Chronic Musculoskeletal Disease Research Articles

The impact of the novel coronavirus on trauma and orthopaedics in the UK.

At first glance, the novel coronavirus pandemic and orthopaedic surgery appear separate entities. Orthopaedic surgeons are not generally considered front-line staff in terms of the treatment of the disease that the novel coronavirus causes compared with anaesthetic and medical colleagues. However, the impact that the novel coronavirus is likely to have on the musculoskeletal injury burden and the morbidity associated with chronic musculoskeletal disease is significant. This article summarises the strategies currently being developed for the remodelling of orthopaedic services in the UK and the emergency British Orthopaedic Association Standards for Trauma and Orthopaedic guidelines released on 24 March 2020 in managing urgent orthopaedic patients during the novel coronavirus pandemic.

Exercise and inflammation.

Based on current knowledge deriving from studies in animals and humans (the general population and patients with non-communicable diseases), there is biological plausibility that exercise may have anti-inflammatory effects. This may be particularly important for patients with chronic inflammatory rheumatic and musculoskeletal diseases (RMDs). The present review discusses the current state-of-the-art on exercise and inflammation, explores how exercise can moderate inflammation-dependent RMD outcomes and the most prevalent systemic manifestations and addresses the relationship between the dosage (particularly the intensity) of exercise and inflammation. We conclude that present data support potential beneficial effects of exercise on inflammation, however, the evidence specifically in RMDs is limited and inconclusive. More targeted research is required to elucidate the effects of exercise on inflammation in the context of RMDs.

Procyanidin B3 alleviates intervertebral disc degeneration via interaction with the TLR4/MD-2 complex.

As a chronic musculoskeletal degeneration disease, intervertebral disc degeneration (IVDD) has been identified as a crucial cause for low back pain. This condition has a prevalence of 80% among adults without effective preventative therapy. Procyanidin B3 (Pro‐B3) is a procyanidin dimer, which is widely present in the human diet and has multiple functions, such as preventing inflammation. But the inhibiting effect of Pro‐B3 in IVDD development is still no known. Thus, our study aimed to demonstrate the therapeutical effect of Pro‐B3 in IVDD and explain the underlying mechanism. In vitro studies, human nucleus pulposus (NP) cells were isolated and exposed in lipopolysaccharide (LPS) to simulate IVDD development. Pro‐B3 pre‐treatment inhibited LPS‐induced production of inflammation correlated factors such as tumour necrosis factor α (TNF‐α), interleukin‐6 (IL‐6), prostaglandin E2 (PGE2) and Nitric oxide (NO). On the other hand, LPS‐medicated extracellular matrix (ECM) breakdown was blocked in Pro‐B3 treated NP cells. Additionally, Pro‐B3 treatment blocked the activation of NF‐κB/toll‐like receptor 4 pathway in LPS‐exposed NP cells. Mechanistically, Pro‐B3 could occupy MD‐2's hydrophobic pocket exhibiting high affinity for LPS to intervene LPS/TLR4/MD‐2 complex formation. In vivo, Pro‐B3 treatment prevented the loss of gelatin NP cells and structural damage of annulus fibrosus in rat IVDD model. In brief, Pro‐B3 is considered to be a treatment agent for IVDD.

Association of Osteoarthritis and Periodontitis in Sample of Iraqi Patients with Knee Osteoarthritis

Background : Osteoarthritis(OA and Periodontitis (PD) share physiopathological characteristics ,and many previous studies show association of PD with other chronic musculoskeletal and bone diseases such as rheumatoid arthritis and Osteoporosis. Objectives : To investigate the association between OA and PD in a sample of Iraqi patientswith knee OA. Patients and Method : Acase-control study included 150 patients with OA and 150 healthy controls. The WHO community periodontal index was used to assess periodontitis, Periodontitis was defined as a CPI greater than or equal to ‘‘code 3’’. Binary regression analysis used to assess the predictors of periodontitis among OA patients Results : OA patients were about 2.3 folds more likely to have Periodontitis, (odds ratio = 2.29, P. value < 0.05). In OA group only smoking showed a significant correlation with Periodontitis; where out of the 38 cases with periodontitis 7 (18.4%) were smokers compared to only 6 (5.4%) of 112 with no Periodontitis, (P. value = 0.013), Other variables showed no significant correlations, (P. value > 0.05).No statistically significant correlation had been found between prevalence of Periodontitis and severity of OA represented by KL score, (P. value > 0.05). Conclusions : Patients with knee OA were about 2.3 folds more likely to have Periodontitis compared to healthy controls. Presence of Periodontitis was not affected by age, gender, Occupation, Alcohol consumption, BMI or severity of disease in knee OA patients.

