Osteoarthritis Disorders Research Articles

Chitosan/Hyaluronan and Alginate-Nanohydroxyapatite Biphasic Scaffold as a Promising Matrix for Osteoarthritis Disorders.

Regenerative medicine offers new techniques for osteoarthritis (OA) disorders, especially while considering simultaneous chondral and subchondral regenerations. Chitosan and hyaluronan were chemically bound as the chondral phase and the osteogenic layer was prepared with alginate and nano-hydroxyapatite (nHAP). These scaffolds were fixed by fibrin glue as a biphasic scaffold and then examined. Scanning electron microscopy (SEM) confirmed the porosity of 61.45±4.51 and 44.145±2.81 % for the subchondral and chondral layers, respectively. The composition analysis by energy dispersive X-ray (EDAX) indicated the various elements of both hydrogels. Also, their mechanical properties indicated that the highest modulus and resistance values corresponded to the biphasic hydrogel as 108.33±5.56 and 721.135±8.21 kPa, despite the same strain value as other groups. Their individual examinations demonstrated the proteoglycan synthesis of the chondral layer and also, the alkaline phosphatase (ALP) activity of the subchondral layer as 13.3±2.2 ng. After 21 days, the cells showed a mineralized surface and a polygonal phenotype, confirming their commitment to bone and cartilage tissues, respectively. Immunostaining of collagen I and II represented greater extracellular matrix (ECM) secretion in the biphasic composite group due to the paracrine effect of the two cell types on each other. For the first time, the ability of this biphasic scaffold to regenerate both tissue types was evaluated and the results showed satisfactory cellular commitment to bone and cartilage tissues. Thus, this scaffold can be considered a new strategy for the preparation of implants for OA.

Counseling on the Potential of Platelet Growth Factor as a Biological Agent to Overcome Osteoarthritis Disorders at Ar-Rasyid Hospital Palembang Indonesia

Growth factor is a cytokine that plays a role in triggering a series of inhibition of inflammatory processes and triggers repair of joint cartilage which acts as a shock absorber. However, the current phenomenon shows that patients are still very hesitant to take advantage of the potential of platelet growth factor as a modality for the treatment of OA. The aspect of patient ignorance related to the potential of this modality is believed to be the reason for the lack of interest in OA patients utilizing this therapeutic modality. This community service aims to increase aspects of knowledge of OA patients about the potential, benefits and possible risks of using platelet growth factor through the process of counseling and education for OA patients at Ar-Rasyid Hospital Palembang Indonesia. This counseling activity was carried out on outpatients at the polyclinic of Ar-Rasyid Hospital Palembang Indonesia. There was an increase in the response knowledge score after counseling on the potential growth factor of platelets to overcome OA, with p<0.05. The results of the study also showed that there was an increase in aspects of attitude and behavior to choose the modality of platelet growth factor therapy after thecounseling process, with p < 0.05. Counseling activities are effective in improving aspects of knowledge and patient behavior at RS Ar Rasyid Palembang Indonesia in choosing growth factor therapy modalities from platelets for OA.

MXene-aromatic thermosetting copolyester nanocomposite as an extremely wear-resistant biocompatible implant material for osteoarthritis applications

Osteoarthritis disorder ranks amongst the most common disabling chronic diseases in young and older adults worldwide. It is linked to degenerative joint diseases and frequently occurs with pain in the knee, hand, hip, and feet. This progression breaks down the cartilage and underlying bones over time and causes motion disability. Artificial bone implantation is a standard therapy to treat patients with severe osteoarthritis injuries. However, commonly-used polymeric implant materials such as polyethylene, poly(aryl ether ether ketone) (PEEK), and polymethyl methacrylate are reported to possess weak tribological properties. In this regard, the wear debris contributes to the progress of periprosthetic osteolysis, and replacement of implant might be required at later stages. This study reports the development of an extremely high wear-resistant composite including aromatic thermosetting copolyester (ATSP) matrix and titanium carbide (Ti3C2Tx) MXene nanosheets reinforcement. The tribomechanical properties of the ATSP-MXene composite were tuned by optimizing the MXene content. The ATSP-MXene is highly biocompatible with mesenchymal stem cells and possesses excellent compressive strength, hardness, and wear resistance in synovial fluid over conventional polyethylene material. Overall, the designed ATSP-MXene shows promising properties of an implant material that paves its way for future applications in medicine.

