Joint Related Disorders Research Articles

Ayurvedic approach to managing Joint Disorders: Case Studies

Around the world, Bone and Joint-related disorders are common and can be extremely painful and impairing. Due to long-term disability and the high expense of surgical procedures, these conditions not only harm people's quality of life but also place a significant financial burden on them. Commonly Joint diseases like Sandhivata, Aamvata and Vatarakta have been mentioned in most classic Ayurvedic texts from ancient times. Another group of disorders known as Vatavyadhi assembles neuro-musculoskeletal conditions with varying etiopathogenesis. An Ayurvedic approach to disease classification involves arranging the various clinical conditions into a particular place, mainly based on their defining characteristics. Ayurvedic treatment offers a comprehensive and successful approach to managing joint disorders by reducing inflammation, improving range of motion, and promoting overall joint health and by integrating conventional knowledge with contemporary research, giving patients sustainable and natural relief and recovery. This article case report has been presented for every bone and joint-related disorder with their treatment protocol given in Ayurvedic Classics.

Validation of a rapid collagenase activity detection technique based on fluorescent quenched gelatin with synovial fluid samples

BackgroundMeasuring collagenase activity is crucial in the field of joint health and disease management. Collagenases, enzymes responsible for collagen degradation, play a vital role in maintaining the balance between collagen synthesis and breakdown in joints. Dysregulation of collagenase activity leads to joint tissue degradation and diseases such as rheumatoid arthritis and osteoarthritis. The development of methods to measure collagenase activity is essential for diagnosis, disease severity assessment, treatment monitoring, and identification of therapeutic targets.ResultsThis study aimed to validate a rapid collagenase activity detection technique using synovial fluid samples. Antibody microarray analysis was initially performed to quantify the levels of matrix metalloproteinase-9 (MMP-9), a major collagenase in joints. Subsequently, the developed gelatin-based test utilizing fluorescence measurement was used to determine collagenase activity. There was a significant correlation between the presence of MMP-9 and collagenase activity. In addition, Lower Limit of Detection and Upper Limit of Detection can be preliminary estimated as 8 ng/mL and 48 ng/mL respectively.ConclusionsThe developed technique offers a potential point-of-care assessment of collagenase activity, providing real-time information for clinicians and researchers. By accurately quantifying collagenase activity, healthcare professionals can optimize patient care, improve treatment outcomes, and contribute to the understanding and management of joint-related disorders. Further research and validation are necessary to establish the full potential of this rapid collagenase activity detection method in clinical practice.

Management of Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear through Ayurvedic management: A case report

Individuals like dancers can suffer from knee difficulties and there is no upper age limit for such knee joint-related disorders. During standing, walking, jogging, etc., the complex structure of the knee joint absorbs a lot of stress. Acute injuries to the joint may cause discomfort, swelling, and difficulty moving, which could be signs of a ruptured or broken ligament. The severity of the condition depends on the source of injury and the involved structures. Despite being less severe, some of them will still be uncomfortable and functionally restrictive. The symptoms of Janu sandhigata vata as described in Ayurveda may be correlated with signs and symptoms related to damage to the knee joint. A case where the patient was diagnosed as Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear was managed by Ayurveda approaches that are presented here. The Ayurveda treatment protocol comprises Tikta ksheera basti (~therapeutic enema), Janu seka (~therapeutic streaming over the knee), Dashanga lepa (~anointment), and Sandhaniya upanaha (~poultice application). The treatment has resulted in significant improvement in the functioning of the affected knee joint. This case has demonstrated the role of Ayurveda treatment protocols and management strategies in such ligament and meniscal injuries, without any surgical intervention.

Anthropometric evaluation of the distal end of the femur in the South Indian population with its clinical implications

