Joint Osteoarthritis Research Articles

Functional and patient reported outcomes of Pyrocardan implants for carpometacarpal osteoarthritis.

The primary aim of this study was to assess functional and patient reported outcomes among those with first carpometacarpal joint osteoarthritis treated with the Pyrocardan implant (Stryker-Wright Medical) in Ireland. The secondary aim of this study was to assess implant survival and revision rates. We conducted a single surgeon retrospective study assessing 40 Pyrocardan arthroplasties among 37 patients, with a minimum of 6months follow-up. Patient reported outcomes were assessed via quick disability of the arm, shoulder and hand (quick DASH) questionnaire, the visual analog score (VAS) for pain, and patient rated wrist evaluation (PRWE) questionnaire. Functional scores were assessed via lateral key pinch strength and Kapandji scores. Implant survival, complication and revision rates were also recorded. Forty Pyrocardan implants among 37 patients were included. Mean follow-up was 2.5years with a 97.5% implant survival rate. One patient underwent revision to trapeziectomy and Weilby sling. Eighty-eight percent of survey responders admitted that they would undergo the operation again, and 75% declared a 75-100% improvement in symptoms. Post-operative pain scores include a mean VAS of 2.07, quickDASH of 22.82, and PRWE of 26.92. Of those tested, there was an average increase in post-operative lateral key pinch, and 89% obtained a post-operative Kapandji score equal to or better than pre-operative scores. This is the first study assessing the Pyrocardan interpositional arthroplasty in Ireland. The implant appears to produce good functional and patient reported outcomes. There is high satisfaction and low revision rate, producing a reliable and successful surgical technique for treating CMC joint osteoarthritis.

Does the distal radioulnar joint orientation influence the outcome of ulnar shortening osteotomy: a retrospective study.

The aim of this retrospective study was to evaluate the long-term outcome of ulnar shortening osteotomy. A total of 66 patients treated with an ulnar shortening osteotomy for a primary or post-traumatic ulnar impaction syndrome were included, with a median follow-up time of 75 months.There was a positive correlation between the sigmoid notch angle and the final QuickDASH score, but no correlation with final range of motion, grip strength or pain level. Radiological signs of osteoarthritis of the distal radioulnar joint were seen in 20% of patients, yet there was no correlation between the development of distal radioulnar joint osteoarthritis and the sigmoid notch angle. No symptomatic distal radioulnar joint osteoarthritis was observed.Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle.Level of evidence: IV.

Multi-class segmentation of temporomandibular joint using ensemble deep learning

Temporomandibular joint disorders are prevalent causes of orofacial discomfort. Diagnosis predominantly relies on assessing the configuration and positions of temporomandibular joint components in magnetic resonance images. The complex anatomy of the temporomandibular joint, coupled with the variability in magnetic resonance image quality, often hinders an accurate diagnosis. To surmount this challenge, we developed deep learning models tailored to the automatic segmentation of temporomandibular joint components, including the temporal bone, disc, and condyle. These models underwent rigorous training and validation utilizing a dataset of 3693 magnetic resonance images from 542 patients. Upon evaluation, our ensemble model, which combines five individual models, yielded average Dice similarity coefficients of 0.867, 0.733, 0.904, and 0.952 for the temporal bone, disc, condyle, and background class during internal testing. In the external validation, the average Dice similarity coefficients values for the temporal bone, disc, condyle, and background were 0.720, 0.604, 0.800, and 0.869, respectively. When applied in a clinical setting, these artificial intelligence-augmented tools enhanced the diagnostic accuracy of physicians, especially when discerning between temporomandibular joint anterior disc displacement and osteoarthritis. In essence, automated temporomandibular joint segmentation by our deep learning approach, stands as a promising aid in refining temporomandibular joint disorders diagnosis and treatment strategies.

Hyaluronic Acid-Based Microparticles with Lubrication and Anti-Inflammation for Alleviating Temporomandibular Joint Osteoarthritis.

