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1.
Int J Mol Sci ; 22(6)2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33801144

RESUMO

We are conducting a clinical study of the use of allogeneic polydactyly-derived chondrocyte sheets (PD sheets) for the repair of articular cartilage damage caused by osteoarthritis. However, the transplantation of PD sheets requires highly invasive surgery. To establish a less invasive treatment, we are currently developing injectable fragments of PD sheets (PD sheets-mini). Polydactyly-derived chondrocytes were seeded in RepCell™ or conventional temperature-responsive inserts and cultured. Cell counts and viability, histology, enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qPCR), and flow cytometry were used to characterize PD sheets-mini and PD sheets collected from each culture. To examine the effects of injection on cell viability, PD sheets-mini were tested in four experimental conditions: non-injection control, 18 gauge (G) needle, 23G needle, and syringe only. PD sheets-mini produced similar amounts of humoral factors as PD sheets. No histological differences were observed between PD sheets and PD sheets-mini. Except for COL2A1, expression of cartilage-related genes did not differ between the two types of PD sheet. No significant differences were observed between injection conditions. PD sheets-mini have characteristics that resemble PD sheets. The cell viability of PD sheets-mini was not significantly affected by needle gauge size. Intra-articular injection may be a feasible, less invasive method to transplant PD sheets-mini.


Assuntos
Condrócitos/citologia , Polidactilia , Tecidos Suporte , Animais , Biomarcadores , Cartilagem Articular , Contagem de Células , Sobrevivência Celular , Condrócitos/metabolismo , Expressão Gênica , Humanos , Imuno-Histoquímica , Imunofenotipagem , Osteoartrite/terapia , Regeneração
2.
Artigo em Inglês | MEDLINE | ID: mdl-33799341

RESUMO

BACKGROUND: Thumb carpometacarpal osteoarthritis (CMC OA) is a common disorder that interferes with the ability to perform the activities of daily life. The purpose of this study was to investigate the immediate effects of ischemic compression on myofascial trigger points (MTrPs) in the first dorsal interosseous (FDI) muscle in patients with the diagnosis of thumb CMC OA. METHODS: In a quasi-experimental clinical trial, thirty-one patients, 87% female (age: 82 ± 9.4 years), with thumb CMC OA, were consecutively assigned to either an experimental treatment that included the ischemic compression of the FDI MTrP or a sham treatment of the FDI MTrP for one session. The main outcome considered in the study was the pressure pain threshold (PPT). Measurements were taken pre- and post-treatment and at a 1-week follow-up period. RESULTS: The PPT over the right (affected) FDI muscle showed statistically significant differences between groups at 1-week follow up (F = 3.518; p = 0.04) in favor of the experimental group. CONCLUSIONS: The ischemic compression of FDI-MTrPs is an appropriate part of a multimodal treatment to decrease local pain sensitivity in patients with CMC OA.


Assuntos
Articulações Carpometacarpais , Osteoartrite , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Osteoartrite/terapia , Polegar , Resultado do Tratamento , Pontos-Gatilho
3.
Orthopade ; 50(5): 346-355, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33837442

RESUMO

BACKGROUND: Osteoarthritis (OA)-the progressive degeneration of synovial joints-is a worldwide problem that affects society, is associated with age and is the dominant reason for pain and immobility of the locomotor system. In the population, 70% of people over the age of 70 show some signs of OA. Overall, up to 25% of the total population is affected, due to the general aging of the population itself, and this is an increasing tendency. However, in people over the age of 40 the incidence of OA is already rising due to posttraumatic or secondary forms, like dysplasia, malalignment and other background factors. CLAIM: There is a high need for mobility and sports in all generations, so the demands on the joints are high, especially if early degenerative changes are already present. Orthopaedic physicians are challenged with the limited load capacity, pain and the progressive joint problems, on the one hand to get the patient back to full mobility, and, on the other, to prevent early joint replacement. Early diagnosis and preventive measurements, as well as conservative treatments-from medication to braces-are necessary to achieve symptom-free movement and joint preservation to avoid joint replacement.


