Chronic Musculoskeletal Disease Research Articles

E053 The use of online platforms in the treatment of chronic musculoskeletal disease

Abstract Background/Aims Persistent pain is a common feature of rheumatic diseases, and has a significant impact on the emotional, physical and social wellbeing of individuals. Despite pharmacological treatment for inflammatory arthritis, such as rheumatoid arthritis (RA), 10-20% have features suggestive of co-existing centralised pain. These patients have worse pain, mood and sleep despite DMARD therapy. Similar to fibromyalgia (FM), non-pharmacological treatments are likely to be useful for this problem. Evidence supports cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for the management of chronic musculoskeletal pain. Unfortunately, access to services is poor for many people. This has driven the development of online treatment programmes and apps. The current study explores willingness of patients with rheumatic diseases to use online platforms in this context. Methods An observational cohort study of patients with a clinical diagnosis of either RA or FM were recruited from NHS outpatient clinics. Data collection was via the online platform Redcap. Analysis compared demographic and clinical features of those with past use of online platforms or apps for health purposes using Student’s t-test and chi squared tests. A similar comparison was conducted for future use of online platforms or apps. Results Of 343 patients 177(52%) FM, 166(48%) RA), 264 (77%) were female with mean (SD) age 48 (13.6). Past use of online platforms is summarised in Table 1. Significantly more patients with FM (70%) would be willing to try an online platform in future, compared to those with RA (30%). Those with future interest are more likely to be younger (mean age 46), have lower mood (mean PHQ-9 13), worse sleep (mean ISI 14.6) and less pain (mean VAS 6.6) compared to those who would not (mean age 60, PHQ-9 12, ISI 12.6 and VAS 7.0 respectively). Conclusion Those with FM are more likely to engage with online platforms or apps for health purposes than those with RA. In this analysis, users were more likely to be younger and experience more severe anxiety and depression but further work is needed to evaluate the contributing factors which will be essential when optimising the impact of online healthcare initiatives. Disclosure A.J.W. Wall: None. E. Kelleher: None. V. Wanigasekera: None. A. Irani (nee Soni): None.

Barriers and enablers to engagement in exercise and physical activity in non-English speaking South Asian people with chronic musculoskeletal disease

BackgroundExercise and physical activity (EPA) are recommended for people with chronic musculoskeletal disease; however, lower levels of engagement with EPA has been consistently reported in people from the South Asian community across a range of diseases. As language can pose a significant barrier in healthcare, this study aimed to understand the enablers and barriers to the acceptance of EPA among non-English speaking South Asian people who attended rheumatology clinics.Methods12 non-English speaking individuals from the South Asian community who had chronic musculoskeletal disease with significant pain scores were interviewed via telephone or face-to-face in their spoken languages. The audio recordings of the interviews were translated into English and transcribed verbatim. Data was analysed using thematic analysis implemented in the NVivo 12 Pro software program.ResultsThe mean age was 52 years (9 women and 2 men). One main theme was identified: ‘Enablers and barriers to exercise and physical activity’. Enablers to EPA were having knowledge about the benefits of EPA, being given resources in a language that they understood, and supportive environments such as having access to community facilities for those who could not undertake EPA in their houses. Barriers included physical health such as pain and fatigue, lack of time, difficulties with transportation to exercise venues, dislike of group exercises and lack of understanding of what and how to do exercise and be physically active. Participants’ beliefs about EPA and whether they impacted their physical health seemed to influence whether they were undertaken or not. There was a perception that their culture shaped their compatriots’ beliefs about EPA, and it was not normal practice for people from their country of birth to engage in it.ConclusionsThis is the first qualitative study to explore the barriers and enablers to engagement in EPA in non-English speaking South Asian people with chronic musculoskeletal disease. Modifiable factors such as addressing the level of knowledge on the benefits of EPA in the management of chronic joint and muscle pain; aiding the development of the skills required to exercise safely and confidently despite chronic pain and providing information and services in the native language could promote the EPA engagement of non-English speaking South Asian individuals with chronic musculoskeletal disease. The findings may inform improvements within clinical services to promote the benefits, impact and self-efficacy of engagement with EPA as part of chronic musculoskeletal disease management.Ethics approvalThe West Midlands-Edgbaston Research Ethics Committee (reference:20/WM/0305).

