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2.
Skeletal Radiol ; 50(4): 781-787, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32995905

RESUMO

OBJECTIVE: Accurate joint fluid quantification on MRI cannot simply rely on measuring the maximum fluid depth or using an ellipsoid approximation as this does not fully characterize the complex shape of a fluid-filled joint. As per the Outcome Measurement in Rheumatology (OMERACT) filter, we sought to evaluate the feasibility, reliability, and validity of a semi-automated supervised technique to quantify hip effusion volume. MATERIALS AND METHODS: Ninety-three hip osteoarthritis patients were imaged with coronal short TI inversion recovery (STIR) and sagittal intermediate weighted fat-suppressed (IWFS) sequences at two time points (Fig. 1). Volumetric quantitative measurement (VQM) of joint fluid and measurement of the largest femoral neck fluid thickness (FTM) was performed using the custom MATLAB software. Self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and clinical measures of pain, stiffness, and function were recorded. RESULTS: Inter-observer reliability was significantly higher for VQM than FTM (ICC = 0.96 vs. 0.85, p < 0.05). VQM and FTM correlated moderately (r = 0.76, p < 0.0001). There was significantly more articular fluid in symptomatic than asymptomatic hips at baseline (mean = 9.8 vs. 5.9 mL). Volumetric quantitative measurement generally displayed more frequent and stronger correlations to clinical parameters than FTM. Volumetric quantitative measurement required 3.9 min/hip vs. < 1 min/hip for femoral neck fluid thickness. CONCLUSION: Volumetric quantitative measurement of joint effusion can serve as an MRI gold-standard, could apply to other joints and collections, and is highly suited to future automation.


Assuntos
Hidrartrose , Osteoartrite do Quadril , Articulação do Quadril , Humanos , Imageamento por Ressonância Magnética , Osteoartrite do Quadril/diagnóstico por imagem , Reprodutibilidade dos Testes , Líquido Sinovial/diagnóstico por imagem
3.
Mod Rheumatol Case Rep ; 4(2): 312-317, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33087007

RESUMO

Wild-type amyloidogenic transthyretin (ATTR) amyloidosis, known as systemic senile amyloidosis (SSA), is an age-related nonhereditary amyloidosis, which is known to cause cardiomyopathy and carpal tunnel syndrome (CTS). Herein, we report a case of unilateral hydrarthrosis with arthritis of the right shoulder joint in an 82-year-old Japanese housewife who has a seven year history of polyneuropathy due to an unknown aetiology. At first, her joint pain was thought to be caused by overuse of her right upper arm. Despite treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and repeated arthrocentesis, her symptoms did not improve. She then visited our hospital, where magnetic resonance imaging (MRI) of her right shoulder suggested synovitis and hydrarthrosis. She also had an arthroscopic synovectomy of the right shoulder joint. The pathological testing revealed a diagnosis of non-specific arthritis with amyloidosis. After further pathological examination, wild-type ATTR was identified and she was diagnosed with senile amyloidosis.


Assuntos
Amiloidose/complicações , Amiloidose/metabolismo , Artrite/diagnóstico , Artrite/etiologia , Hidrartrose/diagnóstico , Hidrartrose/etiologia , Pré-Albumina/metabolismo , Articulação do Ombro , Idoso de 80 Anos ou mais , Amiloidose/etiologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite/terapia , Feminino , Humanos , Hidrartrose/terapia , Imageamento por Ressonância Magnética , Polineuropatias/diagnóstico , Polineuropatias/tratamento farmacológico , Polineuropatias/etiologia , Pré-Albumina/genética , Avaliação de Sintomas
4.
Clin Rheumatol ; 39(3): 841-845, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31897954