Assuntos
Cartilagem Articular , Osteoartrite , Cartilagem , Tratamento Conservador , Humanos , Articulações , Aparelhos Ortopédicos , Osteoartrite/diagnóstico , Osteoartrite/terapia
4.
BMC Musculoskelet Disord ; 22(1): 341, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836697

RESUMO

BACKGROUND: Arthritis, regardless of cause, has significant physical, social and psychological impacts on patients. We aimed to identify the non-healthcare needs perceived by patients with inflammatory arthritis (IA) and osteoarthritis (OA), and to determine if these differ. METHODS: We electronically searched MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2020) systematically to identify non-healthcare-related needs of people with IA or OA. All citations were screened and quality appraised by two reviewers. Data was extracted by a single reviewer. RESULTS: The search identified 7853 citations, with 31 studies included (12 for OA, 20 for IA). Six areas of need emerged and these were similar in both group These were: 1) Assistance with activities of daily living especially related to a lack of independence; 2) Social connectedness: need for social participation; 3) Financial security: worry about financial security and increased costs of health-seeking behaviours; 4) Occupational needs: desire to continue work for financial and social reasons, facilitated by flexibility of workplace conditions/environment; 5) Exercise and leisure: including limitation due to pain; 6) Transportation: limitations in ability to drive and take public transport due to mobility concerns. Many areas of need were linked; e.g. loss of employment and requiring support from family was associated with a sense of "failure" and loss of identity, as social isolation. CONCLUSIONS: This review highlights the pervasive impact of arthritis on peoples' lives, regardless of aetiology, albeit with a limited evidence base. Improved identification and targeting of non-healthcare needs of people with arthritis is likely to improve person-centred care.


Assuntos
Atividades Cotidianas , Osteoartrite , Atenção à Saúde , Emprego , Humanos , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Osteoartrite/terapia , Local de Trabalho
5.
J Biol Regul Homeost Agents ; 35(2): 593-603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33890435

RESUMO

Autologous chondrocyte (CH) transplantation is a novel strategy to treat post-traumatic osteoarthritis (PTOA). In this study, an in vitro coculture model was used to explore the effects of interleukin (IL)-10 overexpressed CHs on degenerated CHs. The original CHs were isolated from the patients' knee joint cartilage and pretreated with IL-1ß to get degenerated CHs. Moreoer, CHs were transfected with a lentivirus vector to overexpress IL-10. After coculture with the degenerated CHs, the apoptosis, collagen X, IL-6, and TNF-α of original CHs were increased, and the collagen II and IL-10 were decreased compared to the separated culture condition. Coculture with original CHs did not alleviate the degeneration of the IL-1ß-pretreated CHs. However, coculture with the IL-10-overexpressed CHs rescued the proliferation, collagen II, aggrecan, SOX9, and IL-10 expression, and suppressed the apoptosis, collagen X, RUnx2, IL-6, and TNF-α levels in the IL-1ß pretreated CHs. Additionally, the IL-10-overexpressed CHs also maintained a healthy state when cocultured with the degenerated CHs. Therefore, transplanting the IL-10-overexpressed CHs in the treatment of PTOA would obtain a more durable and visible effect in alleviating the CH degeneration.


Assuntos
Condrócitos , Osteoartrite , Terapia Baseada em Transplante de Células e Tecidos , Células Cultivadas , Técnicas de Cocultura , Humanos , Interleucina-10/genética , Interleucina-1beta/genética , Osteoartrite/terapia
6.
BMC Musculoskelet Disord ; 22(1): 380, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892692

