Joint Cavity Research Articles

COMPARISON OF THE EFFICACY OF ARTHROCENTESIS WITH AND WITHOUT CONCENTRATED GROWTH FACTOR INJECTIONS IN REDUCING CLINICAL SYMPTOMS IN PATIENTS WITH TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS

There is a significant prevalence of temporomandibular joint (TMJ) disorders, estimated at 34% according to various sources. Given that this condition often leads to a reduced quality of life and disability, there is a pressing need to develop and implement effective treatment methods. Arthrocentesis, along with the injection of pharmacological agents—particularly platelet-rich plasma—into the joint cavity, is a recognized treatment for TMJ osteoarthritis. Recently, a third generation of platelet concentrates has been developed, which is an evolutionary advancement of the platelet-rich plasma technique. This study involved 60 patients, equally divided into control and experimental groups. The control group was treated with arthrocentesis for TMJ osteoarthritis, while the experimental group received arthrocentesis combined with intra-articular injections of concentrated growth factor. The effectiveness of the treatments was evaluated using the visual analogue scale (VAS) for pain and measuring maximum mouth opening. The study results showed a 74.22% reduction in VAS scores in the control group and a 79.87% reduction in the experimental group (p < 0.001). Maximum mouth opening increased by 17.84% in the control group and by 20.53% in the experimental group (p < 0.001). Both treatment methods demonstrated significant clinical efficacy (p < 0.001). In our opinion, the use of arthrocentesis with concentrated growth factor injections for the treatment of TMJ osteoarthritis is clinically justified and more effective than arthrocentesis alone.

Parametric influences on flow, heat transfer, and nutrient transport in the knee joint cavity, a numerical approach

A novel aspect of this study is the investigation of the impact of temperature-dependent Arrhenius reactions and metabolic heat generation on the overall heat transfer within a knee joint cavity. This is a unique contribution where the interaction between thermal effects and metabolic activity is shown to influence the transport of nutrients and the removal of waste products. For the first time, the study also aims to examine the influence of key non-dimensional numbers on the characteristics of mixed convection flow, providing new insights into the dominant physical mechanisms at play. An innovative feature of the model is the incorporation of a non-linear reaction term to address the balance between protein synthesis and degradation. By integrating both thermal and biochemical dynamics, this approach offers a comprehensive analysis of protein aggregation in the knee joint, with potential implications for understanding and treating joint diseases, particularly those related to the health of synovial fluid and cartilage, such as osteoarthritis. The findings have the potential to inform the development of improved therapeutic strategies for managing these conditions. In the context of knee joint cavity dynamics, a low Cauchy number Ca plays a crucial role in ensuring steady and laminar flow, which reduces inertia and ensures that the continuity equation is satisfied. This laminar nature of the flow is essential for maintaining stable synovial fluid movement within the cavity, which aids in the smooth transport of nutrients and waste products. Additionally, higher Peclet number Pe values indicate an increased dominance of convective transport over diffusion, thereby enhancing the supply of essential nutrients to cartilage and bone, while also facilitating the removal of waste products and inflammatory mediators. This efficient convective transport mechanism is vital for the overall health of the joint and for mitigating inflammation. Furthermore, the Zeldovich number β significantly influences the temperature sensitivity of the Arrhenius reaction term within the cavity, where higher values reflect increased reactivity to temperature changes. This temperature dependence impacts metabolic heat generation and protein dynamics, further influencing the biochemical processes that occur within the joint. Collectively, these non-dimensional parameters highlight key aspects of synovial fluid dynamics, nutrient transport, and biochemical reactions that are essential to the functioning and health of the knee joint.