Genome-wide analysis of aberrant methylation of enhancer DNA in human osteoarthritis

BackgroundOsteoarthritis is a chronic musculoskeletal disease characterized by age-related gradual thinning and a high risk in females. Recent studies have shown that DNA methylation plays important roles in osteoarthritis. However, the genome-wide pattern of methylation in enhancers in osteoarthritis remains unclear.MethodsTo explore the function of enhancers in osteoarthritis, we quantified CpG methylation in human enhancers based on a public dataset that included methylation profiles of 470,870 CpG probes in 108 samples from patients with hip and knee osteoarthritis and hip tissues from healthy individuals. Combining various bioinformatics analysis tools, we systematically analyzed aberrant DNA methylation of the enhancers throughout the genome in knee osteoarthritis and hip osteoarthritis.ResultsWe identified 16,816 differentially methylated CpGs, and nearly half (8111) of them were from enhancers, suggesting major DNA methylation changes in both types of osteoarthritis in the enhancer regions. A detailed analysis of hip osteoarthritis identified 2426 differentially methylated CpGs in enhancers between male and female patients, and 84.5% of them were hypomethylated in female patients and enriched in phenotypes related to hip osteoarthritis in females. Next, we explored the enhancer methylation dynamics among patients with knee osteoarthritis and identified 280 differentially methylated enhancer CpGs that were enriched in the human phenotypes and disease ontologies related to osteoarthritis. Finally, a comparison of enhancer methylation between knee osteoarthritis and hip osteoarthritis revealed organ source-dependent differences in enhancer methylation.ConclusionOur findings indicate that aberrant methylation of enhancers is related to osteoarthritis phenotypes, and a comprehensive atlas of enhancer methylation is useful for further analysis of the epigenetic regulation of osteoarthritis and the development of clinical drugs for treatment of osteoarthritis.

Study to Assess the Prescription Pattern and Quality of Life in Osteoarthritis Patients at a Tertiary Care Hospital

Introduction: Osteoarthritis (OA) often called wear and tear arthritis is a chronic progressive musculoskeletal joint disease with multifactorial aetiology, affecting millions of people around the world. It is one of the leading causes of morbidity, having major impact on Quality of Life (QoL) of the patient with substantial economic and social burden. OA can have a negative impact on health related QoL and psychological well-being of the individual. Aim: To evaluate the prescribing trends of drugs in the management of OA in a tertiary care teaching hospital and to assess the effect of pharmacotherapy on QoL of OA patients in terms of subjective and functional status using Western Ontario and McMaster Universities Arthritis index scale (WOMAC)-modified Centre for Rheumatic Disease (CRD) Pune version OA patients. Materials and Methods: Prospective observational study conducted among the OA patients in Orthopaedic Department over the period of one year between November 2014-December 2015. Adult patients of either gender diagnosed with OA for minimum period of three months were enrolled for the study. Out of 285 eligible patients, drug therapy of 256 patients’ data were analysed and they were given treatment by the treating orthopaedician. All the patients were asked to personally complete the WOMAC index scale during their first visit. They were followed-up for one month of pharmacotherapy in order to assess change in the WOMAC index scale. Data were analysed using Statistical Package for the Social Sciences (SPSS) software 16.0 version. The p-value <0.05 was considered statistically significant. Results: Among 256 patients who completed the study, the most frequently prescribed drug class was NSAIDs (82.1%). Acelofenac with Paracetamol combination (117) and Diclofenac monotherapy (44) were most commonly prescribed. Statistically significant reduction in the WOMAC (pain, stiffness and physical function) score was observed in the follow-up visit when compared to first visit (p<0.0001) after one month of pharmacotherapy in patients taking Diclofenac and Aceclofenac with Paracetamol combination. Conclusion: This study highlighted the significant improvement in QoL and significant reduction in WOMAC scores with Aceclofenac-Paracetamol combination and Diclofenac monotherapy in OA patients.

Elder abuse and associated factors in eastern romania.

This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI© ) in comprehensive geriatric assessments. This cross-sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse. There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051). EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.