RESUMO

OBJECTIVES: Palindromic rheumatism (PR) is a type of acute arthritis or periarthritis characterized by recurrence, paroxysmal, or intermittent disease attacks and occasionally progresses to other types of rheumatic disease. PR patients who are anti-citrullinated protein antibodies (ACPA)-negative have a high prevalence of MEFV gene polymorphisms, and intermittent hydrarthrosis (IH) is also associated with MEFV polymorphisms. The purpose of this study was to evaluate the clinical characteristics of and autoinflammatory syndrome-associated gene polymorphisms in patients with PR and IH and to identify predictive factors for developing other rheumatic diseases. METHODS: Six PR patients (four females; median age at disease onset, 20.0 years; median age at evaluation, 47.0 years) were retrospectively evaluated for clinical features and polymorphisms in genes responsible for autoinflammatory diseases. RESULTS: All six patients fulfilled the diagnostic criteria for PR and showed clinical feature of IH. Two presented with recurrent fever. All six patients were negative for rheumatoid factor and ACPA and had normal articular X-ray findings. Among the six patients, MEFV gene polymorphisms known to cause FMF were identified in four, CIAS1 mutation was observed in one, and TNFRSFIA mutation was observed in one. Colchicine was effective in three patients with MEFV polymorphisms. The other five patients continued to experience PR, although three patients achieved remission with medication. CONCLUSIONS: PR presenting with IH might be associated with gene polymorphisms responsible for autoinflammatory diseases; colchicine appears to be effective in these patients.Key Point• Palindromic rheumatism with intermittent hydrarthrosis might be associated with gene polymorphisms responsible for autoinflammatory diseases.


Assuntos
Artrite Reumatoide/genética , Hidrartrose/genética , Polimorfismo Genético , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Colchicina/uso terapêutico , Feminino , Predisposição Genética para Doença , Humanos , Hidrartrose/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mutação , Pirina/genética , Estudos Retrospectivos
5.
Pediatr Emerg Care ; 36(6): e340-e342, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31851076

RESUMO

OBJECTIVE: This study aimed to evaluate live-stream videos for evaluation of pediatric emergency medicine ultrasound using a third generation (3G) network. METHODS: The interrater reliability of a remote 3G network live-streaming assessment of ultrasound scans for abdominal free fluid, intussusception, and hip effusions was evaluated. Fifty-eight deidentified 6-second video clips in .mp4 format of focused assessment with sonography in trauma scans were downloaded to a laptop. A "bedside" ultrasound expert evaluated each scan and marked it positive or negative for the presence of free fluid. Using an iPhone 3G, Skype was used to connect to the second ultrasound expert located in Addis Ababa, Ethiopia, who reviewed the same scans. When the remote expert returned to the United States, evaluation of the scans was repeated as a second bedside reviewer. Interrater reliability was assessed using the κ statistic and percent agreement. This process was repeated for 44 intussusception scans and 28 hip effusion scans. RESULTS: The κ values (95% confidence interval) between the bedside and remote evaluators for focused assessment with sonography in trauma, intussusception, and hip effusion were 0.748 (0.576-0.92), 0.816 (0.648-0.984), and 0.764 (0.519-1.0), respectively. The percent agreements after adjusting for chance were 86%, 80%, and 88%, respectively. The κ values between the bedside assessments by each evaluator were 0.851 (0.71-0.992), 0.8 (0.616-0.984), and 0.747 (0.479-0.884), respectively. The percent agreements after adjusting for chance were 92%, 81%, and 88%, respectively. CONCLUSIONS: Live-stream video conference using cellphones over 3G network is a feasible and accurate method for consultation of ultrasound scans from a remote location.


Assuntos
Emergências , Articulação do Quadril/diagnóstico por imagem , Hidrartrose/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Consulta Remota/métodos , Ultrassonografia , Telefone Celular , Criança , Etiópia , Feminino , Humanos , Masculino , Aplicativos Móveis , Reprodutibilidade dos Testes , Estados Unidos , Comunicação por Videoconferência
6.
J Knee Surg ; 32(3): 280-283, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29653443

RESUMO

The objective of this study was to delineate the usefulness of clinical examination and magnetic resonance imaging (MRI) in acute knee injuries. We aim to establish whether the time period post acute knee injury is related to the diagnostic accuracy of clinical examination and to investigate the strength of specific clinical examination findings in predicting a clinically relevant MRI abnormality. Seventy patients were referred to fracture clinic with an acute knee injury who subsequently went on to be investigated with MRI over 12 months. These patients were retrospectively analyzed looking at the time period they were reviewed, the components that were assessed at physical examination, and the results of their eventual MRI scan looking for any correlation. A greater proportion of patients who were examined at 2 weeks had relevant positive findings on MRI scan, p = 0.03. Range of movement and lateral joint line tenderness were not associated with a positive MRI scan at any period after injury. The presence of a moderate to large effusion was not associated with an MRI abnormality if the examination was within 2 weeks of injury but was if present 2 weeks after injury, p = 0.0001. Range of movement should not form part of the decision making on whether an injury should be investigated with MRI. Joint effusion in isolation within 2 weeks after injury should not be an indication for MRI but a repeat clinical examination in 2 weeks, where if still present, should be investigated with MRI.


Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Exame Físico , Adolescente , Adulto , Artralgia/diagnóstico por imagem , Artralgia/etiologia , Feminino , Humanos , Hidrartrose/diagnóstico por imagem , Hidrartrose/etiologia , Traumatismos do Joelho/complicações , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Amplitude de Movimento Articular , Estudos Retrospectivos
7.
Skeletal Radiol ; 48(1): 89-101, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29961091

RESUMO

OBJECTIVE: To evaluate if baseline pathological knee conditions as assessed via single features of the MR-based Whole-Organ Magnetic Resonance Imaging Scoring (WORMS), standard T2, and T2 gray-level co-occurrence matrix (GLCM) texture parameters of knee cartilage can serve as potential long-term radiological predictors of incident total knee arthroplasty (TKA) 4-7 years later. MATERIALS AND METHODS: Baseline 3-T knee MRIs of 309 subjects from the Osteoarthritis Initiative (n = 81 TKA cases, with right-knee TKA 4-7 years after enrolment, and n = 228 TKA-free matched controls) were evaluated for the presence and severity of pathological knee conditions via modified WORMS. Knee cartilage was segmented and standard T2 cartilage and T2 GLCM texture measures (contrast, variance) were computed. Statistical analysis employed conditional logistic regression. RESULTS: We found that a one-point increase on the joint effusion scale, the bone marrow edema scale or on the cartilage lesion scale at baseline predicted incident TKA (ORs: 2.45, 1.65, and 1.37 respectively (p ≤ 0.003)). For T2 cartilage measurements, we observed that in the lateral femur, a 1-SD increase in T2 relaxation time yielded a 28% increase in the odds of TKA (1.28 [1.09-1.643], p = 0.046). When looking at cartilage texture, we similarly noted that a 1-SD increase in the cartilage texture parameter "contrast" was associated with a 33-40% increased risk of incident TKA in the lateral femur and tibia (0.003 ≤ p ≤ 0.021), as was a 1-SD increase in the texture parameter "variance" in the lateral femur (p = 0.002). CONCLUSION: Radiological evaluation of standard knee MR images via single WORMS features and T2 standard and texture analysis at baseline can help predict the patient's individual risk for an incident TKA 4-7 years later.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Medula Óssea/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Edema/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Hidrartrose/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Idoso , Medula Óssea/patologia , Cartilagem Articular/patologia , Estudos de Casos e Controles , Edema/patologia , Feminino , Fêmur/patologia , Humanos , Hidrartrose/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Medição da Dor , Valor Preditivo dos Testes
8.
Emerg Radiol ; 25(5): 479-487, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29752650

RESUMO

PURPOSE: Traumatic knee injury is a common clinical presentation. However, knee internal derangement often goes undiagnosed on physical exam. The authors hypothesize that patients with suprapatellar joint effusion greater than 10 mm anteroposterior diameter on lateral radiograph have a high likelihood of knee internal derangement on magnetic resonance imaging. MATERIALS AND METHODS: A retrospective review of knee radiographs and magnetic resonance imaging in 198 patients age 18-40 years with acute knee injury was performed. Suprapatellar effusion diameter on lateral radiography was correlated to the presence of internal derangement on magnetic resonance imaging. Magnetic resonance imaging anteroposterior effusion size at four locations was correlated to radiographic suprapatellar effusion measurements. RESULTS: Logistic regression showed a positive correlation between radiographic effusion size and the presence of internal derangement on magnetic resonance exams (p value < 0.001). Radiographic effusion > 10 mm was established as a positive test, yielding test sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 55, 96, 93, 71, and 77%, respectively. Statistical analysis showed the radiographic anteroposterior effusion diameter most closely approximated the magnetic resonance effusion diameter at the lateral patellofemoral recess. CONCLUSIONS: This study shows that knee radiography is a highly specific screening test for internal derangement in patients less than 40 years old with acute knee injury. In this patient population, knee effusion > 10 mm on lateral radiograph should prompt consideration for knee magnetic resonance examination. Adopting this approach as a clinical guideline has the potential to decrease delayed diagnosis, improve patient outcomes, and decrease cost-associated disability.


