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1.
Medicine (Baltimore) ; 100(2): e23944, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466135

RESUMO

ABSTRACT: There has been a highly active area in the pain management of osteoarthritis (OA) over the past 2 decades. The study aims to unmask the global status and trends in this field.Publications on pain management of OA from 2000 to 2019 were retrieved from the Web of Science (WOS) database. The data were analyzed using bibliometric statistical methodology. The software VOS viewer was used for bibliographic coupling, co-authorship, co-citation, co-occurrence analysis and to investigate the publication trends in pain management of OA.A total of 8207 researches in amount were included. The relative research interests and number of publications indicated a rising trend. The USA made the greatest contribution to this field, with the most publications, total citations and the highest H-index, while Sweden had the highest average citation per publication. The most contributive organization was Boston University. The journal OA and Cartilage published the most relative articles. Researches could be grouped into 5 clusters based on co-occurrence network map: Health and Epidemiology; Sport Medicine; Clinical Study; Mechanism Research and Medical Technology and Science. Medical Technology and Science was predicted as the next research topic in this field.The number of publications about pain management of OA would be increasing based on current global trends. The USA made the largest contribution to this field. The development of Medical Technology and Science may be the next popular topics in the pain management of OA research.


Assuntos
Pesquisa Biomédica/tendências , Osteoartrite/complicações , Manejo da Dor/tendências , Dor/etiologia , Bibliometria , Humanos
2.
AJR Am J Roentgenol ; 215(4): 954-962, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32755169

RESUMO

OBJECTIVE. The purposes of this study were to determine the medium-term effect of ultrasound-guided infiltration of platelet-rich plasma (PRP) on partial tears of the supraspinatus tendon (SST) and to identify prognostic indicators of an unfavorable outcome. SUBJECTS AND METHODS. Over a period of 4 years, patients with a partial SST tear smaller than 1.5 cm referred for ultrasound-guided PRP infiltration (1 mL) for shoulder pain lasting more than 3 months were recruited consecutively. MRI was used to analyze the type of acromion and presence of acromioclavicular (AC) arthrosis. Primary (size of the tear and associated bursitis) and secondary (mobility and pain) results were collected at 3 months. RESULTS. The study included 128 patients (66 men, 62 women; mean age, 48.3 years; range, 20-59 years). At 3 months, favorable evolution of the tear repair was recorded in 71.1% (91/128) of patients and resolution of bursitis in 66.7% (42/63). Changes in tear size had large effect sizes (Cohen d ≥ 1.16), as did pain and shoulder mobility (Cohen d ≥ 0.95). The strongest predictors of unfavorable evolution of tear and bursitis were type 3 acromion and types 1 and 2 acromion with AC arthrosis (p < 0.001; ß = 20.412). CONCLUSION. Ultrasound-guided PRP infiltration of partial tears of the SST relieves pain and improves shoulder mobility, but its effect on the size of the tear is influenced by the morphologic characteristics of the acromion and the presence of AC arthrosis. The effect of PRP is insufficient in patients with a type 3 acromion or severe AC arthrosis.


Assuntos
Articulação Acromioclavicular , Acrômio/patologia , Osteoartrite/complicações , Plasma Rico em Plaquetas , Lesões do Manguito Rotador/terapia , Ultrassonografia de Intervenção , Acrômio/diagnóstico por imagem , Adulto , Bursite/diagnóstico por imagem , Bursite/etiologia , Bursite/terapia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/etiologia , Dor de Ombro/terapia , Resultado do Tratamento , Adulto Jovem
3.
J Bone Miner Metab ; 38(6): 806-818, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32656644

