pain in the past 6 months, or were being considered for surgery. Patients were randomly assigned (centralised computer-generated system, 1:1:1:1) to progressive exercise (≤6 sessions), best practice advice (one session), corticosteroid injection then progressive exercise, or corticosteroid injection then best practice advice. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score over 12 months, analysed on an intention-to-treat basis (statistical significance set at 1%). The trial was registered with the International Standard Randomised Controlled Trial Register, ISRCTN16539266, and EuDRACT, 2016-002991-28. FINDINGS: Between March 10, 2017, and May 2, 2019, we screened 2287 patients. 708 patients were randomly assigned to progressive exercise (n=174), best practice advice (n=174), corticosteroid injection then progressive exercise (n=182), or corticosteroid injection then best practice advice (n=178). Over 12 months, SPADI data were available for 166 (95%) patients in the progressive exercise group, 164 (94%) in the best practice advice group, 177 (97%) in the corticosteroid injection then progressive exercise group, and 175 (98%) in the corticosteroid injection then best practice advice group. We found no evidence of a difference in SPADI score between progressive exercise and best practice advice when analysed over 12 months (adjusted mean difference -0·66 [99% CI -4·52 to 3·20]). We also found no evidence of a difference between corticosteroid injection compared with no injection when analysed over 12 months (-1·11 [-4·47 to 2·26]). No serious adverse events were reported. INTERPRETATION: Progressive exercise was not superior to a best practice advice session with a physiotherapist in improving shoulder pain and function. Subacromial corticosteroid injection provided no long-term benefit in patients with rotator cuff disorders. FUNDING: UK National Institute for Health Research Technology Assessment Programme.


Assuntos
Corticosteroides/administração & dosagem , Terapia por Exercício/métodos , Guias de Prática Clínica como Assunto , Lesões do Manguito Rotador/terapia , Síndrome de Colisão do Ombro/terapia , Adulto , Idoso , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
ACS Appl Mater Interfaces ; 13(27): 31379-31392, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34197081

RESUMO

Osteoarthritis (OA) is treated with the intra-articular injection of steroids such as dexamethasone (DEX) to provide short-term pain management. However, DEX treatment suffers from rapid joint clearance. Here, 20 × 10 µm, shape-defined poly(d,l-lactide-co-glycolide)acid microPlates (µPLs) are created and intra-articularly deposited for the sustained release of DEX. Under confined conditions, DEX release is projected to persist for several months, with only ∼20% released in the first month. In a highly rigorous murine knee overload injury model (post-traumatic osteoarthritis), a single intra-articular injection of Cy5-µPLs is detected in the cartilage surface, infrapatellar fat pad/synovium, joint capsule, and posterior joint space up to 30 days. One intra-articular injection of DEX-µPL (1 mg kg-1) decreased the expression of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, IL-6, and matrix metalloproteinase (MMP)-13 by approximately half compared to free DEX at 4 weeks post-treatment. DEX-µPL also reduced load-induced histological changes in the articular cartilage and synovial tissues relative to saline or free DEX. In sum, the µPLs provide sustained drug release along with the capability to precisely control particle geometry and mechanical properties, yielding long-lasting benefits in overload-induced OA. This work motivates further study and development of particles that provide combined pharmacological and mechanical benefits.


Assuntos
Cartilagem Articular/metabolismo , Dexametasona/química , Dexametasona/metabolismo , Portadores de Fármacos/química , Osteoartrite/tratamento farmacológico , Osteoartrite/metabolismo , Animais , Biomarcadores/metabolismo , Preparações de Ação Retardada , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Regulação da Expressão Gênica/efeitos dos fármacos , Injeções Intra-Articulares , Camundongos , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Estresse Mecânico
16.
J Biol Regul Homeost Agents ; 35(2 Suppl. 1): 21-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34281300

RESUMO

Although arthrocentesis is an accepted safe treatment modality for the management of temporomandibular disorders (TMD) in symptomatic patients, the benefit of hyaluronic acid (HA) injections remains uncertain. The aim of this study was to evaluate whether intra-articular HA injections adjunctive to arthrocentesis can be more effective than other medications for the improvement of TMD associated symptoms. Additionally, the impact of HA injections on quality of life of TMD patients was assessed with SF-36® questionnaire in a cohort of patients. An electronic search of Medline, Scopus and Cochrane databases was performed up to March 2020. The following search terms were used: "arthrocentesis", "hyaluronic acid", "intra-articular injections", "visco-supplementation", "temporomandibular disorders". Prospective and retrospective studies that reported the application of HA injections compared to other intra-articular drugs for the treatment of temporomandibular disorders were included. Systematic or narrative reviews and pre-clinical studies were excluded. Additionally, a retrospective clinical study was performed for evaluation of changes in quality of life before and after arthrocentesis with HA injections. In the systematic review, the initial search yielded 1327 articles. After screening of the titles, abstracts, and full texts, 29 studies were selected (26 randomized studies, 2 controlled clinical trials, 1 retrospective report). In the clinical study, 12 patients were included. Intra-articular injections of HA and other medications together with arthrocentesis seemed to be beneficial for improvement of functional symptoms of TMD and pain. The case series also supported the efficacy of HA injections showing an improvement of quality of life of these patients. However, from literature review, it was impossible to identify an optimum drug or a protocol for predictably improving the pain and/or functional symptoms of temporomandibular problems, due to different etiologies, diversity of treatment modalities and conflicting results. In conclusion, there is no consensus in the literature that HA injections shows better results in comparison with other treatment modalities. According to the results of the present clinical study, HA injections with/without arthrocentesis seems to be beneficial in terms of clinical symptoms and quality of life of the TMD patients.


