Osteoarthritis Conditions Research Articles

Direct Reprogramming of Mouse Subchondral Bone Osteoblasts into Chondrocyte-like Cells.

Treatment of full-thickness articular cartilage defects with exposure of subchondral bone often seen in osteoarthritic conditions has long been a great challenge, especially with a focus on the feasibility of in situ cartilage regeneration through minimally invasive procedures. Osteoblasts that situate in the subchondral bone plate may be considered a potentially vital endogenous source of cells for cartilage resurfacing through direct reprogramming into chondrocytes. Microarray-based gene expression profiles were generated to compare tissue-specific transcripts between subchondral bone and cartilage of mice and to assess age-dependent differences of chondrocytes as well. On osteoblast cell lines established from mouse proximal tibial subchondral bone, sequential screening by co-transduction of transcription factor (TF) genes that distinguish chondrocytes from osteoblasts reveals a shortlist of potential reprogramming factors exhibiting combined effects in inducing chondrogenesis of subchondral bone osteoblasts. A further combinatorial approach unexpectedly identified two 3-TF combinations containing Sox9 and Sox5 that exhibit differences in reprogramming propensity with the third TF c-Myc or Plagl1, which appeared to direct the converted chondrocytes toward either a superficial or a deeper zone phenotype. Thus, our approach demonstrates the possibility of converting osteoblasts into two major chondrocyte subpopulations with two combinations of three genes (Sox9, Sox5, and c-Myc or Plagl1). The findings may have important implications for developing novel in situ regeneration strategies for the reconstruction of full-thickness cartilage defects.

Effects of Canine-Obtained Lactic-Acid Bacteria on the Fecal Microbiota and Inflammatory Markers in Dogs Receiving Non-Steroidal Anti-Inflammatory Treatment.

Simple SummaryThe use of non-steroidal anti-inflammatory drugs (NSAIDs) has prolonged the longevity and well-being of dogs with osteoarthritis and other painful conditions. However, this treatment is also associated with diarrhea in dogs, but the pathogenetic mechanisms and possible prevention strategies remain unknown. This study aimed to determine whether canine-obtained lactic acid bacteria affect the frequency of diarrhea, fecal microbiota (dysbiosis index), and gastrointestinal inflammation (assessed by calprotectin and S100A12/Calgranulin C) in dogs receiving NSAIDs. Diarrhea occurred in 4/12 dogs (33%) receiving placebo and 1/10 dogs (10%) receiving canine-obtained lactic acid bacteria (LAB), but this difference was not significant. The fecal dysbiosis index, calprotectin, and S100A12 were not significantly different between dogs receiving NSAIDs and LAB and dogs receiving NSAIDs and placebo. This study suggests that LAB is safe to use in NSAID-treated dogs, but further studies are needed to determine its potential to ameliorate diarrhea and gastrointestinal inflammation in dogs receiving NSAIDs.Non-steroidal anti-inflammatory drugs (NSAIDs) may cause enteropathy in dogs and probiotics may be one option to prevent this. The objective of this study was to determine whether the administration of canine-obtained lactic acid bacteria (LAB) has an effect on the frequency of diarrhea, the composition of the fecal microbiota, and/or markers of gastrointestinal inflammation in dogs receiving NSAIDs when compared to dogs given NSAIDs and a placebo. A total of 22 dogs treated with NSAIDs for various clinical indications were enrolled in a seven-day randomized, double-blinded placebo-controlled interventional study. Dogs were randomized to receive either placebo or LAB, a product containing Limosilactobacillus fermentum, Lacticaseibacillus rhamnosus, and Lactiplantibacillus plantarum. Fecal samples were collected on days one and seven. The fecal microbiota was evaluated using the fecal dysbiosis index (DI) and individual bacterial taxa. Fecal calprotectin (CP) and S100A12/Calgranulin C concentrations were used as markers of gastrointestinal inflammation. There was a difference in frequency of diarrhea between groups, with it affecting 4/12 dogs (33%) in the placebo group and 1/10 dogs (10%) in the LAB group, but this difference did not reach statistical significance (p = 0.32). There was a correlation between S100A12 and CP (p < 0.001), and Clostridium perfringens correlated with S100A12 (p < 0.015). Neither treatment significantly affected S100A12 (p = 0.37), CP (p = 0.12), or fecal DI (p = 0.65). This study suggests that LAB is a safe supplement to use for short-term treatment in NSAID-treated dogs, but further studies are needed to determine its potential to prevent NSAID-induced enteropathy in dogs.