Introduction: The femur is known as the longest weight-bearing bone in the body. Its length is around 45 cm in an average adult. The morphometric studies related to the distal end of the femur in the South Indian population are sparse. The present morphometric study was undertaken to compare and contrast the various measurements of the distal end of the femur in the South Indian population. Materials and Methods: In this study, 111 adult dry femora (56 from the right and 55 from the left side) were used for distal anthropometric measurements. Bicondylar width, medial condylar anteroposterior diameter, lateral condylar anteroposterior diameter, medial condylar transverse diameter, lateral condylar transverse diameter, width of intercondylar notch, and diameter of femur were measured using digital Vernier caliper. Results: The mean bicondylar width on the right and left sides were 70.43 mm, respectively. The average medial condylar anteroposterior distance for the right and left sides were 53.87 mm and 54.84 mm, whereas, the lateral condylar anteroposterior distance for the right and left sides was 55.33 mm and 55.44 mm. The medial condylar transverse distance for the right and left sides were 25.35 mm and 25.52 mm, and that of the lateral condylar transverse distance on the right and left sides were 26.87 mm and 26.71 mm. The intercondylar notch width was measured to be 18.26 mm and 18.43 mm on the right and left femora, respectively. The differences in the bilateral measurements were found to be statistically not significant between the right and left femora. Conclusion: The morphometric evaluation of the lower end of the femur would help the orthopedic surgeon, radiologist, and anthropology practitioner to a great extent, especially in dealing with knee joint-related disorders, and placing various implants in the reconstruction of femoral fragments among South Indian populations.

Comparative Assessment of Some Physicochemical Properties of marketed Ayurvedic Mahanarayan massage oils

Tailas or oils are important group of formulations used by Ayurvedic physicians to treat various types of diseases. Mahanarayan massages oils formulation which is used for the treatment of arthritis, Paralysis, and other joint related disorders. It also helps to stimulate the internal functions of the body while providing nourishment to different body tissues. Oils also lubricate to skin and tissue. The Present work was conducted to standardize the selected five marketed Mahanarayan massages oils for their physicochemical parameters, i.e. color, odor, pH, specific gravity, acid value, peroxide value and saponification value. The findings of the study showed that Mahanarayan massages oils were complies the requirements for physicochemical parameters as prescribed in standard text.

Inflammatory response to the administration of mesenchymal stem cells in an equine experimental model: effect of autologous, and single and repeat doses of pooled allogeneic cells in healthy joints.

BackgroundMesenchymal stem cells (MSCs) transplantation has become a promising therapeutic choice for musculoskeletal injuries. Joint-related disorders are highly prevalent in horses. Therefore, these animals are considered as suitable models for testing MSC-based therapies for these diseases. The aim of this study was to investigate the clinical and inflammatory responses to intra-articular single and repeat dose administration of autologous or of pooled allogeneic MSCs in healthy equine healthy joints. Six horses were intra-articularly injected with a single autologous dose of bone marrow derived MSCs (BM-MSCs) and two separate doses of allogeneic BM-MSCs pooled from several donors. All contralateral joints were injected with Lactated Ringer’s Solution (LRS) as the control vehicle. Signs of synovitis and lameness were evaluated at days 0, 1, 2, 3, 5 and 10 after injection. Total protein (TP), white blood cell count (WBC) and neutrophil count (NC) in synovial fluid were also measured at the same time-points.ResultsA mild synovial effusion without associated lameness was observed after all BM-MSCs injections. The second allogeneic injection caused the lowest signs of synovitis. Local temperature slightly increased after all BM-MSCs treatments compared to the controls. TP, WBC and NC in synovial fluids also increased during days 1 to 5 after all BM-MSCs injections. Both, clinical and synovial parameters were progressively normalized and by day 10 post-inoculation appeared indistinguishable from controls.ConclusionsIntra-articular administration of an allogeneic pool of BM-MSCs represents a safe therapeutic strategy to enhance MSCs availability. Importantly, the absence of hypersensitivity response to the second allogeneic BM-MSCs injection validates the use of repeat dose treatments to potentiate the therapeutic benefit of these cells. These results notably contribute to the development of stem cell based therapies for equine and human joint diseases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-016-0692-x) contains supplementary material, which is available to authorized users.

A TNF variant that associates with susceptibility to musculoskeletal disease modulates thyroid hormone receptor binding to control promoter activation.

Tumor necrosis factor (TNF) is a powerful pro-inflammatory cytokine and immuno-regulatory molecule, and modulates susceptibility to musculoskeletal diseases. Several meta-analyses and replicated association studies have implicated the minor ‘A’ variant within the TNF promoter single nucleotide polymorphism (SNP) rs361525 (-238A/G) as a risk allele in joint related disorders, including psoriatic and juvenile idiopathic arthritis, and osteolysis after joint arthroplasty. Here we characterized the effect of this variant on TNF promoter function. A transcriptional reporter, encoding the -238A variant of the TNF promoter, resulted in 2.2 to 2.8 times greater transcriptional activation versus the ‘G’ variant in murine macrophages when stimulated with pro-inflammatory stimuli. Bioinformatic analysis predicted a putative binding site for thyroid hormone receptor (TR) for the -238A but not the -238G allele. Overexpression of TR-α induced promoter expression 1.8-fold in the presence of the ‘A’ allele only. TR-α expression both potentiated and sensitized the -238A response to LPS or a titanium particulate stimulus, whilst siRNA knockdown of either THRA or THRB impaired transcriptional activation for the -238A variant only. This effect was independent of receptor-ligand binding of triiodothyronine. Immunohistochemical analysis of osteolysis interface membranes from patients undergoing revision surgery confirmed expression of TR-α within osteoclast nuclei at the resorption surface. The ‘A’ allele at rs361525 confers increased transcriptional activation of the TNF promoter and influences susceptibility to several arthritic conditions. This effect is modulated, at least in part, by binding of TR, which both sensitizes and potentiates transcriptional activation of the ‘A’ variant independent of its endogenous ligand.