Moxibustion therapy for treating patients with primary osteoporosis: A systematic review and meta-analysis protocol.

Background:Primary osteoporosis (POP) is a common disease among elderly, which increase the risk of fracture and impact to the quality of life. As a Chinese traditional therapy, moxibustion has been commonly applied in treating chronic musculoskeletal diseases in China. Many trails have shown that moxibustion therapy is effective in treating primary osteoporosis. The protocol aims to present the methods used to access the effectiveness and safety of moxibustion therapy for patients with primary osteoporosis.Methods:The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trails(CENTRAL), Pubmed, EMBASE, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomized controlled trials related to moxibustion therapy for treating primary osteoporosis will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. We will select the fixed-effects or random-effects model according to the heterogeneity assessment for data synthesis. Bone mineral density(BMD) will be the primary outcomes. Visual analogue scale(VAS), response rate, TCM Syndrome scale(TCMSS), bone gla protein(BGP), alkaline phosphatase(BALP), blood calcium(Ca), blood phosphate(P), quality of life(QOL) will be the second outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference(WMD) or standard mean difference (SMD) 95% CIs for continuous data.Trial registration number:PROSPERO CRD42019129507

Long Noncoding RNA Nuclear Enriched Abundant Transcript 1 (NEAT1) Regulates Proliferation, Apoptosis, and Inflammation of Chondrocytes via the miR-181a/Glycerol-3-Phosphate Dehydrogenase 1-Like (GPD1L) Axis.

BackgroundOsteoarthritis (OA) is one of the most common chronic musculoskeletal diseases, yet to date it lacks effective therapeutic strategies. Increasing evidence suggests that long noncoding RNAs (lncRNAs) serve pivotal roles in the occurrence and development of OA. However, the possible molecular mechanism involving lncRNAs, such as nuclear enriched abundant transcript 1 (NEAT1), in OA progression is still unclear.Material/MethodsFirst, NEAT1 and miR-181a expression in OA synovium tissues and normal synovium tissues were detected. Then, the effect of NEAT1 on modulating growth ability, apoptosis, and inflammation in OA chondrocytes was investigated by a series of loss-function experiments. Next, the correlation between NEAT1, miR-181a, and glycerol-3-phosphate dehydrogenase 1-like (GPD1L) was fully investigated. Finally, the downregulation of miR-181a was employed as a recovery experiment to explore the functional mechanism of NEAT1 in OA.ResultsIn the present study, we found that NEAT1 expression was downregulated in OA tissues, while miR-181a expression was prominently upregulated. Moreover, reduced expression of NEAT1 suppressed cell growth while elevating the apoptotic rate and increasing the abundance of inflammatory cytokines released in OA chondrocytes. Furthermore, we clarified that miR-181a was a direct sponge of NEAT1, and GPD1L was able to bind to miR-181a. Additionally, we found that downregulation of miR-181a was able to attenuate the effect of NEAT1 on apoptosis, inflammatory response, and proliferation in OA chondrocytes.ConclusionsOur findings indicate that downregulation of NEAT1 aggravated progression of OA via modulating the miR-181a/GPD1L axis, providing a novel insight into the mechanism of OA pathogenesis.

Reliability and Validity of the Turkish Version of Illness Cognition Questionnaire

ABSTRACTBackground: This study aimed to determine the validity and reliability characteristics of the Illness Cognition Questionnaire (ICQ).Methods: A total of 205 patients who had pain related to chronic musculoskeletal diseases were referred to the study. In order to test the validity, Short Disease Perception Scale (SDPS), Hospital Anxiety and Depression Scale (HADS) were administered together with the ICQ. Confirmatory factor analysis was used to measure the construct validity of the ICQ, and convergent and divergent validities were evaluated using Pearson correlation analysis. In order to achieve the test-retest reliability of the questionnaire, 81 patients re-applied the questionnaire after two days. Cronbach’s alpha internal consistency and test-retest reliability coefficients were calculated to determine the reliability level of the questionnaire.Results: The factor loadings of the ICQ helplessness subscale ranged from 0.784 to 0.853, the acceptance subscale ranged from 0.583 to 0.855, and the perceived benefits subscale ranged from 0.733 to 0.794. Internal consistency coefficients of the ICQ were found α = 0.929 for the helplessness subscale, α = 0.868 for the acceptance subscale, and α = 0.896 for perceived benefits subscale. The results of the analysis showed that there was a statistically significant positive correlation between the initial measurement of helplessness sub-scale and the retest helplessness subscale at 0.697 level (p < .05). A statistically significant positive correlation was determined between the test and the retest of acceptance sub-scale at 0.465 level (p < .05). A statistically significant positive correlation was found between the first test of the perceived benefits sub-scale and the retest test at the 0.661 level.Conclusion: The Turkish version of the ICQ was found to be valid and reliable. It is a measurement tool that could be used easily in clinics because of its short application time and easy to understand. We think that ICQ which provides a new awareness in the perception of disease in Turkish society should be examined in different diseases and age groups.