A Narrative Review Current Physical Therapy Management for Patellar Tendinopathy

Patellar tendinopathy, or jumper’s knee, is a common chronic musculoskeletal disease in the tendon that occurs in lower-extremities injuries. It is common in athletes, particularly sports that integrate frequent jumping and landing, such as volleyball (45%), basketball (32%), and distance running (14%), Patellar tendinopathy is usually difficult for such athletes to manage during the active sports season. This review article is recommended for physical therapists for the conservative treatment in competition season and post-operative rehabilitation of patellar tendon injuries. This review article discusses a new intervention for physiotherapy treatment for Patellar tendinopathy that can support a significant improvement in performance in sport and functional daily activity. The ultimate aim is to develop a clinical practice recommendation for physical therapists for the conservative treatment and post-operative rehabilitation of patellar tendon injuries. This review article found that physical therapy is popularly used to treat Patellar tendinopathy and effective interventions consist of exercise, extracorporeal shockwave therapy, high-energy laser therapy, elastic therapeutic taping, and education for prevention of issues. The post-operative rehabilitation protocol for patella tendon injuries aims to decrease pain, improve the range of motion, and ensure early ambulation and a quick return to sport, though in a time period that is decided on a case-by-case basis depending on the person and the sport. Post-operative rehabilitation is highly important for ensuring a safe return to sport and good quality of life.

M2 macrophage-derived exosomal miR-26b-5p regulates macrophage polarization and chondrocyte hypertrophy by targeting TLR3 and COL10A1 to alleviate osteoarthritis

Osteoarthritis (OA) is one of the most prevalent chronic musculoskeletal diseases among the elderly population. In this study, macrophage-derived exosomes were isolated and identified. Exosomes were subjected to microRNA (miRNA) sequencing and bioinformatic analysis, and differentially expressed miRNAs were verified. miR-26b-5p target genes were confirmed through target-site mutation combined with a dual-luciferase reporter assay. The effects of miR-26b-5p on macrophage polarization and chondrocyte hypertrophy were assessed in vitro. miR-26b-5p agomir was applied to mice with OA induced by anterior cruciate ligament transection (ACLT). The therapeutic effects of miR-26b-5p were evaluated via pain behavior experiments and histological observations. In vitro, miR-26b-5p repolarized M1 macrophages to an anti-inflammatory M2 type by targeting the TLR3 signaling pathway. miR-26b-5p could target COL10A1, further inhibiting chondrocyte hypertrophy induced by M1 macrophage-conditioned medium (M1-CM). In vivo, miR-26b-5p agomir ameliorated gait abnormalities and mechanical allodynia in OA mice. miR-26b-5p treatment attenuated synovitis and cartilage degeneration, thereby delaying OA progression. In conclusion, M2 macrophage-derived exosomal miR-26b-5p could protect articular cartilage and ameliorate gait abnormalities in OA mice by targeting TLR3 and COL10A1. miR-26b-5p further affected macrophage polarization and chondrocyte hypertrophy. Thus, this exosomal miR-26b-5p-based strategy might be a potential method for OA treatment.Graphical

AYURVEDIC MANAGEMENT OF VATARAKTA W.S.R. TO GOUT WITH GUDUCHI KSHEERPAKA A REVIEW

Numerous health-related concerns occur globally as a result of changes in everyone's lives, resulting in a variety of systemic diseases. One of these degenerative and chronic joint and musculoskeletal diseases that mainly affects individuals in their second and third decades of life is Vatrakta, which is a joint disease that is briefly discussed in classical Ayurvedic texts. Vatrakta and gout can be compared based on their clinical similarities. According to recent studies, the prevalence of gout has grown. Medications used to treat hyperuricaemia or gout only provide temporary relief and have a number of adverse effects, finding an effective treatment is essential. Guduchi Ksheerpaka Sevan was advised by Aacharya Charaka and Vagbhata regarding how to manage Vatrakta. For Vatrakta, the preferred medication is Guduchi (Tinospora cordifolia (Willd.) Miers ex hook. & Thoms). Ingredients are easily accessible, and the preparation process is simple and easier to consume.

