Lequesne Index Research Articles

Acupotomy inhibits aberrant formation of subchondral bone through regulating osteoprotegerin/receptor activator of nuclear factor-κB ligand pathway in rabbits with knee osteoarthritis induced by modified Videman method.

To investigate the effects of acupotomy on inhibiting abnormal formation of subchondral bone in rabbits with knee osteoarthritis (KOA). A total of 24 New Zealand rabbits were randomly divided into four groups of 6 rabbits each [control, model, electroacupuncture (EA) and acupotomy]. Eighteen KOA model rabbits were established using a modified Videman method. Rabbits in EA and acupotomy groups received the intervention for 3 weeks. Then, the cartilage and subchondral bone unit were obtained and the histomorphological changes were recorded. Osteo-protegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) in subchondral bone were evaluated by Western blotting, real-time polymerase chain reaction and immunohistochemistry. Compared with the model group, both the acupotomy and EA groups showed a significant decrease in the Lequesne index (both 0.01) and Mankin score ( 0.01, < 0.05). In addition, both EA and acupotomy groups had a higher expression of total articular cartilage (TAC) ( 0.05, < 0.01) and lower expression of articular calcified cartilage (ACC)/TAC ( 0.05, < 0.05) compared with the model group. The thickness of the subchondral bone plate in EA and acupotomy groups were decreased (both 0.01) compared to the model group. Moreover, trabecular bone volume (BV/TV), protein and relative expression of OPG and the ratio of OPG/RANKL in the subchondral bone of acupotomy group were decreased statistically significant, while these parameters were not significantly changed in the EA group compared with the model group. In the rabbit model of KOA, acupotomy inhibits aberrant formation of subchondral bone by suppressing OPG/RANKL ratio as a potential therapy for KOA.

Effect of a Prepared Macaroni From Barley, Turmeric and Ginger in Management of Symptomatic Knee Osteoarthritis

ObjectivesThe aim of this study was to evaluate the effects of using a dietary supplement (macaroni) prepared from barley, and enriched with curcurium, ginger, onion powder and garlic powder in the management of osteoarthritis as regard the clinical assessment, changes in inflammatory and oxidative stress biomarkers.MethodsFifty one patients having bilateral grade 2-3 knee osteoarthritis were selected from the Complementary Medicine clinic at the National Research Centre; they consumed the cooked prepared macaroni daily 75 g raw for 2 months. Clinical characteristic of knee osteoarthritis, serum Interleukin 4 (IL 4), IL1β, IL6, Beta-encephalin, Malondialdehyde (MDA), Total Antioxidants Capacity (TAC), Glutathione S-Transferase Activity (GST) and ESR were detected in each patient before and after the dietary supplement consumption.ResultsChemical composition of the prepared barley macaroni demonstrated that there was an increase in crude fiber, ash, protein and fat contents, and decrease in total carbohydrates content compared with control (macaroni prepared from durum wheat). 51females patients complaining of knee osteoarthritis with mean age 51 ± 8.37 years participated in the study. After 8 weeks of macaroni supplementation, most of the anthropometric measurements decreased numerical without statistical significance, while basal metabolic rate increased without significance at the end of the intervention. All clinical characteristic of knee osteoarthritis, WOMAC score, Lequesne Index and Timed Up and Go test were significantly improved at week 8. Moreover, inflammatory biomarkers were improved as achieved through elevation in serum anti- inflammatory cytokine IL4 and declining of pro-inflammatory cytokine IL1β and IL6. There was a significant reduction in ESR and elevation in serum Encephalin. In addition, dietary supplement resulted in a significant improvement in anti- oxidants status that was achieved through elevation in TAC and declining of MDA and GST Activity during follow up.ConclusionsThis product proved to be healthy and helpful in decreasing the intensity of knee OA associated clinical symptoms and help the patients to get their life back to near normal life.Funding SourcesNational Research Centre support the practical part of the work.