A drug-loaded nano chitosan/hyaluronic acid hydrogel system as a cartilage tissue engineering scaffold for drug delivery

Cartilage lesions, especially osteoarthritis (OA), usually arise from aging, trauma, or obesity and require medical intervention due to the damaged site's inflammation and the cartilage tissue's poor self-healing capacity. This study aimed to prepare a drug-loaded nanoparticle hydrogel system with anti-inflammatory and chondroprotective effects to treat OA. First, hyaluronic acid (HA) was oxidized to create aldehyde functional groups and then cross-linked with adipic acid dihydrazide (ADH) to form a hydrogel. Next, chitosan nanoparticles (CS NPs) loaded with an anti-inflammatory molecule (fisetin) and or a chondrogenic and chondroprotective agent (kartogenin) were incorporated into the hyaluronan hydrogel to improve the release profile of the drug and increase its retention time in the joint cavity. Incorporating drug-loaded NPs into the hyaluronan hydrogel provided the hydrogel with controlled release features and improved properties. In addition, the real-time PCR (Polymerase chain reaction) results showed that the hyaluronan hydrogel containing both drug-loaded NPs performed better than either constituent alone on an in vitro model of OA. Finally, based on the results of in vitro evaluation, this drug-loaded nanoparticle hydrogel system can be a promising technique for treating OA by rapidly suppressing inflammation and supporting cartilage regeneration and requires further investigation in an animal model of OA. Meanwhile, this study investigated, for the first time, the effect of the simultaneous use of fisetin and kartogenin together with a nano CS/HA hydrogel system to treat OA.

Application of superb microvascular imaging technology in clinical disease activity of rheumatoid arthritis.

Detection of synovitis is essential for assessing the activity and predicting the prognosis of rheumatoid arthritis (RA). The aim of this study was to investigate the diagnostic performance of superb microvascular imaging (SMI) in RA patients with high, moderate, and low activity. One hundred four patients with active RA were selected from the hospital between May 2022 and August 2023. The study observed the correlation between bone erosion of the carpal joint, joint cavity effusion, thickness of synovial hyperplasia of the carpal joint, positivity rate of synovial blood vessels, and their semiquantitative scores with the clinical disease activity of RA using SMI examination. The detection of synovial hyperplasia thickness and joint effusion in the high-activity group was higher than that in the low-activity group, and the difference was statistically significant (P < 0.05). The quantitative SMI test demonstrated that the synovial blood flow grading and semiquantitative grade increased gradually with activity level (P<0.05). During the high, moderate, and low-activity groups, the vascular index (VI) value of the hyperplastic synovial membrane decreased gradually, showing statistical significance both between and within the groups (P<0.05). SMI technology exhibited high sensitivity and accuracy in assessing disease activity in RA. It holds significant clinical application value as a reliable auxiliary tool for assessing disease activity in RA and treatment. Key Points • Super micro-vascular imaging (SMI) demonstrated higher detection rates of microvesselsin RA patients with high disease activity compared to those with low activity, showing statistical significance. • The quantitative SMI test revealed a clear correlation between synovial blood flow grading and disease activity levels in RA patients, highlighting the potential of SMI as a valuable tool for disease activity and treatment of rheumatoid arthritis.

Effects of Conditioned Media From Human Umbilical Cord-Derived Mesenchymal Stem Cells on Tenocytes From Degenerative Rotator Cuff Tears in an Interleukin 1β-Induced Tendinopathic Condition.

Evidence suggests that mesenchymal stem cells (MSCs) are safe for treating different tendinopathies. Synovial fluid is a pooled environment of biomarkers from the inflammatory and degenerative joint cavity. Understanding the effects of synovial fluid on MSCs is important, as it is the first microenvironment that administered MSCs encounter. Several studies have reported that exposure to osteoarthritic synovial fluid-activated MSCs increased the release of soluble factors; however, the paracrine effects of shoulder synovial fluid-stimulated umbilical cord-derived MSCs (SF-UC-MSCs) on tendinopathy have yet to be investigated. To assess the effects of the conditioned media from SF-UC-MSCs on tenocytes from degenerative rotator cuff tears in an interleukin-1β (IL-1β)-induced tendinopathic condition. Controlled laboratory study. UC-MSCs were isolated and cultured from healthy, full-term deliveries by cesarean section. Tenocytes were isolated and cultured from patients with degenerative rotator cuff tears. Conditioned media were obtained from UC-MSCs stimulated with synovial fluid. To evaluate the gene expression of proinflammatory and anti-inflammatory cytokines, enzymes and their inhibitors, matrix molecules, and growth factors, the tenocytes were cultured with IL-1β and 50% of the conditioned media from the SF-UC-MSCs; quantitative, real-time, reverse transcriptase polymerase chain reaction was also performed. A prostaglandin E2 (PGE2) assay was performed to investigate the PGE2 level secreted by the tenocytes. Western blotting was performed to examine protein synthesis of collagen type I and III. Cell viability, senescence, and apoptosis assays were also performed. The conditioned media from the SF-UC-MSCs interfered with the inflammatory gene expression on tenocytes induced by IL-1β, but it increased the gene expression of tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-3. Meanwhile, the conditioned media decreased the PGE2 level on cells induced by IL-1β. It did increase the type I/III ratio of gene expression and protein synthesis, mainly through the induction of type I collagen. Conditioned media of SF-UC-MSCs reversed senescence and apoptosis induced by IL-1β. Study findings indicated that the conditioned media from SF-UC-MSCs had anti-inflammatory effects and cytoprotective effects on IL-1β-treated tenocytes from degenerative rotator cuff tears. UC-MSCs have useful potential for the treatment of tendinopathy in practice.