Management of psoriatic arthritis: a consensus opinion by expert rheumatologists

BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease involving several articular and extra-articular structures. Despite the important progresses recently made in all of the aspects of this disease, its management is still burdened by unresolved issues. The aim of this exercise was to provide a set of statements that may be helpful for the management of PsA.MethodsA group of 38 Italian rheumatologists with recognized expertise in PsA selected and addressed the following four topics: “early PsA,” “axial-PsA,” “extra-articular manifestations and comorbidities,” “therapeutic goals.” Relevant articles from the literature (2016–2022) were selected by the experts based on a PubMed search. A number of statements for each topic were elaborated.ResultsNinety-four articles were selected and evaluated, 68 out of the 1,114 yielded by the literature search and 26 added by the Authors. Each of the four topic was subdivided in themes as follows: transition from psoriasis to PsA, imaging vs. CASPAR criteria in early diagnosis, early treatment for “early PsA”; axial-PsA vs. axialspondyloarthritis, diagnosis, clinical evaluation, treatment, standard radiography vs. magnetic resonance imaging for “axial PsA”; influence of inflammatory bowel disease on the therapeutic choice, cardiovascular comorbidity, bone damage, risk of infection for “comorbidities and extra-articular manifestations”; target and tools, treat-to-target strategy, role of imaging for “therapeutic goals.” The final document consisted of 49 statements.DiscussionThe final product of this exercise is a set of statements concerning the main issues of PsA management offering an expert opinion for some unmet needs of this complex disease.

DNMT3a-mediated methylation of PPARγ promote intervertebral disc degeneration by regulating the NF-κB pathway.

Intervertebral disc degeneration (IVDD) is a common chronic musculoskeletal disease that causes chronic low back pain and imposes an immense financial strain on patients. The pathological mechanisms underlying IVDD have not been fully elucidated. The development of IVDD is closely associated with abnormal epigenetic changes, suggesting that IVDD progression may be controlled by epigenetic mechanisms. Consequently, this study aimed to investigate the role of epigenetic regulation, including DNA methyltransferase 3a (DNMT3a)-mediated methylation and peroxisome proliferator-activated receptor γ (PPARγ) inhibition, in IVDD development. The expression of DNMT3a and PPARγ in early and late IVDD of nucleus pulposus (NP) tissues was detected using immunohistochemistry and western blotting analyses. Cellularly, DNMT3a inhibition significantly inhibited IL-1β-induced apoptosis and extracellular matrix (ECM) degradation in rat NP cells. Pretreatment with T0070907, a specific inhibitor of PPARγ, significantly reversed the anti-apoptotic and ECM degradation effects of DNMT3a inhibition. Mechanistically, DNMT3a modified PPARγ promoter hypermethylation to activate the nuclear factor-κB (NF-κB) pathway. DNMT3a inhibition alleviated IVDD progression. Conclusively, the results of this study show that DNMT3a activates the NF-κB pathway by modifying PPARγ promoter hypermethylation to promote apoptosis and ECM degradation. Therefore, we believe that the ability of DNMT3a to mediate the PPARγ/NF-κB axis may provide new ideas for the potential pathogenesis of IVDD and may become an attractive target for the treatment of IVDD.

Potential of molecular biophysical stimulation therapy in chronic musculoskeletal disorders: a narrative review.

