Maintaining Joint Function Research Articles

Maximizing Knee OA Treatment: A Comparative Look at Physiotherapy and Injections.

Knee osteoarthritis (OA) is a prevalent and disabling condition often managed with physiotherapy or intra-articular injections. However, the comparative effectiveness of these treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of physiotherapy and intra-articular injections in managing knee OA. A systematic search of PubMed, Scopus, Web of Science, PEDro, and Cochrane Library was conducted. Randomized controlled trials (RCTs) comparing physiotherapy and intra-articular injections in knee OA patients were included. Key outcomes included pain (VAS), function (WOMAC, KOOS), range of motion (ROM), and quality of life. Data from five studies with a total of 552 participants were analyzed. Intra-articular injections, particularly botulinum toxin and hyaluronic acid, were found to provide rapid pain relief, outperforming physiotherapy in short-term pain management. However, physiotherapy contributed significantly to long-term functional improvements, particularly in early-stage OA. Combination therapy of injections and physiotherapy yielded the best short-term pain relief and functional outcomes. Heterogeneity in study designs and follow-up periods limited the generalizability of findings. Intra-articular injections are effective for immediate pain control, while physiotherapy plays a crucial role in maintaining joint function, especially for long-term management. Combining both interventions may offer the most comprehensive benefits. Further research is needed to determine the long-term efficacy of these treatments.

Unraveling the joints: a narrative review of osteoarthritis.

Osteoarthritis (OA) is a chronic and progressive degenerative disease that affects joint structures, such as the hips, knees, and hands, involving the articular cartilage, subchondral bone, ligaments, capsule, and synovium. OA is characterized by a progressive degeneration of the joint structures, resulting in pain and decreased quality of life. Local and systemic risk factors pave the way for OA development. Different phenotypes may be identified, but three main molecular mechanisms define the endotypes: the bone-driven endotype, the synovitis-driven endotype, and the cartilage-driven endotype. The hallmark of OA pathophysiology involves more than just mechanical degradation; it includes the release of pro-inflammatory mediators, such as interleukins and TNF-α, which elucidates the significant roles of metabolic syndrome, diabetes, and cellular senescence in its development. OA is distinguished by a clinical presentation that varies significantly between people and is marked by pain, stiffness, and functional impairments. The clinical course can be split into Pre-OA, Early OA, Evident OA, and End-Stage. Depending on the stage of the disease, OA diagnosis frequently necessitates a complex strategy that combines clinical evaluation to detect joint tenderness, range of motion, and joint swelling or abnormalities, medical history assessment, imaging modalities, and laboratory investigations. There is no known treatment for OA, and different therapies are usually evaluated based on the stage of the disease to minimize pain and stiffness while maintaining joint function. Treatments are divided into the reduction of modifiable risk factors, pharmacologic therapies, rehabilitation, complementary therapies, interventional pain procedures, and surgery. OA clinical heterogeneity underlines the importance of prevention, early diagnosis, and identifying the phenotype and endotype to tailor the treatment.

Rheumatoid Arthritis - Symptoms and Treatment Demystified

Rheumatoid Arthritis is characterized by the body's immune system mistakenly attacking its own tissues, particularly the synovium, which lines the joints. It commonly presents joint pain, swelling, stiffness, and reduced mobility, which affect multiple joints symmetrically. Beyond joint involvement, RA can impact various organs and systems throughout the body, leading to symptoms like fatigue, fever, and weight loss. Early diagnosis and aggressive treatment can slow down disease progression and mitigate joint damage. While there's no cure, numerous treatment modalities exist to alleviate symptoms, reduce inflammation, and maintain joint function.

Effects of Cannabidiol (CBD) on the inflammatory response of patients with rheumatoid arthritis.