Chronotherapeutic Drug Delivery Systems – An Approach in the Management of Diseases Based on Circadian Rhythm

In recent days, chrono modulated drug delivery systems have gained the attention of researchers as the release of drug is dependent on the circadian rhythm of the disease. These systems release the drug over the right sight in the optimum amount as per the need of the body, thereby refining the sufferer amenability by decreasing frequency of dose administration. These systems are fabricated to accomplish the whole and speedy drug release, which is followed by predetermined lag time and are also known as pulsatile released systems, time-controlled systems, or sigmoid release systems. These systems are well suited for the drugs showing variation in effect with biological timing, such as drugs used in management of rheumatic arthritis, osteoarthritis, and different disorders involving inflammation. The presented review focuses on the role of chronotherapy in the management of diseases following circadian rhythm with their benefit over conventional approach and types of technologies used in their formulation.

Experimental assessment of regenerative properties of platelet rich plasma on the human skin - a review

Several studies demonstrated the favorable effects of platelet rich plasma (PRP) on the skin and promoted its wide use in clinical practice. The growth factors stored in platelet alfa-granules allow for the tissue regeneration and the main fields of application of PRP in current clinical practice are the cartilage and musculoskeletal defects, osteoarthritis and other bone disorders, chronic and difficult to heal wounds, and aesthetic procedures. The relevant number of different PRP preparation protocols may explain the inconsistency of the different clinical outcomes reported in the literature. Despite the technological advances in PRP preparation, the objective assessment of the clinical efficacy of PRP from the literature reports still is difficult due to the low homogeneity of the samples in terms of both inclusion criteria and size. Therefore, it might be useful to establish standardized and reproducible experimental models to confirm and objectively measure the effectiveness of the available clinical results. Many experimental investigations have been carried out to objectively assess the effectiveness of PRP and platelet gel on several tissues. As far as the skin is concerned, the studies carried out to date are limited to fibroblasts in in-vitro culture models or to collagen, vascular supply, epithelium, and hair follicle in in-vivo models. The skin, however, is a very complex organ, where different cell lines coexist and feature complex mutual interaction. A model that combines the advantages of both in-vitro and in-vivo cultures is the ex-vivo model. The demonstration of the platelet derived growth factors effects through the ex-vivo human full-thickness skin culture model is a keystone to support the evidence of the PRP effectiveness, as it represents an objective, fast, reproducible, and ethical investigational method.

Prevalence of osteoarthritis disorders in Iranian chemical injured patients: A cross-sectional study using the COPCORD approaches

Introduction: Osteoarthritis is considered as the most common joint disease. Sulfur mustard (SM) is a toxic compound, which was applied as a chemical warfare agent by Iraq against Iran veterans during 1980-1988. Chemical veterans suffer from chronic implications caused by sulfur mustard that not only adversely affect their quality of life, but also restrict their working abilities and their participation in social activities. This study aims to consider the prevalence of osteoarthritis disorders among Iranian SM-exposed veterans. Methods: In this cross-sectional study, 248 Iranian SM exposed patients were evaluated from 2013 to 2014. Veterans filled a special questionnaire for COPCORD studies and then general and specific rheumatology examinations were applied under the supervision of internists and rheumatologists. The obtained data from 245 filled questionnaires were analyzed by SPSS software and the results were reported as a percentage or mean ±SD. Results: Bone and joint pain (72%), knee joint pain (52.5%), Joint stiffness (49.2%), and shoulder joint pain (45.8%) were the most common type of complications in these patients. Osteoarthritis in at least one joint was the most common type of osteoarthritis in veterans. 69.5% of veterans had osteoarthritis in at least one joint. Knee osteoarthritis was the secondmost common type of osteoarthritis, which has been found in 58.4% of all veterans. The prevalence of neck osteoarthritis in all veterans was 23.9%. Conclusion: The total prevalence of musculoskeletal disorders among Iranian veterans was significantly higher than the average of society.

