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1.
Medicine (Baltimore) ; 100(1): e24107, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429777

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common disabling condition and a heavy financial burden to the society. Platelet-rich plasma (PRP) is considered to be an effective method in the repair and regeneration of cartilage and alleviate pain in KOA. But the utilising of PRP to treat KOA in clinical has shown variable results from many studies. The objective of this protocol is to determine the efficacy of PRP in pain control and cartilage repair in KOA animal models. METHOD: We will search the following three electronic databases: MEDLINE, EMBASE and Web of Science. The primary outcome will include the histological score of cartilage and pain score. The secondary outcomes will be the behavioural assessments and cartilage thickness. SYRCLE's risk of bias tool will be used to assessment the risk of bias of including studies. The standardized mean difference and 95% confidence interval will be used to calculate the effect of PRP treatment. The I2 inconsistency values will be used to calculated the heterogeneity between studies. RESULTS: The results of this paper will be submitted to a peer-reviewed journal for publication. CONCLUSION: This research will determine the efficacy of PRP of the treatment of knee osteoarthritis model. PROSPERO REGISTRATION NUMBER: CRD42020181589.


Assuntos
Cartilagem/efeitos dos fármacos , Protocolos Clínicos , Osteoartrite do Joelho/tratamento farmacológico , Manejo da Dor/normas , Plasma Rico em Plaquetas , Animais , Metanálise como Assunto , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Regeneração/efeitos dos fármacos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(1): e24115, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429780

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), also known as degenerative osteoarthritis, is a common and frequently occurring disease in orthopedics with cartilage degeneration as the pathogenic cause and articular bone hyperplasia as the sign. Many studies have confirmed that KOA can be effectively treated by traditional Chinese medicine (TCM) external treatment. So we take advantage of the method of network meta-analysis to systematically compare the efficacy and safety of different types of TCM external treatment for the KOA. METHODS: We will research on external treatment of KOA by traditional Chinese medicine using randomized controlled trials (RCTs) in search database (EMBASE, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI], Weipu database [VIP], Wanfang, and China BioMedical Literature [CBM]). The data and evidence obtained will be processed using Stata 15.0 and WinBUGS 1.4.3. RESULTS: We will evaluate the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis in this study. CONCLUSION: This study will provide a new regimen for KOA treatment. It has extremely high reference value. INPLASY REGISTRATION NUMBER: INPLASY2020120001. DOI NUMBER: : 10.37766/inplasy2020.12.0001.


Assuntos
Protocolos Clínicos , Medicina Tradicional Chinesa/normas , Osteoartrite do Joelho/tratamento farmacológico , Humanos , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Osteoartrite do Joelho/complicações , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
Arthroscopy ; 36(12): 3079-3080, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33276894

RESUMO

Knee osteoarthritis is associated with an annual cost to society exceeding US$27 billion. Value-based treatment is an important consideration, and cost-benefit analyses are crucial to determine the benefits to both patients and society. The quality-adjusted life year (QALY) is a generic measure of burden including both quality and quantity. Recent studies have suggested that intra-articular injection of platelet-rich plasma (PRP) is effective treatment for knee osteoarthritis and comparable to hyaluronic acid (HA). Although the costs (dollars) per QALY were higher for PRP ($8,635) than for HA ($5,331), PRP was more cost effective at 1 year and was associated with an incremental cost-effectiveness ratio (ICER) of $12,628 QALY. Similarly, the utility value (proportion of QALY compared with perfect health) of PRP was higher by 0.11 QALY: 0.69 versus 0.58.