RESUMO

INTRODUCTION: Our previous studies demonstrated that a high bone turnover state under osteoporotic changes decreased the threshold of skeletal pain. Recent studies reported that the incidence of joint pain due to osteoarthritis (OA) in postmenopausal women was higher than that in males even with the same radiographic OA grade. The aim of this study was to evaluate whether a high bone turnover state affects the induction of pain-like behaviors in mild OA model mice. MATERIALS AND METHODS: We established mild OA model mice with accompanying osteoporotic changes by monosodium iodoacetate injection after ovariectomy. We assessed pain-like behaviors by von Frey test and paw-flick test; histological changes in OA joints; the expression of Runx2, Osterix, Osteocalcin, and Rankl; bone micro-architecture by µCT and measured serum tartrate-resistant acid-phosphatase 5b levels in the model mice. RESULTS: Pain-like behaviors in mice with OA and osteoporotic changes were significantly increased in comparison with those in OA mice without osteoporotic changes. The severity of histological OA changes did not differ significantly between the OA mice with and without osteoporotic changes. Bisphosphonate significantly improved pain-like behaviors accompanied with improvement in the high bone turnover state in the OA mice with osteoporosis, while it had no significant effect on pain-like behaviors in the OA mice without osteoporosis. In addition, the improvement was maintained for more than 4 weeks even after the discontinuation of bisphosphonate treatment. CONCLUSION: These results indicated that a high bone turnover state under osteoporotic changes could affect the induction of pain-like behaviors in mild OA model mice.


Assuntos
Comportamento Animal , Remodelação Óssea , Osteoartrite/complicações , Osteoporose/complicações , Osteoporose/fisiopatologia , Dor/etiologia , Animais , Remodelação Óssea/efeitos dos fármacos , Cartilagem/patologia , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/genética , Inibidores de Ciclo-Oxigenase/farmacologia , Difosfonatos/farmacologia , Modelos Animais de Doenças , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Iodoacetatos , Masculino , Camundongos Endogâmicos C57BL , Osteoartrite/sangue , Osteoartrite/patologia , Osteoartrite/fisiopatologia , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Osteoblastos/patologia , Osteocalcina/genética , Osteocalcina/metabolismo , Osteoclastos/efeitos dos fármacos , Osteoclastos/metabolismo , Osteoclastos/patologia , Osteoporose/sangue , Ovariectomia , Dor/sangue , Fosfatase Ácida Resistente a Tartarato/sangue , Microtomografia por Raio-X
4.
Bone Joint J ; 102-B(7): 881-889, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600138

RESUMO

AIMS: Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making. METHODS: A total of 163 shoulders in 162 patients with conservatively treated isolated proximal humeral fractures were included. The fractures occurred between January 2015 and May 2018. The mean age of the patients was 69 years (26 to 100) and the mean follow-up was 144 days (42 to 779). The fractures were classified according to Neer. Scores for osteoporosis (Tingart, Deltoid Tuberosity Index (DTI)) and osteoarthritis (OA) of the glenohumeral joint were assessed. Translation of the head on follow-up radiographs of more than 10 mm was defined as displacement. Eccentric head index (EHI) describes the offset of the humeral head centre in relation to the diaphyseal axis. The ratio was estimated on anteroposterior (AP) and Neer views. Medial hinge was considered intact if the medial cortex proximal and distal to the fracture was in line on AP view. RESULTS: Secondary fracture displacement occurred in 41 patients (25.2%). Clinical risk factors were alcohol abuse (odds ratio (OR) 6.8; 95% confidence interval (CI) 1.3 to 36; p = 0.025) and previously diagnosed osteoporosis (OR 4.6; 95% CI 0.6 to 34; p = 0.136). Age (OR 1.1; 95% CI 1.0 to 1.1; p = 0.003) and sex (OR 0.9; 95% CI 0.3 to 2.8; p = 0.867) were not independent factors. Radiological risk factors were OA grade 3 (OR 16.4; 95% CI 0.25 to 37.6; p = 0.107) and osteoporosis with the DTI (OR 10; 95% CI 0.8 to 250; p = 0.031) being more predictive than the Tingart score (OR 2.3; 95% CI 0.8 to 4.7; p = 0.041). A high EHI (AP/Neer > 0.4, OR 18.9; 95% CI 2.1 to 30.9/3.0; 95% CI 1.1 to 8.0; p = 0.002/p = 0.033) and a disrupted medial hinge (OR 3.7; 95% CI 1.1 to 12.6; p = 0.039) increased the risk of secondary displacement significantly. Neer classification had no influence. CONCLUSION: During conservative treatment, a quarter of patients showed secondary fracture displacement of at least 10 mm. Patients with alcohol abuse, severe OA, and osteoporosis are at risk. Newly defined EHI and disrupted medial hinge are relevant predictors for secondary displacement. Cite this article: Bone Joint J 2020;102-B(7):881-889.