Diz Osteoartritinde Tanı İçin Termal Görüntü İşlemenin Uygulanması

Bu çalışmanın amacı, Osteoartrit rahatsızlıklarını kızılötesi görüntü işleme yöntemini kullanarak erken teşhis edebilmektir. Çalışmamızda termal görüntüler farklı kişilerden alınmış olup CNN (Convolutional Neural Networks) yöntemini kullanılarak işlenmiştir. Gerçekleştirilen uygulama, ortopedi tetkik mekanizmasında Osteoartrit ön teşhisinde kullanılarak hastaların gereksiz yere radyasyona maruz kalmasını önlemek, ortaya çıkacak maddi yükün tedavinin ileri aşamalarında daha gerekli yerlerde harcanmasını sağlamak ve zaman açısından tasarruf edebilmek için planlanmıştır.

PENDAMPINGAN LANSIA DALAM KONTEKS MENJAGA KESEHATAN FISIK DI POSYANDU LANSIA KENTINGAN KULON JEBRES SURAKARTA

Background : Regular health checks and good exercise can maintain the health of the elderly so that there is no drastic decline. Routine health checks aim to control the health of the elderly on a regular basis so that they can find out what is happening. The obstacles encountered in the partner groups are the lack of awareness of the elderly in maintaining health due to busy work and other activities. Output: increased knowledge of partner groups about health and how to protect them. Method: health education, routine health checks, therapy and exercise to maintain the health of the elderly. Results: after counseling and health assistance before and after the provision of information increased knowledge. Prior to counseling knowledge of the elderly on osteoarthritis disorders by 32% and low back pain by 36%. After being given information, there was an increase of 64% knowledge of osteoarthritis disorders and by 72% knowledge of low back pain disorders. Conclusion: an increase in knowledge in the elderly about osteoarthritis disorders and low back pain.

Management of muscular dystrophy during osteoarthritis disorder: A topical phytotherapeutic treatment protocol.

Background:Creatine kinase-muscle (CK-MM) and aldolase A (AldoA) levels are proven to be realistic biochemical markers to detect muscular dystrophy during osteoarthritic disorders (MD-OADs). The aim of this study is to normalize the MD-OADs characterized by muscle weakness, atrophy, inflammatory disorders, pain with chronic arthropathy by specialized topical phytotherapeutic treatment.Methods:Baseline data were collected and evaluated from 153 patients, aged 59.89±11.37years, and suffering with MD-OADs for 7.89±1.90 years. Serum CK-MM and aldoA levels were measured at baseline and after a six- week treatment using the appropriate kits. All patients underwent standardized physical, radiographic examinations and completed a questionnaire. All the patients were treated with topical application of phytoconstituents from the extracts of seven Indian medicinal plants namely Cissus quadrangularis, Calotropis gigantea, Zingiber officinalis, Rosemarinus officinale, Boswellia serratia, Curcuma longa and Withata somnifera mixed with sesame oil and beehives wax for six-week.Results:The elevated levels of biomarkers, CK-MM and aldoA, were reduced to their mean±SEM values 82.77±1.32 and 4.94±1.30U/L, respectively at the end of six-week treatment and the improvements of deranged anatomical features, Pearson’s correlation coefficients, international-approved pain related abnormalities (VAS, WOMAC, KPS and KOOS) and reduction of weight at the end of treatment were all highly significant (p<0.0001).Conclusion:It is firmly confirmed that MD-OADs resulted with the elevated levels of CK-MM, and AldoA, along with deranged anatomical features (KGB, DTM, DCM, DAP, DBP, SLR, KFS and KES) and pain related parameters (VAS, WOMAC-index, KPS, KOOS and BMI) can be successfully normalized by topical phytotherapeutic treatment protocol.