Assuntos
Hidrartrose/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-29422400

RESUMO

OBJECTIVES: The aim of this study was to investigate the preoperative variables in patients with articular disk displacement without reduction that may influence the results of arthrocentesis on joint effusion (JE). STUDY DESIGN: The records of 203 patients with clinical signs and symptoms of unilateral painful disk displacement without reduction and JE, confirmed by magnetic resonance imaging (MRI), and treated with arthrocentesis were selected. The following preoperative data were recorded: sex; age; joint side; pain duration; pain intensity, measurement with the visual analogue scale; and maximum interincisal distance (MID). All patients underwent a second MRI examination 3 to 4 months postoperatively to assess JE. The sample was then divided into 2 groups: group 1 (n = 160) comprised patients with no signs of JE; and group 2 (n = 43) comprised patients still showing signs of JE. Univariate and multivariate analyses were used to compare the groups. RESULTS: Among the studied variables, pain duration (P = .0175), pain intensity (P < .0001), and MID (P = .0085) were shown to affect arthrocentesis outcomes. The longer the pain duration (odds ratio [OR] = 0.930), the more intense was the pain (OR = 0.346), and the smaller the MID (OR = 0.562), the less were the chances of arthrocentesis completely eliminating JE. CONCLUSIONS: Pain duration, pain intensity, and MID can be used as predictors for the effect of arthrocentesis on JE outcomes and considered during treatment planning.


Assuntos
Artrocentese , Hidrartrose/cirurgia , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Medição da Dor , Valor Preditivo dos Testes , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento , Trismo
10.
Clin Biomech (Bristol, Avon) ; 42: 115-119, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28157619

RESUMO

BACKGROUND: Multiple factors contribute to range of motion of the hip joint in the transverse plane: bony anatomy, hip capsule, corresponding ligaments, articular labrum, ligamentum teres, and negative intra-articular pressure. We hypothesized that violation of the negative pressure of the hip and simulation of an effusion would increase range of motion in the transverse plane in a cadaver model. METHODS: Ten hip specimens were obtained and dissected with the femur and iliac wing mounted in a custom joint-testing rig in neutral position. Specimens were tested at 0 and at 90° of flexion with 1.5Nm internal and external rotational torque. Three conditions were assessed: (1) intact specimen, (2) an effusion modeled by a 10ml saline infusion, and (3) a capsular tear. FINDINGS: The modeled effusion decreased rotational range of motion limits in both 0 and 90° of flexion, with a greater effect on the specimens at 0° flexion in external rotation with 4.1° less external rotation (p=0.009). A modeled capsular tear increased rotational motion limits in 0° of flexion in both internal and external rotation and in 90° flexion in internal rotation only (p<0.025). INTERPRETATION: An effusion may decrease the rotation of the hip, and a capsular tear may increase its rotation. This should be considered in hips with traumatic capsular tears or arthroscopic portals.


Assuntos
Articulação do Quadril/fisiopatologia , Hidrartrose/fisiopatologia , Cápsula Articular/lesões , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Feminino , Fêmur , Lesões do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Cápsula Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos
11.
J Oral Maxillofac Surg ; 75(3): 491-497, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27741415

RESUMO

PURPOSE: Lymphadenopathy often occurs in the setting of inflammation, with or without infection. We sought to elucidate any association of parotid lymphadenopathy with joint effusion in temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS: We performed a retrospective cohort study. We analyzed the magnetic resonance imaging studies of patients with suspected TMJ disorders performed from April 2006 to March 2007. The degree of joint effusion was graded on sagittal T2-weighted spin echo images according to a commonly used system. On axial short T1-weighted short inversion recovery images, the number and short-axis diameter of the parotid lymph nodes were recorded. We performed analyses of the cluster-correlated data using the Mann-Whitney U test and Spearman's correlation coefficients. P < .05 was considered to indicate significance. To assess the possible predictive value of certain variables, a generalized linear model (generalized estimation equation) was constructed, considering the multiple measurements. RESULTS: A total of 402 TMJ disorders were analyzed from 201 patients during the study period. The number and size of the parotid lymph nodes identified was significantly greater in the patients with TMJ effusion (P < .01) than in those without effusion. CONCLUSION: In the present study, we found an association between parotid lymphadenopathy and joint effusion in TMJ disorders. These findings indicate that lymphadenopathy should be considered as an inflammation condition commonly associated with joint effusion in TMJ disorders.