Сlinical Efficacy of Individually Dosed Intermittent Hypoxia-Hyperoxic Therapy in Osteoarthritis Patients with Post-Covid Syndrome

Aim. To evaluate the clinical efficiency of the individually dosed interval hypoxia-hyperoxic therapy in the medical rehabilitation of patients with osteoarthritis (OA), having post-COVID syndrome. Material and methods. 50 patients with OA (84% females, age of 43 to 68 years) where included in the randomized placebo-controlled study. Coronavirus infection COVID-19 were diagnosed from 12 to 26 weeks before the study. Patients had at least 6 symptoms of post-COVID syndrome. All patients were randomized into 3 groups. 18 patients of the study group received 10 hypoxia-hyperoxic therapy procedures, 15 comparison group patients – 10 placebo procedures, 14 control group patients – only standard rehabilitation. The study group patients were breathing hypoxic (FiO2 13–15%) and hyperoxic (FiO2 up to 40%) gas mixture through the mask in the interval mode using device ReOxy. The duration of 1–4 procedures was 30 min, 5–10 procedures – 40 min. The placebo procedures were performed using the mask with the atmospheric air hole. The standard rehabilitation program in all groups for 2 weeks included: 10 group sessions of physical exercises with elements of breathing exercises, 10 procedures of magnetic therapy for joints, 10 sodium chloride baths. Joint pain and general health on 100-mm visual analog scale, Lequesne and WOMAC indexes, Spielberger-Khanin reactive anxiety test, Beck depression inventory and breathlessness on Modified Borg scale were evaluated at baseline (control point T0) and at 2 weeks (control point T1). Results and discussion. After 2 weeks (T1) in the study group, pain decreased by 51.4% (p &lt; 0.01), Lequesne index – by 34.8% (p &lt; 0.05), WOMAC – by 44.7% (p &lt; 0.05), reactive anxiety level – by 23.7% (p &lt; 0.05), depression symptoms – by 52.9% (p &lt; 0.01), breathlessness – by 71.2% (p &lt; 0.01), general health improved by 52.1% (р &lt; 0.01). In the study group, there were statistically significant differences from the control group in all parameters (р &lt; 0.05) and from the comparison group in most indicators (р &lt; 0.05), excluding the Lequesne index. These results are consistent with the data of modern studies of efficiency of hypoxic conditioning. Conclusion. 2-week rehabilitation program, including interval hypoxia-hyperoxic therapy, reduces pain, breathlessness, depression and reactive anxiety symptoms, improves general health and functional status in patients with OA, having post-COVID syndrome.

Влияние мелатонина на фактор дислипидемии при метаболическом фенотипе остеоартроза

Introduction Osteoarthritis (OA) has long been considered from the mechanical point of view of etiology and pathogenesis, as a "wear and tear" disease. However, advances in fundamental medicine have changed the way we look at this disease. The role of systemic inflammation was determined in OA progression and risk factor related clinical phenotypes were differentiated as post-traumatic OA, age associated OA, genetic OA and metabolic syndrome associated OA. The development and progression of OA in metabolic disorders envision a concept of systemic regulation of osteocartilaginous and synovial tissues, and several studies showed that dysregulation of circadian rhythms may be involved in the development of dyslipidemia and systemic inflammation associated with obesity. The objective was to explore the effect of melatonin on the dynamics of lipid metabolism and the severity of clinical symptoms in patients with OA and insomnia based on the role of dyslipidemia in the pathogenesis of degenerative diseases. Materials and Methods The study included 36 individuals including 12 healthy volunteers and 24 inpatients of experimental groups with insomnia and Kellgren-Lawrence grades 2 and 3 gonarthrosis. Standard conservative treatment consisted of drug and physical therapy. Medical history, complaints were collected from the patients and physical examination performed to evaluate edema of the joint, alignment of the lower limb, range of motion in the joints and measure waist circumference, body height, body weight; body mass index. The biochemistry blood parameters measured included total cholesterol concentration (TCC), high-density lipoprotein cholesterol, low density lipoprotein cholesterol (LDL) and triglycerides (TG). VAS and Lequesne scale were used to assess pain and function of the joints. Results Patients with the metabolic OA showed statistically significant (p &lt; 0.05) increase in TCC (6.23 (4.28 to 6.44) mmol/L, p &lt; 0.0002), LDL fractions (4.52 (3.08 to 4.92) mmol/L, p &lt; 0.00004), atherogenic coefficient (CA) (4.33 (3.15–4.8) mmol/L, p &lt; 0.00003) and a decrease in the HDL fraction (1.08 (0.93 to 1.4) mmol/L, p &lt; 0.01) before treatment in comparison with healthy individuals. The TG level remained within the normal range (0.73 [0.62 to 0.78] mmol/L). At a month, a statistically significant (p &lt; 0.006) decrease in TC (4.62 [3.71 to 5.29] mmol/L), a decrease in atherogenic fractions of LP (LDL) (2.65 [1.90 to 3.05] mmol / L) (p &lt; 0.002), an increase in the HDL fraction (1.49 [1.17 to 1.72] mmol/L) (p &lt; 0.004) and a decrease in CA (2.07 [1.81 to 2.34] mmol/L) (p &lt; 0.002) were observed in the experimental group of patients who received melatonin at the dose of 3 mg per day as an adjunctive therapy to the basic treatment. There was no significant dynamics of lipid metabolism in patients receiving standard treatment. The Lequesne's functional index significantly (p &lt; 0.03) decreased in melatonin patients after treatment from 12 [12 to 13] to 10 (8.75 to 10.25) points and showed no significant dynamics measuring 10.5 [10 to 11.75] and 10 [10 to 19.25] points in patients receiving standard treatment. Although positive dynamics in VAS scores was observed in both experimental groups a greater improvement (p &lt; 0.005) was seen in the drug group with VAS score improved from 4.5 [3.75 to 5] to 2.5 [2 to 3.25] mm versus 4.5 [4 to 5] and 3.5 [3 to 4] mm in the no-drug group (p &lt; 0.01). Conclusion Melatonin incorporated into the basic therapy was shown to exert a positive effect on pain assessment, condition of the knee joint evaluated with knee rating scales and subjective instruments, objective examination. The moderate antiatherogenic effect facilitates the therapeutic regimen to be considered in management of metabolic osteoarthritis.