Analysis of the assortment, socio-economic availability and volumes of drugs consumption of the nonsteroidal anti-inflammatory group on the Ukrainian pharmaceutical market

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the world and in Ukraine. Anti-inflammatory and analgesic therapy of chronic musculoskeletal system diseases should be conducted for long periods of time. This requires the presence of NSAIDs that are characterized by distinct pharmacological properties and a high level of safety. Aim. To study the assortment, economic availability and volumes of NSAIDs consumption on the pharmaceutical market of Ukraine during the period of 2014-2018. Materials and methods. Data of the information and retrieval system “Morion” were used to analyze the assortment of NSAIDs. To analyze the availability of NSAIDs, the solvency adequacy ratio of Ca.s. was calculated, which means % of the average salary needed to pay for a monthly course of treatment with a certain drug. Consumption of drugs was carried out using the ATC / DDD methodology, which is a tool for determining the number of prescribed and taken for a specific time period daily doses of drugs (DDD) with a specific ATC code, which defines indications for use. Results were reported in standardized international units of DDDs/1000 inhabitants/day (DiD). Results. Studies have shown that NSAIDs on the pharmaceutical market are represented by 32 INN and 302-419 trade names (TNs). Most of the drugs are represented by foreign manufacturers. Ukrainian pharmaceutical companies presented 37 % of TN in 2018. The following INNs were presented during the study period by the largest number TN: Diclofenac (69-80), Ketorolac (14-18), Diclofenac Combinations (13-20), Meloxicam (52-66), Ibuprofen (58-66), Dexketoprofen (17-24), Nimesulide (21-25), Chondroitin sulfate (18-22). From 75 % to 86 % of TN on the market had high availability for the population in 2014-2018, from 3 to 4 % of TN – low availability. The volume of NSAID consumption use in Ukraine during 2014-2018 was significant: in 2014 – 16.67 DiD; in 2015 – 14.67 DiD; at 2016 – 16.37 DiD; in 2017 – 18.5 DiD; in 2018 – 20.4 DiD. The following drugs were most consumed in all five years of study: Diclofenac, Nimesulide, Ibuprofen, Ketorolac, Meloxicam. Among them, only Ibuprofen is a non-prescription drug and used in pediatrics as an antipyretic and analgesic drug. These are the INN that are on the Ukrainian market with the greatest number of TNs and that have advantages in terms of their pharmacological action and safety with long-term use for the treatment of chronic diseases. Conclusions. On the pharmaceutical market of Ukraine wide assortment of INN and TNs of NSAIDs are represented, consumed in large volumes, increasing every year. Among them, a large segment of TN based on five INN (Diclofenac, Nimesulide, Ibuprofen, Ketorolac and Meloxicam), which have marked clinical efficacy and are safe for long-term use, are the most consumed.

Platelet-rich plasma in orthopaedic sports medicine: state of the art

Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.

Return to Work between the Conflicting Priorities of Work and Health Orientation

The basic aim of this study was to analyse health-related exit processes from working life and their conditional constellations. It focused on biographical coping in the context of professional reorientation and Return to Work (RTW). The aim was to describe, among other things, phases, characteristics and mechanisms of coping with a double-folded biographical disruption, i. e. coping with the chronic disease and the vulnerable occupational situation. The study focused on 6 women and 4 men between 25 and 57 years of age who were interviewed (episodically-narrative) at 2 different points in the survey period from 2011 to 2014: during their medical respectively vocational rehabilitation (t1) and again about one year later (t2). The overall characteristic of all cases was the initiated or already faced health-related occupational biographical disruption caused by a chronic musculoskeletal disease partly accompanied by psychosomatic issues or triggered by a mental illness. This study followed the methodological approach and research style of the Grounded Theory 1. A health-related exit from working life is usually gradual and is caused by complex risk constellations. Only in the interplay of personal and contextual factors does a framework for the double-folded biographical disruption develop. The resulting social, biographical and health challenges lie in the areas of private and working life. RTW is experienced as an experimental phase to return to everyday working life under limited health conditions. A key finding of this study is the recognition that the transformation of the importance of health is taking place in exit and reorientation processes. This paper focuses on its significance for the rehabilitation and RTW process. The applied perspective on biographical processes makes it possible to describe health-related breaks as a change in status from healthy to sick, from high performance to limited performance. Professional stakeholders in medical and rehabilitative settings should be made more aware of the identity-building processes, individual professional biographical crises and disease management processes of those affected. It is important not only to evaluate RTW as the one and only success, key outcome and end of the rehabilitation process, but to understand RTW as a continuing process of occupational reorientation under limited health conditions and to design it as a participatory process.