Assuntos
Hidrartrose/etiologia , Linfadenopatia/etiologia , Glândula Parótida/patologia , Transtornos da Articulação Temporomandibular/complicações , Adulto , Feminino , Humanos , Hidrartrose/diagnóstico por imagem , Hidrartrose/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Parótida/diagnóstico por imagem , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/patologia
12.
Orthopade ; 45(9): 795-806, 2016 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-27562127

RESUMO

The fundamental components of the differential diagnostics of joint effusions are the patient history and clinical examination. In the case of unclear findings, arthrosonography can provide information for the distinction between intra-articular and extra-articular pathologies. In atraumatic joint effusions inflammatory parameters in blood are determined in order to differentiate between systemic inflammatory and local inflammatory joint effusions. In the case of normal values further diagnostics are carried out using imaging. With elevated inflammatory parameters the main differential diagnoses are gouty arthritis, autoimmune joint processes and septic arthritis. When in doubt, a joint aspiration and synovial fluid analysis should be performed to rule out septic arthritis or if necessary confirmation of gouty arthritis.


Assuntos
Artrite/diagnóstico por imagem , Artrografia/métodos , Hidrartrose/diagnóstico , Anamnese/métodos , Líquido Sinovial/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico Diferencial , Humanos , Exame Físico
13.
Skeletal Radiol ; 45(6): 843-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27020451

RESUMO

Femoral neck stress fracture (FNSF) is well documented in the orthopedic literature and is generally associated with strenuous activities such as long-distance running and military training. The diagnostic yield of magnetic resonance imaging (MRI) for FNSF was reported to be 100 %, and early MRI is recommended when this fracture is suspected. We encountered a 16-year-old male long-distance runner with FNSF in whom the left femoral neck showed no signal changes on MRI although an effusion was detected in the left hip joint. One month later, roentgenograms revealed periosteal callus and oblique consolidation of the left femoral neck, confirming the diagnosis of compression FNSF. Because FNSF with a normal bone marrow signal on MRI is very rare, this patient is presented here.


Assuntos
Erros de Diagnóstico/prevenção & controle , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Hidrartrose/diagnóstico por imagem , Imageamento por Ressonância Magnética , Osteoartrite do Quadril/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Reações Falso-Negativas , Fraturas do Colo Femoral/complicações , Fraturas de Estresse/complicações , Humanos , Hidrartrose/etiologia , Masculino , Osteoartrite do Quadril/etiologia
14.
Ann Rheum Dis ; 75(3): 519-25, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25550336

RESUMO

OBJECTIVE: To describe the cross-sectional and longitudinal associations between knee regional effusion-synovitis and structural changes in older adults. METHODS: A total of 977 subjects were randomly selected from the local community (mean 62 years, 50% female) at baseline and 404 were followed up 2.6 years later. T2-weighted MRI was used to assess knee effusion-synovitis in four subregions: suprapatellar pouch, central portion, posterior femoral recess and subpopliteal recess. Knee cartilage defects, cartilage volume and bone marrow lesions (BMLs) were measured using MRI at baseline and follow-up. RESULTS: Cross-sectionally, effusion-synovitis in most subregions was significantly associated with a higher risk of cartilage defects, BMLs and reduced cartilage volume. Longitudinally, suprapatellar pouch effusion-synovitis at baseline predicted an increase in cartilage defects (p<0.01), loss of cartilage volume (p=0.04) and an increase in BMLs (p=0.02) in multivariable analyses. The significant associations of effusion-synovitis with cartilage volume and BMLs disappeared after adjustment for cartilage defects. Effusion-synovitis in whole knee joint (p<0.01) and subpopliteal recess (p<0.05) was consistently associated with longitudinal changes in cartilage defects but not in cartilage volume and BMLs. CONCLUSIONS: There are independent associations between knee joint effusion-synovitis and knee cartilage defects in both cross-sectional and longitudinal analyses, suggesting a potential causal relationship. The associations of effusion-synovitis with BMLs and cartilage volume were largely dependent on cartilage defects, suggesting potential causal pathways.