Analysis of the efficacy of triple-channel minimally invasive knee arthroscopy in treating popliteal cysts in children

BackgroundThis study aimed to investigate a technique for treating pediatric popliteal cysts with a triple-channel knee arthroscopic approach, hypothesizing that this technique exhibits favorable clinical outcomes with reduced recurrence rates.MethodsA retrospective analysis was conducted on the clinical data of 14 patients with symptomatic pediatric popliteal cysts admitted to the joint surgery center using an arthroscopic minimally invasive technique from December 2017 to December 2020. Arthroscopy was employed for adequate enlargement of the posterior medial flap opening between the cyst and the joint cavity and to completely resect the cyst wall. The popliteal cyst recurrence was assessed through Magnetic Resonance Imaging(MRI) at 3 and 12 months post-surgery, and the Rauschning and Lindgren scores were recorded to evaluate the clinical prognosis.ResultsA total of 14 children completed the follow-up, including 8 boys and 6 girls, with a mean age of 9.9 ± 1.1 years (5–12 years); 5 cases in the left knee and 9 cases in the right knee; the mean operative time was 19.2 ± 2.7 min (10–25 min); and the mean follow-up time was 15.1 ± 2.4 months (12–24 months). There was no intraoperative vascular or nerve injury and no incisional exudate infection. Postoperatively, posterior knee symptoms disappeared in the children, Rauschning and Lindgren scores significantly improved, and no recurrence signs were observed on MRI.ConclusionsThis study determined that the arthroscopic three-channel minimally invasive technique is effective and safe for treating popliteal cysts in children, making it worthy of clinical promotion.

Ultrasound- Versus Landmark-Guided Corticosteroid Injections in Patients With Shoulder Pain: A Meta-Analysis and Systematic Review.

This meta-analysis evaluated the effects of ultrasound-guided (USG) and landmark-guided (LMG) injections of corticosteroids into the shoulder joint cavity of patients with shoulder pain. The PubMed database was searched for articles (January 1, 2004-December 31, 2023) comparing USG and LMG injections of corticosteroids for the treatment of adult shoulder pain. Two authors independently performed data extraction and appraisal. The outcome measures collected were visual analogue scale (VAS) score and VAS score change at 1 and 6 weeks postinjection and range of motion (ROM) at 6 weeks postinjection. Thirteen studies including 656 patients were reviewed (USG and LMG groups, 328 patients each). The VAS score at 1 week postinjection and the ROM in abduction at 6 weeks postinjection were statistically different, but there were no statistically significant differences in other outcomes. This meta-analysis indicated that USG corticosteroid injection may have a better effect than LMG corticosteroid injection for early-stage shoulder pain and abduction in the mid- to long-term, but does not affect later shoulder pain or other ROMs.

A clinical study on the effect of axillary approach in the treatment of Ideberg type II scapular glenoid fractures

BackgroundDue to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages.MethodsThe clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score.ResultsThe patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good.ConclusionOpen reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory.

Targeting Synovial Macrophages with Astaxanthin-Loaded Liposomes for Antioxidant Treatment of Osteoarthritis.