Effect of lower limb orthoses on cartilage in patients with knee osteoarthritis: A narrative review.

The objective of this review was to infer how the use of an orthosis affects cartilage in patients with knee osteoarthritis. A search was performed in four different databases (Web of Science, Scopus, EMBASE, and PubMed) up to the 21st of November of 2020 to evaluate how the patient's condition was monitored. The parameters chosen for this review were medial tibial cartilage volume, x-ray evaluation, Lequesne Index, pain visual analog scale score, Western Ontario and McMaster Universities Arthritis Index pain score, and Knee Injury and Osteoarthritis Outcome Score pain subscale score. The initial search yielded a total of 12,622 documents. After thoroughly screening them, 38 were selected for analysis. Of the resulting data, only two objectively evaluated the cartilage (medial tibial cartilage volume, n = 1; x-ray evaluation, n = 1), with the remainder evaluating subjective symptoms (Lequesne Index, n = 8; pain visual analog scale score, n = 18; Western Ontario and McMaster Universities Arthritis Index pain score, n = 10; Knee Injury and Osteoarthritis Outcome Score pain subscale score, n = 10). The data did not converge toward any general outcome. The articles read demonstrated a great tendency to evaluate qualitative parameters pertinent to the symptoms of this condition or quantitative parameters related to the biomechanics of the knee. However, these parameters are not ideal because they are ambiguous. As such, a shift toward more objective quantitative parameters that directly assess the cartilage volume of the knee should be considered in future clinical trials.

Radial T2* mapping reveals early meniscal abnormalities in patients with knee osteoarthritis.

We aimed to validate a 2D radial T2* mapping method and its ability to reveal subtle alterations in the menisci of patients with knee osteoarthritis (OA). Of 40 enrolled participants, 20 were diagnosed with OA, and 20 were age- and sex-matched asymptomatic controls. Data from the right knee of each participant were collected using a 1.5-T MRI equipped with a single-channel knee coil. T2* values were acquired using a conventional T2* mapping protocol and a radial T2* mapping method. Mean T2* values in the meniscal white zones, meniscal red zones, and total menisci were calculated. Numerical simulation was performed for validation. Both simulation and clinical data confirmed that 2D radial T2* mapping provided better discrimination than the conventional method. Compared to controls, the OA group showed significantly greater mean (standard deviation) T2* values in the white zones (9.33 [2.29] ms vs. 6.04 [1.05] ms), red zones (9.18 [2.03] ms vs. 6.81 [1.28] ms), and total menisci (9.26 [2.06] ms vs. 6.34 [1.14] ms). Correlations were found between the Lequesne index and the meniscal T2* values in all three regions (r = 0.528, p = 0.017; r = 0.635, p = 0.003; and r = 0.556, p = 0.011, respectively). These findings indicate that in early OA, radial T2* mapping is an alternative means of assessing meniscal degeneration and can be used to monitor its progression. • Radial T2* mapping outperforms Cartesian T2* mapping. • Radial T2* measurements are useful in assessing meniscal degeneration. • Meniscal T2* values correlate well with disease severity.

