Form Of Joint Disease Research Articles

Drug Prescription Pattern in Osteoarthritis in a Tertiary Care Teaching Hospital

Objective: Drug prescribing studies aim to provide feedback to the prescriber and to create awareness among them about rational use of medicines. The primary aim of drug utilization research is to facilitate the rational use of drugs in patients. Osteoarthritis is the most common form of joint disease and the leading cause of pain in elderly people. The aim of the study was to study the prescription pattern of drugs used in the management of osteoarthritis.
 Methods: A prospective observational study was conducted in a tertiary care hospital for period of 12 months in collaboration with the department of Orthopaedics. A total of 300 patients enrolled in the present study with fulfilling inclusion and exclusion criteria. Patients’ data was recorded in case report form and analysed to study the prescription pattern.
 Results: Out of the total 300 patients enrolled in this study, Osteoarthritis was found to be more common in females. In our study 58.3% of patients were females as compared to 41.7 % of male patients. Patients of age group 46-60 years (60%) were most commonly affected followed by 61-75 years (30.3%). Etoricoxib was the most commonly used NSAID in 28.3% of patients followed by Aceclofenac in 18%, combination of Aceclofenac and Paracetamol in 15.6% & combination of Tramadol and Paracetamol in 8.3% of patients.
 Conclusions: In our study it is seen that osteoarthritis affects females more often than males and the knee joint is the most commonly affected joint. Etoricoxib was the most prescribed drug because of good gastrointestinal tolerance.

Safety and efficacy of a single intra-articular injection of hyaluronic acid in osteoarthritis of the hip: a case series of 87 patients

BackgroundOsteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA use in hip OA is lacking. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA.MethodsThis single site study is an analysis of prospectively collected outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA. Inclusion criteria were male or female patients over 18-years of age with mild to moderate hip OA on x-ray. Patients with severe hip OA were excluded. The primary outcome measure was a modified Harris Hip Score (mHHS) questionnaire at baseline and 6-weeks with a minimal clinically important difference (MCID) of 10 points. All adverse events were recorded and assessed.ResultsData from 87 patients, 49 women and 38 men with mean age of 54 (SD = 10.8) were analysed. At baseline, mean mHHS was 58.47 (SD 14.31). At the 6 week follow up, mean mHHS improved to 71.30 (SD 16.46), a difference of 12.83 (p < 0.01). This was greater than the MCID of 10. No significant adverse events were encountered. Five patients reported short-lived injection site pain.ConclusionA single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10.Trial registrationThe study was retrospectively registered on the 1st of February 2021 in the Australian New Zealand Clinical Trials Registry with registry number ACTRN12621000098831. All research was performed in accordance with the Declaration of Helsinki.

The Eyes Have it: A Rheumatologist's View of Uveitis.

Uveitis is defined as intraocular inflammation. It is an extraarticular manifestation of many forms of joint disease, which include spondyloarthritis, juvenile idiopathic arthritis, and Behçet's disease. Rheumatologists may be asked to consult on the ophthalmologic care of patients with uveitis in order to identify an associated systemic illness. Diagnoses such as spondyloarthritis, sarcoidosis, and interstitial nephritis with uveitis are frequently overlooked by referring ophthalmologists. Alternatively, rheumatologists may be asked to help manage the patient's immunosuppression, including biologic therapy, which can be required to treat a subset of patients with uveitis. This review is intended to provide rheumatologists with the necessary information to facilitate collaboration in the comanagement of patients with uveitis.

Imaging of elbow replacement arthroplasty.

Elbow replacement arthroplasty has become a standard surgical treatment for a variety of diseases of the elbow. First popularized for the treatment of late-stage rheumatoid arthritis and other debilitating forms of joint disease, the current indications have expanded to include primary treatment of elbow trauma. The most commonly used total elbow replacements are linked semiconstrained chromium-molybdenum alloy or titanium alloy prostheses with polyethylene bearing surfaces. These are inserted after resection of the ulnotrochlear joint and typically cemented in place; the radial head is often sacrificed. Modular metal components or massive osteoarticular allografts may be used when there is extensive bone deficiency. Metal radial head replacements are increasing being used for primary fracture treatment and in posttraumatic elbow reconstructive surgery. Long-term outcomes for total elbow replacement are similar to those of other joints, with 10-year survivals of ∼ 90%. Complications specific to elbow implants include infection, aseptic loosening, prosthetic failure, and periprosthetic fracture.

Diagnostic value of Anti-CCP antibodies compared with Rheumatoid factor in Rheumatoid arthritis patients.