Abstract – With an increase in the understanding of rheumatoid arthritis (RA) in terms of genetic and environmental risk factors, the pathogenesis of the disease is still not entirely understood. Treatments focus on maintaining joint function, analgesia and immunosuppression, however, in some cases there is little to no response to therapeutic drugs, highlighting the need to explore further therapeutic treatments. Cannabidiol (CBD) has been studied for its potential anti-inflammatory properties with regards to inflammatory conditions, but with conflicting and limited research surrounding RA. The aim of this systematic review was to determine the effects of cannabidiol on the inflammatory response of patients with RA. Most recent findings, relevance and quality of available research has been analyzed following the principles of the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. An electronic literature search was conducted through PubMed, Google Scholar, ScienceDirect. The PICO framework, FINER, inclusion and exclusion criteria were considered to identify specific components within the studies. Four studies were identified as relevant after being assessed through the critical appraisal tool CASP. Two qualitative in vivo experiments on 58 humans and 54 rats. One in vivo study analyzed qualitative and quantitative data from 133 mice and a final study giving quantitative data from an in vitro experiment on macrophages. All participants were diagnosed with either acute or chronic rheumatoid arthritis, whilst receiving a variation of dosages and routes of administration, with a collation of data and observations from both before and after administration of the CBD treatment. The reviewed studies highlighted no significant adverse reactions from the use of the CBD therapeutics in the varying dosages and routes of administration. From these four studies there is evidence to suggest that there are benefits of CBD as a therapeutic in terms of inflammation, three of the studies specifically found a reduction in the inflammatory marker TNF-α caused by RA after administration of the various therapeutic interventions and dosages. There is a requirement for more human clinical trials to determine the anti- inflammatory properties, the safety, dosage, route of administration and efficacy of CBD in humans with RA.

Tuberculous Arthritis: A Forgotten Diagnosis During Pandemic Covid-19

Tuberculosis (TB) is a respiratory disease that primarily affects the lungs. The challenge is to recognize the characteristic of TB disease, including extrapulmonary presentation. TB arthritis is an extrapulmonary TB presentation in the joint, which is frequently neglected and misdiagnosed. A 41-year-old female patient was presented with a major complaint of chronic pain in her left wrist for three months. The patient had a low-grade fever without respiratory symptoms. Local examination revealed swelling, warmth and tenderness. Erythrocyte sedimentation rate (ESR) was increased and chest radiograph demonstrated pulmonary TB. She underwent arthrotomy debridement and culture examination. We initiated adjuvant anti-tuberculous treatment. On the evaluation, she reported relief from pain and showed improvement in general condition. TB arthritis is unique due to its rare incidence and unspecific clinical manifestations. A better understanding of these issues will prevent possible diagnostic errors. Prompt treatment was crucial to maintain joint function and prevent permanent destruction.

Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis.

Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient's overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the "Physiotherapy Pyramid") aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.

Reconstruction of Severe Osteolytic Malleoli using Femoral Head Allograft in a Revision Total Ankle Replacement: A Case Report

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Case: A 38-year-old male patient presented with severe pain in the left ankle who underwent a total ankle replacement (TAR) and syndesmotic fusion for end-stage ankle osteoarthritis (OA) 13 years ago. Radiographic evaluation showed implant loosening and extensive osteolytic lesion of both malleoli. Revision was performed using a three-component TAR system and reconstruction of the malleoli with femoral head allograft. Methods: N/A Results: N/A Conclusion: Reconstruction of severe osteolytic lesions of the malleoli with femoral head allograft in the setting of revision TAR allowed to create a stable bone stock, implant anchorage, desirable stability and therefore maintaining joint function.

Progress and prospect of technical and regulatory challenges on tissue-engineered cartilage as therapeutic combination product.

Hyaline cartilage plays a critical role in maintaining joint function and pain. However, the lack of blood supply, nerves, and lymphatic vessels greatly limited the self-repair and regeneration of damaged cartilage, giving rise to various tricky issues in medicine. In the past 30 years, numerous treatment techniques and commercial products have been developed and practiced in the clinic for promoting defected cartilage repair and regeneration. Here, the current therapies and their relevant advantages and disadvantages will be summarized, particularly the tissue engineering strategies. Furthermore, the fabrication of tissue-engineered cartilage under research or in the clinic was discussed based on the traid of tissue engineering, that is the materials, seed cells, and bioactive factors. Finally, the commercialized cartilage repair products were listed and the regulatory issues and challenges of tissue-engineered cartilage repair products and clinical application would be reviewed.

Recommendations for the use of imaging and management of osteoarthritis in the light of current guidelines

Osteoarthritis (OA) is the most common disease of joints, affecting over 300 million people. It is characterised by joint pain and stiffness, leading to joint dysfunction over time. This paper presents current recommendations for the use of imaging (published by EULAR) and management of OA (issued by EULAR, ACR and NICE). The goal of the treatment is to control symptoms of the disease, maintain joint function and maximise patient’s performance.