Assuntos
Osteoartrite do Joelho , Plasma Rico em Plaquetas , Análise Custo-Benefício , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(46): e23242, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181712

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a worldwide disease and more and more people are suffered from it. With the increasing number of patients, it brings a huge burden on social economy and security system. There are varieties of methods to cure KOA, such as Traditional Chinese Medicine and surgery. Needle knife therapy plus Sodium hyaluronate Injection is one of the prevalent treatments for KOA. Therefore, we perform a systematic review and meta-analysis to evaluate the evidence for the treatment of needle knife therapy plus sodium hyaluronate Injection. METHODS: Randomized controlled trials will be used to compare the effect of needle knife therapy plus sodium hyaluronate injection with needle knife alone for KOA patients. Six studies will be included in this meta-analysis, and the relative risk and weight mean difference with 95% CI for the Lysholm knee score, visual analogue scale, and effective rate will be evaluated by using RevMan 5.3 software. Besides, the bias assessment of the included studies will be evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations, Assessment Development, and Evaluation system will be applied to assess the overall quality of the evidence. RESULTS: From the study we will assess the effectiveness, safety of needle knife therapy plus sodium hyaluronate injection on joint pain relief and functional improvement in patients with KOA. CONCLUSION: The study will provide a new evidence to confirm the effect of needle knife therapy plus sodium hyaluronate injection on KOA, which can further guide the selection of therapy. PROSPERO REGISTRATION NUMBER: CRD42020169602.


Assuntos
Terapia por Acupuntura/métodos , Ácido Hialurônico/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Terapia por Acupuntura/normas , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares/métodos , Injeções Intra-Articulares/normas , Metanálise como Assunto , Manejo da Dor/métodos , Manejo da Dor/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(47): e22943, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217798

RESUMO

INTRODUCTION: There are many injection methods for the treatment of knee osteoarthritis, but there is no comprehensive comparison, based on the fixed effect model. METHODS: According to the retrieval strategy, we searched randomized controlled trials (RCTs) randomly from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), Wanfang Database from their inceptions to August 2020, and 2 members of us selected literatures and extracted data independently. Methodological quality was assessed by using the Cochrane bias risk tool, and meta-analysis was performed by using the Stat.14.0. RESULTS: This study will evaluate the effectiveness and safety of different injectable drugs for the treatment of knee osteoarthritis and rank the efficacies of drugs, then to determine the optimal treatment. CONCLUSION: This study will provide evidence for the choice of injection therapy for knee osteoarthritis. INPLASY REGISTRATION NUMBER: INPLASY202080099.


Assuntos
Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Projetos de Pesquisa , Teorema de Bayes , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
6.
Medicine (Baltimore) ; 99(47): e23262, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217849

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a kind of degenerative osteoarthropathy, which causes joint pain and limited mobility, seriously affects the quality of life of the patient. Traditional Chinese Medicine acupuncture and moxibustion has been widely used to treat KOA, and acupoint injection is 1 of the acupuncture treatment methods. The purpose of this work is to evaluate the effectiveness of Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection for KOA. METHODS: We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2020. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS: This study will evaluate the efficacy and safety of Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection in the treatment of KOA, to provide high-quality, evidence-based clinical recommendations. TRIAL REGISTRATION NUMBER: INPLASY2020100058 CONCLUSION:: This study will provide reliable evidence on whether Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection is more effective in treating KOA.


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Ácido Hialurônico/administração & dosagem , Metanálise como Assunto , Osteoartrite do Joelho/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto/métodos , Humanos , Injeções/métodos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(43): e22767, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120786

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) causes joint pain and limited mobility, which affects the quality of life. The use of Chinese herbal medicine to treat KOA has achieved certain effects, and Wutou decoction (WTD) is one of them. But there is no high-level evidence to support this result. The purpose of this work is to evaluate WTD's efficacy and safety in the management of KOA. METHODS: We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), Chinese databases SinoMed (CBM), PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to September 2020. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS: This study will evaluate the current efficacy and safety of WTD in the treatment of KOA, to provide high-quality, evidence-based clinical recommendations. CONCLUSION: This study will provide reliable evidence on whether WTD is safe and effective in treating KOA. TRIAL REGISTRATION NUMBER: INPLASY202090022.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
9.
Radiology ; 297(3): 503-512, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33079000

RESUMO

Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.