Serum and Synovial Fluid Levels of Interleukin-17A in Primary Knee Osteoarthritis Patients: Correlations With Functional Status, Pain, and Disease Severity.

Objectives This study aims to assess the serum and synovial fluid (SF) levels of interleukin (IL)-17A in primary knee osteoarthritis (KOA) patients and to study their correlations with functional status, pain, and disease severity.Patients and methods This cross-sectional study was conducted between December 2017 and March 2018 and it included 70 patients (46 males, 24 females; mean age 57.3±10.0 years; range 34 to 76 years) with primary KOA and 30 age-, sex-, and body mass index-matched healthy individuals (20 males, 10 females; mean age 53.3±10.3 years; range, 35 to 70 years). Western Ontario and McMaster Universities osteoarthritis index (WOMAC), visual analog scale (VAS), Lequesne index, and Kellgren and Lawrence (KL) grading scale were used for assessment of the disease. IL-17A levels were measured in the serum for patients and healthy controls, and in SF for patients only using an enzyme-linked immunosorbent assay.Results Serum levels of IL-17A were significantly higher in KOA patients than controls (p=0.04). A positive correlation was found between serum and SF IL-17A levels. Serum and SF IL-17A levels had positive correlations with VAS, WOMAC pain score, Lequesne pain score, WOMAC function score, and Lequesne index. SF IL-17A levels had strong positive correlations with radiographic severity (KL grade) and duration of OA.Conclusion Higher IL-17A levels in primary KOA patients were significantly associated with longer disease duration, higher pain scores, worse quality of life, extreme disability, and advanced structural damage. Therapeutics that target IL-17A warrant further investigation.

Hybrid Hyaluronic Acid versus High Molecular Weight Hyaluronic Acid for the Treatment of Hip Osteoarthritis in Overweight/Obese Patients.

Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500–2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patients.

Joint Dysfunctionality Alleviation along with Systemic Inflammation Reduction Following Arthrocen Treatment in Patients with Knee Osteoarthritis: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

Background and objectives: Many mediators and cytokines are involved in the pathogenesis of osteoarthritis (OA). Some of these cytokines are spontaneously expressed by cultured fibroblast-like synoviocytes. Therefore, using serum samples, the efficacy and the effects of avocado/soy unsaponifiables, ASU, (Arthrocen) on cytokine changes were assessed in patients with knee OA (KOA). Materials and Methods: Experimental procedure: A randomized, double-blind, placebo-controlled clinical trial was conducted on patients with a diagnosis of mild to moderate OA who received either Arthrocen 300 mg/day (n = 61) or placebo (n = 58) for 3 months. Data collection was performed using questionnaires including the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), 20-item short form survey (SF-20), Lequesne index of severity for osteoarthritis of the knee (LISOK), and three visual analog scales (VASs) as pain quality indices. The serum levels of interleukins 2 (IL-2), IL-4, IL-10, IL-17α, and TNF-α were measured using an ELISA reader. Results: Both quality of life indices, pain sensation and scored by specialists (as VASs), respectively, including WOMAC and SF-20, as well as joint dysfunctionality symptoms assessed by physicians were significantly improved (p < 0.05) in OA patients receiving Arthrocen. The serum levels of anti-inflammatory interleukins 4 and 10 were also augmented, while levels of inflammatory IL-17 and TNF-ɑ cytokines were decreased significantly (p < 0.05) compared with the control groups during the 3- and 6-month treatment. Conclusions: Arthrocen consumption may increase the quality of life in OA patients through amelioration of inflammation and improvement of functional activities without any adverse effects in the long term.

Associated Factors with the Severity of Hip Involvement in Spondyloarthritis and Efficacy of TNF α Inhibitors in these Patients.