Distal femur aneurysmal bone cyst treated with two stages of surgery in the pandemic COVID-19 by excision-skeletal traction and endoprosthesis replacement: a case report

Introduction: An aneurysmal bone cyst (ABC) is benign but has a progressive nature that can cause severe problems if it occurs close to joints such as the knee. The ultimate goal of treatment is to remove the tumor, maintain limb function, and prevent a recurrence. Local therapy is still better than tumor resection. This study aims to describe a rare case about distal femur ABC treated with two stages of surgery in the pandemic COVID-19 by excision-skeletal traction and endoprosthesis replacement. Case description: A 31-year-old woman presented with a lump on the right knee. The patient has complained of limping. Open biopsy was performed, and the patient was confirmed to have ABC on the distal of her right femur. The patient had a leg length discrepancy of 8 cm. We decided to do skeletal traction first. One week after the skeletal traction, the patient undergoes endoprosthesis replacement. Conclusion: The management of wide excision of the tumor requires special postoperative attention. This is because aggressive measures can reduce the recurrence rate of tumors, but large reconstructions are also needed to maintain joint function.

Progress on surgical treatment for elbow tuberculosis

Elbow tuberculosis is a rare disease of infectious osteoarthritis. The aim of operation for elbow tuberculosis is to maintain joint function, ensure stability of joint and improve quality of life, while there were controversies about the implementation details of different procedures. For elbow tuberculosis at an advanced stage, the clinical effect of forked osteotomy arthroplasty is effective and could meet with most patients without demand of strength. However, arthrodesis is only recommended for heavy manual workers with high demand of strength, and making research on the optimal fusion angle could improve satisfaction of patients. For elbow tuberculosis at the early stage, there were few reports about interposition arthroplasty, which has a recommendation of lower degree. Otherwise, hinged external fixator with arthrolysis is main procedure for its safety, effective clinical effects, and less recurrence of inflammation, the optimal approach of arthrolysis is the research focus at present. Elbow arthroscopic surgery could not only treat the simple synovial tuberculosis of elbow joint under arthroscope, but also improve positive rate under arthroscopic, and it is recommended to be used at the early unclear diagnosis of swelling and pain of chronic elbow joint. In addition, total elbow arthroplasty may be an option for patients with high functional requirements in the future.

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Periprosthetic joint infection (PJI) is a catastrophic complication of shoulder arthroplasty. Commonly used surgical treatments include one- or two-stage revision, but their effectiveness in controlling infection is uncertain. We aimed to compare re-infection (recurrent and new infections) rates; clinical measures of function and pain; and noninfection complication rates of one- and two-stage revision surgery for shoulder PJI using a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library to February 2018. Longitudinal studies conducted in patients with shoulder PJI treated exclusively by one- or two-stage revision were eligible. No clinical trials were identified. Re-infection rates were meta-analysed using random-effect models after arcsine transformation. The re-infection rate (95% CI) in pooled analysis of eight one-stage studies (147 participants) was 5.3% (1.4–10.6). The corresponding rate for 27 two-stage studies (351 participants) was 11.5% (6.0–18.1). Postoperative clinical measures of function and pain were not significantly different between the two revision strategies. The pooled noninfection complication rate (95% CI) for one-stage and two-stage revision was 12.1% (6.1–19.5) and 18.9% (8.4–31.9) respectively. New evidence suggests one-stage revision is at least equally as effective as the two-stage in controlling infection, maintaining joint function, and improving complications in shoulder PJI.

Research progress of knee-salvage treatment for knee osteoarthritis

To review the progress of knee-salvage treatment based on the step therapy idea for knee osteoarthritis (KOA). The domestic and foreign literature in recent years was searched, and the treatments of KOA at different stages were summarized and analyzed. The treatment of KOA is aimed at alleviating symptoms, delaying structural changes of joints, maintaining joint function, and improving quality of life. So the conservative treatment is still the first choice for KOA at early stage. Arthroscopic surgery can assist in the diagnosis and classification, simultaneously remove the intra-articular irritants, and limitedly repair the cartilage. Osteotomy is suitable for the KOA with abnormal lower extremity weight bearing line and articular line. And it can effectively balance the weight bearing stress of knee joint, improve the clinical symptom, and alleviate the progression of disease. Joint distraction can improve the mechanical environment of knee joint and repair the defect cartilage partly. With the technical development, unicompartmental knee arthroplasty (UKA) is back in fashion in recent years. It is a kind of real joint surface replacement, which is an important means of knee preservation method in patients with anterior medial KOA. At present, there are many knee-salvage treatments based on the severity of the disease. Osteotomy and UKA are the most widely used and successful surgical techniques for knee preservation. However, the indications should be properly selected, and the surgeon should accumulate enough clinical experience. Otherwise, it is difficult to achieve good results.