The pathogenesis of temporomandibular joint osteoarthritis (TMJOA) is closely associated with mechanical friction, which leads to the up-regulation of inflammatory mediators and the degradation of articular cartilage. Injectable drug-loaded microparticles have attracted widespread interest in intra-articular treatment of TMJOA by providing lubrication and facilitating localized drug delivery. Herein, a hyaluronic acid-based microparticle is developed with excellent lubrication properties, drug loading capacity, antioxidant activity, and anti-inflammatory effect for the treatment of TMJOA. The microparticles are facilely prepared by the self-assembly of 3-aminophenylboronic acid-modified hyaluronic acid (HP) through hydrophobic interaction in an aqueous solution, which can further encapsulate diol-containing drugs through dynamic boronate ester bonds. The resulting microparticles demonstrate excellent injectability, lubrication properties, radical scavenging efficiency, and antibacterial activity. Additionally, the drug-loaded microparticles exhibit a favorable cytoprotective effect on chondrocyte cells invitro under an oxidative stress microenvironment. Invivo experiments validate that intra-articular injection of drug-loaded microparticles effectively alleviates osteoporosis-like damage, suppresses inflammatory response, and facilitates matrix regeneration in the treatment of TMJOA. The HP microparticles demonstrate excellent injectability and encapsulation capacity for diol-containing drugs, highlighting its potential as a versatile drug delivery vehicle in the intra-articular treatment of TMJOA.

A case of Melkersson-Rosenthal syndrome with temporomandibular joint osteoarthritis: multidisciplinary treatment and autoimmune etiological hypothesis

BackgroundMelkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder characterized by recurrent edema, facial palsies, and nerve dysfunctions often associated with the plicata tongue. Although the etiology of MRS is not well understood, there is growing evidence suggesting an autoimmune involvement.Case presentationThis paper presents a case report of a 25-year-old male with MRS as the initial symptom, followed by temporomandibular joint osteoarthritis (TMJ-OA). A comprehensive diagnosis and multidisciplinary treatment approach including surgery, local injections, and oral medication were implemented, resulting in a favorable prognosis.ConclusionsThese findings support the hypothesis that MRS is a systemic granulomatous disease caused by autoimmunity, which may also influence the occurrence and development of TMJ-OA through immune-related mechanisms. This study emphasizes the significance of systemic immune regulation in the treatment of patients with MRS and TMJ-OA comorbid conditions.

The role of cytokine receptor-like factor 1 (CRLF1) in facet joint osteoarthritis pathogenesis

BackgroundFacet joint osteoarthritis (FJOA) is a prevalent condition contributing to low back pain, particularly in the elderly population. This study aimed to investigate the potential role of Cytokine Receptor-like Factor 1 (CRLF1) in FJOA pathogenesis and its therapeutic implications. MethodsBioinformatics analysis was utilized to identify CRLF1 as the target gene, followed by quantification of CRLF1 expression levels and joint degeneration degree using immunohistochemistry (IHC). In primary chondrocytes, the inhibition of CRLF1 expression by siRNA was performed, and Western blot analysis was conducted to evaluate the involvement of the extracellular matrix and MAPK/ERK signaling pathway. Flow cytometry was employed to assess the apoptosis rate of chondrocytes, while immunofluorescence (IF) was utilized to evaluate the localization of CRLF1, cleaved-caspase3, MMP13, COL2A1, and ERK. ResultsThe expression of CRLF1 was found to be significantly elevated in FJOA tissues compared to normal tissues. Through the use of loss-of-function assays, it was determined that CRLF1 not only enhanced the rate of apoptosis in chondrocytes, but also facilitated the degradation of the extracellular matrix in vitro. Furthermore, CRLF1 was found to activate the ERK1/2 pathways. The pro-arthritic effects elicited by CRLF1 were mitigated by treatment with the MEK inhibitor U0126 in chondrocytes. ConclusionThese results suggest that CRLF1 enhances chondrocytes apoptosis and extracellular matrix degration in FJOA and thus may therefore be a potential therapeutic target for FJOA.

Mid-Term Clinical and Radiological Changes in the Ankle Joint in Varus Knee Osteoarthritis Following Total Knee Arthroplasty.