Assuntos
Tratamento Conservador , Fraturas do Ombro/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoporose/complicações , Recidiva , Fatores de Risco , Fraturas do Ombro/diagnóstico por imagem
5.
Arch Osteoporos ; 15(1): 109, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32700153

RESUMO

A consensus platform is provided by the experts of the Gulf Cooperation Council (GCC) countries' respective osteoporosis societies, on which specific guidelines can be developed further for regional use on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. INTRODUCTION: Guidance is provided in a Gulf Cooperation Council (GCC) country setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis, which is an adaptation of the European guidance by Kanis et al., jointly published by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). The respective osteoporosis societies of the Gulf Cooperation Council (GCC) countries assembled for a unifying consensus on the diagnosis and management of osteoporosis in postmenopausal women for the region. METHODS: The Chair for Biomarkers of Chronic Diseases (CBCD) in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA), in cooperation with the Saudi Osteoporosis Society (SOS), hosted regional experts and respective leaders from different GCC osteoporosis societies, together with an adviser from the ESCEO. An assembly of experts representing the different osteoporosis societies from Saudi Arabia, the UAE, Bahrain, Oman, and Kuwait gathered on February 15-16, 2019 in Riyadh, KSA for the formulation of a general osteoporosis consensus for the region. RESULTS: The following areas were covered: diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; and hip fractures, vitamin D, recommendation on which FRAX tool to follow, and the importance of country-specific FRAX® and fracture liaison services for secondary fracture prevention. CONCLUSIONS: A platform is provided on which specific guidelines can be developed for regional use in GCC.


Assuntos
Osteoartrite , Osteoporose Pós-Menopausa , Idoso , Barein , Consenso , Feminino , Humanos , Kuweit , Pessoa de Meia-Idade , Omã , Osteoartrite/complicações , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/terapia , Pós-Menopausa , Arábia Saudita
7.
Bone Joint J ; 102-B(6): 727-735, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475250

RESUMO

AIMS: It remains controversial whether patellofemoral joint pathology is a contraindication to lateral unicompartmental knee arthroplasty (UKA). This study aimed to evaluate the effect of preoperative radiological degenerative changes and alignment on patient-reported outcome scores (PROMs) after lateral UKA. Secondarily, the influence of lateral UKA on the alignment of the patellofemoral joint was studied. METHODS: A consecutive series of patients who underwent robotic arm-assisted fixed-bearing lateral UKA with at least two-year follow-up were retrospectively reviewed. Radiological evaluation was conducted to obtain a Kellgren Lawrence (KL) grade, an Altman score, and alignment measurements for each knee. Postoperative PROMs were assessed using the Kujala (Anterior Knee Pain Scale) score, Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), and satisfaction levels. RESULTS: A total of 140 knees (130 patients) were identified for analysis. At mean 4.1 years (2.0 to 8.5) follow-up, good to excellent Kujala scores were reported. The presence of mild to moderate preoperative patellofemoral joint osteoarthritis had no impact on these scores (KL grade 0 vs 1 to 3, p = 0.203; grade 0 to 1 vs 2 to 3, p = 0.674). Comparable scores were reported by patients with osteoarthritis (Altman score of ≥ 2) evident on either the medial or lateral patellofemoral joint facet (medial, p = 0.600 and lateral, p = 0.950). Patients with abnormal patellar congruence and tilt angles (≥ 17° and ≥ 14°, respectively) reported good to excellent Kujala scores. Furthermore, lateral UKA resulted in improvements to patellofemoral alignment. CONCLUSION: This is the first study demonstrating that mild to moderate preoperative radiological degenerative changes and malalignment of the patellofemoral joint are not associated with poor patient-reported outcomes at mid-term follow-up after lateral fixed-bearing UKA. Our data suggest that this may be explained by realignment of the patella and thereby redistribution of loads across the patellofemoral joint. Cite this article: Bone Joint J 2020;102-B(6):727-735.