Osteoarthritis (OA) is a chronic joint disease highly associated with an imbalance in the network of inflammatory factors and typically characterized by oxidative stress and cartilage damage. Moreover, the specificity of the joint structure makes it difficult for drugs to achieve good penetration and effective enrichment in the joint cavity. Therefore, therapeutic strategies that increase the specific targeting of drugs to inflammatory joint and incorporate antioxidative stress effects are important to improve the efficacy of OA. Here, we developed a folic acid-modified liposomal nanoparticle (AST@Lip-FA) loaded with the antioxidant astaxanthin (AST) to enhance the water solubility and stability of AST and to target the delivery of AST to the site of OA, leading to a significant improvement in therapeutic efficacy. In vitro experiments demonstrated that, due to the recognition by FA of the receptor folate receptor β on the surface of activated macrophages, the cellular uptake efficiency of AST@Lip-FA was increased. Meanwhile, intracellularly overexpressed inflammatory mediators such as reactive oxygen species and nitric oxide were efficiently removed by AST@Lip-FA. In addition, in the ACLT-induced OA mouse model, AST@Lip-FA was precisely enriched in the inflamed joints and achieved long-term retention, fully utilizing the anti-inflammatory, antioxidant, and cartilage-protecting effects of AST to effectively alleviate the progression of OA. In summary, AST@Lip-FA has an important prospect as a potential and effective therapeutic strategy for OA.

Macrophage Membrane-Biomimetic Multi-Layered Nanoparticles Targeting Synovial Angiogenesis for Osteoarthritis Therapy.

Osteoarthritis (OA) is an inflammatory and progressive joint disease characterized by angiogenesis-mediated sustained, chronic, and low-grade synovitis. Anti-angiogenesis is emerging as a strategy for attenuating OA progression, but is often compromised by poor targeted drug delivery and immune clearance. Recent studies have identified macrophages formed a "protective barrier" in the lining layer (LL) of synovium, which blocked the communication of joint cavity and sublining layer (SL) of synovium. Inspired by natural mimicry, macrophage membrane-camouflaged drug delivery is explored to avoid immune clearance. Based on the single cell RNA sequencing, the CD34+ synovial cells are identified as "sentinel cells" for synovium angiogenesis. Consequently, CD34 antibody-modified macrophage membraneis constructed to target new angiogenesis. Hence, a biomimetic multi-layered nanoparticle (NP) is developed that incorporates axitinib-loaded poly(lactic-co-glycolic) acid (PLGA) with CD34 antibody modified macrophage membrane (Atb@NP@Raw@CD34) to specifically deliver axitinib (Atb) to the SL and sustain inhibiting angiogenesis without immune elimination. It is found that the Atb@NP@Raw@CD34 can pass through macrophage "barrier", specifically targeting CD34+ cells, continuously releasing Atb and anti-angiogenesis in OA synovitis. Furthermore, in vivo data demonstrated that Atb@NP@Raw@CD34 can attenuate joint degeneration by inhibiting synovium angiogenesis-mediated synovitis. In conclusion, local injection of Atb@NP@Raw@CD34 presents a promising approach for clinically impeding OA progression.

Modulation of IFN-γ induced macrophage inflammatory responses via indomethacin-loaded NLCs for OA management

Macrophages are the main cells present in the synovial membrane. They play an important role in the development and progression of osteoarthritis (OA). After the establishment of the disease macrophages mostly adopt a pro-inflammatory secretory phenotype (OA phenotype) further inducing cartilage degradation. Indomethacin (IND) is a non-steroidal anti-inflammatory drug (NSAID) able to inhibit the synthesis of prostaglandins mediated by both cyclooxygenase isoforms depicting a potent anti-inflammatory capacity. However, the lack of specificity and short half-like of free drugs within the joint cavity limits its utility in controlling inflammation after intra-articular administration. This study aims at developing IND loaded glycosylated nanostructured lipid carriers (NLCs) to selectively target macrophages and promote their reprogramming to an anti-inflammatory phenotype. This approach focused on the local administration of the NLCs, offers a promising therapeutic strategy for treating OA by modulating the inflammatory environment within the joint. NLCs will be designed by combining experimental and in silico docking analyses, and thoroughly characterized to obtain drug delivery systems with high stability and suitable physicochemical properties. The proposed mannose-functionalized systems exhibited adequate particle sizes (≈ 70 nm) and positive surface charges (> 20 mV) to be efficiently retained in the joint cavity. Moreover, the developed NLCs demonstrated effective and specific uptake by OA-like macrophages leading to a significant decrease in the secretion of the pro-inflammatory cytokines IL-6, IL-8 and TNF-α similarly to the free drug. Therefore, these systems effectively reprogrammed OA-associated macrophages to adopt a more regenerative phenotype, offering a promising strategy for managing inflammation in OA.