PROXIMAL TIBIAL SLIDING OSTEOTOMY AS AN ALTERNATIVE SOLUTION FOR PATIENTS WITH PROXIMAL TIBIAL BONE DEFECT AFTER NEGLECTED TIBIAL PLATEAU FRACTURES UNDERGOING TOTAL KNEE ARTHROPLASTY: A CASE REPORT

Trauma case to the joints, especially the knee joint is a difficult and challenging case to manage. In the initial conditions of trauma, this case may be relatively more rational to do reduction and fixation. However, in cases of delayed treatment, it will be a challenge for an orthopedic, where in the late condition, the knee joint will degenerate earlier and becomes early osteoarthritis. The therapy that can be done depends on the severity of the joint damage itself. One of the actions that can be taken in severe conditions of osteoarthritis is Total Knee Arthroplasty (TKA). But if the defect is very large, a special additional tool is usually needed, which will also be more expensive. We report a 51 years old female patient with secondary osteoarthritis and severe depressed in the medial proximal tibia due to neglected tibial plateau fracture. The patient had a total knee arthroplasty performed with an oblique osteotomy on the medial side of the tibial plateau and shifting it proximally to cover the defect area. The operation went smoothly and the implant used was a primary Posterior Stabilized (PS) TKA implant without metal augmentation. After the procedure, the patient's knee is reassessed. There was improvement in knee deformity, with good stability and full range of motion of the knee. The purpose of this paper is to demonstrate a sliding osteotomy technique for medial proximal tibia in Total Knee Arthroplasty, with the hope of being an alternative solution and reducing additional costs for osteoarthritis cases with a severe defect in the medial proximal tibia.

Functionalized Nanogels with Endothelin-1 and Bradykinin Receptor Antagonist Peptides Decrease Inflammatory and Cartilage Degradation Markers of Osteoarthritis in a Horse Organoid Model of Cartilage.

Osteoarthritis (OA) is a degenerative and heterogeneous disease that affects all types of joint structures. Current clinical treatments are only symptomatic and do not manage the degenerative process in animals or humans. One of the new orthobiological treatment strategies being developed to treat OA is the use of drug delivery systems (DDS) to release bioactive molecules over a long period of time directly into the joint to limit inflammation, control pain, and reduce cartilage degradation. Two vasoactive peptides, endothelin-1 and bradykinin, play important roles in OA pathogenesis. In this study, we investigated the effects of two functionalized nanogels as DDS. We assessed the effect of chitosan functionalized with a type A endothelin receptor antagonist (BQ-123-CHI) and/or hyaluronic acid functionalized with a type B1 bradykinin receptor antagonist (R-954-HA). The biocompatibility of these nanogels, alone or in combination, was first validated on equine articular chondrocytes cultured under different oxic conditions. Further, in an OA equine organoid model via induction with interleukin-1 beta (IL-1β), a combination of BQ-123-CHI and R-954-HA (BR5) triggered the greatest decrease in inflammatory and catabolic markers. In basal and OA conditions, BQ-123-CHI alone or in equimolar combinations with R-954-HA had weak pro-anabolic effects on collagens synthesis. These new nanogels, as part of a composite DDS, show promising attributes for treating OA.

Efficacy of Tui-na for Treatment of Osteoarthritis: A Systematic Review and Meta-analysis

Osteoarthritis (OA) is one of the most common causes for chronic joint pain in canine patients. The objective of this systematic review and meta-analysis study was to determine whether Tui-na can be an effective treatment for osteoarthritis when performed alone or part of a multi-modal approach. All studies using Tui-na as a treatment for OA published in peer-reviewed journals were considered in initial search results. To be included in the meta-analysis, the study must have reported statistical results associated with one of the following endpoints: 1) relief of pain; 2) improvement of mobility; 3) improved quality of life. There were 10 articles in experimental OA animal models and 18 in human clinical studies that met inclusion criteria. Overall p-value on experimental OA animal model studies was 4.47×10-11, suggesting that Tui-na treatments were significantly effective when compared to model control animals not receiving treatments. Overall p-value on human studies was 6.74×10-13, also suggesting that Tui-na treatments can be effective for treating OA-related diseases in human patients. With treatment effective rate available in 14 human studies, meta-analysis performed with effect size model revealed a significant overall group effect (p = 6.72×10-10), suggesting patients treated with Tui-na can have a higher effective rate than those treated without receiving Tui-na. The positive results on experimental model and human clinical studies indicate that Tui-na treatments have potential to be an effective treatment option for veterinary patients with OA conditions.