Background/Objectives: In patients with varus knee osteoarthritis, compensatory changes occur in the foot and ankle joints to compensate for the varus deformity of the knee. The aim of the study was to investigate the changes in the ankle of patients whose knee alignment was corrected with total knee arthroplasty (TKA) and to explore the clinical implications of these findings. Methods: In this retrospective observational study, we analyzed 204 knees of 179 patients who had regular follow-ups out of 431 patients who underwent TKA for varus knee osteoarthritis between January 2019 and July 2021. Patient demographics, body mass index, follow-up time, and radiographs were studied. The hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA), talar tilt (TT) angle, ground talar dome (GT) angle, ground tibia plafond (GP) angle, and the American Orthopaedic Foot & Ankle Society (AOFAS) score were assessed preoperatively and at the last follow-up. Results: A total of 204 knees of 179 patients with a mean follow-up time of 32.50 ± 6.68 months were evaluated. It was found that the change in the HKA had a positive effect on the AOFAS score and a negative effect on the TT, GT, and GP angles. While the clinical score improved in 82 patients, it worsened in 8 patients. The age difference between the groups whose AOFAS score improved and worsened was statistically significant. Conclusions: The correction of the varus malalignment in the knee was shown to also improve the compensatory valgus in the foot and ankle over the mid-term, with a statistically significant improvement in the patients' clinical ankle scores.

Ion channels in osteoarthritis: emerging roles and potential targets.

Osteoarthritis (OA) is a highly prevalent joint disease that causes substantial disability, yet effective approaches to disease prevention or to the delay of OA progression are lacking. Emerging evidence has pinpointed ion channels as pivotal mediators in OA pathogenesis and as promising targets for disease-modifying treatments. Preclinical studies have assessed the potential of a variety of ion channel modulators to modify disease pathways involved in cartilage degeneration, synovial inflammation, bone hyperplasia and pain, and to provide symptomatic relief in models of OA. Some of these modulators are currently being evaluated in clinical trials. This review explores the structures and functions of ion channels, including transient receptor potential channels, Piezo channels, voltage-gated sodium channels, voltage-dependent calcium channels, potassium channels, acid-sensing ion channels, chloride channels and the ATP-dependent P2XR channels in the osteoarthritic joint. The discussion spans channel-targeting drug discovery and potential clinical applications, emphasizing opportunities for further research, and underscoring the growing clinical impact of ion channel biology in OA.

Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation.

Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone. Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made. The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography. The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.

Influence of inflammation on the expression of microRNA-140 in extracellular vesicles from 2D and 3D culture models of synovial-membrane-derived stem cells.

In osteoarthritis (OA), articular homeostasis is regulated by microRNA-140 that inhibits ADAMTS-5, an enzyme that cleaves aggrecan and stimulates the synthesis of other inflammatory mediators. This study aims to evaluate the expression of microRNA-140 in extracellular vesicles (EVs) derived from equine synovial-membrane-derived mesenchymal stem cells (eqSMMSCs) cultured in monolayer (2D) and three-dimensional (3D) culture models under an in vitro inflammatory environment. Four experimental groups of eqSMMSC cultures were defined for isolation of the EVs. The 2D and 3D control groups were cultured in a conventional cell culture medium, while the 2D-OA and 3D-OA treatment groups were exposed to an OA-like medium containing IL-1β and TNFα. The culture media samples were collected at 24h, 72h, and 120h time points for EV isolation and characterization using nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM). Reverse transcription quantitative polymerase chain reaction was employed to assess the expressions of microRNA-140 in both the cells and EVs. All statistical analyses were conducted at the 5% significance level. Encapsulation of the eqSMMSCs protected the cells from the inflammatory media compared to the monolayer cultures. EVs were found in higher concentrations in the 3D-OA cultures. Additionally, higher expressions of microRNA-140 were observed in the cells of the 3D-OA group at 24 and 72h, whereas microRNA-140 expressions in the EVs were higher in the 3D group at 72h and in the 2D-OA group at 120h (p < 0.001). However, the 3D-OA culture showed higher expression of the mRNA Adamts5 in the EVs at 120h. The responses of the eqSMMSCs to inflammatory stimuli involve intracellular expression of microRNA-140 and its subsequent transportation via the EVs, with quicker responses observed in the 3D than 2D cultures. This study sheds light on the behaviors of stem cells in restoring homeostasis in osteoarthritic joints.