Synovial vancomycin and meropenem concentrations in periprosthetic joint infection treated by single-stage revision combined with intra-articular infusion.

We aimed to determine the concentrations of synovial vancomycin and meropenem in patients treated by single-stage revision combined with intra-articular infusion following periprosthetic joint infection (PJI), thereby validating this drug delivery approach. We included 14 patients with PJI as noted in their medical records between November 2021 and August 2022, comprising eight hip and seven knee joint infections, with one patient experiencing bilateral knee infections. The patients underwent single-stage revision surgery, followed by intra-articular infusion of vancomycin and meropenem (50,000 µg/ml). Synovial fluid samples were collected to assess antibiotic concentrations using high-performance liquid chromatography. The peak concentrations of vancomycin and meropenem in the joint cavity were observed at one hour post-injection, with mean values of 14,933.9 µg/ml (SD 10,176.3) and 5,819.1 µg/ml (SD 6,029.8), respectively. The trough concentrations at 24 hours were 5,495.0 µg/ml (SD 2,360.5) for vancomycin and 186.4 µg/ml (SD 254.3) for meropenem. The half-life of vancomycin was 6 hours, while that of meropenem ranged between 2 and 3.5 hours. No significant adverse events related to the antibiotic administration were observed. This method can achieve sustained high antibiotic concentrations within the joint space, exceeding the reported minimum biofilm eradication concentration. Our study highlights the remarkable effectiveness of intra-articular antibiotic infusion in delivering high intra-articular concentrations of antibiotics. The method provided sustained high antibiotic concentrations within the joint cavity, and no severe side-effects were observed. These findings offer evidence to improve clinical treatment strategies. However, further validation is required through studies with larger sample sizes and higher levels of evidence.

Anti-arthritic potential and antioxidant properties of infusion, fractions and flavonoid glycosides from Dipteryx alata (baru) leaves

Dipteryx alata Vogel., popularly known as "baru", is a native species of Brazilian cerrado used by "Ribeirinhos" in the North Araguaia microregion. In the traditional medicine, maceration of barks or leaves infusion are used to treat back and muscle pain, osteoporosis and rheumatism. However, few studies have demonstrated the pharmacological effects of this species. The goal of this study was to perform phytochemicals studies of lyophilized infusion of D. alata leaves (LI-DA), as well as obtaining ethyl acetate fraction (EAF-DA) and hydromethanolic fraction (HMF-DA), and isolated flavonoids. The antioxidant of LI-DA, EAF-DA and HMF-DA, anti-inflammatory effects of LI-DA and quercetin-3-O-β-glucoside-7-O-α-rhamnoside (DA-1) and quercetin-7-O-α-rhamnoside (DA-2) were performed while in silico tests were used for absorption, distribution, metabolism, excretion and toxicity predictions of DA-1 and DA-2. LI-DA, EAF-DA and HMF-DA were evaluated in antioxidant assays (2, 2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid - ABTS; 2,2-diphenyl-1-picrylhydrazyl - DPPH; hydrogen peroxide - H2O2; reducing power and oxidation of β-carotene). The DA-1 and DA-2 were isolated from EAF-DA using chromatographic methods and characterized by Nuclear Magnetic Resonance (NMR) spectrometer. The Programs ProTox 3.0 and ADMETlab 2.0 were used for the prediction studies of DA-1 and DA-2. Mice received a single dose of LI-DA (3, 30, and 100 mg/kg), DA-1 (3 mg/kg) and DA-2 (3 mg/kg) and were subjected to inflammation induced by Complete Freund's Adjuvant (CFA) and in the zymosan-induced articular inflammation model. DA-1 and DA-2 have been identified for the first time in the leaves of D. alata. LI-DA, EAF-DA and HMF-DA demonstrated a high level of antioxidant activity as measured by ABTS (IC50 ≤ 5.62 μg/mL) and DPPH (IC50 ≤ 11.45 μg/mL). Oral administration of LI-DA (3, 30 and 100 mg/kg), DA-1 (3 mg/kg) and DA-2 (3 mg/kg) showed significantly reduced edema, cold and mechanical allodynia in the CFA-induced inflammation model (24 hours). LI-DA (3, 30, and 100 mg/kg) and DA-1 (3 mg/kg) reduced leukocytes migration into the joint cavity, mechanical allodynia, edema and NO production in mice (24 hours) in the zymosan-induced articular inflammation model. Additionally, DA-2 (3 mg/kg) reduced leukocyte migration and LI-DA (30 mg/kg) reduced protein exudation (24 hours) in zymosan model. DA-1 and DA-2 showed good oral bioavailability and low toxicity predicted by the ProTox model. This is the first chemical and biological study performed of D. alata infusion and two quercetin glycoside derivatives. The results indicated promising potential for the treatment of inflammation, pain, and rheumatism, supporting the traditional use of the infusion obtained from the leaves of D. alata.