Impact of the Trivedi Effect ® - Energy of Consciousness Healing on the Proliferation of Plant, Mouse and Human Stem Cells

The objective of the present study was to evaluate the effect of Biofield Energy Healing on the plant callus, mouse and human derived Mesenchymal Stem Cells (MSCs) for their cell count and cellular proliferation. All the three type stem cells and DMEM media for the stem cell culture were divided into two parts, one received Biofield Energy Treatment (known as The Trivedi Effect®-Energy of Consciousness Healing Treatment) by a renowned Biofield Energy Healer, Mahendra Kumar Trivedi through the Healer’s unique Energy Transmission process remotely and defined as Biofield Energy Treated (BT) group. On day 9 after treatment, the plant callus flasks of mandukparni, amla, and Centella were observed and visualized which showed an increased percentage in weight of the callus by 11.4%, 24.9%, and 51.7%, respectively as compared with the untreated groups. In addition, stem cell assay in murine bone marrow derived Mesenchymal Stem Cells (MSCs) showed an increased cellular proliferation by 115.2%, 127.6%, 161.9%, and 123.6%, in Biofield Energy Treated DMEM in the passage 1, 2, 3, and 4, respectively. Similarly, human derived Mesenchymal Stem Cells, Adipose-Derived (AD-MSC) cells showed a significant increased cell count by 139%, 119%, and 182% in the Biofield Energy Treated DMEM group with the passage 1, 2, and 3, respectively. Similarly, bone marrow (BM-MSC) cells showed a significant increased cell count by 102%, 170%, and 141% in the Biofield Energy Treated DMEM group with the passage 1, 2, and 3, respectively. However, BrdU assay for % cellular proliferation in the AD-MSC cells showed a significant increased cellular proliferation by 122%, 120%, and 184% in the passage 1, 2, and 3, respectively. On the other hand, BM-MSC cells showed a significant increased cellular proliferation by 125%, 146%, and 157% in the passage 1, 2, and 3, respectively. Hence, the results suggest that there was a significant growth in plant callus weight, mouse and human stem cell growth and proliferation after The Trivedi Effect®-Energy of Consciousness Treatment. It can be concluded that The Trivedi Effect® can be used as a complementary and alternate therapy for the stem cells regeneration, improvement of tissue injury that might be every effective against various autoimmune human diseases such as arthritis, osteoarthritis, and different neurodegenerative disorders.

Cause di fallimento della chirurgia protesica dell’anca: inquadramento diagnostico e gestionale

Total hip arthroplasty (THA) is the treatment of choice for advanced-stage osteoarthritis or other hip disorders with high successful rates. Over time, however, a hip replacement can fail for a variety of reasons. In this paper the authors describe the diagnosis and management of the most frequent causes of THA failure.

Calcium Fructoborate for Bone and Cardiovascular Health

Calcium fructoborate (CF), a natural sugar-borate ester found in fresh fruits and vegetables, is a source of soluble boron. CF contains three forms of borate (diester, monoester, and boric acid) and all are biologically active, both at the intracellular (as free boric acid) and extracellular level (as fructose-borate diester and monoester). At the cellular and molecular level, CF is superior to the boric acid/borate, exhibiting a complex “protective” effect against inflammatory response. CF is commercially available in the USA as a “nature-identical” complex, an active compound for dietary supplements. It provides effective and safe support against the discomfort and lack of flexibility associated with osteoarticular conditions (arthritis and joint degeneration), and improves Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and McGill indexes. In addition, orally administered CF is effective in ameliorating symptoms of physiological response to stress, including inflammation of the mucous membranes, discomfort associated with osteoarthritis disorders, and bone loss, and also for supporting cardiovascular health. Clinical studies have exhibited the ability of CF to significantly modulate molecular markers associated with inflammatory mechanisms, mainly on the elevated serum levels of C-reactive protein (CRP).

Management of knee osteoarthritis by combined stromal vascular fraction cell therapy, platelet-rich plasma, and musculoskeletal exercises: a case series.