Ultrasmall Cu2I2 nanoclusters trigger metabolic-epigenetic reprogramming and endogenous antioxidant systems for alleviating osteoarthritis

Temporomandibular joint (TMJ) osteoarthritis (OA) affects millions of people worldwide, characterized by imbalance metabolism, excess reactive oxygen species (ROS), aberrant epigenetic alterations and so on. Currently, analgesics and anti-inflammatory drugs are mainly used for treatment, but they only alleviate symptoms. Here, we designed a ultrasmall copper-based nanoclusters agent (copper iodide coordination, Cu2I2), which exhibited remarkable ROS-scavenging activities. And the antioxidant properties of Cu2I2 nanoclusters (Cu2I2 NCs) were achieved by activating the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. Excitingly, Cu2I2 NCs exhibited excellent metabolic-epigenetic regulation property via reprogramming energy metabolism to inhibit S-adenosylmethionine (SAM)-production metabolic pathway and contributing to the global hypomethylation mediated by Dnmt3a. Then, the expression of anti-osteoclastogenic genes was upregulated. Consistent with in vitro observations, Cu2I2 NCs efficiently alleviated subchondral bone destruction of TMJ OA in rats. Altogether, this study not only provides a novel nanoclusters agent for TMJ OA treatment that can activate endogenous antioxidant systems, but also reveals the significance and feasibility of therapeutic strategies to break the bridge between metabolic and epigenetic regulation.

Exploring the therapeutic potential of urine-derived stem cell exosomes in temporomandibular joint osteoarthritis.

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative ailment that causes slow cartilage degeneration, aberrant bone remodeling, and persistent discomfort, leading to a considerable reduction in the patient's life quality. Current treatment options for TMJOA have limited efficacy. This investigation aimed to explore a potential strategy for halting or reversing the progression of TMJOA through the utilization of exosomes (EXOs) derived from urine-derived stem cells (USCs). The USC-EXOs were obtained through microfiltration and ultrafiltration techniques, followed by their characterization using particle size analysis, electron microscopy, and immunoblotting. Subsequently, an invivo model of TMJOA induced by mechanical force was established. To assess the changes in the cartilage of TMJOA treated with USC-EXOs, we performed histology analysis using hematoxylin-eosin staining, immunohistochemistry, and histological scoring. Our findings indicate that the utilization of USC-EXOs yields substantial reductions in TMJOA, while concurrently enhancing the structural integrity and smoothness of the compromised condylar cartilage surface. Additionally, USC-EXOs exhibit inhibitory effects on osteoclastogenic activity within the subchondral bone layer of the condylar cartilage, as well as attenuated apoptosis in the rat TMJ in response to mechanical injury. In conclusion, USC-EXOs hold considerable promise as a potential therapeutic intervention for TMJOA.

Best timing of bilateral total hip arthroplasty – an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD)

BackgroundThe burden of osteoarthritis (OA) in multiple joints is high and for patients with bilateral OA of the hip there is no clear recommendation about the indication for simultaneous (one-stage) bilateral total hip arthroplasty (THA) versus two-staged procedures. The purpose of this study was therefore to compare revision and mortality rates after different strategies of surgical timing in bilateral hip OA from the German Arthroplasty Registry (EPRD).MethodsSince 2012 22,500 patients with bilateral THA (including 767 patients with one-staged bilateral surgery and 11,796 patients with another separate procedures within one year after first THA) are documented in the registry. The patients who underwent simultaneous bilateral THA were matched with a cohort of 767 patients who underwent the second THA between 1 and 90 days postoperatively (short interval) and another cohort of 4,602 patients with THA between 91 and 365 days postoperatively (intermediate interval). Revision for all reasons and mortality rates were recorded. Cox regression was performed to evaluate the influence of different patient characteristics.ResultsThe cumulative 5-year revision rate for patients with simultaneous bilateral THA was 1.8% (95% CI 0.9–2.6), for patients with two-staged THA 2.3% (95% CI 1.0-3.6) in the short interval and 2.5% (95% CI 2.1–2.9) in the intermediate interval, respectively. In all three groups, patients who underwent THA in a high-volume center (≥ 500 THA per year) had a significant lower risk for revision (HR 0.687; 95% CI 0.501–0.942) compared to surgeries in a low-volume center (< 250 THA per year). There was no significant difference regarding cumulative mortality rates in the three cohorts. Higher age (HR 1.060; 95% CI 1.042–1.078) and severe comorbidities as reflected in the Elixhauser Score (HR 1.046; 95% CI 1.014–1.079) were associated with higher mortality rates after simultaneous THA.ConclusionSimultaneous bilateral THA seems to be a safe procedure for younger patients with limited comorbidities who have bilateral end-stage hip OA, especially if performed in high-volume centers.Level of evidenceIII.

Can treatment with chondroitin and glucosamine sulphate prevent changes in the articular disc caused by temporomandibular joint osteoarthritis?