Current treatment of chronic musculoskeletal diseases does not give sufficient results despite the implementation of novel drugs and techniques in orthopaedics and physical therapy. For instance, osteoporosis treatment is currently mainly limited to drug application, while the goal of osteoarthritis treatment is to mitigate pain symptoms through physical therapy. The main therapeutic principle in the management of osteoporosis is not only to increase bone mass, but also to improve bone and the cartilage quality, which depends on the biomechanical balance. Therefore, there is a strong demand for advanced technologies that would safely and non-invasively accelerate cartilage regeneration and improve bone density. Ten years ago, a new state-of-the-art technology - "Molecular biophysical stimulation therapy (MBST)", specifically nuclear magnetic resonance therapy, emerged on the medical technology market and until now, it has shown successful results in the conservative treatment of musculoskeletal disorders, including back pain. The aim of this review is to provide an integrated, synthesized overview of the current evidence of efficacy of MBST for managing chronic musculoskeletal disorders.

Study of polymorbidity in patients with musculoskeletal diseases at the stage of medical and ­physical rehabilitation

Background. The study of multimorbidity is an urgent task for assessing individual clinical risks and prognosis, developing a treatment and rehabilitation plan.
 Aim. To study multimorbidity in patients with chronic musculoskeletal diseases.
 Material and methods. The study was conducted in 20222023 on the basis of the medical center for the treatment of spine and joints DEMA and the Peoples' Friendship University of Russia named after Patrice Lumumba. Study subjects were patients with musculoskeletal diseases (n=212) who sought medical and physical rehabilitation. Men n=75 (average age 40.26.65 years, proportion of patients 60 years 20%), women n=137 (average age 47.26.84 years, proportion of patients 60 years 18%). The subject of the study was polymorbidity in patients with musculoskeletal diseases. The following methods were used: content analysis, analytical, statistical, mathematical, comparative analysis method.
 Results. Spinal diseases were detected in 79.2% of patients, and various dysfunctions of the musculoskeletal system were detected in 19.36%. 43 (20.28%) patients were diagnosed with two diseases of the musculoskeletal system. Women were more likely than men to be diagnosed with spinal osteochondrosis (p=0.015), cervicalgia (p=0.015), degenerative diseases of the hip and knee joints (p=0.022) and consequences of skeletal injuries (p=0.015). Of the concomitant diseases in all patients, eye (23.1%) and cardiovascular diseases (25.5%) were common. Women were more often diagnosed with endocrine (p=0.025), ophthalmic (p=0.001), gynecological (p=0.001) diseases, urolithiasis (p=0.025) and cholelithiasis (p=0.025); men with consequences of injuries/surgeries (p=0.025). Polymorbidity was established in 50.33% of patients 42 men and 72 women. Two and three concomitant chronic diseases were predominantly diagnosed in women, and six or more were diagnosed in men. All patients 60 years of age (25%) had three or more chronic diseases.
 Conclusion. Most patients with musculoskeletal pathology suffer from several chronic diseases.

Challenges and complications and their management of the transarterial microembolization for chronic musculoskeletal pain.

Transarterial microembolization (TAME) is an increasingly well-known novel and minimally invasive treatment option for painful chronic musculoskeletal diseases that is gaining popularity. Although the safety and effectiveness of TAME have been established, limited knowledge of intraarticular and musculocutaneous arterial anatomy may lead to challenges and complications. This article aims to present cases illustrating these challenges and complications, based on multicenter experiences and a comprehensive literature review. Furthermore, the article also provides preventive tips, solutions, and follow-up strategies to reduce the learning curve for interventional radiologists and facilitate familiarity with post-TAME follow-up images for diagnostic radiologists. CLINICAL RELEVANCE STATEMENT: This article illustrates the intra- and post-interventional complications of transarterial microembolization (TAME) through detailed pictorial reviews, including how to distinguish them from normal angiographic findings. It provides strategies for their prevention, management, and follow-up, which can further improve clinical outcomes. KEY POINTS: • Transarterial microembolization for chronic musculoskeletal pain may result in intrainterventional challenges (IIC) and postinterventional complications (PIC), and their importance may be underestimated. • The intrainterventional challenges include microarterial perforation, arterial dissection, and catheter tip fracture, whereas postinterventional complications include tissue ischemia-related complications, puncture site hemorrhage, and arterial injury. • Being familiar with the intrainterventional challenges and postinterventional complications may help minimize the procedure risk and improve outcomes.