Assuntos
Artroplastia do Joelho , Mau Alinhamento Ósseo/complicações , Osteoartrite/complicações , Osteoartrite/patologia , Articulação Patelofemoral/patologia , Medidas de Resultados Relatados pelo Paciente , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
J Vis Exp ; (159)2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32510505

RESUMO

The current animal models of osteoarthritis (OA) can be divided into spontaneous models and induced models, both of which aim to simulate the pathophysiological changes of human OA. However, as the main symptom in the late stage of OA, pain affects the patients' daily life, and there are not many available models. The mono-iodoacetate (MIA)-induced model is the most widely used OA pain model, mainly used in rodents. MIA is an inhibitor of glyceraldehyde-3-phosphate dehydrogenase, which causes chondrocyte death, cartilage degeneration, osteophyte, and measurable changes in animal behavior. Besides, expression changes of matrix metalloproteinase (MMP) and pro-inflammatory cytokines (IL1 ß and TNF α) can be detected in the MIA-induced model. Those changes are consistent with OA pathophysiological conditions in humans, indicating that MIA can induce a measurable and successful OA pain model. This study aims to describe the methodology of intra-articular injection of MIA in rats and discuss the resulting pain-related behaviors and histopathological changes.


Assuntos
Modelos Animais de Doenças , Ácido Iodoacético/administração & dosagem , Ácido Iodoacético/farmacologia , Osteoartrite/complicações , Dor/induzido quimicamente , Animais , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/patologia , Condrócitos/efeitos dos fármacos , Condrócitos/metabolismo , Citocinas/metabolismo , Injeções Intra-Articulares , Masculino , Metaloproteinases da Matriz/metabolismo , Dor/complicações , Dor/patologia , Ratos
9.
PLoS One ; 15(6): e0234972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574222

RESUMO

OBJECTIVE: To evaluate prevalence of structural lesions, synovitis and bone marrow lesions (BMLs) on MRI performed with a 0.3T imaging system in patients with erosive hand osteoarthritis (EHOA) and to compare them to the anatomic radiographic Verbruggen-Veys score (VV). DESIGN: For this Cross-sectional study, fifty-five EHOA patients were studied with 0.3T contrast-enhanced MRI and radiography (RX) of their dominant hand. Structural lesions were scored according to the OMERACT Hand Osteoarthritis MRI Scoring System as follows: osteophytes and erosions were graded from 0 to 3. On joint destruction lesion synovitis and BMLs were graded from 0 to 1. And on MRI, we evaluated the presence of several structural features: N: normal, O: osteophytic lesions, E: erosive lesions, E/O: osteophytic and erosive lesions and D: joint destruction. RX was scored according to the VV system. Relations between MRI features and VV stages were analysed. RESULTS: MRI identified more structural lesions than RX (77.3% versus 74.8%) and particularly more erosive lesions (E or E/O) than VV Phase E (33.5% versus 20.2%). E/O and D were mostly found on MRI. Synovitis and BMLs were significantly associated with E/O and D with the following odds ratios (ORs): 8.4 (95% CI 1.8-13.6); OR: 13.7 (95% CI 2.9-21.0); OR: 15.7 (95% CI 3.2-23.5); OR: 38.5 (95% CI 9.5-57.0), respectively. CONCLUSION: MRI 0.3T appears completely relevant for EHOA lesion analysis. First, MRI shows more erosive lesions than RX in EHOA; second, it allows for the analysis of synovitis and BMLs to be associated with more specific structural MRI features (E/O and D).