RESUMO

INTRODUCTION: Implementation of clinical practice guidelines (CPGs) to manage musculoskeletal conditions among physiotherapists appears suboptimal. Osteoarthritis is one of the most disabling conditions worldwide and several studies showed a lack of knowledge of and adherence to osteoarthritis CPGs in physiotherapists' clinical practice. However, those studies are not conclusive, as they examine the knowledge of and adherence to CPGs only in isolation, or only by focussing on a single treatment. Thus, analysis of the knowledge of and adherence to CPGs in the same sample would allow for a better understanding of the evidence-to-practice gap, which, if unaddressed, can lead to suboptimal care for these patients. This study aims at assessing Italian physiotherapists' evidence-to-practice gap in osteoarthritis CPGs. METHODS: An online survey divided into two sections investigating knowledge of and adherence to CPGs was developed based on three high-quality, recent and relevant CPGs. In the first section, participants had to express their agreement with 24 CPG statements through a 1 (completely disagree) to 5 (completely agree) scale. We defined a ≥ 70% agreement with a statement as consensus. In the second section, participants were shown a clinical case, with different interventions to choose from. Participants were classified as 'Delivering' (all recommended interventions selected), 'Partially Delivering' (some recommended interventions missing) and 'Non-Delivering' (at least one non-recommended interventions selected) the recommended intervention, depending on chosen interventions. RESULTS: 822 physiotherapists (mean age (SD): 35.8 (13.3); female 47%) completed the survey between June and July 2020. In the first section, consensus was achieved for 13/24 statements. In the second section, 25% of the participants were classified as 'Delivering', 22% as 'Partially Delivering' and 53% as 'Non-Delivering'. CONCLUSIONS: Our findings revealed an adequate level of knowledge of osteoarthritis CPGs regarding the importance of exercise and education. However, an adequate level of adherence has yet to be reached, since many physiotherapists did not advise weight reduction, but rest from physical activity, and often included secondary treatments (e.g. manual therapy) supported by low-level evidence. These results identify an evidence-to-practice gap, which may lead to non-evidence based practice behaviours for the management of patients with osteoarthritis.


Assuntos
Osteoartrite , Fisioterapeutas , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Itália/epidemiologia , Osteoartrite/diagnóstico , Osteoartrite/terapia , Inquéritos e Questionários
7.
Int J Mol Sci ; 22(5)2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33806315

RESUMO

Systemic injection of a nerve growth factor (NGF) antibody has been proven to have a significant relevance in relieving osteoarthritis (OA) pain, while its adverse effects remain a safety concern for patients. A local low-dose injection is thought to minimize adverse effects. In this study, OA was induced in an 8-week-old male Sprague-Dawley (SD) rat joint by monoiodoacetate (MIA) injection for 2 weeks, and the effect of weekly injections of low-dose (1, 10, and 100 µg) NGF antibody or saline (control) was evaluated. Behavioral tests were performed, and at the end of week 6, all rats were sacrificed and their knee joints were collected for macroscopic and histological evaluations. Results showed that 100 µg NGF antibody injection relieved pain in OA rats, as evidenced from improved weight-bearing performance but not allodynia. In contrast, no significant differences were observed in macroscopic and histological scores between rats from different groups, demonstrating that intra-articular treatment does not worsen OA progression. These results suggest that local administration yielded a low effective NGF antibody dose that may serve as an alternative approach to systemic injection for the treatment of patients with OA.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Artrite Experimental/terapia , Fator de Crescimento Neural/antagonistas & inibidores , Osteoartrite/terapia , Manejo da Dor/métodos , Animais , Artrite Experimental/patologia , Artrite Experimental/fisiopatologia , Cartilagem Articular/patologia , Relação Dose-Resposta Imunológica , Hiperalgesia/fisiopatologia , Hiperalgesia/terapia , Injeções Intra-Articulares , Ácido Iodoacético/toxicidade , Masculino , Fator de Crescimento Neural/imunologia , Osteoartrite/patologia , Osteoartrite/fisiopatologia , Ratos , Ratos Sprague-Dawley , Suporte de Carga/fisiologia
8.
BMC Musculoskelet Disord ; 22(1): 317, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789636