The clinical observation of DRG pulsed radiofrequency treatment for chronic musculoskeletal disease

Objective: To observe the clinical effect of Chronic Musculoskeletal Pain (CMP). Methods: 80 CMP patients admitted to our department from January 2022 to June 2023 were selected as the pain improvement after pulse radiofrequency treatment. Results: The total response rate at 1 week and 4 weeks was 91.25% and 97.50%, respectively. The excellent rate at 4 weeks after treatment was significantly higher than at 1 week after treatment. VAS scores were significantly lower at 1 week and 4 weeks after treatment than before treatment (P<0.05). Conclusion: Pulsed radiofrequency therapy for CMP has a significant clinical effect, significant pain improvement, and significantly improved quality of life. It is a widely used interventional therapy in chronic pain.

The Human Microbiome and Its Role in Musculoskeletal Disorders.

Musculoskeletal diseases (MSDs) are characterized as injuries and illnesses that affect the musculoskeletal system. MSDs affect every population worldwide and are associated with substantial global burden. Variations in the makeup of the gut microbiota may be related to chronic MSDs. There is growing interest in exploring potential connections between chronic MSDs and variations in the composition of gut microbiota. The human microbiota is a complex community consisting of viruses, archaea, bacteria, and eukaryotes, both inside and outside of the human body. These microorganisms play crucial roles in influencing human physiology, impacting metabolic and immunological systems in health and disease. Different body areas host specific types of microorganisms, with facultative anaerobes dominating the gastrointestinal tract (able to thrive with or without oxygen), while strict aerobes prevail in the nasal cavity, respiratory tract, and skin surfaces (requiring oxygen for development). Together with the immune system, these bacteria have coevolved throughout time, forming complex biological relationships. Changes in the microbial ecology of the gut may have a big impact on health and can help illnesses develop. These changes are frequently impacted by lifestyle choices and underlying medical disorders. The potential for safety, expenses, and efficacy of microbiota-based medicines, even with occasional delivery, has attracted interest. They are, therefore, a desirable candidate for treating MSDs that are chronic and that may have variable progression patterns. As such, the following is a narrative review to address the role of the human microbiome as it relates to MSDs.

Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality

Abstract: Background: Chronic musculoskeletal (MSK) diseases are an important cause of disability in the Mayan community of Chankom in Yucatán, Mexico. Objective: To understand a community-based participatory research (CBPR) strategy implemented in Chankom to design a community-based rehabilitation (CBR) program for people living with MSK diseases. Methods: Qualitative descriptive thematic analysis from an ethnographic work conducted in Chankom, during the implementation of a CBPR strategy from 2014 to 2017. Results: Four main themes describe the main processes that formed our CBPR strategy: 1) forming and maintaining an alliance between academic and community members, 2) prioritizing community needs, 3) integrating local and global knowledge and 4) shared-decision-making. This CBPR strategy allowed the design of a CBR program formed by six main interventions: 1) health services coordination, 2) personal support, 3) community venous blood sampling services, 4) community specialized services, 5) health promotion, and 6) health transportation services. Conclusions: Co-designing a CBR program for people living with chronic MSK diseases in Chankom was possible through an extensive community engagement work structured around four main processes, including the essential principles of CBPR. The designed CBR program includes culturally sensitive interventions aimed at improving the quality, availability, accessibility, and acceptability of health care services. Moreover, the program mainly addressed the "health" component of the World Health Organization–CBR matrix, suggesting a need for a new CBPR cycle after it is implemented and evaluated in the future.

Transarterial Embolization for Refractory Overuse Sports Injury: Pictorial Case Reports.

Transarterial embolization for the treatment of chronic musculoskeletal diseases is gaining increasing interest in the field of interventional radiology. Overuse sports injury is defined as an injury occurring in the absence of a single, identifiable traumatic cause. In the treatment of this condition, there is a need for reliable results and a quick return to activity. Minimally invasive treatments with short periods of missed practice are required. Intra-arterial embolization has the potential to meet this need. In this article, we describe cases of embolization for refractory overuse sports injuries including patellar tendinopathy, pes anserine, plantar fasciitis, triangular fibrocartilage complex injury, hamstring injury, infrapatellar fat pad inflammation, Achilles tendinopathy, delayed union metatarsal bone fracture, lumbar spondylolysis, and repetitive hamstrings strain.