Citrullinated proteins have been discovered in the joints of patients with rheumatoid arthritis but not in other forms of joint disease. The citrullinated proteins in the joints correspond to the presence of the citrulline antibodies in the blood and suggest a possible role for these antibodies in the development of rheumatoid arthritis. The present study assessed the recent diagnostic value of anti-cyclic citrullinated antibodies (CCP) compared with rheumatoid factor (RF) in patients with rheumatoid arthritis. One hundred blood samples were collected from RA patients and thirty from apparently healthy group. Sera from each subject were tested for anti- CCP and RF by enzyme linked immunosorbent assay (ELISA). The majority of patients were females (84%), with a female: male ratio 5.2:1. The results indicated that anti-CCP postivity for RA patients was (69%) when compared with the healthy group (0.0%), which was highly significant in RA in comparison with control groups (P<0.001). The current study revealed that the sensitivity and specificity of Anti-CCP appeared the highest (69%) in comparison with low (47%) sensitivity for RF. Moreover, the specificity of Anti-CCP was very high (100%), while the specificity of RF was high (90%).

Radiosynoviorthesis for Treating Recurrent Joint Effusions After Endoprosthetic Knee Replacement

Radiosynoviorthesis (RSO) has been established as a treatment modality for rheumatoid arthritis. Other forms of joint diseases like recurrent joint effusions after knee arthroplasties are under investigation. The aim of this study was to examine whether RSO therapy is effective in the application of an endoprosthesis and whether there are common causes of failure. Between 1998 and 2005, 55 patients received RSO treatment (90Y colloid) for recurrent joint effusions after endoprosthetic knee replacement. A total of 46 patients were followed up and questioned anonymously according to a modified Knee Society Knee Scoring System (KSS) and Hospital for Special Surgery score. On the basis of patient records, a subgroup analysis of patients with revision surgery after RSO (subgroup A) and without further operative interventions (subgroup B) was performed. Subgroup A comprised 46% (21/46) and subgroup B comprised 54% (25/46) of all patients. Most patients from subgroup A did not benefit from RSO. Of these 21 patients, 7 presented with low-grade infection, 7 presented with signs of endoprosthetic loosening, 2 presented with metal allergy, and 2 had undergone revision because of trauma.Patients in subgroup B experienced a significant improvement in pain (KSS score, from 22.5 to 34 points) and function (KSS score, from 62.9 to 77.3 points; Hospital for Special Surgery score, from 30.2 to 38.7) after RSO. Radiosynoviorthesis resulted in an improvement in pain and function in ∼50% of patients with knee endoprostheses. In 85% of all patients, in whom RSO treatment failed, endoprosthetic complications like infection, loosening, allergy, and trauma were detected. In conclusion, RSO is a valid therapeutic option for joint effusions after knee arthroplasties. However, if RSO fails, a thorough exclusion of endoprosthetic complications should be performed.

English

Knee osteoarthritis is the most common form of joint disease and is a major cause of pain and physical disability among the elderly. Although, numerous treatments have been developed to treat osteoarthritis, no definitive treatments with high efficacy and low risk have been identified until now. In recent years, it has been reported that nutraceuticals may be good candidates for the management of knee osteoarthritis. This paper describes the efficacy of nutraceuticals for treating knee osteoarthritis in terms of pain and structural change. To accomplish this, this paper reports on the analysis of randomized, placebo-controlled, clinical trials that were published prior to December 2011. Key words : Nutraceuticals, knee, osteoarthritis, pain.

Osteoarthritis: genetic factors, animal models, mechanisms, and therapies

Osteoarthritis (OA) is the most common form of joint disease. OA frequently affects knees, hips, hands, and the spine. It is characterized by the progressive destruction of articular cartilage and subchondral bone accompanied by low-grade inflammation that together result in pain and deformity. Recent studies have shed light on the nature of OA genetic susceptibility and confirmed a number of candidate genes involved in the destruction of the synovium, articular cartilage, and subchondral bone in OA pathogenesis. During the progression of OA, there are several cellular changes in joints, including an increase in the number of activated osteoclasts and macrophages and an infiltration of the synovium by activated T-cells and B-cells. Pro-inflammatory mediators (e.g. interleukin IL-1, IL-1beta, IL-6, IL-17, and IL-18, and Tumor necrosis actor-alpha), proteinases (e.g. matrix metalloproteinase 9 and cathepsin K), and regulators of cartilage and bone formation (e.g. BMPs) have been shown to have important roles in OA progression at the molecular level. Studies have suggested that OA shares several common characteristics with rheumatoid arthritis (RA). To systematically understand OA, this review summarizes OA disease genes, mouse models of human disease experimental mouse models, mechanisms of OA pathogenesis, and current OA therapies.