RESUMO

BACKGROUND: Osteoarthritis (OA) is a common condition that is often associated with chronic pain. Pain often leads patients to seek healthcare advice and treatment. In this retrospective cohort analysis of German longitudinal healthcare claims data, we aimed to explore the healthcare resource utilisation (HRU) and related healthcare costs for patients with OA who develop chronic pain. METHODS: Patient-level data was extracted from the German Institut für Angewandte Gesundheitsforschung (InGef) database. Insured persons (≥18 years) were indexed between January 2015 and December 2017 with a recent (none in the last 2 years) diagnosis of OA. HRU and costs were compared between patients categorised as with (identified via diagnosis or opioid prescription) and without chronic pain. Unweighted HRU (outpatient physician contacts, hospitalisations, prescriptions for physical therapy or psychotherapy, and incapacity to work) and healthcare costs (medication, medical aid/remedy, psychotherapy, inpatient and outpatient and sick pay in Euros [quartile 1, quartile 3]) were calculated per patient for the year following index. Due to potential demographic and comorbidity differences between the groups, inverse probability of treatment weighting (IPTW) was used to estimate weighted costs and rate ratio (RR; 95% confidence interval) of HRU by negative binomial regression modelling. RESULTS: Of 4,932,543 individuals sampled, 238,306 patients with OA were included in the analysis: 80,055 (34%) categorised as having chronic pain (24,463 via opioid prescription) and 158,251 (66%) categorised as not having chronic pain. The chronic pain cohort was slightly older, more likely to be female, and had more comorbidities. During the year following index, unweighted and IPTW-weighted HRU risk and healthcare costs were higher in patients with chronic pain vs those without for all categories. This led to a substantially higher total annual healthcare cost ─ observed mean; €6801 (1439, 8153) vs €3682 (791, 3787); estimated RR = 1.51 (1.36, 1.66). CONCLUSIONS: German patients with chronic pain and OA have higher healthcare costs and HRU than those with OA alone. Our findings suggest the need for better prevention and treatment of OA in order to reduce the incidence of chronic pain, and the resultant increase in disease burden experienced by patients.


Assuntos
Dor Crônica , Osteoartrite , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Dor Crônica/terapia , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Custos de Cuidados de Saúde , Recursos em Saúde , Humanos , Masculino , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Osteoartrite/terapia , Estudos Retrospectivos
9.
Rev. bras. ortop ; 56(2): 133-137, Apr.-June 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1251352

RESUMO

Abstract Medial arthrosis of the knee is an evolutionary pathology that occurs due to progressive muscle imbalance. The muscles of the knee region have a large imbalance caused by the difference of power and lever arm. With the progression of life, this imbalance manifests itself more importantly, especially due to the loss of muscle strength due to aging. Pathological postures begin to occur and determine areas of support and pressure harmful to the joint. Meniscal injury is typical in the evolution of this pathology, as well as cartilage injury. The recognition of this pathology enables good results with less aggressive treatments, such as correction of muscle imbalance and consequent reeducation of joint support. Economic and partial meniscectomy brings good results in the early stages of the degenerative process. Progressive evolution leads to knee degeneration and the consequent need for broader surgeries.


Resumo A artrose medial do joelho é uma patologia evolutiva que ocorre em decorrência de desequilíbrio muscular progressivo. Os músculos da região do joelho têm um grande desequilíbrio, provocado pela diferença de potência e braço de alavanca. Com a progressão da vida, este desequilíbrio se manifesta de forma mais importante, especialmente em decorrência da perda de força muscular em função do envelhecimento. Posturas patológicas passam a ocorrer e determinar zonas de apoio e pressão lesivas para a articulação. A lesão meniscal é típica na evolução desta patologia, assim como a lesão da cartilagem. O reconhecimento desta patologia possibilita resultados bons com tratamentos menos agressivos, como a correção do desequilíbrio muscular e consequente reeducação do apoio da articulação. A meniscectomia econômica e parcial traz bons resultados nas fases iniciais do processo degenerativo. A evolução progressiva leva à degeneração do joelho e à consequente necessidade de cirurgias mais amplas.


Assuntos
Osteoartrite/diagnóstico , Osteoartrite/terapia , Osteonecrose , Menisco/lesões
10.
Vet Surg ; 50(4): 713-728, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33710628

RESUMO

Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate mechanical force away from the tendon's bony attachment site, thereby protecting it from failure. The comparison of these two anatomically distinct structural systems demonstrates their similar adaptations to mechanical forces, and illustrates that important functional insights can be gained from studying anatomic convergences and cross-species comparisons of function. Such a functional conceptualization of the equine navicular apparatus resolves confusion about the diagnosis of navicular syndrome and offers insights for the development of mechanically based therapies. Through comparison with the human Achilles complex, this review (1) re-conceptualizes the equine navicular apparatus as an enthesis organ in which mechanical forces are distributed throughout the structures of the organ; (2) describes the relationship between failure of the navicular enthesis organ and lesions of navicular syndrome; (3) considers the therapeutic implications of navicular enthesis organ degeneration as a form of chronic osteoarthritis; and based upon these implications (4) proposes a focus on whole body posture/motion for the development of prehabilitative and rehabilitative therapies similar to those that have already proven effective in humans.