CircSCAPER knockdown attenuates IL-1β-induced chondrocyte injury by miR-127-5p/TLR4 axis in osteoarthritis

Purpose Osteoarthritis (OA) is a chronic inflammatory degenerative disease characterized by articular cartilage degradation. Circular RNAs have been shown to play significant roles in OA process. Herein, this work aimed to investigate the potential role and mechanism of circSCAPER in OA progression. Methods Levels of circSCAPER, miR-127-5p and toll-like receptor 4 (TLR4) were detected by qRT-PCR or western blotting. Cell apoptosis was determined by flow cytometry. The expression of Aggrecan and Matrix metallopeptidase was examined using western blot to assess extracellular matrix (ECM) degradation. Inflammatory response and oxidative stress were determined by measuring the release of inflammatory factors, along with the generation of intracellular reactive oxygen species and malondialdehyde. The interaction between miR-127-5p and circSCAPER or TLR4 was determined by dual-luciferase reporter, RNA immunoprecipitation and pull-down assays. Results Chondrocytes were treated with interleukin-1β (IL-1β) to mimic OA condition in vitro. CircSCAPER was increased in OA cartilages and IL-1β-induced chondrocytes. Functionally, knockdown of circSCAPER attenuated IL-1β-evoked apoptosis, ECM degradation, inflammation and oxidative stress in vitro. CircSCAPER up-regulation in OA cartilages was discovered to be accompanied by decreased miR-127-5p and increased TLR4. Mechanistically, circSCAPER acted as a sponge for miR-127-5p to positively regulate TLR4 expression in chondrocytes. IL-1β treatment reduced miR-127-5p expression but up-regulated TLR4 expression, re-expression of miR-127-5p suppressed IL-1β-caused chondrocyte injury, which was abolished by TLR4 overexpression. Moreover, miR-127-5p inhibition reversed the protective action of circSCAPER knockdown on chondrocytes under IL-1β treatment. Conclusion CircSCAPER silencing protected against IL-1β-induced apoptosis, ECM degradation, inflammation and oxidative stress in chondrocytes via miR-127-5p/TLR4 axis.

LncRNA CRNDE hinders the progression of osteoarthritis by epigenetic regulation of DACT1.

Osteoarthritis (OA) is mainly characterized by articular cartilage degeneration, synovial fibrosis, and inflammation. LncRNA CRNDE (colorectal neoplasia differentially expressed) has been reported to be down-regulated in age-related OA, but its role in injury-induced OA needs to be further explored. In this study, an OA rat model was established using anterior cruciate ligament transection, and the adenovirus-mediated CRNDE overexpression (Ad-CRNDE) or DACT1 (dapper antagonist of catenin-1) interference (sh-DACT1) vectors were administered by intraarticular injection. Moreover, chondrocyte‑like ATDC5 cells were treated with IL-1β (10ng/mL) to simulate OA conditions in vitro. We found that overexpression of CRNDE alleviated cartilage damage and synovitis in OA rats, and suppressed IL-1β-induced apoptosis, inflammation, and extracellular matrix (ECM) degradation in chondrocyte‑like ATDC5 cells, while silencing DACT1 effectively antagonized the protective effect of CRNDE both in vivo and in vitro. Mechanism studies revealed that DACT1 could act as a downstream target of CRNDE. By recruiting p300, CRNDE promoted the enrichment of H3K27ac in the DACT1 promoter, thus promoting DACT1 transcription. In addition, CRNDE hindered the activation of the Wnt/β-catenin pathway in IL-1β-stimulated cells by inducing DACT1 expression. In conclusion, CRNDE promoted DACT1 expression through epigenetic modification and restrained the activation of Wnt/β-catenin signaling to impede the progression of OA.

Tannic Acid-mediated Multifunctional 3D Printed Composite Hydrogel for Osteochondral Regeneration.