IntroductionKnee osteoarthritis is associated with persistent joint pain, stiffness, joint deformities, ligament damage, and surrounding muscle atrophy. The complexity of the disease makes treatment difficult. There are no therapeutic drugs available to halt the disease progression, leaving patients dependent on pain medication, anti-inflammatory drugs, or invasive joint replacement surgery.Case presentationsFour patients with a history of unresolved symptomatic knee osteoarthritis were investigated for the therapeutic outcome of combining an exercise rehabilitation program with intra-articular injections of autologous StroMed (ie, stromal vascular fraction cells concentrated by ultrasonic cavitation from lipoaspirate) and platelet-rich plasma (PRP). The Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS) was administered along with physical function tests over a 12-month period. The first patient achieved a maximum therapeutic outcome of 100 in all five KOOS subscales (left knee), and 100 for four subscales (right knee). The second patient scored 100 in all five KOOS subscales (left knee), and greater than 84 in all subscales (right knee). Treatment of the third patient resulted in improved outcomes in both knees of >93 for four KOOS subscales, and 60 for the Function in Sport and Recreation subscale. The fourth patient improved to 100 in all five KOOS subscales. In all patients, the physical function “Get-up and Go” test and “Stair Climbing Test” returned to normal (a value of zero).ConclusionThis case series indicates that improved outcomes may be obtained when autologous stromal vascular fraction (StroMed) cell therapy is combined with traditional exercise practices and PRP for osteoarthritis. Of the seven joints treated: all patients’ scores of pain improved to >96; and quality of life scores to >93. Functional performance measures of mobility returned to normal. This simple treatment appears to be extremely effective for osteoarthritis disorders that have no drug treatment to halt disease progression.

Primary care approaches to musculoskeletal multiple-site joint pain pharmacological therapy: a survey of general practitioners

Chronic multiple-site joint pain (MSJP) due to osteoarthritis and soft tissue disorders is common in people over 50 years old and associated with poor outcomes. This study examined current pharmacological approaches to MSJP management in primary care. One hundred and fifty general practitioners (GPs) attending an educational seminar participated in an electronic survey (mean response rate 96%). Most GPs reported treating multiple painful joints concurrently (78%) compared with focusing on a single joint (21%). The majority believed there was no difference in analgesia for different disorders when selecting paracetamol (84%), non-steroidal anti-inflammatory drugs (NSAID)/COX-2 inhibitors (57%) or opioids (70%). When optimising therapy, intra-class optimisation (increase NSAID dose 41%, change to another NSAID/COX-2 inhibitor 30%) was preferred to inter-class step up therapy (add opioid 23%, change to opioid 6%). For NSAID gastrointestinal intolerance, the preference was to add a gastro-protective agent (74%). There is a need to better characterise MSJP and examine optimal pharmacotherapy regimens.

Reflecting on pain management for patients with osteoarthritis and other rheumatic disorders: there's more to pain management than managing pain.

SUMMARYMedical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that "the practice of medicine is an art, based on science". This doesn't change.

Characterization of Patients Undergoing Total Knee Arthroplasty in a Real-World Setting and Pain-Related Medication Prescriptions for Management of Postoperative Pain

ABSTRACTPresently, no “gold-standard” exists for the management of pain after total knee arthroplasty (TKA) surgery. Understanding pain management methods used in clinical practice and the associated patient outcomes are necessary to fill gaps in pain management strategies. This study characterizes medication use in the immediate postoperative period among patients undergoing TKA at an academic medical center. Additionally, pre- and postoperative measures of pain (numeric pain rating scale), physical function (Knee Society Scale and Lower Extremity Function [LEFS]), and quality of life (Medical Outcomes Study Short-Form [SF]-36) were evaluated. The patient data were extracted from a clinical database at the University of Utah Orthopedic Clinic between September 1, 2008, and November 30, 2010. A total of 168 patients (mean age 64.0 ± 10.1 years, 63.1% were female, mean body mass index [BMI] 31.7 ± 7.1 kg/m2) were included. The most common comorbidities in these patients were osteoarthritis, hypertension, and major depressive disorders. Bupivacaine and fentanyl were commonly given on the day of surgery with oxycodone, hydrocodone/acetaminophen, and celecoxib prescribed at hospital discharge. Preoperative pain levels were reduced by half at 6 weeks. Physical function and quality of life were similar to established benchmarks and previously reported levels, respectively. Confirmation of results over a longer follow-up period is warranted.