Assuntos
Doenças do Pé/veterinária , Doenças dos Cavalos/terapia , Osteoartrite/veterinária , Ossos do Tarso/patologia , Animais , Fenômenos Biomecânicos , Doença Crônica/veterinária , Doenças do Pé/etiologia , Doenças do Pé/patologia , Doenças do Pé/terapia , Doenças dos Cavalos/etiologia , Doenças dos Cavalos/patologia , Cavalos , Osteoartrite/etiologia , Osteoartrite/patologia , Osteoartrite/terapia , Tendões/patologia
11.
Biomed Res Int ; 2021: 6380141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33708990

RESUMO

The aim of this study was to investigate the therapeutic efficacy and safety of transplanting human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in the treatment of cartilage injury. First, the articular cartilage defect model in rabbits was constructed. Then, the identified hUCB-MSCs and rabbit bone marrow stem cells (rBM-MSCs) were transplanted into the bone defect, respectively, and the cartilage repair effect was observed by hematoxylin-eosin (HE) staining and immunohistochemistry. Besides, the glycosaminoglycan (GAG) content and biomechanics of the restoration area were also evaluated. In our study, hUCB-MSCs and rBM-MSCs exhibited typical MSC characteristics, with positive expressions of CD73, CD105, and CD90 and negative for CD45, CD34, CD14, and HLA-DR. After the transplantation of hUCB-MSCs and rBM-MSCs, the overall quality of cartilage tissue was significantly improved, and the recipients did not show significant side effects in general. However, the expression of matrix metalloproteinase-13 (MMP-13) in the de novo tissues of the hUCB-MSCs and rBM-MSCs groups was both increased, indicating that the novel tissues may have some potential osteoarthritic changes. In conclusion, our results suggest the therapeutic effect of hUCB-MSCs transplantation in cartilage regeneration, providing a promising future in the clinical treatment of cartilage injury.


Assuntos
Antígenos de Diferenciação/metabolismo , Cartilagem Articular , Sangue Fetal/metabolismo , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Osteoartrite , Animais , Cartilagem Articular/lesões , Cartilagem Articular/metabolismo , Cartilagem Articular/patologia , Xenoenxertos , Humanos , Osteoartrite/metabolismo , Osteoartrite/patologia , Osteoartrite/terapia , Coelhos
12.
Arch Oral Biol ; 125: 105110, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33774341

RESUMO

OBJECTIVE: This study aimed to provide further information on the exact mechanisms involved in the anti-inflammatory effect of low-intensity pulsed ultrasound (LIPUS) on rabbit temporomandibular joint osteoarthritis (TMJOA) on interleukin-6 (IL-6) production in subchondral bone, IL-6 production in IL-1ß stimulated via inhibition of the TGF-ß1/Smad3 pathway in mouse embryo osteoblast precursor (MC3T3-E1) cells. DESIGN: Bilateral joints were injected with type II collagenase to establish TMJOA models in two male and four female rabbits. The left joint was continuously stimulated by LIPUS, while the right joint was treated with the power off in this model. One male and two female rabbits were used as normal healthy controls without treatment. The histological features of subchondral bone were examined by Safranin-O/Fast staining. Immunohistochemistry was conducted to evaluate IL-6 expression. Then, cells were stimulated by LIPUS with IL-1ß. IL-6 expression and activity of the TGF-ß1/Smad3 pathway were evaluated by Enzyme-linked immunosorbent assay (ELISA), Immunofluorescence and Western blotting, respectively. Specific inhibition of the TGF-ß1/Smad3 pathway was conducted by transfecting with small interfering RNA (siRNA) of type II receptor (siTßRII). RESULTS: LIPUS significantly ameliorated the production of IL-6 in vitro and in vivo. Its inhibitory effect on the production of IL-6 induced by IL-1ß in MC3T3-E1 cells was partly reversed by siTßRII knockdown. CONCLUSIONS: LIPUS inhibited IL-6 production by suppressing the TGF-ß1/Smad3 pathway of subchondral bone in TMJOA. These data revealed the part of the pathways involved in the anti-inflammatory effect of LIPUS and provided a possible treatment strategy for TMJOA patients and other inflammatory diseases.