Oral or transdermal opioids for osteoarthritis of the knee or hip

BACKGROUND: Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Opioids may be a viable treatment option if patients suffer from severe pain or if other analgesics are contraindicated. However, the evidence about their effectiveness and safety is contradictory. OBJECTIVES: To determine the effects on pain and function and the safety of oral or transdermal opioids as compared with placebo or no intervention in patients with osteoarthritis of the hip or knee. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, and CINAHL (up to 28 July 2008), checked conference proceedings, reference lists, and contacted authors. SELECTION CRITERIA: Studies were included if they were randomised or quasi-randomised controlled trials that compared oral or transdermal opioids with placebo or no treatment in patients with osteoarthritis of the knee or hip. Studies of tramadol were excluded. No language restrictions were applied. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated for pain and function, and risk ratios for safety outcomes. Trials were combined using inverse-variance random-effects meta-analysis. MAIN RESULTS: Ten trials with 2268 participants were included. Oral codeine was studied in three trials, transdermal fentanyl and oral morphine in one trial each, oral oxycodone in four, and oral oxymorphone in two trials. Overall, opioids were more effective than control interventions in terms of pain relief (SMD -0.36, 95% CI -0.47 to -0.26) and improvement of function (SMD -0.33, 95% CI -0.45 to -0.21). We did not find substantial differences in effects according to type of opioid, analgesic potency (strong or weak), daily dose, duration of treatment or follow up, methodological quality of trials, and type of funding. Adverse events were more frequent in patients receiving opioids compared to control. The pooled risk ratio was 1.55 (95% CI 1.41 to 1.70) for any adverse event (4 trials), 4.05 (95% CI 3.06 to 5.38) for dropouts due to adverse events (10 trials), and 3.35 (95% CI 0.83 to 13.56) for serious adverse events (2 trials). Withdrawal symptoms were more severe after fentanyl treatment compared to placebo (SMD 0.60, 95% CI 0.42 to 0.79; 1 trial). AUTHORS' CONCLUSIONS: The small to moderate beneficial effects of non-tramadol opioids are outweighed by large increases in the risk of adverse events. Non-tramadol opioids should therefore not be routinely used, even if osteoarthritic pain is severe.

Determination of MMP‐2 and ‐9 activities in synovial fluid of horses with osteoarthritic and arthritic joint diseases using gelatin zymography and immunocapture activity assays

Matrix metalloproteinases (MMPs)-2 and -9 activities have been found elevated in synovial fluid from various joint diseases in man. However, in the horse few data are available. To explore the clinical significance of MMP-2 and -9 activities in synovial fluid of horses with different forms of joint diseases. Gelatin zymography and MMP-2 and -9 immunocapture activity assays were applied on synovial fluids from control joints and joints with aseptic joint disease (AJD) and septic arthritis (SA). Additionally, MMP-2 and -9 activities were measured in samples from SA to monitor the disease process. Zymographic analysis revealed that samples from AJD and SA contained significantly increased latent MMP-2 activity compared to controls. Samples from SA showed significantly increased monomeric latent MMP-9 activity compared with all other affected joints and controls. Trace amounts of MMP-9 activity, due to the active and dimer form, were detected in samples from SA; however, these bands were absent in samples from AJD and controls. Using immunocapture activity assays, MMP-2 and -9 activities were found to be significantly elevated in joints from SA compared to controls and AJD samples. MMP-2 activity in samples from AJD was significantly increased compared to controls. Both MMP activities decreased in the joints from SA in the course of successful therapy. Data from zymographic analysis confirmed that MMP-2 and -9 were elevated in equine joint diseases. Immunocapture activity assays have been shown to be suitable for the quantitative determination of MMP-2 and -9 activities in synovial fluid of horses. Both MMP-2 and -9 activities seem to be useful to indicate SA, and MMP-2 activity might be a suitable marker for AJD. These findings encourage the potential use of MMP-2 and -9 as additional aids to clinical investigation. Further work is required to validate the clinical significance of MMP activities in the progress of different joint diseases in horses.