Hydrogels have become an attractive option for tissue repair. A novel multifunctional hydrogel was developed using a two-step method involving photopolymerization and tannic acid (TA) solution incubation. The mechanical properties of this hydrogel were enhanced by the multi-hydrogen bond interaction between the TA and N-acryloyl glycinamide/gelatin methacrylate (NAGA/GelMA). The compressive modulus was doubled. The compressive strengths of the hydrogel were 5.5 MPa. The swelling rate was reduced by a factor of three. The adhesion strength of the composite hydrogel reached 80 KPa. The TA-mediated NAGA/GelMA/Laponite composite hydrogel exhibited excellent anti-fatigue and anti-oxidation properties, as well as printability. In vitro experiments indicated that the TA-mediated hydrogel facilitated the proliferation of bone marrow mesenchymal stem cells and osteogenic and chondrogenic differentiation. The developed multifunctional composite hydrogel has great potential for osteochondral defect repair under osteoarthritis conditions.

Atomic force microscope observation of the surfaces of natural articular cartilage

Hydrophilic and negatively charged natural cartilage surface is covered by phospholipids bilayers. These phospholipids have been demonstrated to exert highly desirable characteristics on the surface articular cartilage such as efficient lubrication, load processing, and semipermeability for nutrient transport. We examined a bovine cartilage (BC) surface using atomic force microscope. The study was performed using cartilage samples with healthy surfaces and completely depleted surface phospholipids. The artificially degraded cartilage surfaces (lipid depleted) were resurfaced with different species and combinations of synthetic bilayer of phospholipids found in human joints. Our results demonstrated that it is possible to recreate a potentially viable layer of phospholipids on the surface of degenerated cartilage. However, further studies will be required to advance the resurfacing idea developed in this paper for the potential treatment of osteoarthritis and other related orthopedic joint conditions.

Efficacy of Cabbage Leaf versus Cooling Gel Pad or Diclofenac Gel for Patients with Knee Osteoarthritis: A Randomized Open-Labeled Controlled Clinical Trial.

Background Osteoarthritis (OA) is one of the most common joint degeneration ailments adversely affecting the elderly population by impairing their physical movements and quality of life. This study aimed to establish the efficacy of cabbage leaf application in alleviating pain-related distress and positively improving OA conditions. Materials and Methods Patients with moderate to severe (grades 3-4) OA by the Kellgren and Lawrence grading system with a poor to good Oxford Knee Score were selected for enrollment in this clinical trial. The participants were divided into three intervention groups: the cooling gel pad group for 20 minutes duration once a day (n = 20), the diclofenac gel group for 4 times a day (n = 20) as the control group (total n = 40), and the cabbage leaf group for 1-hour duration once a day (n = 20) as the experimental group (total n = 20). All trial participants were trained to record their Numerical Rating Scale (NRS) pain score and Oxford Knee Score and were advised to undergo weekly follow-ups and assessment of the outcome at 4 weeks. Data were analyzed by the paired t-test and analysis of variance (ANOVA). Results The cabbage leaf group and cooling gel pad group showed a significant difference in both the Oxford Knee Score (p < 0.001 in both groups) and NRS score (p < 0.001 in both groups) before and after the intervention, by using the paired t-test. The three study procedures were found to be significantly different with respect to both the Oxford Knee Score (p=0.012) and NRS score (p < 0.001), by using ANOVA. Conclusion This study clinically demonstrated that cabbage leaf application and cooling gel pad application showed similar improvements in reducing OA symptoms in terms of the overall NRS score and Oxford Knee Score. Their therapeutic effectiveness was better than that of diclofenac gel.

Apple polyphenols exhibits chondroprotective changes of synovium and prevents knee osteoarthritis

Apple polyphenols (AP) have strong antioxidant and anti-inflammatory properties. We examined the effects of AP on the progression of osteoarthritis (OA) AP was administered to surgically-induced OA model rats for 4 or 8 weeks. This treatment suppressed inflammation and oxidative stress in the synovium, resulting in a decrease in the OA severity score, and the expression of tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMP)-13 in the synovium. It was suggested that long-term administration of AP may be effective for the treatment of OA. In addition, superoxide dismutase (SOD) activity was enhanced in serum samples by AP. AP or its constituent procyanidin B2 (PC) were added to HIG-82 synoviocytes. The results showed that AP enhanced cell proliferation and hyaluronan production. This indicates that AP may improve synovial conditions in OA and suppress OA progression. These effects may be attributed to the antioxidant and anti-inflammatory properties of AP.