Assuntos
Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/tratamento farmacológico , Humanos , Injeções Intra-Articulares
10.
Medicine (Baltimore) ; 99(37): e21813, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925717

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic disease with worldwide prevalence of 10% to 79%, with costs ranging from $560 to $635 billion for year in United States of America. The main guidelines recommend interventions with undesirable adverse events (AE) or highly dependent on the patient's persistence. Thus, intra-articular (IA) therapies appear to be attractive in patients with KOA, as well as a valid therapy by maximizing effects locally in the joint and limiting systemic AE. Presently, the main available IA therapies are corticosteroids and hyaluronic acid.As several meta-analyses about the efficacy of intra-articular hyaluronic acid (IAHA) for treatment of KOA with discordant results were published, we decided to conduct an umbrella review to summarize this efficacy METHODS:: We will search MEDLINE/PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) from inception to February 2020 for systematic reviews with meta-analyses of randomized clinical trials that investigate IAHA for therapy of KOA. Grey literature will be searched in Opengray platform, Research Gate, and Google Scholar. The reference lists of eligible studies will be screened. The search will be performed without language restriction.We will include any type of IAHA as experimental intervention and different types of oral or intra-articular placebo or medications as controls. The primary outcome will be measures of efficacy as the Western Ontario and McMaster Universities Osteoarthritis Index.A synthesis of the evidence will be conducted and data will be presented in tables.Two reviewers will independently appraise the quality of included meta-analyses using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and will classify the included systematic reviews into high, moderate, low, or critically low levels of confidence. RESULTS: The results of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION: No ethical approval is required since this study data is based on published literature. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD42019120269 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).


Assuntos
Ácido Hialurônico/administração & dosagem , Osteoartrite do Joelho/tratamento farmacológico , Viscossuplementação/estatística & dados numéricos , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Viscossuplementação/métodos
11.
Ann Intern Med ; 173(11): 861-869, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32926799

RESUMO

BACKGROUND: Current pharmacologic therapies for patients with osteoarthritis are suboptimal. OBJECTIVE: To determine the efficacy of Curcuma longa extract (CL) for reducing knee symptoms and effusion-synovitis in patients with symptomatic knee osteoarthritis and knee effusion-synovitis. DESIGN: Randomized, double-blind, placebo-controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000080224). SETTING: Single-center study with patients from southern Tasmania, Australia. PARTICIPANTS: 70 participants with symptomatic knee osteoarthritis and ultrasonography-defined effusion-synovitis. INTERVENTION: 2 capsules of CL (n = 36) or matched placebo (n = 34) per day for 12 weeks. MEASUREMENTS: The 2 primary outcomes were changes in knee pain on a visual analogue scale (VAS) and effusion-synovitis volume on magnetic resonance imaging (MRI). The key secondary outcomes were change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and cartilage composition values. Outcomes were assessed over 12 weeks. RESULTS: CL improved VAS pain compared with placebo by -9.1 mm (95% CI, -17.8 to -0.4 mm [P = 0.039]) but did not change effusion-synovitis volume (3.2 mL [CI, -0.3 to 6.8 mL]). CL also improved WOMAC knee pain (-47.2 mm [CI, -81.2 to -13.2 mm]; P = 0.006) but not lateral femoral cartilage T2 relaxation time (-0.4 ms [CI, -1.1 to 0.3 ms]). The incidence of adverse events was similar in the CL (n = 14 [39%]) and placebo (n = 18 [53%]) groups (P = 0.16); 2 events in the CL group and 5 in the placebo group may have been treatment related. LIMITATION: Modest sample size and short duration. CONCLUSION: CL was more effective than placebo for knee pain but did not affect knee effusion-synovitis or cartilage composition. Multicenter trials with larger sample sizes are needed to assess the clinical significance of these findings. PRIMARY FUNDING SOURCE: University of Tasmania and Natural Remedies Private Limited.