Chondroitin and glucosamine sulphates (CGS) are considered structure-modifying drugs and have been studied in the prevention, delay or reversal of structural morphological changes in joints caused by osteoarthritis. The aim of the present study was to investigate the action of CGS on the progression of chemically induced osteoarthritis in the temporomandibular joint (TMJ) of rabbits by evaluating the serum levels of tumour necrosis factor (TNF-α) and collagen in the articular discs. A sample of 36 male rabbits was divided into three groups: control (CG), osteoarthritis (OG) and treatment (TG). The disease was induced by intra-articular injection of sodium monoiodoacetate (10 mg/mL) in the OG and TG groups bilaterally. After 10 days, the TG animals received subcutaneous injection of chondroitin sulphates and glucosamine (7.5 mg/kg) and the OG and CG received saline solution (50 μL). Euthanasia times were subdivided into 40 and 100 days. Collagen quantification was performed by biochemical and histological analysis and for the quantification of serum levels of TNF-α, an enzyme immunoassay was used. The TG showed an increase in the collagen area of the articular disc when compared to the CG and the OG. The increase collagen concentration in the discs did not show a statistically significant difference between the groups. Post-treatment TNF-α levels were significantly lower in TG compared to OG. The results indicate that CGS treatment delayed the degeneration of the collagen in the TMJ articular disc and reduced serum TNF-α levels, indicating a preventive effect on OA progression.

Features Associated With Different Inflammatory Phenotypes of Calcium Pyrophosphate Deposition Disease: Study Using Data From the International American College of Rheumatology/EULAR Calcium Pyrophosphate Deposition Classification Criteria Cohort.

The study objective was to examine the disease, demographic, and imaging features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease, ie, recurrent acute calcium pyrophosphate (CPP) crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS). Data from an international cohort (assembled from 25 sites in 7 countries for the development and validation of the 2023 CPPD classification criteria from the American College of Rheumatology/EULAR) that met the criteria were included. Three cross-sectional studies were conducted to determine the phenotypic characteristics of recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and CDS. Multivariable logistic regression analysis was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) to examine the association between potential risk factors and the inflammatory phenotype. Among the 618 people included (56% female; mean age [standard deviation] 74.0 [11.9] years), 602 (97.4%) had experienced acute CPP crystal arthritis, 332 (53.7%) had recurrent acute arthritis, 158 (25.6%) had persistent inflammatory arthritis, and 45 (7.3%) had had CDS. Recurrent acute CPP crystal arthritis associated with longer disease duration (aOR 2.88 [95% CI 2.00-4.14]). Chronic CPP crystal inflammatory arthritis was associated with acute wrist arthritis (aOR 2.92 [95% CI 1.81-4.73]), metacarpophalangeal joint osteoarthritis (aOR 1.87 [95% CI 1.17-2.97]), and scapho-trapezo-trapezoid (STT) joint osteoarthritis (aOR 1.83 [95% CI 1.15-2.91]), and it was negatively associated with either metabolic or familial risk for CPPD (aOR 0.60 [95% CI 0.37-0.96]). CDS was associated with male sex (aOR 2.35 [95% CI 1.21-4.59]), STT joint osteoarthritis (aOR 2.71 [95% CI 1.22-6.05]), and more joints affected with chondrocalcinosis (aOR 1.46 [95% CI 1.15-1.85]). CPPD disease encompasses acute and chronic inflammatory phenotypes, each with specific clinical and imaging features that need to be considered in the diagnostic workup.

A single-centre RetrospeCtive sTudy Investigating patient-reported outcomeS of extended dressing wear time for incisional healing following orthopaedic surgery: the ARCTIS study.