The silencing of miR-199a-5p protects the articular cartilage through MAPK4 in osteoarthritis.

BackgroundOsteoarthritis (OA) is the most common joint disorder, and places a heavy burden on individuals and society. As conventional therapies, such as surgery, rarely cure the disorder, targeted therapies represent a promising alternative. This research sought to explore the potential effect of miR-199a-5p on the development of OA.MethodsBased on the OA rat model, the serum was collected at 6 and 12 weeks, and microRNA (miRNA) sequencing was performed. A bioinformatics analysis was conducted to examine the differentially expressed micro ribonucleic acids, and qRT-PCR (real-time quantitative PCR) was conducted to determine their expression in the joint tissues of rats with OA. Rats articular chondrocytes were collected and treated with a miR-199a-5p antagomir or agomir. Afterwards, cell viability, autophagy was determinated. Dual luciferase was used to verify that miR-199a-5p targets the regulation of mitogen-stimulated protein kinase 4 (MAPK4). Subsequently, in chondrocytes, MAPK was knockdown to rescue the effect of miR-199a-5p inhibition, and cell viability and autophagy were examined. Finally, the OA model was treated with miR-199a-5p antagomir to detect joint pathology, cartilage tissue and inflammatory factor and autophagy was measured.ResultsMiR-199a-5p was greatly upregulated in OA, and miRNA was found to be differentially expressed in OA tissues. MAPK4 was identified to be a target gene of miR-199-5p. Inhibiting miR-199a-5p not only decreased the survival of chondrocytes and induced apoptosis, but also relieved inflammation and decreased the content of pro-inflammatory cytokines. Further, the silencing of miR-199a-5p protected the articular cartilage and improved gait abnormalities, but this effect was abrogated by the silencing of MAPK4.ConclusionsThe silencing of miR-199a-5p appears to improve gait abnormalities, promote the survival of chondrocytes, and improve the condition of OA. Our findings may lead to the development of miR-199a-5p-based targeted therapy for OA.

E3 ubiquitin ligase ITCH improves LPS-induced chondrocyte injury by mediating JAG1 ubiquitination in osteoarthritis

ITCH is an E3 ubiquitin ligase associated with some inflammatory diseases, but its role in osteoarthritis (OA) remains to be explored. Here, we investigated the effects of ITCH in OA-induced chondrocyte damage and its potential mechanisms. Here, we found that ITCH was downregulated, while JAG1 was upregulated in OA tissues compared to normal cartilaginous tissues. And primary human chondrocytes were induced by LPS to simulate OA condition. Overexpressing ITCH or silencing JAG1 promoted proliferation, and restrained apoptosis, inflammation and extracellular matrix (ECM) degradation in LPS-stimulated chondrocytes. Mechanistically, ITCH bound to JAG1 protein through the WW-PPXY motif and degraded it via K48 ubiquitination. JAG1 overexpression reversed the protective effect of ITCH on LPS-induced chondrocyte damage. ITCH prevented LPS-caused Notch1 signaling activation by suppressing JAG1. Furthermore, GSI (a Notch specific inhibitor) abrogated the effects of ITCH knockdown on chondrocyte injury. Additionally, a mouse OA model was established by destabilization of the medial meniscus operation, and H&E and Safranin O-fast green staining was used to evaluate articular cartilage damage. And ITCH overexpression alleviated OA-induced articular cartilage damage in vivo. In conclusion, ITCH mitigated LPS-induced chondrocyte injury and OA-induced articular cartilage damage through attenuating Notch1 pathway activation by degrading JAG1 via ubiquitination, which provides a novel strategy for the treatment of OA.