Measurement of equine myeloperoxidase (MPO) activity in synovial fluid by a modified MPO assay and evaluation of joint diseases – An initial case study

The aim of this study was to develop a specific myeloperoxidase (MPO) activity assay in the synovial fluid of horses and investigate whether MPO activity is increased in different forms of joint diseases. Synovial fluid samples were taken from affected joints from horses with osteoarthritis, chronic non-septic arthritis and septic arthritis, and from healthy control horses. MPO activity was measured using a specific modified o-dianisidine-assay containing 4-aminobenzoic acid hydrazide as a potent and specific inhibitor of the MPO. This assay is characterized by high reproducibility. The results reveal only a slight elevation of MPO activity in the synovial fluid of horses with osteoarthritis and chronic non-septic arthritis. However, in the cases of septic arthritis a significant increase in MPO activity was found when compared to the controls. In conclusion the first field study suggests that synovial fluid MPO may be used as a marker for septic arthritis in horses.

How crystals damage tissue.

Basic calcium phosphate, calcium pyrophosphate dihydrate, and monosodium urate crystals are the most common types of crystals associated with human disease. Although there is a well-established association between these crystals and various forms of joint disease, recent evidence points to an association of basic calcium phosphate crystals with breast cancer and atherosclerosis. Crystal-induced tissue damage is affected by degradative proteases, cytokines, chemokines, and prostanoids produced by cells stimulated by crystals. In the case of basic calcium phosphate and calcium pyrophosphate dihydrate crystals, these responses are augmented by the cellular proliferation that results from their induction of mitogenesis. The understanding of the molecular mechanisms involved in generating these pathologic effects has been significantly advanced in recent years. Such advances are essential to the ongoing search for more effective therapies for crystal-associated diseases.

Synovial Fluid Analysis in Cattle

Bovine lameness causes significant monetary losses to the industry. The majority of lameness often originates from disorders of the digits and diagnosis, management, and prevention programs for digit disorders on a herd basis are well established. In contrast, non-digital lameness originating from joint diseases has a lower prevalence. However, joint diseases cause significant losses in productivity, often lead to premature culling with loss of genetic material and increase cost for replacement. One study recorded 22 days of lameness in 63 non-digital lameness cases. Infectious arthritis presents a diagnostic and therapeutic challenge to the practitioner and clinician. This may be caused in part by vague clinical signs in the early stages of the disease or by inconsequent treatment due to economic concerns. It is generally accepted that early diagnosis and aggressive treatment of infectious arthritis are essential to successful management and full return to function. Inadequate treatment lowers the prognosis and may also preclude the application of various treatment modalities previously described in other species. While infectious arthritis has received a lot of attention in other species, reports on diagnosis and management of this disorder in cattle are sparse. In other species, synovial fluid analysis is an integral part in the diagnosis of various forms of joint diseases and clinical guidelines for the differentiation of infectious and non-infectious arthritis are well established. In cattle there are only few reports on synovial fluid analysis and these are frequently based on small sample sizes. The purpose of this study is to describe the changes of the synovial fluid constituents in cattle with various forms of arthritis and to establish guidelines for clinical differentiation of infectious and non-infectious arthritis in cattle based on changes in the cellular components and protein concentration of synovial fluid.

Essentials of Rheumatology, 2nd edition H L F Currey Churchill Livingstone 196pp £7.95 0-443-03913-5.

The second edition of this popular rheumatology textbook is not just an update on new treatments for those suffering from arthritis and other forms of joint disease. It is expanded, has more illustrations and useful reference lists. For those not familiar w'ith the first edition, Essentials of Rheumatology is a medical pocketbook written for medical students using the traditional medical model.

The effect of pregnancy on the onset of psoriatic arthritis.

Pregnancy may be a risk factor for the development of arthritis. The effect of pregnancy and other hormone-associated events on the expression of psoriasis and arthritis was investigated retrospectively in 33 female patients with psoriatic arthritis. Eighteen per cent of patients or 30% of mothers had onset of arthritis within 3 months postpartum. Another 5 patients (15%) had perimenopausal onset of arthritis. No such temporal association was seen with the onset of skin psoriasis. Hormone-associated events appear to be as important modifiers of the arthritis associated with psoriasis as they are for other forms of joint disease.

Extracutaneous sporotrichosis

Although an uncommon cause of arthritis, sporotrichosis may mimic other forms of joint disease and should be considered in the differential diagnosis of a patient with a chronic monoarticular arthritis or if granulomatous synovitis is recognized by histologic examination. Characteristic skin findings may be absent, repeated cultures may be necessary, severe osseous destructive changes can occur, and surgical extirpation of the diseased tissue combined with amphotericin B chemotherapy is recommended.

Inheritance of psoriasis in a Utah kindred.