Effects of Kinesio tape on lower limb muscle strength, hop test, and vertical jump performances: a meta-analysis

BackgroundTo date, published systematic reviews concerning the effects of Kinesio Taping (KT) on muscle strength have not analysed facilitatory and inhibitory applications separately. As a result, their results could be substantially affected by clinical heterogeneity. This meta-analysis was conducted to determine the effectiveness of using a facilitatory application of KT for lower limb muscle strength and functional performance (distance in a single-leg hop and vertical jump height) in individuals without disabilities and in those with musculoskeletal conditions (muscle fatigue, chronic musculoskeletal diseases, and post-operative orthopaedic conditions).MethodsSearches were conducted on six major electronic databases. Randomised controlled trials that used facilitatory KT were included. Standardised mean differences (SMDs) were calculated and random-effects models were used for analysis.ResultsThirty-seven randomised controlled trials were included. KT was superior to controls for improving lower limb muscle strength in individuals with muscle fatigue (short-term effect, pooled SMD = 0.53, 95% CI = 0.09 to 0.96; long-term effect, pooled SMD = 0.61, 95% CI = 0.12 to 1.11) and in individuals with chronic musculoskeletal diseases (pooled SMD = 1.24, 95% CI = 0.33 to 2.16) with large effect sizes. The use of KT in populations without disabilities was not supported. There is insufficient evidence for the effect of KT on functional performance in individuals with musculoskeletal conditions.ConclusionsContrary to prior research, the existing evidence shows that KT can improve lower limb muscle strength in individuals with muscle fatigue and chronic musculoskeletal diseases. The effect sizes produced in this meta-analysis show that KT may be superior to some existing treatments for these conditions. In addition, this study suggests that practitioners may wish to avoid the use of KT in individuals without disabilities.Trial registrationPROSPERO registration number CRD42017075490, registered on 21 November 2017.

Cryo-EM Structure of Chikungunya Virus in Complex with the Mxra8 Receptor

Mxra8 is a receptor for multiple arthritogenic alphaviruses that cause debilitating acute and chronic musculoskeletal disease in humans. Herein, we present a 2.2Å resolution X-ray crystal structure of Mxra8 and 4 to 5Å resolution cryo-electron microscopy reconstructions of Mxra8 bound to chikungunya (CHIKV) virus-like particles and infectious virus. The Mxra8 ectodomain contains two strand-swapped Ig-like domains oriented in a unique disulfide-linked head-to-head arrangement. Mxra8 binds by wedging into a cleft created by two adjacent CHIKV E2-E1 heterodimers in one trimeric spike and engaging a neighboring spike. Two binding modes are observed with the fully mature VLP, with one Mxra8 binding with unique contacts. Only the high-affinity binding mode was observed in the complex with infectious CHIKV, as viral maturation and E3 occupancy appear to influence receptor binding-site usage. Our studies provide insight into how Mxra8 binds CHIKV and creates a path for developing alphavirus entry inhibitors.