Evaluation of Verbascum species and harpagoside in models of acute and chronic inflammation

AbstractVerbascum species are widely used in folk medicine because of their broad range of biological activities. Harpagoside, an iridoid glycoside isolated from some Verbascum plants is known for its anti-inflammatory properties. In the present study, the effect of five extracts of Verbascum species and harpagosides were evaluated in mouse models of acute and chronic inflammation. The results demonstrate that Verbascum phoeniceum extract strongly inhibits COX-1 (60.2% inhibition vs PMA-stimulated cells) and COX-2 (44.8% inhibition) expression stimulated peritoneal macrophages resulting in reduced paw swelling in carrageenan-induced oedema (55.5% inhibition vs PBS-treated mice). Harpagoside ameliorated the development of zymosaninduced arthritis and reduced pathological changes in joints as shown by the decreased histological score for cell infiltration in synovial cavity (3.5±0.2 in vs 2.0±0.16), cartilage loss (2.5±0.3 vs 1.8±0.5) and bone resorption (2.4±0.2 vs 1.8±0.4). Molecular docking simulations of harpagoside suggest that it may function with increased specific affinity towards COX-1 than COX-2. The potential of harpagoside to be applied as an effective agent for treating joint-related disorders is discussed.

Comparison of Patients with Orofacial Pain of Different Diagnostic Categories

The authors compared the pain intensity and difficulty experienced in performing activities of daily living (ADL) among 237 patients with orofacial pain. The patients underwent comprehensive examinations and recorded their subjective symptoms on a form (five items for pain intensity and six for ADL-related difficulty). On the basis of the primary diagnosis, the patients were divided into the temporomandibular joint dysfunction (TMJ), myofascial pain (MP), neuropathic pain (NP), and fibromyalgia (FM) groups. The intensity of pain in the jaw/face, tightness in the jaw/face, pain in the neck, and toothache significantly differed among the groups (p<0.01, Kruskal-Wallis test). Compared to other patients, the FM and NP groups reported greater pain intensity, whereas those in the TMJ group reported lesser pain intensity. The ADL-related difficulty was not significantly different among the groups. Thus, compared to pain due to joint-related disorders, myalgic and neuropathic pain seem to be of higher intensity.

The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study

The suprascapular nerve and its articular branch innervate the acromioclavicular (AC) joint. Documenting the detailed anatomy of this innervation in the AC joint, including the pertinent surgical and anatomic relationships of the suprascapular nerve and its branches to the AC joint, will aid in the prevention of injury and the reduction of risk of denervation during shoulder surgery. Twelve shoulders from 6 embalmed human cadavers were bilaterally dissected to study the course of the suprascapular nerve and its motor and sensory branches. The sensory branch runs superiorly to the supraspinatus muscle towards the AC joint. The average distance from the supraglenoid tubercle to the nerve at the coracoid base was 15 mm. The average distance from the coracoclavicular ligaments to the nerve at the coracoid base was 6 mm. The average distance from the spinoglenoid notch to the sensory branch at the suprascapular notch was 22 mm. The average length of the sensory branch was 30 mm. In half of the specimen shoulders, the suprascapular artery accompanied the nerve at the suprascapular notch under the transverse scapular ligament. The innervation of the AC joint by the suprascapular nerve has been described, along with pertinent distances to anatomic landmarks. The sensory branch of the suprascapular nerve, which passed through the scapular notch inferior to the transverse scapular ligament, was found in 100% of the study specimens. The sensory branch of the suprascapular nerve runs superiorly to the supraspinatus muscle towards the AC joint. The detailed information can be used to help decrease the risk of nerve injury during shoulder surgery and to aid in effectively diagnosing and treating AC joint-related disorders.