Trained immunity of synovial macrophages is associated with exacerbated joint inflammation and damage after Staphylococcus aureus infection.

Investigate whether and which synoviocytes would acquire trained immunity characteristics that could exacerbate joint inflammation following a secondary Staphylococcus aureus infection. Lipopolysaccharide (LPS) and S. aureus were separately or double injected (21 days of interval) into the tibiofemoral joint cavity of male C57BL/6 mice. At different time points after these stimulations, mechanical nociception was analyzed followed by the analysis of signs of inflammation and damage in the affected joints. The trained immunity markers, including the glycolytic and mTOR pathway, were analyzed in whole tissue or isolated synoviocytes. A group of mice was treated with Rapamycin, an mTOR inhibitor before LPS or S. aureus stimulation. The double LPS - S. aureus hit promoted intense joint inflammation and damage compared to single joint stimulation, including markers in synoviocyte activation, production of proinflammatory cytokines, persistent nociception, and bone damage, despite not reducing the bacterial clearance. The double LPS - S. aureus hit joints increased the synovial macrophage population expressing CX3CR1 alongside triggering established epigenetic modifications associated with trained immunity events in these cells, such as the upregulation of the mTOR signaling pathway (p-mTOR and HIF1α) and the trimethylation of histone H3. Mice treated with Rapamycin presented reduced CX3CR1+ macrophage activation, joint inflammation, and bone damage. There is a trained immunity phenotype in CX3CR1+ synovial macrophages that contributes to the exacerbation of joint inflammation and damage during septic arthritis caused by S. aureus.

Clinical Versus Ultrasound Assessment of Joint Activity in Patients with Asymptomatic Hyperuricemia

Background: In this study, we aimed to investigate subclinical ultrasonographic change suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic hyperuricemia (AH) individuals with hyperuricemia. Methods: We conducted a cross-sectional, observational study including US examinations of the knees and first MTPJs as well as of the tendons and enthesis. The normal distribution of different parameters was tested by the Shapiro–Wilk normality test. Quantitative data were expressed in mean ± standard deviation and the difference between means of two groups was tested by Student’s t-test while qualitative data were expressed in frequency and the difference between proportions was tested by the chi-square test or Fisher exact test. Results: Fifty-nine AH individuals and 52 normouricemic subjects were included. A total of 118 knees, ankles and first MTPJs in patients with AH and 104 in the normouricemic subjects were studied. The most common abnormality found on USG was power Doppler signal in 1st MTPJ (37% vs. 0%; P &lt; .001) followed by joint cavity widening (31% vs. 0%; P &lt; .001). Double contour sign was found in 11% of the first MTPJs from AH individuals versus none in the control group ( P &lt; .001). Posterior tibialis tenosynovitis (6% vs. 0%; P &lt; .01) and Achilles tendon enthesopathy (8% vs. 0%; P &lt; .001). Conclusions: These data demonstrate that subclinical changes detected in the US suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically AH individuals.