Assuntos
Osteoartrite , Fator de Crescimento Transformador beta1 , Animais , Feminino , Humanos , Interleucina-6 , Masculino , Camundongos , Osteoartrite/terapia , Coelhos , Proteína Smad3 , Articulação Temporomandibular/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Ondas Ultrassônicas
13.
Aging Clin Exp Res ; 33(4): 1079-1083, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33666899

RESUMO

BACKGROUND AND AIMS: To assess experts' preference for sarcopenia outcomes. METHODS: A discrete-choice experiment was conducted among 37 experts (medical doctors and researchers) from different countries around the world. In the survey, they were repetitively asked to choose which one of two hypothetical patients suffering from sarcopenia deserves the most a treatment. The two hypothetical patients differed in five pre-selected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue and falls. A mixed logit panel model was used to estimate the relative importance of each attribute. RESULTS: All sarcopenia outcomes were shown to be significant, and thus, important for experts. Overall, the most important sarcopenia outcome was falls (27%) followed by domestic activities and mobility (24%), quality of life (15%) and fatigue (10%). DISCUSSION AND CONCLUSION: Compared to patient's preferences, experts considered falls as a more important outcome of sarcopenia, while the outcomes fatigue and difficulties in domestic activities were considered as less important.


Assuntos
Doenças Musculoesqueléticas , Osteoartrite , Osteoporose , Sarcopenia , Idoso , União Europeia , Humanos , Osteoartrite/terapia , Qualidade de Vida
14.
J Oral Facial Pain Headache ; 35(1): 17-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33730123

RESUMO

AIMS: To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications. METHODS: On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors' personal libraries, and the reference lists of included articles. The focus question was: In patients with TMD (P), does TMJ arthrocentesis (I), compared to any control treatment (C), provide positive outcomes (O)? RESULTS/CONCLUSION: Thirty papers were included comparing TMJ arthrocentesis to other treatment protocols in patients with disc displacement without reduction and/or closed lock (n = 11), TMJ arthralgia and/or unspecific internal derangements (n = 8), or TMJ osteoarthritis (n = 11). In general, the consistency of the findings was poor because of the heterogenous study designs, and so caution is required when interpreting the meta-analyses. In summary, it can be suggested that TMJ arthrocentesis improves jaw function and reduces pain levels, and the execution of multiple sessions (three to five) is superior to a single session (effect size = 1.82). Comparison studies offer inconsistent findings, with the possible exception of the finding that splints are superior in managing TMJ pain (effect size = 1.36) compared to arthrocentesis, although this conclusion is drawn from very heterogenous studies (I2 = 94%). The additional use of cortisone is not effective for improving outcomes, while hyaluronic acid or platelet-rich plasma positioning may have additional value according to some studies. The type of intervention, the baseline presence of MRI effusion, and the specific Axis I diagnosis do not seem to be important predictors of effectiveness, suggesting that, as in many pain medicine fields, efforts to identify predictors of treatment outcome should focus more on the patient (eg, age, psychosocial impairment) than the disease.


Assuntos
Osteoartrite , Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Osteoartrite/terapia , Amplitude de Movimento Articular , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
15.
Prim Dent J ; 10(1): 132-140, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33722124

RESUMO

The symptoms of TMJ Osteoarthrosis/Osteoarthritis(TMJ OA) are characteristic and in most cases specific to the disorder. There is, however, an overlap of symptoms with other TMDs.Treatment of TMJ OA is generally directed towards management of the symptoms as the temporomandibular joint does retain the capacity throughout life to repair and remodel. Non-conservative and invasive treatment is only rarely necessary.It should be remembered that the mandibular condyle retains the capacity to repair and remodel throughout life and patients should be encouraged to bear this in mind. Conservative measures are usually sufficient to treat symptoms and a period of time should be allowed to elapse before undertaking a more aggressive treatment plan, which, in the overwhelming majority of patients, will not be necessary. This disorder should be approached on the terms of 'a quality of life issue' and treatment should be directed towards patient needs.