Assuntos
Medula Óssea/patologia , Articulação da Mão/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Osteoartrite/complicações , Radiografia/estatística & dados numéricos , Sinovite/epidemiologia , Idoso , Medula Óssea/diagnóstico por imagem , Estudos Transversais , Feminino , Articulação da Mão/diagnóstico por imagem , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Sinovite/diagnóstico por imagem , Sinovite/etiologia
10.
Pain Res Manag ; 2020: 5759265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32351639

RESUMO

Background: Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results: Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p ≤ 0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p ≤ 0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion: Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.


Assuntos
Analgésicos Opioides/uso terapêutico , Preparações de Ação Retardada/uso terapêutico , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Tapentadol/uso terapêutico , Idoso , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Osteoartrite/complicações , Estudos Prospectivos , Qualidade de Vida
12.
Artigo em Inglês | MEDLINE | ID: mdl-32365479

RESUMO

To investigate sensory changes, physical function (pF), quality of life (QoL) and pain intensity of patients with osteoarthritis (OA) in the natural course of disease, and patients undergoing total joint replacement therapy (TJR) 31 (20 females, mean age 64.6 ± 10.4 years), patients with OA were investigated with questionnaires and quantitative sensory testing (QST) in the area of referred pain at the thigh at baseline and follow-up 22-49 weeks later; changes were analyzed separately for patients with (n = 13) and without TJR (n = 18). In patients without TJR pain intensity, pF, QoL did not improve, and increased pain sensitivity to cold and a stronger loss of detection were observed. In patients after TJR, however, a reduction in mechanical pain sensitivity and allodynia occurred in accordance with a reduction of pain intensity and improvement of functionality while QoL did not improve. Additionally, an increased sensitivity to heat pain and a more pronounced loss of mechanical detection could be observed in this group. TJR seems to stop peripheral pain input leading to a reduction of pain intensity and central sensitization, but surgery-induced sensory changes such as peripheral sensitization and loss of detection occur. Furthermore, TJR has favorable effects on pain intensity and functionality but not QoL.


Assuntos
Osteoartrite do Joelho , Osteoartrite , Limiar da Dor , Fenótipo , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Dor , Qualidade de Vida
13.
Artigo em Inglês | MEDLINE | ID: mdl-32340336

RESUMO

(1) Osteoarthritis, the most common disease of the temporomandibular joints (TMJs), is diagnosed by clinical and radiographic examination. Cone beam computed tomography (CBCT) is a method of choice for the imaging of osteoarthritic changes. The objective was to compare the morphology of the TMJs in CBCT images regarding the number of the osteoarthritic changes diagnosed in the area of the condyle. (2) A total of 105 patients participated in the study; their 210 TMJs were allocated into one of three groups regarding the number of diagnosed osteoarthritic changes: 1 (none or 1 type), 2 (2 types), 3 (3 or more types). The morphology of the TMJ was examined for each TMJ in the CBCT images. Statistical analysis was performed with STATISTICA version 12.0. The statistical significance level was p = 0.05 for all the measurements included. (3) The articular surface flattening was the most common type of the osteoarthritic changes (90%). The condylar A-P dimension differed significantly among the groups (p = 0.0001). The bigger the number of osteoarthritic changes diagnosed in one joint, the smaller the condylar A-P dimension that was observed. (4) The temporomandibular joints' osteoarthritic changes occur very often, even among asymptomatic patients. The increased number of osteoarthritic changes seems to have an impact on the condylar anteroposterior dimension.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Osteoartrite/complicações , Osteoartrite/fisiopatologia , Transtornos da Articulação Temporomandibular/patologia , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Transtornos da Articulação Temporomandibular/diagnóstico por imagem
14.
J Clin Nurs ; 29(13-14): 2675-2690, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32301200

RESUMO

AIM AND OBJECTIVES: To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use. BACKGROUND: African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. DESIGN: A descriptive, secondary mixed-methods analysis. METHODS: A convenience sample of 110 African American adults (50-94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis. RESULTS: Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension. CONCLUSIONS: There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. RELEVANCE TO CLINICAL PRACTICE: Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.