Awareness of Osteoarthritis among Housewives of Pakistan

Osteoarthritis (OA) is the most common articular disorder that causes chronic disability because of the progressive resorption of bone and cartilage and results in joint failure specifically in elder population. Its incident rate varies according to region and ethnicity. A cross-sectional study was conducted among 191 housewives belonging to Lahore,Islamabad and other major cities of Pakistan in 2017 to assess the awareness level of OA. Data were collected through a structured questionnaire that included personal details of participants, their awareness about osteoarthritis, its causes, treatment, and its effects. Then, data were analyzed by using SPSS and appropriate statistical tests like Chi-squaredfor different variables. Almost 40% of the population sample belonged to 30-40 years of age group. Overall, about 39% participants had awarenessabout various aspects of OA and 57% individual had the awareness about the general information of OA. Awareness about factors affecting the OA condition was the lowest, only 24% individuals had the self-awareness about this. In this study, there was no significant association between the aspects about the awareness of OA with different age groups. Most housewives of Lahore and other areas of Pakistan had poor to moderate awareness of OA. Proper awareness of OA will result in the better understanding of promising management modalities for the treatment of OA.

IDENTIFICATION OF TRANSCRITPION FACTORS RESPONSIBLE FOR TRANSFORMING GROWTH FACTOR-β-INDUCED HYPERTROPHY IN OSTEOARTHRITIC CHONDROCYTES

Purpose: During osteoarthritis (OA) hypertrophic chondrocytes are observed in cartilage which are thought to contribute to the disease process. In healthy cartilage, transforming growth factor-β (TGF-β) prevents such hypertrophic differentiation and maintains chondrocyte homeostasis. However, with OA, TGF-β levels are increased and more permanently active. This leads to the activation of different signaling pathways and gene expression in chondrocytes under OA conditions than in a healthy joint.

The Science of Placebo, to Understand the Importance of Placebo Effects in OA:

A placebo is an inert substance that produces beneficial therapeutic effects. In the context of clinical trials, the placebo response refers to an improvement in symptoms in study participants assigned to placebo treatment. High placebo responses pose a substantial impediment to distinguishing active treatment effects and may in part account for the failure to identify effective treatments in clinical trials in osteoarthritis (OA) and other conditions. The treatment response to placebos has been to linked to an effect on opioid receptors in the brain.

Biogenic Phytochemicals Modulating Obesity: From Molecular Mechanism to Preventive and Therapeutic Approaches.

The incidence of obesity and over bodyweight is emerging as a major health concern. Obesity is a complex metabolic disease with multiple pathophysiological clinical conditions as comorbidities are associated with obesity such as diabetes, hypertension, cardiovascular disorders, sleep apnea, osteoarthritis, some cancers, and inflammation-based clinical conditions. In obese individuals, adipocyte cells increased the expression of leptin, angiotensin, adipocytokines, plasminogen activators, and C-reactive protein. Currently, options for treatment and lifestyle behaviors interventions are limited, and keeping a healthy lifestyle is challenging. Various types of phytochemicals have been investigated for antiobesity potential. Here, we discuss pathophysiology and signaling pathways in obesity, epigenetic regulations, regulatory mechanism, functional ingredients in natural antiobesity products, and therapeutic application of phytochemicals in obesity.

MANAGEMENT OF PHYSIOTHERAPY IN THE CASE OF OSTEOARTHRITIS GENU DEXTRA IN KRAKATAU MEDIKA HOSPITAL

Background: Osteoarthritis is also known as calcification of the joints. The main disorder of osteoarthritis is the breakdown of joint cartilage. Joint cartilage is a joint component that lines the ends of bones in joints, functions as a cushion and shock absorber when two bones collide when the joint is moved (1) Complaints of joint pain usually come and go and attack only a few joints. In&#x0D; &#x0D; &#x0D; the early stages, joint pain occurs after strenuous physical exercise and then disappears after rest. The complaint then progresses to joint stiffness when you wake up in the morning which disappears within 15-30 minutes and decreases after being moved (2). Objective: to determine the management of physiotherapy in the condition of genu dextra osteoarthritis at the Krakatau medika hospital. Method: quantitative research with cross sectional design. Measurement of research variables was only done once by observation. Results: The patient did the examination, there was motion pain in the right knee joint, limited right knee LGS, decreased muscle strength. Parameters used to evaluate pain using a vase, LGS with Goneo Meter, muscle strength with MMT. Patients have difficulty walking long distances, squatting to standing, for toileting, limited range of motion, decreased muscle strength. In this case the management given is MWD, Tens, exercise therapy (isometric exercise, Hold Relax). Conclusion: Giving these three modalities greatly affects the condition of knee osteoarthritis, which can help prevent and treat problems such as:1. reduce pain in the knee starting from tenderness and movement using the VDS scale, 2. increasing the range of motion of the joint with a goneometer, 3. increasing muscle strength with MMT, 4. increasing the patient's functional activity with the jette scale. Suggestion: Physiotherapists are advised to always try to improve knowledge so as to identify problems that can arise in patients and can perform appropriate physiotherapy interventions for successful therapy.