Analgesic efficacy and safety of non-prescription doses of naproxen sodium in the management of moderate osteoarthritis of the knee or hip

Objectives: Current osteoarthritis therapies aim to alleviate pain and maintain joint function. Non-prescription oral non-steroidal anti-inflammatory drugs are frequently used alone for pain relief in osteoarthritis. This post-hoc pooled analysis evaluated the analgesic efficacy and safety of two non-prescription doses of naproxen sodium for short-term use in patients with osteoarthritis of the knee or hip. A separate sub-group analysis of older patients who were administered a lower dose of naproxen sodium was performed.Methods: In four multi-center, multi-dose, randomized, parallel, double-blind, placebo-controlled studies, oral naproxen sodium (age-based dosing regimen: <65 years, 660 mg/day; ≥65 years, 440 mg/day) or placebo was administered over 7 days. Data at baseline and after 7 days in 818 patients who received naproxen sodium or placebo (n = 409 in each group) was pooled and analyzed. Five-point rating scales were used to assess knee or hip joint pain, stiffness after rest, day and night pain, and patient and investigator assessment of treatment, while function was evaluated using a timed 50-foot walk test.Results: Compared with placebo, there were significant improvements in pain and physical function with naproxen sodium (p < .05), and treatment was rated “good” to “excellent” significantly more often (p < .001) by investigators and patients. Efficacy results were similar among younger and older patients. There were no significant differences in adverse events between groups, regardless of age.Conclusions: For the acute management of underlying pain in patients with moderate osteoarthritis of the hip or knee, non-prescription naproxen sodium is effective and well tolerated in patients of all ages.

Gene-expression changes in knee-joint tissues with aging and menopause: implications for the joint as an organ.

BackgroundWhen considering the “joint as an organ”, the tissues in a joint act as complementary components of an organ, and the “set point” is the cellular activity for homeostasis of the joint tissues. Even in the absence of injury, joint tissues have adaptive responses to processes, like aging and menopause, which result in changes to the set point.PurposeThe purpose of this study in a preclinical model was to investigate age-related and menopause-related changes in knee-joint tissues with the hypothesis that tissues will change in unique ways that reflect their differing contributions to maintaining joint function (as measured by joint laxity) and the differing processes of aging and menopause.MethodsRabbit knee-joint tissues from three groups were evaluated: young adult (gene expression, n=8; joint laxity, n=7; water content, n=8), aging adult (gene expression, n=6; joint laxity, n=7; water content, n=5), and menopausal adult (gene expression, n=8; joint laxity, n=7; water content, n=8). Surgical menopause was induced with ovariohysterectomy surgery and gene expression was assessed using reverse-transcription quantitative polymerase chain reaction.ResultsAging resulted in changes to 37 of the 150 gene–tissue combinations evaluated, and menopause resulted in changes to 39 of the 150. Despite the similar number of changes, only eleven changes were the same in both aging and menopause. No differences in joint laxity were detected comparing young adult rabbits with aging adult rabbits or with menopausal adult rabbits.ConclusionAging and menopause affected the gene-expression patterns of the tissues of the knee joint differently, suggesting unique changes to the set point of the knee. Interestingly, aging and menopause did not affect knee-joint laxity, suggesting that joint function was maintained, despite changes in gene expression. Taken together, these findings support the theory of the joint as an organ where the tissues of the joint adapt to maintain joint function.

A novel composite formulation of palmitoylethanolamide and quercetin decreases inflammation and relieves pain in inflammatory and osteoarthritic pain models