Hip involvement in patients with spondyloarthritis is responsible for disability and functional impairment. Its treatment is not codified. Our study aimed to determine the associated factors with moderate and severe hip involvement in spondyloarthritis patients. It also aimed to assess the efficacy of tumour necrosis factor inhibitors (TNFi) on hip disease. We conducted a cross-sectional study, including 44 spondyloarthritis patients with hip involvement. Hip involvement was diagnosed based on radiographic findings. We assessed the following parameters: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), patient global assessment (PGA), and Lequesne index. We compared these parameters and the mean radiographic joint space width between the time of the study to those right before the use of TNFi. Hip involvement was bilateral in 31 patients. The mean age was 44.56±12.21 years. There were 29 men. Severe and moderate involvement (BASRI-hip>3) was reported in 21 hips from 75 affected. These patients were older and had longer diagnosis delays than patients with BASRI- hip<3. They had a higher body mass index and more limited spine mobility (BASMI). Functional hip impairment assessed by the Lequesne index was higher in these patients. TNFi prescribed in 23 patients with hip involvement, led to an improvement in the Lequesne index (12.75 vs 7.5, p: 0.001) and PGA (7 vs 2, p: 0.001). However, the mean joint space width remained unchanged (3.8 vs 3.7mm, p: 0.532). Our study showed that higher body mass and Lequesne indexes are associated with moderate and severe hip involvement. TNFi may improve both the Lequesne index and PGA and stabilize the radiological findings.

Ефективність і безпечність лікування хворих на остеоартроз колінних суглобів гідролізатом колагену (FORTIGEL®)

Мета дослідження — оцінити ефективність і безпеку використання проФЛЕКС (Schonen, Швейцарія) — гідролізату колагену (FORTIGEL®) у хворих з остеоартозом колінних суглобів. У відкрите клінічне дослідження включили 30 хворих (8 чоловіків і 22 жінки) віком 45–74 роки (середній вік 59 ± 8 років) з остеоартрозом колінних суглобів, тривалість патології становила в середньому 8,9 ± 6,0 року. Усім хворим на додаток до нестероїдного протизапального препарату було призначено гідролізат колагену (FORTIGEL®) перорально у дозі 10 г на добу. Тривалість лікування — 3 місяці.За період спостереження відмічено позитивну динаміку, що підтверджувалася зменшенням суб’єктивного відчуття болю за візуальною аналоговою шкалою наприкінці дослідження на 44 % (р &lt; 0,05) у стані спокою і на 62 % (р &lt; 0,05) при рухах порівняно з контрольною групою. Зниження індексу Лекена було більш виражене — на 48 % (р &lt; 0,05). Більшість пацієнтів відзначали позитивний вплив гідролізату колагену (FORTIGEL®): 10 % — значне покращення, 53 % — помірне поліпшення і 37 % — без змін. В основній групі відзначено більш виражене зниження дози диклофенаку натрію порівняно з контрольною групою в кінці спостереження — на 73 і 47 % відповідно. Суттєвих побічних ефектів, що потребували б відміни питного гідролізату колагену (FORTIGEL®), протягом дослідження не реєструвалося.проФЛЕКС (гідролізат колагену (FORTIGEL®)) є ефективним та безпечним засобом для комплексного лікування хворих на остеоартроз колінних суглобів.

A single intraarticular platelet-rich plasma improves pain and function for patients with early knee osteoarthritis: Analyses by radiographic severity and age.

Most studies use platelet-rich plasma (PRP) requiring multiple intraarticular injections for knee osteoarthritis (OA). To investigate the efficacy of a single intraarticular PRP injection for patients with early knee OA and consider subgroup analyses of radiographic severity and age, respectively. Forty-one patients with knee OA (Kellgren-Lawrence grade 1-2) received a single PRP injection into the target knee and were assessed at baseline and 1, 3, and 6 months postinjection. The primary outcome was the mean change from baseline in the visual analog scale (VAS) pain (0-100 mm) at 6 months postinjection. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patients' satisfaction. Thirty-eight patients completed the study. The mean pain VAS decreased significantly from 45.6 ± 13.0 mm at baseline to 16.9 ± 13.4 mm, 14.0 ± 13.1 mm and 15.5 ± 14.0 mm at 1, 3 and 6-month follow-ups (p< 0.001 for all). Significant improvements in WOMAC, Lequesne index, SLS and consumption of analgesics from baseline (p< 0.001 for all) were noted at each follow-up. Patients' satisfaction was high. No serious adverse events occurred. Subgroup analyses revealed that patients with grade 1 OA showed significantly greater VAS pain reduction at 3 months (p= 0.006) and 6 months (p= 0.005) than patients with grade 2 OA. The older-age group (age > 60) showed significantly greater improvements in VAS pain, WOMAC function subscale scores and total scores at 6-month postinjection, compared with the younger age-group (age ≤ 60). The younger-age group reported better satisfaction at 1 and 3-month postinjection. One injection of PRP improved pain and function for 6 months for patients with early knee OA. This study supports putting the one-injection regimen into clinical practice. Further research is needed for more definite conclusions.