Assuntos
Osteoartrite do Joelho/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Sinovite/tratamento farmacológico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Curcuma , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/efeitos dos fármacos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Medição da Dor , Fitoterapia/métodos , Sinovite/etiologia , Ultrassonografia
12.
Ann Intern Med ; 173(6): JC34, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32926813

RESUMO

SOURCE CITATION: Deyle GD, Allen CS, Allison SC, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020;382:1420-9. 32268027.


Assuntos
Glucocorticoides , Osteoartrite do Joelho , Glucocorticoides/uso terapêutico , Humanos , Injeções , Osteoartrite do Joelho/tratamento farmacológico , Dor/etiologia , Dor/prevenção & controle , Modalidades de Fisioterapia
13.
Acta Chir Orthop Traumatol Cech ; 87(4): 273-277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32940223

RESUMO

PURPOSE OF THE STUDY In this study it is aimed to prospectively evaluate the safety and efficacy of 20 mg/2 ml Hyaluronic Acid (HA) injections for non-operative palliation treatment of osteoarthritis (OA) of the knee joint. MATERIAL AND METHODS After institutional review board approval was obtained for the study, 63 patients were enrolled and followed prospectively. All the patients have signed informed consent form. Patients who had diagnosis of gonarthrosis according to clinical and radiological evaluation, were given nonsteroid antiinflammatory drug (NSAID) treatment for four weeks. Patients between 55-80 years old in both sexes, whose pain did not relieve were included to the study and were followed up for 6 months. They were applied HA injections in total; three times with one week of interval. Patients were evaluated three times during the study. First one at third week (at the control visit of third injection), secondly at third month and lastly at sixth month. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Short Form Health Survey (SF-36) scores were used to clinically evaluate the patients at follow ups. RESULTS 56 (88.9%) patients completed the study and 7 (11.1%) patients did not show up for follow-up examinations and they were excluded. The mean age of the patients was 63.6 ± 6.90 (range 47 and 76) years old. 22 (39.2%) of the patients were male and 34 (60.7%) were female. Any adverse events and adverse effects were not seen in the enrolled patients group. CONCLUSIONS Results of this study revealed that the use of 20 mg/2 ml HA injection was effective in improving the WOMAC index score in patients of knee OA. Additionally, patients' quality of life as measured by SF-36 questionnaire was also significantly improved at the end of the study. None of the patient reported any of the adverse events during the study. Overall, the 20 mg/2 ml HA injection can be considered as a good treatment option for the knee OA in patients who do not respond to non-pharmacological therapy, NSAIDs or analgesics. Key words: osteoarthritis, hyaluronic acid, injection, non-operative.


Assuntos
Ácido Hialurônico , Osteoartrite do Joelho , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/tratamento farmacológico , Qualidade de Vida , Resultado do Tratamento
14.
PLoS One ; 15(9): e0238024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991606