BackgroundOsteoarthritis (OA) is a common progressive joint disease in dogs and cats. The goal of OA treatment is to reduce inflammation, minimize pain, and maintain joint function. Currently, non-steroidal anti-inflammatory drugs (e.g., meloxicam) are the cornerstone of treatment for OA pain, but side effects with long-term use pose important challenges to veterinary practitioners when dealing with OA pain. Palmitoylethanolamide (PEA) is a naturally-occurring fatty acid amide, locally produced on demand by tissues in response to stress. PEA endogenous levels change during inflammatory and painful conditions, including OA, i.e., they are typically increased during acute conditions and decreased in chronic inflammation. Systemic treatment with PEA has anti-inflammatory and pain-relieving effects in several disorders, yet data are lacking in OA. Here we tested a new composite, i.e., PEA co-ultramicronized with the natural antioxidant quercetin (PEA-Q), administered orally in two different rat models of inflammatory and OA pain, namely carrageenan paw oedema and sodium monoiodoacetate (MIA)-induced OA. Oral treatment with meloxicam was used as benchmark.ResultsPEA-Q decreased inflammatory and hyperalgesic responses induced by carrageenan injection, as shown by: (i) paw oedema reduction, (ii) decreased severity in histological inflammatory score, (iii) reduced activity of myeloperoxidase, i.e., a marker of inflammatory cell infiltration, and (iv) decreased thermal hyperalgesia. Overall PEA-Q showed superior effects compared to meloxicam. In MIA-treated animals, PEA-Q exerted the following effects: (i) reduced mechanical allodynia and improved locomotor function, (ii) protected cartilage against MIA-induced histological damage, and (iii) counteracted the increased serum concentration of tumor necrosis factor alpha, interleukin 1 beta, metalloproteases 1, 3, 9 and nerve growth factor. The magnitude of these effects was comparable to, or even greater than, those of meloxicam.ConclusionThe present findings shed new light on some of the inflammatory and nociceptive pathways and mediators targeted by PEA-Q and confirm its anti-inflammatory and pain-relieving effects in rodent OA pain models. The translatability of these observations to canine and feline OA pain is currently under investigation.

Abnormal tibiofemoral contact kinematics are related to superficial cartilage damage

Abnormal tibiofemoral contact kinematics are related to superficial cartilage damage

Articular cartilage solutions for the knee: present challenges and future direction

Articular cartilage serves a vital role in maintaining joint function by minimising friction and distributing load. While the intricate ultrastructure of articular cartilage is critical for proper function, these same properties create challenges for cartilage restoration. Articular cartilage injury can lead to pain, dysfunction and decreased athletic participation in the short term, but can progress to osteoarthritis and deteriorating function in the long term. Currently, there is good evidence that cartilage restoration techniques are effective in improving knee function, but questions about durable joint surface restoration and return to high demand activity with long-term follow-up remain. Existing cartilage treatment options include marrow stimulation, osteochondral tissue transfer or transplantation, cell-free synthetic scaffolds and cell-based repair strategies. The current literature supporting these techniques is limited by heterogeneity in surgical procedures, lesion and patient characteristics, and reporting of non-standardised outcome measures. Therefore, often an individualised approach based on the patient's goals and surgeon preferences is necessary. In this state of the art review, we evaluate the current knowledge, practice, evidence, and surgical techniques for available cartilage restoration options. In addition, we discuss future strategies to manage articular cartilage injuries to enhance the biological quality of the repair tissue to improve clinical outcomes.

Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice

This clinical review discusses the organization, neuroanatomy, assessment, clinical relevance, and rehabilitation of sensorimotor (SM) control impairment after wrist trauma. The wrist SM control system encompasses complex SM pathways that control normal wrist active range of motion and mediate wrist joint neuromuscular stability for maintaining joint function. Among various known assessment methods of wrist SM control impairment, the active wrist joint position sense test is determined to be a clinically meaningful and responsive measure for wrist SM control impairment after wrist fracture. Wrist trauma may involve significant soft tissue injury (ie, skin, ligament, muscle), which could disrupt the generation and transmission of adequate proprioceptive input from wrist mechanoreceptors, thus leading to significant joint SM impairment. Various clinical examples of wrist trauma (eg, distal radius fracture, scapholunate joint injury) along with known prognostic factors (eg, pain) that may influence wrist SM control impairment recovery are discussed to illustrate this point. This article proposes promising rehabilitation strategies toward restoring wrist joint conscious and unconscious SM control impairments, integrating current research evidence with clinical practice. These strategies require more rigorous evaluation in clinical trials. Level of evidence5.

Échographie et PR

Rheumatoid arthritis (RA) requires an early diagnosis to introduce DMARD quickly to prevent articular destructions and maintain joint function. For a few years, ultrasonography became inescapable in the initial evaluation of polyarthritis, because its sensibility is superior to clinical examination to search for synovitis and tenosynovitis. It also has sensibility superior to standard radiography for the research of erosions of MCP and MTP joints. The elementary lesions of RA are not specific, they can be found in healthy subjects. Future works will have to reach a consensus on the joints to be explored at the time of diagnosis and for follow-up of early arthritis.