GAMBARAN KLINIS DAN RADIOLOGIS MENURUT KELLGREN AND LAWRENCE PADA PENDERITA OSTEOARTHRITIS GENU YANG BEROBAT JALAN DI POLOKLINIK ORTOPEDI RSU ANUTAPURA PALU TAHUN 2018

Osteoarthritis (OA) is a progressive and degenerative chronic musculoskeletal disease caused by thinning of the cartilage in the joint due to bone rubbing against each other. History of the patient's history, clinical picture of the physical examination and the results of the radiological examination are basic things to diagnose OA. Patient's complaints include joint pain which is a major complaint that brings the patient to the doctor, joint stiffness, crepitation, joint swelling, and changes in gait. Gait changes due to pain are found on a physical examination even though radiologically is still at an initial level. In addition it can be found that crepitus, swollen joints are often asymmetrical. The aim of this study was to determine clinical and radiological features by counselor and Lawrence of outpatient genotypes osteoarthritis patients in the rsu anutapura hammer orthopedic polyclinic in 2018. Descriptive research methods were conducted on 27 people with genital osteoarthritis who were treated at the orthopedic clinic in Anutapura Palu Public Hospital 2018. Consecutive sampling was used and data collection through interviews and observations in the form of pain, joint stiffness, crepitus, joint swelling and gait changes and radiological examinations based on Kellgren and Lawrence criteria. Data analysis using SPSS 25 with frequency distribution test. The results of the study were (1) based on the clinical picture in genu osteoarthritis patients pain (100%), pain accompanied by gait changes (70.37%), pain accompanied by joint stiffness (51.4%), pain accompanied by joint swelling (44, 4%), and pain with crepitus (37.0%). (2) based on radiology in patients with osteoarthritis genu with the highest grade 3 and 4 respectively (33.3%), grade 2 (29.6%), grade 1 (3.7%) and in grade 0 not found. Conclusion: found joint pain and a small portion of pain accompanied by crepitus, radiologists found in most grades 3 and 4 while grade 0 was not found.

Study of Reduced Salivary Secretion and Increased Caries Susceptibility in Rheumatoid Arthritis

It is a chronic inflammatory musculoskeletal disease with extra-articular manifestations including involvement of exocrine lacrimal and salivary glands. The aim of this study was to assess the reduced salivary secretion and calculate and compare DMF index in rheumatoid arthritis patients. The salivary output was determined in unstimulated (resting) whole saliva and caries status in all individuals was determined by using the DMF index in 20 rheumatoid arthritis patients and 20 healthy control subjects. Compared with healthy control groups, rheumatoid arthritis patients had significantly decreased output of saliva and higher DMF index than in the control group. The results indicate that xerostomia in patients with rheumatoid arthritis may be indicative of increased disease activity and impacts negatively on oral health leading to increased caries susceptibility and should receive increased stomatological attention.

Evaluation of platelet-rich plasma injection in knee osteoarthritis patients

Objectives The aim of this study was to determine the effect of local injection of platelet-rich plasma (PRP) in patients with mild and moderate knee osteoarthritis (OA) and its effect on pain in comparison to corticosteroid injection. Background OA is one of the most prevalent chronic musculoskeletal diseases worldwide. The use of PRP appeared in the last years for the management of symptoms of knee OA. Patients and methods This study included 50 patients with knee OA. Our patients were divided to two groups: a group of 25 patients who were injected intra-articularly with about 3–4 ml of PRP and another of 25 patients who were injected intra-articularly with triamcinolone acetate for one affected knee. We measure and assess all patients by Western Ontario and McMaster Universities Osteoarthritis Index and visual analog score – pain questionnaires before injection and after 1 and 3 months of injection. Results There was a highly statistically significant difference between preinjection and postinjection after 1 month with more decrease in postinjection (P Conclusion Intra-articular injection PRP is an effective method for the treatment of knee OA. Also, PRP intra-articular injection is more effective than intra-articular injection of corticosteroid.

PMS119 - ACCEPTABILITY OF HEALTH PROBLEMS IN CHRONIC MUSCULOSKELETAL DISEASES

Literature data suggest that individuals consider moderate health problems as acceptable beyond a certain age. However, little is known about the age-related acceptability of non-perfect health in chronic diseases. We aimed to assess the age-related acceptability of health problems among the general population and match the results to the health status of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), systemic sclerosis (SSc) and osteoporosis (OP). A cross-sectional online survey was performed in a convenience sample. Participants were asked to indicate which level of health problem they considered to be acceptable from ages 30, 40, 50, 60, 70 and 80 years and onwards, or ‘Never’ on the five domains of the EQ-5D-3L descriptive system. EQ-5D-3L index scores (UK tariffs) were computed for each age by aggregating the single responses obtained on the 5 domains and acceptable health curve (AHC) was drawn. EQ-5D-3L index scores of patients from four previous cross-sectional surveys were matched to the AHC. Altogether 9,281 individuals (males 67.2%) completed the acceptability survey with mean (SD) age of 36.0 (10.6) years, their EQ-5D-3L index score was 0.852 (0.177). Acceptable EQ-5D-3L index scores for ages from 30 to 80 were mean 0.97, 0.94, 0.89, 0.77, 0.52 and 0.10, respectively. Median EQ-5D-3L index score of patients with RA (N=248) PsA (N=177), SSc (N=80) and OP (N=207) was 0.477, 0.587, 0.620 and 0.656, respectively, and 88.3%, 87.6%, 87.5% and 50.2% of the patients were under the AHC. Severe problems levels were considered as never acceptable by the majority (52.9%-70.9%) of the public, however these occured up to 21.4% among the patients. Our study provides age-specific reference points for health and highlights the burden of chronic musculoskeletal diseases from the societal perspective. These findings may have implications for health economic evaluations and decision making in healthcare.