Orthopaedic surgery is an effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA). Frequent wound dressing changes, unless clinically indicated, can disrupt the healing process and increase the occurrence of incision site contamination. Protection from contamination is critical for surgical incisions and, therefore, undisturbed wound healing (UWH) in surgical wound management is vital. This article describes a retrospective study reporting the clinical performance of a self-adherent, absorbent postoperative dressing, with a focus on dressing wear time. A single-centre, retrospective electronic medical record review of a convenience sample of adult patients treated with a dressing (Mepilex Border Post Op; Mölnlycke, Sweden) following elective hip or knee replacement was undertaken. Data relating to dressing wear time, rationale for dressing changes and patient-reported outcomes were extracted from a mobile health application moveUP Therapy (moveUP NV, Belgium). Health-related quality of life assessment was conducted using the EQ-5D-5L questionnaire and orthopaedic-specific quality of life (QoL) indicator tools. Of the 558 records reviewed, 151 respondents (27.1%) reported outcomes relating to dressing wear time and frequency of dressing change. The average wear time of the first dressing was 13.6 days (second dressing: 5.3 days). The proportion of patients who wore the first dressing for 1-7 days, 8-13 days and for ≥14 days was 17.2%, 13.2% and 69.5%, respectively. Data from the completed questionnaires revealed improvement in QoL over time. The results of this study are a good indicator of the suitability of the postoperative dressing for a 14-day wear time, in line with the principles of UWH.

Relationship between Lumbar Foraminal Stenosis and Multifidus Muscle Atrophy - A Retrospective Cross-Sectional Study.

Retrospective cross-sectional study. To evaluate the relationship between lumbar foraminal stenosis (LFS) and multifidus muscle atrophy. The multifidus muscle is an important stabilizer of the lumbar spine. In LFS, the compression of the segmental nerve can give rise to radicular symptoms and back pain. LFS can impede function and induce atrophy of the segmentally innervated multifidus muscle. Patients with degenerative lumbar spinal conditions who underwent posterior spinal fusion for degenerative lumbar disease from December 2014 to February 2024 were analyzed. Multifidus fatty infiltration (FI) and functional cross-sectional area (fCSA) were determined at the L4 upper endplate axial level on T2- weighted MRI scans using dedicated software. Severity of LFS was assessed at all lumbar levels and sides using the Lee classification (Grade: 0 - 3). For each level, Pfirrmann and Weishaupt gradings were used to assess intervertebral disc disease (IVDD) and facet joint osteoarthritis (FJOA), respectively. Multivariable linear mixed models were run for the LFS grade of each level and side separately as the independent predictor of multifidus FI and fCSA. Each analysis was adjusted for age, sex, BMI, as well as FJOA and IVDD of the level corresponding to the LFS. A total of 216 patients (50.5% female) with a median age of 61.6 years (IQR=52.0 - 69.0) and a median BMI of 28.1kg/m2 (IQR=24.8 - 33.0) were included. Linear mixed model analysis revealed that higher multifidus FI (Estimate [Confidence interval]=1.7% [0.1 - 3.3], P=0.043) and lower fCSA (-18.6mm2 [-34.3 - -2.6], P=0.022) were both significantly predicted by L2-L3 level LFS severity. The observed positive correlation between upper segment LFS and multifidus muscle atrophy points towards compromised innervation. This necessitates further research to establish the causal relationship and guide prevention efforts.

Nonoperative Management of Trapeziometacarpal Joint Arthritis: A Systematic Review of the Clinical Trials.

This systematic review evaluates nonoperative treatments for trapeziometacarpal joint osteoarthritis (TMJO), a common degenerative condition in postmenopausal females causing pain, reduced mobility, and diminished grip strength.Following PRISMA guidelines, a search was conducted across PubMed, Cochrane, Embase, and MEDLINEfor randomized controlled trials (RCTs) assessing pain outcomes with nonoperative interventions over at least a six-month follow-up, using the visual analog scale (VAS) for pain measurement. Eleven RCTs yielded moderate-quality evidence for the following: (1) corticosteroid (CSI) and hyaluronic acid (HA) injections exhibit comparable mean delta pain scores after six months, with CSI offering early relief at two to three weeks. After 12 months, CSI led to a continued decrease in pain, with a mean delta pain score of 1.0 (p<0.05), contrasting with hyaluronic acid (HA) injections, which presented a modest though nonsignificant improvement, demonstrating a mean delta pain score of 0.5 (p=0.16). (2) Relatively novel therapies for TMJO, such as platelet-rich plasma (PRP) and dextrose, appear to surpass CSI in long-term effectiveness, with dextrose showing a mean delta pain score of 3.8 (p<0.001) at six months and PRP achieving a mean delta pain score of 5.5 (p=0.005) at 12 months. (3) Various hand therapies, notably standard hand exercises and extracorporeal shockwave therapy (ESWT), demonstrated significant pain reduction, with the former achieving a mean delta pain score of 1.5 (p=0.019) and the latter a score of 4.2 (p<0.001). (4) The use of orthoses substantially decreases pain levels, demonstrating a mean delta pain score reduction of 2.6 at a 180-day follow-up (p=0.023) and 2.2 at a 12-month follow-up (p=0.002). In conclusion, nonoperative treatments for TMJO, including intra-articular injections, hand therapy, and orthoses, provide significant pain relief at a minimum of six months follow-up. The synergistic effect of combined nonoperative management, as well as the effect size of each, is unknown.