Post Hoc Analysis of Predictors of Clinical Response to Repository Corticotropin Injection in Persistently Active Rheumatoid Arthritis.

IntroductionA phase IV clinical trial confirmed the safety and efficacy of repository corticotropin injection (RCI, Acthar® Gel) in patients with refractory rheumatoid arthritis (RA) that was nonresponsive to standard-of-care therapies. The objective of this post hoc analysis was to identify baseline demographics and clinical characteristics that may be predictors of response to RCI.MethodsThe phase IV trial was a two-part, randomized, placebo-controlled withdrawal study. Post hoc analysis was conducted with the open-label portion of the trial data, in which all 258 subjects received RCI (80 U) twice weekly for 12 weeks. Responders were subjects who achieved low disease activity (LDA) by a Disease Activity Score with 28-joint count and erythrocyte sedimentation rate (DAS28-ESR) of < 3.2 at week 12. Responders were compared with nonresponders by assessing the proportion of subjects in each group for demographics and clinical characteristics, including weight, disease duration, medical history including osteoarthritis and unrelated joint conditions, hemoglobin A1c, C-reactive protein, ESR, DAS28-ESR, Clinical Disease Activity Index (CDAI), depression, anxiety, tender joint count (TJC), and swollen joint count (SJC). Bivariate analysis followed by multiple logistic regression analysis were conducted to identify significant baseline predictors for the outcome of achieving LDA by week 12.ResultsBivariate analysis showed that RCI responders had significantly lower baseline TJC (p = 0.0310), SJC (p = 0.0018), ESR (p = 0.0487), and CDAI (p = 0.0112) and shorter RA disease duration (p = 0.0446). Subjects were less likely to achieve LDA if they had osteoarthritis (p < 0.0001), other joint-related conditions unrelated to RA (p < 0.0001), anemia (p = 0.0132), depression (p = 0.0006), or prior or concomitant use of targeted-synthetic or biologic disease-modifying antirheumatic drugs (p < 0.0001). Multiple logistic regression analysis revealed that, of the above, only ongoing osteoarthritis (p = 0.0272) or other joint-related conditions (p = 0.0193) were significant negative predictors of RCI response.ConclusionsThese results identify specific patient characteristics that may be considered predictors of positive or negative clinical response to RCI.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-022-00429-w.

A pilot clinical study to manifest theefficacy of Pankajakasthuri orthoherb cream/thermagel in the treatment of patients diagnosed with osteoarthritis

Osteoarthritis (OA) is a major form of arthritis associated with severe joint pain that reduces the quality of life. Various pharmacological interventions may be utilized for arthritis treatment when non-pharmacological therapy is insufficient. However, pharmacological treatment can have serious side effects and high costs. Therefore, alternative therapies have been under investigation to manage this condition. Medicinal plants and their secondary metabolites are significant as alternative treatments available for inflammatory diseases. In the current study, we investigated the efficacy of Pankajakasthuri orthoherb cream/thermagel in managing OA. A total of thirty patients over 18 years of age diagnosed with osteoarthritis were enrolled from July 1st, 2021 to August 31st, 2021 for the clinical trial. All subjects were applied with Pankajakasthuri Orthoherb cream/thermagel 1gm (pea size) at a time, externally, thrice daily with an interval of 6hours. The following clinical parameters, viz. pain, swelling, stiffness, tenderness, pain on movement, were used for evaluating the effect of Pankajakasthuri Orthoherb cream/thermagel in managing osteoarthritis conditions. The intervention was continued for one month and assessments were done before treatment and on the 10th, 20th and 30th days after the treatment. The study results showed that Pankajakasthuri orthoherb cream/thermagel in managing recorded significant improvement in the clinical condition associated with osteoarthritis within 30days of intervention when analyzed using a paired t-test. This clinical study proved that Pankajakasthuri orthoherb cream/thermagel is highly effective in managing the clinical conditions associated with osteoarthritis.