The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials.

Objective This systematic review and meta-analysis were performed to investigate the efficacy and safety of Chinese herbal medicine (CHM) in the treatment of knee osteoarthritis (KOA). Methods An electronic search was conducted in eight databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese VIP Database, and Wanfang Database) from inception until December 2019. The risk of bias assessment of the included RCTs was evaluated by Cochrane collaboration's tool. The inclusion criteria were RCTs that investigated the efficacy and safety of CHM in the treatment of KOA, with no restrictions on publication status or language. The exclusion criteria included nonrandomized or quasi-RCTs, no clear KOA diagnostic approach, combined Chinese medicinal herbs with other traditional Chinese medicine treatment modalities, and published using repeated data and missing data. We computed the relative risk (RR) and the standard mean difference (SMD) for dichotomous outcomes and continuous outcomes, respectively. When heterogeneity was detected or there was significant statistical heterogeneity (P < 0.05 or I2 > 50%), a random-effects model was employed, followed by further subgroup analysis and metaregression estimations to ascertain the origins of heterogeneity. Otherwise, we used a fixed-effects model (P ≥ 0.05 or I2 ≤ 50%). The primary outcome measures were visual analog score (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and Lequesne index. Secondary outcome measures were the total clinical effective rate and adverse events. The meta-analysis was performed using the Stata 14.0 software. Results A total of 56 RCTs comprising 5350 patients met the inclusion criteria. This meta-analysis showed that application of CHM as adjuvant therapy or monotherapy for KOA can significantly decrease VAS, WOMAC, and the Lequesne index and improve the Lysholm score as well as the total effective rate. In addition, this treatment has fewer adverse effects, suggesting that CHM is generally safe and well tolerated among patients with KOA. Conclusion Our study offers supportive evidence that CHM, either adjuvant therapy or monotherapy, reduces the VAS, WOMAC, and Lequesne index and improves the Lysholm score and overall effective rate in patients with KOA. Additionally, CHM was well tolerated and safe in KOA patients. We found frequently used CHMs that might contribute to the formulation of a herbal formula that could be considered for further clinical use. However, given the heterogeneity and limited sample size in this study, larger multicenter and high-quality RCTs are needed to validate the benefits of CHM in the treatment of KOA.

Интервальная гипокси-гипероксическая терапия в комплексной реабилитации пациентов с остеоартритом

The purpose — to evaluate the clinical efficiency of the individually dosed interval hypoxic-hyperoxic therapy in the medical rehabilitation of patients with osteoarthritis (OA). Material and methods. 68 patients with OA (81% females, aged 44 to 69 years) were included in the randomized controlled study. 35 study group patients received 10 hypoxic-hyperoxic therapy procedures, 33 control group patients – only standard rehabilitation. The study group patients were breathing hypoxic (FiO2 13–15%) and hyperoxic (FiO2 up to 40%) gas mixture through a mask in the interval mode using ReOxy device. The duration of 1–4 procedures was 30 min, 5–10 procedures — 40 min. The patients of both groups underwent a 2-week standard rehabilitation program: 10 group sessions of physical exercises, 10 procedures of magnetic therapy for joints, 10 sodium chloride baths. Results. After 2 weeks, joint pain on a 100 mm visual analog scale in the study group decreased by 54% (p &lt; 0.01), Lequesne index — by 35.7% (p &lt; 0.05), WOMAC index — by 49.6% (p &lt; 0.05), Spielberger — Khanin reactive anxiety test — by 30.1% (p &lt; 0.05), depression symptoms by Beck depression inventory — by 60.8% (p &lt; 0.01). In the study group there were statistically significant differences from the control group in all parameters (р &lt; 0.05). Conclusion. The 2-week rehabilitation program, including interval hypoxic-hyperoxic therapy, reduces pain, depression and reactive anxiety symptoms, improves functional status in patients with OA.

The Association of Blood Biomarkers and Body Mass Index in Knee Osteoarthritis: A Cross-Sectional Study.