Effects of acupuncture on serotonin, histamine, substance P, and tryptase levels at sensitized points in model rats with knee osteoarthritis

ObjectiveTo elucidate the differences in manual acupuncture effectiveness at sensitized points by investigating the mechanisms of local skin action at different sensitization points in rats with knee osteoarthritis (KOA). MethodsForty Sprague–Dawley rats were equally divided into control, model (1 mg of monoiodoacetate into the right knee joint cavity), sham operation, manual acupuncture at right Tianjing acupoint (MAR-SJ 10), and left SJ 10 groups. Safranine-O and fast green staining were used to assess the modeling. The morphological and functional changes in mast cells (MCs) were assessed during acupoint sensitization using toluidine blue and immunofluorescence staining. The levels of serotonin, histamine, substance P (SP), and tryptase at skin acupoints and serum levels of IL-β, IL-6, and TNF-α were detected using ELISA. ResultsAfter 14 days of treatment, the number of MCs and their degranulation rates were statistically higher in the model group than in the control group (both P < .001). After applying acupuncture, the levels of 5-HT, HA, and SP at skin acupoints were lower than those in the model group (all P < .05), and tryptase level was higher (both P < .05). Tryptase level was higher on the skin at the MAL-SJ 10 acupoint than that on the MAR-SJ 10 acupoint (P = .004). Compared with the model group, the serum levels of IL-1β, IL-6, and TNF-α in the MAR-SJ 10 and MAL-SJ 10 groups were lower (all P < .05). ConclusionAcupuncture at KOA-sensitized acupoints mitigates joint injury in KOA rats and may bidirectionally regulate local MCs of these acupoints. This finding not only enhances the reference value of sensitizing points in clinical diagnosis and treatment, but also contributes to the understanding of the biological mechanisms underlying acupuncture intervention at sensitizing points.

Hyperbaric oxygen treatment promotes tendon-bone interface healing in a rabbit model of rotator cuff tears.

Due to the high-intensity pressure that the shoulder cuff endures, it is prone to traumas and tears. The main critical function of the shoulder cuff muscles is to effectively facilitate shoulder movement and securely maintain the humeral head in the precise center of the joint cavity to prevent superior migration during abduction processes. Shoulder cuff injuries typically involve the muscle-tendon-bone interface, but existing repair techniques do not always guarantee complete and secure healing, leading to retears. Hyperbaric oxygen therapy, as an auxiliary treatment, can significantly promote the muscle-tendon-bone healing process. To explore the impact of hyperbaric oxygen therapy on the bone-tendon interface healing process in a rabbit model specifically designed for shoulder cuff tears, an experiment was conducted on New Zealand white rabbits by performing a full-thickness tear of the supraspinatus tendon in the left shoulder, followed by 2 hours per day of 100% oxygen treatment at 2 absolute atmospheres for 5 days. The results indicate that hyperbaric oxygen therapy significantly enhances vascularization at the interface between the shoulder cuff and tendon-bone, promotes collagen fiber regeneration in the tendon, improves the tensile strength of the tendon-bone complex, and does not have a significant effect on biomechanical stability. This suggests that hyperbaric oxygen therapy has a significant positive impact on the histological and biomechanical healing of shoulder cuff tears in rabbits, expediting the healing process of the tendon-bone interface.