Assuntos
Dor Crônica/tratamento farmacológico , Hipertensão/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Dor Crônica/complicações , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Medição da Dor/métodos , Pesquisa Qualitativa , Inquéritos e Questionários
15.
Medicine (Baltimore) ; 99(15): e19735, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282732

RESUMO

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.


Assuntos
Candida albicans/isolamento & purificação , Prótese Articular/microbiologia , Osteoartrite/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/cirurgia , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Fluconazol/uso terapêutico , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/cirurgia , Osteoartrite/complicações , Prevalência , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
J Shoulder Elbow Surg ; 29(7): e253-e268, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32113865

RESUMO

BACKGROUND: During anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (GHOA), the anterior shoulder joint capsule (ASJC) is characterized grossly by contracture, synovitis, and fibrosis. In tissues that develop fibrosis, there is substantial cross-talk between macrophages, fibroblasts, and myofibroblasts, modulated by calcium signaling and transient receptor potential (TRP) channel signaling. The purpose of this study was to compare and characterize the degree of synovitis, inflammatory infiltrate, and TRP channel expression in ASJC harvested from shoulders with and without primary GHOA. METHODS: The ASJC was resected from patients undergoing TSA for primary GHOA or other diagnoses and compared with ASJC from cadaveric donors with no history of shoulder pathology. ASJC was evaluated by immunohistochemistry to characterize synovial lining and capsular inflammatory cell infiltrate and fibrosis, and to evaluate for expression of TRPA1, TRPV1, and TRPV4, known to be involved in fibrosis in other tissues. Blinded sections were evaluated by 3 graders using a semiquantitative scale; then results were compared between diagnosis groups using nonparametric methods. RESULTS: Compared with normal control, the ASJC in primary GHOA had significantly increased synovitis, fibrosis, mixed inflammatory cell infiltrate including multiple macrophages subsets, and upregulation of TRP channel expression. CONCLUSION: These data support the clinical findings of ASJC and synovial fibrosis in primary GHOA, identify a mixed inflammatory response, and identify dysregulation of TRP channels in the synovium and joint capsule. Further studies will identify the role of synovial and capsular fibrosis early in the development of GHOA.


Assuntos
Contratura/etiologia , Cápsula Articular/metabolismo , Osteoartrite/metabolismo , Articulação do Ombro/metabolismo , Canais de Receptores Transientes de Potencial/metabolismo , Adulto , Artroplastia do Ombro , Contratura/metabolismo , Contratura/cirurgia , Feminino , Fibrose , Humanos , Imuno-Histoquímica , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Membrana Sinovial/patologia , Regulação para Cima
17.
Rev Med Suisse ; 16(685): 500-502, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167252

RESUMO

Osteoarthritis (OA) remains a prevalent and difficult to treat entity, mostly due to its different phenotypes. Varying constellations of mechanic, metabolic and extrinsic factors such as trauma are main drivers of OA. Anti-inflammatory therapy by anti-interleukin 1 did not show a clear effect neither in hand or knee OA whilst it seem to reduce joint replacement at least in a certain patient populations. Corticosteroids did reduce pain and methotrexate reduced structural progression in recent hand OA trials. More promising for mechanical knee OA are growth factors such as sprifermin or kartogenin which foster the differentiation of chondrocytes. New data are available on joint safety of the subcutaneously administered anti-nerve growth factor (NGF) molecule tanezumab. In OA treatment, pain, structure, and biomechanic impairment need to be addressed.