RESUMO

INTRODUCTION: At present, information about clinical efficacy and adverse events of controlled release (CR) form of pelubiprofen, a prodrug of 2-arylopropionic acid with relatively selective effects on cyclooxygenase-2 activity, remains scarce. In this study, we sought to determine non-inferiority of pelubiprofen CR 90 mg/day compared to aceclofenac 200 mg/day regarding clinical efficacy and adverse events after a 4-week course of medication in the patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A total of 191 patients were randomly assigned to take either pelubiprofen CR 90 mg (n = 95) or aceclofenac 200 mg (n = 96). The primary outcome variable was non-inferiority of pain reduction between baseline and week 4 when assessed using a 100 mm pain visual analogue scale (VAS). Pelubiprofen was considered non-inferior to aceclofenac if the upper limit of the one-sided 97.5% confidence interval for the difference in terms of pain VAS was above 15 mm (the average change of pain VAS in the pelubiprofen group-pain VAS reduction in the aceclofenac group). Secondary outcome variables were the changes in 100 mm pain VAS at week 2 versus baseline, K-Western Ontario, and McMaster University Arthritis Index (K-WOMAC) changes at weeks 2 and 4 as compared to baseline, patient global assessment at weeks 2 and 4. The frequency and amount of rescue medicine usage at weeks 2 and 4 were also evaluated as the secondary outcome variable. For safety analysis, adverse events, clinical laboratory tests, vital signs, and physical examinations were assessed and conducted at each follow-up visit. RESULTS: At week 4, the pain VAS values were significantly reduced in both groups receiving either pelubiprofen CR 90 mg or aceclofenac 200 mg as compared to the baseline. However, the pelubiprofen group and the aceclofenac group respectively showed the pain VAS changes of -22 and -21.9 in the pre-protocol set and -20.8 and -21.7 in the full analysis set, confirming non-inferiority. The pelubiprofen CR 90 mg showed a reduced incidence of adverse events compared to the aceclofenac 200 mg (p = 0.005). CONCLUSIONS: Pelubiprofen CR 90 mg is as effective as aceclofenac 200 mg with reduced adverse events for the treatment of symptomatic knee osteoarthritis.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/análogos & derivados , Osteoartrite do Joelho/tratamento farmacológico , Fenilpropionatos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diclofenaco/uso terapêutico , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Medição da Dor , Segurança do Paciente , Resultado do Tratamento
15.
Am J Sports Med ; 48(11): 2703-2710, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32870042

RESUMO

BACKGROUND: Blood derivative injections have been recently proposed to address osteoarthritis (OA) with overall positive results, although long-term data on their efficacy are lacking. A novel blood derivative has been developed to concentrate growth factors and antagonists of inflammatory cytokines and shown promising early findings. PURPOSE: To investigate if the positive effects of a single intra-articular injection of autologous protein solution (APS) in patients affected by knee OA-previously documented at 1 year in a multicenter double-blind randomized saline-controlled trial-last up to 3 years. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 46 patients with Kellgren-Lawrence 2 or 3 knee OA were randomized into 2 groups: 1 ultrasound-guided APS injection (n = 31) or 1 saline injection (n = 15). At 1 year, the saline group was allowed to cross over. Patients were re-evaluated at 24 and 36 months through the visual analog scale for pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index Likert 3.1 (WOMAC LK 3.1), Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey (SF-36), and Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder rate. Magnetic resonance imaging evaluation was performed with the MRI Osteoarthritis Knee Score (MOAKS) before and at 24 months after treatment, and radiographs were assessed per Kellgren-Lawrence before and annually after treatment. RESULTS: In the APS cohort, WOMAC pain improved from 11.5 ± 2.4 (mean ± SD) to 4.3 ± 4.0 at 1 year and to 5.7 ± 5.0 at 3 years (P < .0001 vs baseline). The APS cohort also showed a statistically significant improvement in its KOOS pain score from 39.4 ± 13.1 to 70.6 ± 21.5 at 1 year and to 64.1 ± 24.6 at 3 years (P < .0001 vs baseline) and VAS pain scores from 5.5 ± 2.2 to 2.6 ± 2.5 at 1 year and to 3.4 ± 2.9 at 3 years (P = .0184 vs baseline). VAS pain score significantly worsened from 12 to 36 months (P = .0411). All patients in the saline group decided to cross over to APS, and their final scores were better than baseline, although not significantly better than at the crossover point. Overall, 7 of 26 (26.9%) APS cases and 4 of 14 (28.6%) crossover cases were considered failures as patients underwent further injective treatments or surgical procedures between the 12- and 36-month follow-up. MOAKS findings showed no statistically significant differences. Patients with better cartilage had greater WOMAC pain improvement when their baseline scores were worse, whereas the trend was reversed for patients with cartilage loss at baseline. CONCLUSION: Intra-articular use of APS for mild to moderate knee OA was safe, and significant pain improvement was documented 3 years after a single injection. Patients with better cartilage status seem to respond better than patients with more cartilage loss, with more clinical improvement even when starting from more painful conditions. REGISTRATION: NCT02138890 (ClinicalTrials.gov identifier).