Experiences with Volumetric Modulated Arc Therapy (VMAT) for treating symptomatic peripheral joint osteoarthritis (OA) with Low Dose Radiotherapy (LDRT) – a case series

Introduction: Peripheral joint osteoarthritis (OA) in Australia is the third leading cause of life-years lost. Implant surgery is a great help, but patients who are waiting or are inoperable suffer. Low Dose Radiotherapy (LDRT) is well established in some countries. Three-dimensional conformal radiotherapy (3DCRT) is recommended. However, some departments may only have Volumetric Modulated Arc Therapy (VMAT). We present our experiences treating ten volumes of symptomatic OA treated with VMAT in nine consecutive patients to two months post-LDRT. Methods: The hypothesis was that LDRT using VMAT was feasible and effective at two months. Patient response data was collected prospectively. The Visual Analog Scale Pain (VASP) for pain was used. A Visual Analog Scale Mobility (VASM) was created for mobility. Bones within radiation oncologists (RO) skin marks around the joint were auto-contoured for clinical target volume (CTV) with 2 mm expansion to planning target volume (PTV). Treatment was titrated to clinical response. Phase 1 was 3 Gray (Gy) in 6 fractions at 2-3 fractions per week. There was RO review at 2 months post-phase 1 for consideration of phase 2. If no response, then phase 2 was 6 Gy in 6 fractions, if a partial response (PR), then a repeat of phase 1. A third phase similar to phase 2 was possible. RO follow-up was done 2 months after the last phase. Results: Nine consecutive patients, eight males and one female, average age of 69 years (60-84), with ten volumes of symptomatic OA were treated. Joints were three single knees, two cases of both knees, three cases of both hands, one hip and one carpometacarpal joint. They had suffered from OA for an average of eight years (1-20). All were on at least one systemic therapy. All were using some sort of local therapy or device. Eight had a PR to phase 1 and proceeded to phase 2. Two had an equivocal response. No patient had a third phase. Average VASP pain scores fell from baseline of 7.4 to 3.6 after phase 1, and to 2.3 after phase 2. Average VASM immobility scores fell from baseline of 6.9 to 4.4 after phase 1 and to 3.3 after phase 2. Conclusion: In this small Australian cohort LDRT using VMAT is feasible and clinically effective when measured at 2 months. More study is needed.

17β-estradiol promotes the progression of temporomandibular joint osteoarthritis by regulating the FTO/IGF2BP1/m6A-NLRC5 axis.

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative cartilage disease. 17β-estradiol (E2) aggravates the pathological process of TMJOA; however, the mechanisms of its action have not been elucidated. Thus, we investigate the influence of E2 on the cellular biological behaviors of synoviocytes and the molecular mechanisms. Primary fibroblast-like synoviocytes (FLSs) isolated from rats were treated with TNF-α to establish cell model, and phenotypes were evaluated using cell counting kit-8, EdU, Tanswell, enzyme-linked immunosorbent assay, and quantitative real-time PCR (qPCR). The underlying mechanism of E2, FTO-mediated NLRC5 m6A methylation, was assessed using microarray, methylated RNA immunoprecipitation, qPCR, and western blot. Moreover, TMJOA-like rat model was established by intra-articular injection of monosodium iodoacetate (MIA), and bone morphology and pathology were assessed using micro-CT and H&E staining. The results illustrated that E2 facilitated the proliferation, migration, invasion, and inflammation of TNF-α-treated FLSs. FTO expression was downregulated in TMJOA and was reduced by E2 in FLSs. Knockdown of FTO promoted m6A methylation of NLRC5 and enhanced NLRC5 stability by IGF2BP1 recognition. Moreover, E2 promoted TMJ pathology and condyle remodeling, and increased bone mineral density and trabecular bone volume fraction, which was rescued by NLRC5 knockdown. E2 promoted the progression of TMJOA.