Assuntos
Medula Óssea/patologia , Cartilagem Articular/patologia , Hidrartrose/patologia , Articulação do Joelho/patologia , Osteoartrite do Joelho/patologia , Sinovite/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Progressão da Doença , Exsudatos e Transudatos , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos
15.
BMC Complement Altern Med ; 15: 451, 2015 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-26703073

RESUMO

BACKGROUND: Hydrarthrosis, which is associated with knee pain and limited range of motion, decreases the quality of life (QOL) of patients with osteoarthritis (OA). The Kampo medicine boiogito is prescribed for the treatment of knee OA with hydrarthrosis; however, its precise mechanisms of action remain unknown. The purposes of this study were to assess the pharmacological effects of boiogito and its mechanisms of action on joint effusion in rats with surgically induced OA. METHODS: A rat OA model was produced by transecting the anterior (cranial) cruciate ligament, medial collateral ligament, and medial meniscus in the right knee joints of 7-week-old female Wistar rats. The rats were given chow containing boiogito (1 or 2%) or indomethacin (0.002 %) for 4 weeks after surgical transection. Levels of interleukin-1ß (IL-1ß) and hyaluronic acid (HA) were measured by enzyme-linked immunosorbent assay. Knee joint pain was assessed using an incapacitance tester. Osmotic water permeability in cultured rabbit synovial cells was assessed using stopped-flow analysis. RESULTS: Increased synovial fluid volume and knee joint pain were observed in rats with surgically induced OA. In rats with OA, levels of IL-1ß and HA in the articular cavity were higher but concentration of HA in synovial fluid was lower than in sham-operated rats, suggesting excessive synovial fluid secretion. Administration of boiogito improved hydrarthrosis, IL-1ß, and HA concentrations and alleviated knee joint pain in rats with OA. Indomethacin reduced IL-1ß and knee joint pain but failed to improve hydrarthrosis or HA concentration in rats with OA. Osmotic water permeability in synovial cells, which is related to the function of the water channel aquaporin, was decreased by treatment with boiogito. CONCLUSION: Boiogito ameliorates the increased knee joint effusion in rats with OA by suppressing pro-inflammatory cytokine IL-1ß production in the articular cavity and regulating function of water transport in the synovium. The improvement of hydrarthrosis by boiogito results in the increased HA concentration in synovial fluid, thus reducing joint pain. Boiogito may be a clinically useful treatment of QOL in patients with OA with hydrarthrosis.


Assuntos
Hidrartrose/tratamento farmacológico , Medicina Kampo , Osteoartrite do Joelho/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Animais , Feminino , Humanos , Ácido Hialurônico/metabolismo , Hidrartrose/metabolismo , Interleucina-1beta/metabolismo , Osteoartrite do Joelho/metabolismo , Plantas Medicinais , Coelhos , Ratos , Ratos Wistar , Líquido Sinovial/metabolismo
17.
J Knee Surg ; 28(3): 213-22, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24807194

RESUMO

An effusion at the onset of viscosupplementation has been thought to diminish the efficacy and increase adverse event rates. This study compares efficacy of hylan G-F 20 in patients with and without an effusion. Patients with knee osteoarthritis (OA) received three weekly injections of hylan G-F 20. A total of 50 patients with an effusion requiring aspiration were compared with 50 matched patients without an effusion. Outcome measurements included Western Ontario and McMaster's Universities Osteoarthritis index (WOMAC) and visual analog scale (VAS). Patients were followed for 26 weeks. Both effusion and control group VAS was significantly lowered at all time points. WOMAC scores improved (p < 0.025) at all visits in the effusion group except for WOMAC A-1 week 14. Control WOMAC scores also significantly improved at all visits (p < 0.027), except for full WOMAC and WOMAC A-1 at week 1. Neither group experienced an adverse event. Presence of an effusion at onset of viscosupplementation requiring aspiration does not negatively impact efficacy of hylan G-F 20 or increase adverse event rates.


Assuntos
Ácido Hialurônico/análogos & derivados , Hidrartrose/terapia , Osteoartrite do Joelho/terapia , Viscossuplementos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção , Resultado do Tratamento , Viscossuplementação
20.
J Athl Train ; 48(2): 186-91, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23672382

RESUMO

CONTEXT: Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive. OBJECTIVE: To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction. DESIGN: Crossover study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers. INTERVENTION(S): All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee. MAIN OUTCOME MEASURE(S): Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced. RESULTS: Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05). CONCLUSIONS: Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.


Assuntos
Hidrartrose/fisiopatologia , Articulação do Joelho/fisiopatologia , Dor/fisiopatologia , Músculo Quadríceps/fisiopatologia , Análise de Variância , Estudos Cross-Over , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Medição da Dor , Torque , Adulto Jovem
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