Assuntos
Luxações Articulares , Osteoartrite , Transtornos da Articulação Temporomandibular , Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Qualidade de Vida , Articulação Temporomandibular , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia
16.
ANZ J Surg ; 91(4): 673-679, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33609074

RESUMO

BACKGROUND: Currently, non-surgical treatments for glenohumeral osteoarthritis (GH-OA) mainly aim to reduce pain. Autologous conditioned serum (ACS), Orthokine, an interleukin-1 inhibitor from the patient's own blood has an anti-inflammatory effect. The objective was to determine whether intra-articular injections of this ACS improved symptoms in patients with GH-OA and delayed the need for a shoulder replacement. METHODS: A total of 36 consecutive patients, 40 shoulders, with OA received up to 6-weekly intra-articular injections of ACS were included. Imaging of GH-OA, range of motion, visual analogue scale (VAS) pain, Shoulder Pain And Disability Index (SPADI), American Shoulder and Elbow Surgeons and Constant scores were assessed pre-injection and post treatment at 3 months. At a minimum of 2 years, VAS and SPADI scores and whether anyone had progressed to a shoulder replacement were recorded. RESULTS: Outcomes 3 months post-ACS injections demonstrated on average statistically significant improvement (P < 0.05) of all measurements: SPADI (54.3 ± 21.5 vs 43.7 ± 23.7), Constant score (50.5 ± 14.1 vs 57.1 ± 17.4), VAS pain (4.8 ± 2.2 vs 3.7 ± 2.4) and range of motion. Of these, 16 shoulders progressed to a shoulder replacement, nine cases quickly (0.6 ± 0.2 years) and seven cases were delayed by 3.1 ± 1.7 years. The other 18 cases had significant improvement in pain, SPADI (58.0 ± 19.6 to 31.8 ± 21.4; P < 0.01) scores and no progression to a shoulder replacement at 3.6 ± 1.0 years follow-up. There was no correlation of glenoid Walch score or joint space with clinical outcome parameters. CONCLUSION: ACS injections in the shoulder joint for OA can reduce pain and disability, and postpone the need for a shoulder replacement.


Assuntos
Osteoartrite , Articulação do Ombro , Humanos , Injeções Intra-Articulares , Osteoartrite/terapia , Manejo da Dor , Amplitude de Movimento Articular , Ombro , Resultado do Tratamento
17.
Biomed Res Int ; 2021: 6663003, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33614784

RESUMO

Objective: Osteoarthritis (OA) is the most common degenerative joint disease, causing joint pain, stiffness, and even disability. Guidelines recommend intra-articular injections as an alternative treatment to relieve OA symptoms for patients who demonstrate poor tolerability or compliance to oral administration of drugs. Mesenchymal stem cells (MSCs) are a potential treatment for of OA. We conducted this network meta-analysis to comprehensively compare the efficacy and safety between hyaluronic acid (HA), corticosteroids (GCs), platelet-rich plasma (PRP), and MSCs. Design: Systematic review and Bayesian network meta-analysis. Data Sources. Relevant studies, published from January 2000 to January 2020, in the PubMed, Cochrane library, EMBASE, and CKNI databases. Methods: Bayesian network and conventional meta-analyses were conducted. Pain relief, functional improvement, improvement in joint stiffness, and risk of adverse effects (AEs) were assessed. Results: Twenty-five articles with 4642 patients were included. Overall, MSC therapy was the most effective treatment for pain relief (standardized mean difference compared with placebo = 3.61, 95% CI [1.87 to 5.35]). Both MSC and PRP therapies improved every symptom of OA effectively and have an advantage over HA and GCs which are recommended by guidelines. MSCs, PRP, HA, and GCs are tolerated well for patients in long-term treatment of OA compared with placebo. Conclusions: The results show that MSCs relieve pain, stiffness, and dysfunction due to OA better than PRP, HA, and GCs and are not statistically correlated with greater safety concerns. More high-quality trials are needed to reconfirm the findings of this study, however, standardization of preparation of MSCs and PRP should be investigated in the future.