Study of the Cytotoxicity of a Composite of Carboxymethylcellulose (CMC) and a BioCeramic (Biphasic Calcium Phosphate-BCP) Injection for Use in Articular Cartilage Repair

The failure of organs and tissues caused by trauma and other injuries is one of the most costly of human health problems. It is estimated that 1.6 million people experience work limitations caused by osteoarthritis and related disorders, representing 8.3% of all main conditions. Joint injuries frequently lead to progressive joint degeneration and post-traumatic osteoarthritis. Articular cartilage has only a limited capacity for self-healing, mainly due to the fact that it is avascular; and once seriously damaged, articular cartilage lesions will not regenerate. There is strong evidence that cartilage lesions may lead to osteoarthritis when left untreated. Numerous animal experiments and clinical studies have shown that early biological reconstruction of circumscribed cartilage defects in the knee is superior to conservative or delayed surgical treatment. Tissue engineering has shown promising therapeutic strategies for repair or regeneration of damaged tissues. Currently, ceramic based and polymeric scaffolds have been developed to bring about the restoration of tissue functions. The bioceramics associated with water-soluble polymers have been developed as substitutes for various orthopedic applications. The objectives of this work are the processing and characterization of a composite of carboxymethylcellulose (CMC) and biphasic calcium phosphate (Biphasic Calcium Phosphate - BCP) in the form of a hydrogel, and a study of its cytotoxicity (in vitro), aimed at its application as an injectable biomaterial in order to repair the extracellular matrix of articular cartilage. The CMC and BCP were characterized by Fourier Transform Infrared Spectrometry (FTIR) and X-Ray Diffraction (XRD), X-ray fluorescence (XRF), respectively, and scanning electron microscopy (SEM) of powders and the composite. To evaluate the biological effect of the composite hydrogel, tests of cytotoxicity (MTT) and rheological tests under real conditions of use were performed. The composite of carboxymethylcellulose (CMC) and bioceramics (biphasic calcium phosphate-BCP) in the form of hydrogel showed an adequate injectability in the conditions studied, and a non-toxic response, presenting potential for use as fillers or to stimulate the healing of cartilage defects in the extracellular matrix of articular cartilage.

Selective MMP-12 inhibitors: WO-2008057254

Amino-substituted xanthene, thioxanthene and carbazole sulfonamido-carboxylic acid of carboxamido carboxylic acid derivatives, their use to treat metalloprotease mediated conditions, and especially to inhibit MMP-12, and to treat osteoarthritis, rheumatoid arthritis, atherosclerosis, heart failure, fibrosis, pulmonary emphysema, tumour growth, asthma and chronic obstructive pulmonary disorder (COPD). Compounds of this category are suggested to be particularly useful in the treatment of COPD.

Geriatric Spinal Injury

Geriatric spinal injury has unique mechanisms, confounding treatment factors, and outcomes. Mechanisms of injury frequently involve low velocity falls, as opposed to the high velocity traumas responsible for most other spinal cord injuries. Age-related comorbidities such as cervical spondylosis, osteoporosis, osteoarthritis, and neuromuscular disorders play into the pathophysiology of injury in this population. Three common injuries encountered include central cord injury, cervical extension distraction injuries, and odontoid fractures. Treatment is aimed at balancing safety of surgery with risks of nonoperative management. Understanding features unique to geriatric spinal injury is important in maximizing recovery.

Exercise solutions for the pain from osteoarthritis disorders.

Osteoarthritis (OA) is one of the most common musculoskeletal disorders. Hips and knees are the most frequently affected sites; pain and impairment in these weight-bearing joints can seriously hinder mobility and lead to disability in older people. Exercise has an important role to play in reducing pain but people with OA may be reluctant to exercise because of fear of causing pain or making the condition worse. Movement in water is often easier and less painful than on land. Support of joints and muscles by the buoyancy of the water allows people to exercise a greater range of movement. Warm water also promotes relaxation which decreases muscle spasm and tightness. This study found increased knee and hip flexibility and aerobic fitness after a 12-week aquatic exercise programme. Nurses who are engaged in health promotion with people with OA should consider recommending or implementing aquatic classes to improve physical function.