Assuntos
Ácido Hialurônico , Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Resultado do Tratamento
18.
Am J Sports Med ; 49(9): 2509-2521, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34259597

RESUMO

BACKGROUND: A previous publication demonstrated that the oral intake of losartan promoted microfracture-mediated hyaline-like cartilage repair in osteochondral defects of a rabbit knee model. However, an intra-articular (IA) injection of losartan may have direct beneficial effects on cartilage repair and has not been studied. PURPOSE: To determine the dosage and beneficial effects of an IA injection of losartan on microfracture-mediated cartilage repair and normal cartilage homeostasis. STUDY DESIGN: Controlled laboratory study. METHODS: Rabbits were divided into 5 groups (n = 6 each): a microfracture group (MFX group) and 4 different losartan treatment groups that received varying doses of IA losartan (0.1, 1, 10, and 100 mg per knee). An osteochondral defect (5 mm) was created in the trochlear groove cartilage of 1 limb in each rabbit, and 5 microfracture perforations were made in the osteochondral defect. Both the injured and the contralateral knee joints were injected with IA losartan immediately after microfracture and at 2 and 4 weeks after surgery. Rabbits were sacrificed at 6 weeks after surgery for analysis including gross observation, micro-computed tomography, histology, and reverse transcription quantitative polymerase chain reaction. RESULTS: Micro-computed tomography and gross observation demonstrated comparable subchondral bone healing and hyaline-like cartilage morphology in the 0.1-, 1-, and 10-mg losartan groups relative to the MFX group. Conversely, the 100-mg losartan group showed neither bony defect healing nor cartilage repair. Histology revealed higher O'Driscoll scores and hyaline-like cartilage regeneration in the 1-mg losartan group compared with the MFX group. In contrast, the 100-mg losartan group showed the lowest histology score and no cartilage repair. An IA injection of losartan at the doses of 0.1, 1, and 10 mg did not cause adverse effects on uninjured cartilage, while the 100-mg dose induced cartilage damage. Quantitative polymerase chain reaction results showed downregulation of the transforming growth factor ß (TGF-ß) signaling pathway after IA losartan injection. CONCLUSION: An IA injection of losartan at the dose of 1 mg was most effective for the enhancement of microfracture-mediated cartilage repair without adversely affecting uninjured cartilage. Conversely, a high dose (100 mg) IA injection of losartan inhibited cartilage repair in the osteochondral defect and was chondrotoxic to normal articular cartilage. CLINICAL RELEVANCE: An IA injection of losartan at an optimal dosage represents a novel microfracture enhancement therapy and warrants a clinical trial for future clinical applications.


Assuntos
Cartilagem Articular , Fraturas de Estresse , Animais , Injeções Intra-Articulares , Losartan/farmacologia , Coelhos , Microtomografia por Raio-X
19.
J Ayub Med Coll Abbottabad ; 33(2): 315-321, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137552

RESUMO

BACKGROUND: Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS: PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different combinations. Standardized mean difference (SMD) in VAS for pain relief and Lequesne index for functional outcomes while risk ratio (RR) for complications was used for data pooling. RESULTS: Four studies comprising 185 and 189 patients in HMWHA and control groups were included, respectively. SMD for VAS and Lequesne index was -0.056 and -0.114, respectively while RR for complication was 0.879. CONCLUSIONS: Intra-articular HMWHA injection provided pain relief, functional improvement, and no severe complications on immediate short term basis. However, the results do not favor treatment with HMWHA over other treatment methods. Randomized trials are further necessary to provide data regarding comparisons between HMWHA for hip osteoarthritis concerning clinicians' convenience, compliance, duration of relief, and cost-effectiveness.


Assuntos
Ácido Hialurônico/administração & dosagem , Osteoartrite do Quadril/tratamento farmacológico , Viscossuplementos/administração & dosagem , Idoso , Humanos , Ácido Hialurônico/química , Injeções Intra-Articulares , Peso Molecular , Osteoartrite do Quadril/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Escala Visual Analógica
20.
Medicine (Baltimore) ; 100(25): e26508, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160471

RESUMO

ABSTRACT: This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.Overall, there were significant increases in FBG levels by 64.7 ±â€Š42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ±â€Š49.0 mg/dL and 46.5 ±â€Š3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ±â€Š48.7 mg/dL and 48.0 ±â€Š20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.


Assuntos
Agente Laranja/efeitos adversos , Artralgia/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Glucocorticoides/efeitos adversos , Hiperglicemia/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Idoso , Glicemia/análise , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Injeções Intra-Articulares , Insulina/administração & dosagem , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Triancinolona/administração & dosagem , Triancinolona/efeitos adversos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Guerra do Vietnã , Exposição à Guerra/efeitos adversos
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