Psoriasis is a chronic inflammatory skin disorder of unknown etiology and inconstant course which constitutes about 6% of all new skin cases seen by dermatologists. 1 Of interest is the association of arthritis and psoriasis. This arthritis is characterized by absorptive phenomena usually of peripheral joints and has been considered to be a distinct form of joint disease. 2,3 The familial occurrence of psoriasis is well known and studies have described the inheritance as recessive, double recessive, and irregular dominant. Schamberg 4 reviewed 592 patients with psoriasis and reported a family occurrence of 13%. He concluded that there was no satisfactory evidence for genetic transmission of this disease. Steinberg et al. 5 examined 464 patients with psoriasis. The disease was present among the patient's siblings 4 times as often when one parent had psoriasis as when neither parent was affected. Six per cent of the patient's parents had psoriasis. Because

Current status of the treatment of gout.

Substantial advances in the management of gout have been made in recent years. Acute attacks of gout can now be terminated rapidly in most patients by the use of one of several medicaments. By proper management, the frequency of such attacks can be diminished and the later complications of the disease minimized or prevented. Although there is no known cure for gout in the strict sense of the word, results with the measures now available, if adapted to the stage of the disease and the needs of the individual patient, are distinctly better than those that could be obtained previously. Diagnosis Although gout is less common than some other forms of joint disease, it is by no means rare. It constitutes approximately 5% of the diagnoses in patients attending clinics devoted to arthritis and related diseases. The most important factor in establishing the correct diagnosis is to keep the possibility

Gout: Clinical, Pathologic and Roentgenographs Observations

While it is true that gout often goes undiagnosed and much needs to be done toward educating American physicians to recognize this disease, nevertheless progress has been made. This progress has had a distinct bearing on roentgenology, for important developments in the clinical and pathological fields have greatly improved our ability to interpret roentgenographic findings in patients with this disease. In this paper, we shall outline briefly some historical features regarding roentgenography in gout. We shall also describe some significant developments concerning clinical and pathologic aspects of gout and relate these to the principles of roentgenology which are pertinent to the diagnosis of this condition. Historical The use of the roentgen rays as an aid in the diagnosis of gout was first reported by Huber (1). That writer, in 1896, published a reproduction of a roentgenogram which illustrated the lesions produced by gout in one case. Circular zones of translucency in the subchondral bone were demonstrated and their probable relationship to the deposition of urates in the affected tissues was discussed. Hypertrophic spurs, partial or complete destruction of some joints, and subluxations were described A very large number of publications have, since that time, referred to the roentgenographic phenomena associated with gout. This literature is not reviewed here in detail. It seems appropriate, however, to mention the contributions of a few outstanding writers. Points of distinction between the roentgen changes which are to be seen in gout and those encountered in patients with rheumatoid arthritis were described in 1905 by Strangeways and Burt (2). Their observations were based upon a comparison of roentgenograms from a hundred gouty and a hundred rheumatoid patients. Findings which were described as characteristic of gout included increased density of bone, bony additions about joints, nodes on the shafts of phalanges, spurs about the heads of the long bones, loss of cartilage, erosion of bone, transparent areas, and dislocations. There were some instances of complete disorganization of bones and even of bony ankylosis. Strangeways and Burt conducted this study with great thoroughness but unfortunately omitted a correlation of roentgenographic findings with the clinical aspects of the cases. As a result, roentgenographic changes which they encountered in advanced stages of gout were subsequently considered characteristic of all gouty joints. It remained for Jacobsohn (3) to point out, in 1913, that roentgenograms should not be relied upon to distinguish gout from other forms of arthritis in every instance. In some cases of gout he found changes which closely resembled those encountered in other diseases of joints, but in certain instances lesions which are not to be seen in any other form of joint disease, notably semicircular or oval zones of destruction irregularly disposed about affected joints, were present.

THE USE AND ABUSE OF GOLD THERAPY IN RHEUMATOID ARTHRITIS

Unfortunately, some physicians employ gold salts in any type of arthritis; a few begin gold therapy at the first complaint of joint pain. Workers experienced in the care of rheumatic patients agree that gold is of no value in any type of joint disease except rheumatoid arthritis; some have not observed pronounced improvement even in the latter disease. Because of this indiscriminate, frequent abuse of gold salts in many forms of joint disease, the known facts concerning gold therapy in rheumatoid arthritis are discussed here briefly. There are several important facts concerning gold therapy in arthritis: Gold is of no value in any form of joint disease except rheumatoid arthritis. Gold does not benefit all patients with rheumatoid arthritis. Gold is not the final answer to the treatment of rheumatoid arthritis. Toxic symptoms may appear at any time during this form of therapy. From 10