Kas İskelet Sistemi Hastalıklarında Tamamlayıcı ve Alternatif Tıp Yöntemleri Kullanım Sıklığının Değerlendirilmesi

Amac: Tamamlayici ve alternatif tip yontemlerinin kullanim sikligi ve en sik tercih edilen yontemin belirlenmesidir. Gerec ve Yontemler: Bu calismaya hastanemize 30.09.17-30.12.17 tarihleri arasinda basvuran hastalar dahil edildi. Calismaya 18 yas ustu kronik kas iskelet sistem hastaligi olan sorulari cevaplayabilecek olan 512 kadin ve erkek hasta alindi. Hastalarin tamamlayici ve alternatif tip (TAT) yontemlerini kullanma formu ile veriler toplanmistir. Anket formu icerisindeki sorulara cevap vermesi istendi ve hekim tarafindan not edildi. Arastirmalarin verileri sayi, yuzde dagilimlari ve ki-kare testi kullanilarak degerlendirilmistir. Bulgular: Arastirmaya katilan hastalarin yas ortalamasi 53,25±14,61, 367 (%71.7) kadin, 145 (%28.3) erkek idi. Calismaya katilanlarin %65.8’inin komorbid hastaligi vardi. %87.9 TAT kullanimi mevcuttu. TAT uygulayanlarin %19.6’si doktor,%13.2 fizyoterapist, %4.2 hemsire, %9.1 din gorevlisi,%53.9 diger kisilerden olusmaktadir. En cok tercih edilen yontem sifali su %73,9 olarak tespit edildi. Yas ile TAT yontemlerinden fayda gorme, hacamat ve yoga arasinda pozitif yonlu korelasyon saptandi. Tartisma ve Sonuc: Kronik kas iskelet sistemi hastaligi olan hastalar siklikla TAT yontemlerine basvurmaktadir. Ancak basvuranlarin cogu hekim onerisi disinda aile, cevre gibi yakin kisilerin onerisiyle gerceklesmektedir. Ayrica bu calismada hastalarin yaridan fazlasina alaninda egitilmemis kisiler tarafindan uygulandigi tespit edilmistir. Bunun yaninda, komorbid hastaliklarda yas ilerlemesi ile TAT kullanimin arttigi belirlenmistir. Aim: To determine the frequency of use of complementary and alternative medicine and the most preferred method Material Method: Patients who applied to the hospital between 30.09.17-30.12.17 were included in this study. A total of 512 male and female patients with chronic musculoskeletal disease over the age of 18 who were able to answer questions were included in the study. The form of using complementary and alternative medicine (CAM) methods and data were collected. It was requested by the physician to answer the questions in the questionnaire and it was noted by the physician. Data were evaluated using the number, percentage distributions and chi-square test. Results: The mean age of the participants was 53,25 ± 14,61, 367 (71.7%) were female and 145 (28.3%) were male. 65.8% of those participating in the study had comorbid disease. 87.9% CAM usage were recorded. CAM practitioners are 19.6% physicians, 13.2% physiotherapists, 4.2% nurses, 9.1% religious officers and 53.9% others. The most preferred method was 73.9% of mineral spring. Benefit from age and CAM methods, positive correlated between hajamat and yoga. Discussion and Conclusion: Patients with chronic musculoskeletal disease frequently refer to CAM methods. However, most of the applicants, apart from the physician's suggestion, take place with the suggestion of close family members and the environment. It was also found that more than half of the patients in this study were practiced by persons not trained in the field. In addition, age progression and TAT use increased in comorbid diseases.