ObjectiveDespite massive efforts, there are no diagnostic blood biomarkers for knee osteoarthritis (KOA). This study investigated several candidate diagnostic biomarkers and the metabolic phenotype in end-stage KOA in the context of obesity.DesignIn this cross-sectional study, adult patients undergoing knee arthroplasty were enrolled and KOA severity was assessed using the Lequesne index. Blood biomarkers with an important role in obesity, the metabolic syndrome, or KOA (oxidized form of low-density lipoprotein [oxLDL], advanced glycation end product [AGE], soluble AGE receptor [sRAGE], fatty acid binding protein 4 [FABP4], phospholipase A2 group IIA [PLA2G2A], fibroblast growth factor 23 [FGF-23], ghrelin, leptin, and resistin) were measured using enzyme-linked immunosorbent assay (ELISA; n = 70) or Luminex technique (subgroup of n = 35). H1-NMR spectroscopy was used for the quantification of metabolite levels (subgroup of n = 31). The hip-knee-ankle angle was assessed. Multivariable and multivariate regression analysis was used to examine the relationship of biomarkers with body mass index (BMI) and KOA severity in complete case and multiple imputation analysis.ResultsWhile most of the investigated biomarkers were not associated with KOA severity, FABP4 and leptin were found to correlate with BMI and gender. Resistin was associated with Lequesne index in complete case analysis. Using a targeted metabolomics approach, BMI-dependent changes in the metabolome were hardly visible.ConclusionsOur findings confirm studies on FABP4, leptin, and resistin with regard to obesity and the metabolic syndrome. There was no association of the investigated biomarkers with KOA severity, most likely due to the patient selection (end-stage KOA patients). Based on this absence of BMI-dependent changes in the metabolome, we might assume that BMI is not correlated with KOA severity in this specific patient group.

The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old

Background: Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. Objective: This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. Methods: Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). Results: A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = −0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. Conclusion: Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.

GLUCOSAMINE SULFATE EFFICACY IN TREATING KNEE OSTEOARTHRITIS: A FOLLOW-UP STUDY.

Osteoarthritis (OA) can be treated using either a pharmacological or non-pharmacological approach, or a combination of both. The purpose of the present study was to investigate the efficacy of crystalline glucosamine sulfate (CGS) in patients with knee OA. This open-label prospective study (with a 12-month follow-up) included 111 patients of both genders suffering from knee OA, who attended the Special Hospital for Rheumatic Diseases in Novi Sad, Serbia during the 2011-2013 period. Patients were divided into the experimental (n=52) and the control (n=59) group. While the former was prescribed CGS 1500 mg/day, the latter was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) according to the standard protocol. The efficacy of both treatment modes was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index, along with the radiological findings which involved knee joint space width (JSW) measurements. One year following the initial assessment, all patients reported pain intensity reduction; however, those in the CGS group experienced significantly lower pain intensity when compared with controls. At the end of the study, no reduction in the progression of joint structure damage (p>0.5) was noted in either group. Thus, while CGS demonstrated symptomatic efficacy, it failed to delay the progression of knee OA.

The Effects of Curcuma Longa on the Osteoarthritis: A Systematic Review of Placebo-Controlled Clinical Studies

Osteoarthritis (OA) is a joint disorder characterized by chronic, degenerative, and irreversible inflammation leading to pain and disability. The standard drugs are ineffective for many patients and are usually associated with numerous side effects such as gastrointestinal complaints. Curcuma longa and its bioactive compounds have been considered for OA. The objective of this study was to perform a systematic review of the effects of Curcuma longa and its derivatives on OA. Pubmed, Cochrane, and Embase were searched, and PRISMA guidelines were followed to build this review. Only Randomized Clinical Trials (RCTs) that performed placebo-comparison were included. Most included studies showed that Curcuma longa or formulations prepared with curcuminoids can benefit the OA scores such as Visual Analog Scale, Knee injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index; and Lequesne's pain functional index. The use of Curcuma longa extracts or curcuminoids can benefit patients with OA. Nevertheless, the available RCTs show treatment time, doses, and formulations heterogeneity. Thus, the standardization of RCTs can guide researchers and physicians on the dosages and formulations that are most effective in addressing this condition, which is very prevalent in the world's populations.