Factors associated with COVID-19 severity in patients with spondyloarthritis: Results of the French RMD COVID-19 cohort

ObjectivesThe objective of the current study was to evaluate the severity of COVID-19 and identify factors associated with severe disease outcomes in patients with spondyloarthritis (SpA), a chronic inflammatory rheumatic and musculoskeletal disease (RMD). MethodsWe utilized patient data from the French national multicenter RMD COVID-19 cohort (NCT04353609). The primary outcome was to describe COVID-19 characteristics in patients with SpA based on disease severity of COVID-19 (mild, moderate or severe) with serious infection including moderate and severe cases. The secondary outcome was to identify the factors associated with serious COVID-19 classification. ResultsAmong the 626 patients with SpA (56% female, mean age 49±14 years) from the French RMD cohort, COVID-19 severity was mild in 508 (81%), moderate in 93 (15%), and severe in 25 (4%) patients. Clinical signs and symptoms of COVID-19 were reported in 587 (94%) patients, with the most frequent presented symptom of fever (63%) and cough (62%), followed by flu-like symptoms (53%), agueusia (39%), anosmia (37%), dyspnea (32%) and diarrhea (19.9%). COVID-19 severity was associated with corticosteroid therapy (OR=3.08 [95% CI: 1.44–6.58], P=0.004) and age (OR=1.06 [95% CI: 1.04–1.08], P<0.001) while use of tumor necrosis factor inhibitor (TNFi, OR=0.27 [95% CI: 0.09–0.78], P=0.01) was associated with less severe disease. We did not identify an association between NSAID use and COVID-19 severity. ConclusionsIn this study, the majority of patients with SpA had a favorable COVID-19 outcome. We confirmed age and corticosteroids therapy had a negative impact on disease outcomes while TNFi use was protective.

Common non-cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease.

Among older adults, non-cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non-cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), or atrial fibrillation (AF). Using 2015-2016 Medicare data, we took 1% random sample to create 3 cohorts of beneficiaries diagnosed with AMI (n = 24,808), CHF (n = 57,285), and AF (n = 36,277) prior to 1/1/2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 9 non-cardiovascular comorbidities (anemia, cancer, chronic kidney disease, chronic lung disease, dementia, depression, diabetes, hypothyroidism, and musculoskeletal disease). Mortality, cardiovascular and non-cardiovascular hospitalizations, and home time lost over a 1-year follow-up period were compared across non-cardiovascular multimorbidity classes. Similar non-cardiovascular multimorbidity classes emerged from the 3 CVD cohorts: (1) minimal, (2) depression-lung, (3) chronic kidney disease (CKD)-diabetes, and (4) multi-system class. Across CVD cohorts, multi-system class had the highest risk of mortality (hazard ratio [HR], 2.7-3.9), cardiovascular hospitalization (HR, 1.6-3.3), non-cardiovascular hospitalization (HR, 3.1-7.2), and home time lost (rate ratio, 2.7-5.4). Among those with AMI, the CKD-diabetes class was more strongly associated with all the adverse outcomes than the depression-lung class. In CHF and AF, differences in risk between the depression-lung and CKD-diabetes classes varied per outcome; and the depression-lung and multi-system classes had double the rates of non-cardiovascular hospitalizations than cardiovascular hospitalizations. Four non-cardiovascular multimorbidity patterns were found among Medicare beneficiaries with CHF, AMI, or AF. Compared to the minimal class, the multi-system, CKD-diabetes, and depression-lung classes were associated with worse outcomes. Identification of these classes offers insight into specific segments of the population that may benefit from more than the usual cardiovascular care.

A chikungunya virus-like particle vaccine induces broadly neutralizing and protective antibodies against alphaviruses in humans.

Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes epidemics of acute and chronic musculoskeletal disease. Here, we analyzed the human B cell response to a CHIKV-like particle-adjuvanted vaccine (PXVX0317) from samples obtained from a phase 2 clinical trial in humans (NCT03483961). Immunization with PXVX0317 induced high levels of neutralizing antibody in serum against CHIKV and circulating antigen-specific B cells up to 6 months after immunization. Monoclonal antibodies (mAbs) generated from peripheral blood B cells of three PXVX0317-vaccinated individuals on day 57 after immunization potently neutralized CHIKV infection, and a subset of these inhibited multiple related arthritogenic alphaviruses. Epitope mapping and cryo-electron microscopy defined two broadly neutralizing mAbs that uniquely bind to the apex of the B domain of the E2 glycoprotein. These results demonstrate the inhibitory breadth and activity of the human B cell response induced by the PXVX0317 vaccine against CHIKV and potentially other related alphaviruses.

POPÜLER BİR TAMAMLAYICI TIP TEDAVİSİ: PROLOTERAPİ

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The Identification of Immune-Related Biomarkers for Osteoarthritis Immunotherapy Based on Single-Cell RNA Sequencing Analysis.

Osteoarthritis (OA) is a chronic musculoskeletal disease affecting approximately 500 million people worldwide. Globally, OA is one of the most common and leading causes of disability. Several genetic factors are involved in OA, including inherited genes, genetic susceptibility, and genetic predisposition. As the pathogenesis of OA is unknown, there are almost no effective treatments available to prevent the onset or progression of the disease. In recent years, many researchers focused on bioinformatics analysis to explore new biomarkers for the diagnosis, treatment, and prognosis of human diseases. In this work, we obtain the traditional RNA sequencing data of OA patients from the GEO database. By performing the differentially expressed analysis, we successfully obtain the genes that are closely associated with the OA. In addition, the Venn diagram was applied to evaluate the genes that are involved in OA and immune-related genes. The protein-protein interaction analysis was further conducted to explore the hub genes. The single-cell RNA sequencing analysis was used to evaluate the expression distribution of the MMP, VEGFA, SPI1, and IRF8 in synovial tissues of patients with osteoarthritis. Finally, the GSVA enrichment analysis discovered the potential pathways involved in OA patients. Our analysis provides a new direction for the exploration of the process of OA patients. In addition, VEGFA may be considered a promising biomarker in OA.

The Role of Lubricin, Irisin and Exercise in the Prevention and Treatment of Osteoarthritis

Osteoarthritis is a chronic degenerative musculoskeletal disease that worsens with age and is defined by pathological alterations in joint components. All clinical treatment recommendations for osteoarthritis promote exercise, although precise molecular pathways are unclear. The purpose of this study was to critically analyze the research on lubricin and irisin and how they relate to healthy and diseased joint tissue. Our research focused specifically on exercise strategies and offered new perspectives for future potential osteoarthritis treatment plans. Although lubricin and irisin have only recently been discovered, there is evidence that they have an impact on cartilage homeostasis. A crucial component of cartilage lubrication and integrity, lubricin is a surface-active mucinous glycoprotein released by the synovial joint. Its expression increases with joint movement. In healthy joints, lubricin molecules cover the cartilage surface to lubricate the boundary of the joint and inhibit protein and cell attachment. Patients with joint trauma, inflammatory arthritis, or genetically mediated lubricin deficiency, who do not produce enough lubricin to protect the articular cartilage, develop arthropathy. Irisin, sometimes known as the "sports hormone", is a myokine secreted primarily by skeletal muscle. It is a physiologically active protein that can enter the circulation as an endocrine factor, and its synthesis and secretion are primarily triggered by exercise-induced muscle contraction. We searched PubMed, Web of Science, Google Scholar, and Scopus using the appropriate keywords to identify the most recent research. The studies considered advance our knowledge of the role that exercise plays in the fight against osteoarthritis, serve as a valuable resource, and support the advancement of osteoarthritis prevention and therapy.