Assuntos
Osteoartrite do Joelho , Proteínas , Método Duplo-Cego , Humanos , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Proteínas/administração & dosagem , Soluções/administração & dosagem , Resultado do Tratamento
16.
Clin Drug Investig ; 40(11): 1071-1084, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32965598

RESUMO

BACKGROUND AND OBJECTIVES: The guidelines for osteoarthritis (OA) treatment recommend different therapies including pharmacotherapy, and several analgesic options are available for pain management. In Japan, research on hip and knee OA treatment trends is scarce and OA-related healthcare costs are unknown. Therefore, this study aimed to examine the treatment and healthcare cost trends among Japanese patients with hip or knee OA. METHODS: This was a cross-sectional study held between 2013 and 2019, using a medical claims database. The demographic and treatment characteristics of hip or knee OA patients for each year were descriptively analyzed and the medians for healthcare utilization and all-cause healthcare costs were calculated. RESULTS: The yearly mean age of 59,218 hip OA and 270,722 knee OA patients ranged from 66.3 to 68.6 years and 71.1 to 73.1 years, respectively. The prevalence of comorbidities was higher in knee OA than hip OA. In both groups, > 70% of patients were female, and the most common treatment was pain-related medication. In hip OA, topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) were mostly used throughout the study period (34.1-41.4% and 32.0-40.3%, respectively). Similarly, in knee OA, topical and systemic NSAIDs were used in 58.3-63.3% and 36.5-46.0% patients, respectively. Increase in the use of acetaminophens (10.9% in hip OA and 10.2% in the knee OA) and weak opioids (3.7%, and 3.4%, respectively) from 2013 to 2019 were observed. Most patients were treated as outpatients in both groups. The median all-cause healthcare costs were approximately 35,000 JPY for hip OA and 74,000 JPY for knee OA. CONCLUSIONS: Although a considerable change in total healthcare cost was not observed in our study, the contents of medical treatment and cost breakdown were greatly altered due to the treatment and cost for OA itself, and the treatment and cost for comorbidities. Similar studies to investigate such a trend may help predict necessary resources and social needs. Thus, further investigation utilizing other databases is needed.


Assuntos
Custos de Cuidados de Saúde , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Dor/tratamento farmacológico , Prevalência
18.
Biosci Rep ; 40(9)2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32803252

RESUMO

OBJECTIVES: In the treatment of osteoarthritis (OA), tramadol, a common weak opioid, has become popular due to its effectiveness in inhibition of pain. In the present study, we aimed to explore the effect of tramadol on subchondral bone, especially changes in the microstructure and mechanical properties. METHODS: A mouse model of OA was established in the present study by destabilization of the medial meniscus (DMM). A vehicle or drug was administered for 4 weeks. Specimens were harvested and analyzed radiologically and histologically using micro-computed tomography (micro-CT), scanning electron microscopy (SEM), atomic force microscopy (AFM) and histological staining to evaluate the knee joints of mice undergoing different forms of intervention. RESULTS: In the early stages of OA induced by DMM, the subchondral bone volume fraction in the OA group was significantly higher than in the sham+vehicle (sham+veh) group, while the volume in the treatment groups was lower than in the DMM+vehicle (DMM+veh) and sham+veh groups. In addition, the elastic moduli in the treatment groups clearly decreased compared with the DMM+veh and sham+veh groups. Observations of the subchondral bone surface by SEM indicated serious destruction, principally manifesting as a decrease in lacunae and more numerous and scattered cracks. Histological staining demonstrated that there was no difference in the degeneration of either the articular cartilage or synovial cells whether tramadol was used or not. CONCLUSION: Although tramadol is effective in inhibiting pain in early OA, it negatively regulates the microstructure and mechanical properties of subchondral bone in joints.