РЕЗУЛЬТАТЫ ПЕРВОГО ОПЫТА СИМУЛЬТАННЫХ ОПЕРАЦИЙ ПРИ ВАРИКОЗНОЙ БОЛЕЗНИ И ГОНАРТРОЗЕ

Objective: To analyze the results of the first experience of performing simultaneous operations for saphenous varicose veins of the lower extremities and knee osteoarthritis. Methods: The results of simultaneously performed combined phlebectomy and arthroscopic knee surgery in patients with varicose veins (VV) were analyzed. A total of 15 female patients (mean age 52.8±1.9 years) were included in the study. In 5 patients, Clinical Class II, according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification, published in 1994 for chronic venous disease, was noted, and in 10 – class III. In 13 (86.7%) cases, there was a bilateral dilatation of the saphenous veins; and in 12 patients, there was a combined dilatation of both the Great Saphenous Vein (GSV) and Small Saphenous Vein (SSV). Perforator venous insufficiency was present in 5 patients. Among those examined, in 5 cases, clinical and laboratory findings of the КOA grade II, according to the Kellgren and Lawrence system (1957) for OA classification, were noted, and in 10 patients – grade III. Overweight was observed in 9 patients, and the mean weight was 77.5±3.8 kg. Assessment of the function of the knee joints before and three months after the operation was carried out according to Lequesne's algo-functional index (AFI). Results: The mean diameter of the GSV and SSV was 10.2±0.4 and 6.4±0.4 mm, respectively, and the diameter of insufficient perforating veins was 4.1±0.3 mm. The malleolar circumference before surgical treatment was 37.7±1.5 cm. In all cases, patients had pain and discomfort during the night (n=5 with movement and n=10 without), morning stiffness (n=9), and increased pain when walking a certain distance (n=8) or at the beginning of the movement (n=7). A positive correlation was found between pain and discomfort with age (r=0.53), KOA stage (r=0.70), malleolar circumference (r=0.58) and a negative correlation with body weight (r=-0.55) and recurrence of VV(r=-0.68). All patients complained of walking difficulties, and as a result, their walking distance was reduced. A direct correlation was found between walking distance and body weight (r=0.71), KOA stage (r=0.84), malleolar circumference (r=0.81), pain and discomfort during the night (r=0.66). In addition, in all cases, there was a decrease in daily life activities – the ability to climb one flight of stairs up or down at a moderate effort, squatting or kneeling, and limited ability to walk on uneven ground. The mean operative time of the combined operation's first step (phlebectomy) and arthroscopic knee surgery was 125.5±25.5 and 58.2±10.5 minutes, respectively. The development of postoperative seroma in the wound area was observed in only one case. The average hospital stay was 7.2±1.2 days, and sutures were removed within 10-12 days. A follow-up examination of patients after 1 and 3 months revealed a significant decrease in all the above parameters of Lequesne's AFI and malleolar circumference to 32.0±1.3 cm. Conclusion: Combined phlebectomy with arthroscopic knee surgery in VV comorbid with KOA results in a significant improvement in symptomatic KOA patients with increased walking distance and daily activity with no significant complications. Keywords: Varicose veins, knee osteoarthritis, phlebectomy, vein stripping, arthroscopic knee surgery, combined operations.

SELF-MANAGEMENT PROGRAM (PARQVE) IMPROVES QUALITY OF LIFE IN SEVERE KNEE OSTEOARTHRITIS.

ABSTRACTObjective:To evaluate the effects of the self-management program PARQVE in patients with severe knee osteoarthritis (KOA).Methods:Prospective randomized controlled clinical trial with 65 grade IV Kelgren & Lawrence (K&L) KOA patients who were allocated into groups: Control (CG) and Intervention (IG). Both groups received usual care. IG also participated in two days of multi-professional interventions about OA (causes and treatment) and received the program’s DVD and book. Standing X-rays were obtained at inclusion and Ahlback’s classification was registered. Western Ontario and McMaster Universities Index (WOMAC), Numerical Rating Scale (NRS), Lequesne, weight, and body mass index (BMI) were obtained at inclusion, and after 6, 12 and 24 months.Results:Groups were similar at baseline, despite higher WOMAC stiffness scores and a greater number of Ahlback’s grade 4 and 5 in the IG. Only the IG improved WOMAC and total functions (p<0.001) during the study period above 12%, but did not reach the minimal clinically important difference of 20%. Best results were in one year. Non-significant improvements were observed without changes in body composition (P>0.05).Conclusions:Patients with severe KOA have mild to moderate function and quality of life improvement due to self-management program (PARQVE). Level of Evidence I; Therapeutic Studies; Prospective Randomized Controlled Trial.