Assuntos
Transplante de Células-Tronco Mesenquimais , Osteoartrite/terapia , Corticosteroides/uso terapêutico , Idoso , Artralgia/terapia , Teorema de Bayes , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Transplante de Células-Tronco Mesenquimais/métodos , Pessoa de Meia-Idade , Plasma Rico em Plaquetas , Resultado do Tratamento
18.
Int J Mol Sci ; 22(3)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540695

RESUMO

Lipidomics is a lipid-targeted metabolomics approach that aims to the comprehensive analysis of lipids in biological systems in order to highlight the specific functions of lipid species in health and disease. Lipids play pivotal roles as they are major structural components of the cellular membranes and energy storage molecules but also, as most recently shown, they act as functional and regulatory components of intra- and intercellular signaling. Herein, emphasis is given to the recently highlighted roles of specific bioactive lipids species, as polyunsaturated fatty acids (PUFA)-derived mediators (generally known as eicosanoids), endocannabinoids (eCBs), and lysophospholipids (LPLs), and their involvement in the mesenchymal stem cells (MSCs)-related inflammatory scenario. Indeed, MSCs are a heterogenous population of multipotent cells that have attracted much attention for their potential in regulating inflammation, immunomodulatory capabilities, and reparative roles. The lipidomics of the inflammatory disease osteoarthritis (OA) and the influence of MSCs-derived lipids have also been addressed.


Assuntos
Inflamação/metabolismo , Lipídeos/fisiologia , Células-Tronco Mesenquimais/metabolismo , Imunidade Adaptativa , Animais , Diferenciação Celular , Eicosanoides/fisiologia , Endocanabinoides/fisiologia , Vesículas Extracelulares , Ácidos Graxos Insaturados/farmacologia , Humanos , Imunidade Inata , Inflamação/imunologia , Lipídeos/classificação , Lisofosfolipídeos/fisiologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/efeitos dos fármacos , Osteoartrite/metabolismo , Osteoartrite/terapia
19.
Vet J ; 269: 105605, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593496

RESUMO

Mesenchymal stromal cells (MSC) are used for cell-based treatment for canine osteoarthritis (OA). Compared with human MSCs, detailed information on the functional characterisation of canine MSCs is limited. In particular, the chondrogenic differentiation of canine adipose tissue-derived MSCs (cAT-MSCs) is challenging. In this study, we aimed to compare cAT-MSCs with bone marrow-derived MSCs (cBM-MSCs), focusing specifically on their in vitro chondrogenic potential, with or without bone morphogenetic proteins (BMP). cBM-MSCs and cAT-MSCs were characterised using flow cytometry and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The chondrogenic differentiation potential of all cMSC preparations in the presence of TGF-ß1 alone or when supplemented with 10, 100, or 250 ng/mL BMP-2 or BMP-6 was investigated using RT-qPCR, and biochemical, histochemical and immunohistological analyses. Both cBM-MSCs and cAT-MSCs expressed the surface markers CD90, CD73, and CD29, and were negative for CD45 and CD34, although the expression of CD73 and CD271 varied with donor and tissue origin. Interestingly, expression of ACAN and SOX9 was higher in cBM-MSCs than cAT-MSCs. In contrast with cBM-MSCs, cAT-MSCs could not differentiate toward the chondrogenic lineage without BMP-2/-6, and their in vitro chondrogenesis was inferior to cBM-MSCs with BMP-2/-6. Thus, cAT-MSCs have lower in vitro chondrogenic capacity than cBM-MSC under the studied culture conditions with 10, 100, or 250 ng/mL BMP-2 or BMP-6. Therefore, further characterisation is necessary to explore the potential of cAT-MSCs for cell-based OA treatments.


Assuntos
Células da Medula Óssea/fisiologia , Proteína Morfogenética Óssea 2/farmacologia , Proteína Morfogenética Óssea 6/farmacologia , Condrogênese/fisiologia , Células-Tronco Mesenquimais/fisiologia , Animais , Antígenos de Superfície/análise , Técnicas de Cultura de Células/veterinária , Diferenciação Celular/efeitos dos fármacos , Ensaio de Unidades Formadoras de Colônias/veterinária , Doenças do Cão/terapia , Cães , Transplante de Células-Tronco Mesenquimais , Osteoartrite/terapia , Osteoartrite/veterinária , Fator de Crescimento Transformador beta1/farmacologia
20.
BMC Musculoskelet Disord ; 22(1): 194, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33593307

RESUMO

BACKGROUND: Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions: 1. What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? 2. Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? 3. Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? 4. Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline? METHODS: Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. DISCUSSION: The findings will improve access to evidence-based management of people with hand OA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.


Assuntos
Terapia Ocupacional , Osteoartrite , Humanos , Noruega/epidemiologia , Osteoartrite/diagnóstico , Osteoartrite/terapia , Dor , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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