Assuntos
Osso e Ossos/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/fisiopatologia , Tramadol/efeitos adversos , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacologia , Animais , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/ultraestrutura , Cartilagem/efeitos dos fármacos , Cartilagem/patologia , Modelos Animais de Doenças , Módulo de Elasticidade/efeitos dos fármacos , Masculino , Meniscos Tibiais/fisiopatologia , Camundongos Endogâmicos C57BL , Microscopia de Força Atômica , Microscopia Eletrônica de Varredura , Osteoartrite do Joelho/diagnóstico por imagem , Sinovite/induzido quimicamente , Sinovite/patologia , Tramadol/farmacologia , Microtomografia por Raio-X
19.
Complement Ther Clin Pract ; 40: 101219, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32835919

RESUMO

BACKGROUND AND OBJECTIVES: Knee osteoarthritis is one of the most common types of arthritis. The disease not only has a high disease burden but also reduces the quality of life of patients. The purpose of this research was to study the effect of Foeniculum vulgare Mill. (commonly known as Fennel) seed extract on knee pain in women patients with knee osteoarthritis. METHODS: In this randomized, double-blind trial, a total of 66 patients were assigned randomly via the blocking method in two groups, fennel and placebo. All patients received four capsules daily of either powdered fennel extract (each capsule contained 200 mg dried fennel extract from 7 g of fennel seeds) or placebo twice a day for two weeks. The patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and Visual Analog Scale (VAS) for pain intensity measurement before and after the study completion. Data were then analyzed via intention to treat method using the SPSS statistical software package. RESULTS: Two weeks after the trial, a significant decrease was noted between the two groups in terms of pain, disability, total WOMAC score, and VAS variables. After comparing the pre- and post-intervention, the variables mentioned above revealed a significant decline in both groups. The stiffness variable indicated a significant reduction in the fennel group (between baseline and study completion) after two weeks, but this decline was not significant in the placebo group, and was not significant either between the two groups. At the end of the trial, the percentage change was higher in the fennel group than in the placebo group. Also, the effect size was greater in the fennel group especially in pain variable based on WOMAC and VAS than in the placebo group. CONCLUSION: The results indicated that fennel may be an appropriate alternative for complementary treatment in patients with knee osteoarthritis. This study is the first clinical trial using oral fennel on knee pain in these patients, and the outcomes should be confirmed through additional studies.


Assuntos
Foeniculum/química , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Adulto , Cápsulas , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica
20.
J Acupunct Meridian Stud ; 13(4): 129-135, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32738365

RESUMO

BACKGROUND: Osteoarthritis is the most common type of arthritis. Depression, anxiety, and stress are associated with knee osteoarthritis. OBJECTIVES: The aim of the study was to check the effectiveness of acupressure therapy with pharmacological treatment on pain, depression, anxiety, and stress in patients with knee osteoarthritis and to assess the effect of pain improvement on psychological health. METHODS: Eligible 212 patients with knee osteoarthritis were divided into two groups (intervention and control group). The intervention group (n = 106) received acupressure therapy in combination with pharmacological treatment, whereas the control group (n = 106) continued pharmacological treatment only. Pain and psychological symptoms were measured using the visual analog scale and Depression Anxiety Stress Scale-21. Pearson's correlation was used to check the effect of pain improvement on psychological health. RESULTS: Patients of both groups reported severe pain initially. On analyzing the results after completion of the study, it was found that patients in the intervention group scored better on the pain scale (p < 0.001) and DASS-21 (p ≤ 0.0001). However, it may be noted that reduction in the DASS-21 score was not found to be significant for the control group (p = 0.08). Pearson's correlation coefficients value ranged from 0.231 to 0.412 for DASS-21 (p < 0.05). CONCLUSIONS: On analysis, it can be concluded that acupressure can be used as add-on therapy in combination with conventional treatment (pharmacological treatment), which may assist in pain reduction. The reduction in pain directly contributes to improvement in the physiological wellness among patients with knee osteoarthritis.


Assuntos
Acupressão , Anti-Inflamatórios não Esteroides/administração & dosagem , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/terapia , Idoso , Ansiedade/terapia , Terapia Combinada , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor
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