Assuntos
Osteoartrite , Artroplastia de Substituição , Progressão da Doença , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Osteoartrite/cirurgia , Osteoartrite do Joelho/tratamento farmacológico , Dor/complicações , Dor/tratamento farmacológico
18.
Orthop Nurs ; 39(2): 99-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218004

RESUMO

BACKGROUND: With the urgency related to improving quality and creating efficiency in healthcare, partnership is emerging as a critical concept related to transitions of care. PURPOSE: This quality improvement project included facilitation of hospital partnership with skilled nursing facilities to improve outcomes associated with the lower extremity total joint arthroplasty population. METHODS: The clinical nurse specialist (CNS) utilized a standardized framework to implement partnership strategies with multidisciplinary teams. Outcomes were monitored for the 2 quarters of partnership activities. RESULTS: All recommendations for developing a partnership model were facilitated within the project timeline. Patient experience and quality measures remained at, or improved, from baseline and met all strategic targets. Efficiency through episode payment demonstrated improvement at each interval during the study period. Analysis revealed a significant (p < .05) reduction in the mean hospital length of stay. CONCLUSION: The CNS practice outcomes suggest that the use of structured partnership strategies between agencies improves efficiency of care and accelerates rapid spread of innovation.


Assuntos
Artroplastia de Substituição/normas , Extremidade Inferior/cirurgia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade , Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/estatística & dados numéricos , Comportamento Cooperativo , Humanos , Tempo de Internação/estatística & dados numéricos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Osteoartrite/complicações , Osteoartrite/cirurgia , Indicadores de Qualidade em Assistência à Saúde
19.
Int J Mol Sci ; 21(4)2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32098316

RESUMO

Fibromyalgia (FM) diagnosis follows the American College of Rheumatology (ACR) criteria, based on clinical evaluation and written questionnaires without any objective diagnostic tool. The lack of specific biomarkers is a tragic aspect for FM and chronic pain diseases in general. Interestingly, the endogenous opioid system is close to the immune one because of the expression of opioid receptors on lymphocytes membrane. Here we analyzed the role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM and osteoarthritis (OA) patients. We enrolled three groups of females: FM patients, OA patients (chronic pain control group) and healthy subjects (pain-free negative control group). We collected blood samples to apply immunophenotyping analysis. Written tests were administrated for psychological analysis. Data were statistically analyzed. Final results showed that the percentage of Mu-positive B cells were statistically lower in FM and OA patients than in pain-free subjects. A low expression of Mu-positive B cell was not associated with the psychological characteristics investigated. In conclusion, here we propose the percentage of Mu-positive B cells as a biological marker for an objective diagnosis of chronic pain suffering patients, also contributing to the legitimacy of FM as a truly painful disease.


Assuntos
Linfócitos B/metabolismo , Biomarcadores/sangue , Dor Crônica/diagnóstico , Fibromialgia/complicações , Osteoartrite/complicações , Receptores Opioides mu/metabolismo , Adolescente , Adulto , Idoso , Dor Crônica/etiologia , Dor Crônica/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Sensibilidade e Especificidade , Método Simples-Cego , Adulto Jovem
20.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041761

RESUMO

This is a case of a 77-year-old woman with a 4.0 cm gas-containing iliopsoas bursa collection in the setting of mild-to-moderate degenerative joint disease. Given the limited extent of this patient's osteoarthritis and the absence of infectious signs or symptoms, both of which are typically related to gas collections at the hip, it was difficult to determine the aetiology of the patient's gas collection, whether it was related to her pain, and how best to manage her symptoms. Even in the setting of her MRI findings, which showed the gas collection lifting the iliopsoas tendon off the bone, the gas-containing bursa ultimately appeared to be a minor component of the patient's pain and definitive treatment of her underlying joint disease with a total hip arthroplasty allowed for successful pain management. Our case report demonstrates an unusual presentation of iliopsoas bursitis with a surprising response to medical, interventional and surgical management.


Assuntos
Bursite/diagnóstico , Osteoartrite/complicações , Dor/etiologia , Idoso , Artroplastia de Quadril , Bursite/cirurgia , Feminino , Virilha/patologia , Articulação do Quadril/patologia , Humanos , Artropatias/diagnóstico , Imagem por Ressonância Magnética , Osteoartrite/cirurgia , Tomografia Computadorizada por Raios X
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