OUTCOMES OF SHOULDER JOINT ENDOPROSTHETICS AFTER REMOVAL OF TUMORS IN THE HUMERUS

Introduction. The use of endoprostheses of the shoulder joint is possible with primary and secondary (metastatic) tumor lesions of the proximal part of the humerus. The possibility of using both individual oncological endoprostheses and modular oncological endoprostheses for tumors of the proximal part of the humerus is reported. Aim. To assess the effectiveness of restoring the function of the shoulder joint and upper limb and improving the patient's quality of life after shoulder joint arthroplasty for tumors of the proximal part of the humerus. Materials and methods. The results of the treatment of 27 patients who underwent shoulder arthroplasty in the conditions of the clinical departments of the "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" for tumors of the proximal part of the humerus from 2014 to 2024 were evaluated. Endoprosthesis was performed in 22 (81.5%) patients with primary tumors of the proximal part of the humerus and in 5 (18.5%) with metastatic tumors. Endoprosthesis of the shoulder joint was performed with individual oncological endoprostheses in 24 (88.9%) patients and modular oncological endoprostheses in 3 (11.1%) patients. Arthroplasty was primary in 25 (92.6%) patients and secondary in 2 (7.4%) patients. Results. During follow-up, 3 (11.1%) patients died with an average follow-up period of 10.3±1.9 months, the other 24 (88.9%) were alive, with an average follow-up period of 88.1±8.7 months. The overall frequency of complications in our study was 6 (22.2%) cases, 3 (11.1%) patients had an infectious complication in the late postoperative period after 12, 24 and 36 months, 1 (3.7%) patient had aseptic loosening of the leg of the endoprosthesis after 36 months, in 2 (7.4%) patients after 5 and 6 months, dislocation of the head of the endoprosthesis from the joint cavity was noted. Local tumor recurrence was observed in 2 (7.4%) patients. The overall mean MSTS total limb functional outcome after shoulder arthroplasty for all 27 patients was 74.2%, and of the 24 patients who survived, the mean limb functional outcome after shoulder arthroplasty was 78.4%. The patients' quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 32 points in the preoperative period to 78 points after shoulder joint replacement. Conclusions. Endoprosthetics is a modern method for reconstructing bone segments in the surgical treatment of tumors of long bones in the limbs. This method allows for the replacement of bone defects of any size (volume) and length. Shoulder joint endoprosthetics within the framework of combination and multimodal treatment of primary and metastatic tumors of the proximal part of the humerus provides restoration of both shoulder joint functions and the upper limb as a whole, thereby improving the quality of life for this group of patients.

Application of Injectable Hydrogels as Delivery Systems in Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis and rheumatoid arthritis, though etiologically distinct, are both inflammatory joint diseases that cause progressive joint injury, chronic pain, and loss of function. Therefore, long-term treatment with a focus on relieving symptoms is needed. At present, the primary treatment for arthritis is drug therapy, both oral and intravenous. Although significant progress has been achieved for these treatment methods in alleviating symptoms, certain prominent drawbacks such as the substantial side effects and limited absorption of medications call for an urgent need for improved drug delivery methods. Injected hydrogels can be used as a delivery system to deliver drugs to the joint cavity in a controlled manner and continuously release them, thereby enhancing drug retention in the joint cavity to improve therapeutic effectiveness, which is attributed to the desirable attributes of the delivery system such as low immunogenicity, good biodegradability and biocompatibility. This review summarizes the types of injectable hydrogels and analyzes their applications as delivery systems in arthritis treatment. We also explored how hydrogels counteract inflammation, bone and cartilage degradation, and oxidative stress, while promoting joint cartilage regeneration in the treatment of osteoarthritis (OA) and rheumatoid arthritis (RA). This review also highlights new approaches to developing injectable hydrogels as delivery systems for OA and RA.

Garlic-derived Exosomes Alleviate Osteoarthritis Through Inhibiting the MAPK Signaling Pathway.

Osteoarthritis (OA) is the most common degenerative joint disease affecting millions of people worldwide. Garlic-derived exosomes (GDEs) are nanoparticles extracted from garlic that exhibit anti-inflammatory effects on other diseases, but the effect of GDEs on OA has not been elucidated. In this study, GDEs were extracted and characterized. Chondrocytes were treated with IL-1β and incubated with GDEs in vitro, and the expression of cartilage matrix components (collagen II and aggrecan) and matrix degrading enzymes (MMP3 and MMP9) was evaluated via Western blotting. Changes in the MAPK pathway was also examined using Western blotting. The transcriptomic changes associated with GDE intervention were evaluated using high-throughput RNA-seq method. In vivo, we used anterior cruciate ligament transection (ACLT) combined with destabilization of the medial meniscus (DMM) surgery to establish a mouse OA model, and GDEs was intraarticularly injected into the joint cavity. The therapeutic effect of GDE was evaluated by behavioral and histopathological analysis. The results showed that IL-1β treatment inhibited the expression of collagen II and aggrecan, and upregulated the expression of MMP3 and MMP9, while GDE intervention alleviated these effects. GDEs also inhibited the phosphorylation of ERK, JNK, and P38. In vivo, GDE alleviated the sensitivity to heat stimulation and altered walking gait in a mouse OA model. Histopathological analysis indicated that GDE intervention ameliorated joint destruction in the knee joint without obvious toxicity. The results proved that GDEs alleviated the progression of OA in vitro and in vivo, and may be a potential disease-modifying drug for OA.