Osteoarthritis Of Knee Joint Research Articles

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs

Total knee arthroplasty combined with simultaneous open reduction and internal fixation in the treatment of knee osteoarthritis with patellar fracture: a case report and review of the literature

BackgroundPatients with severe knee osteoarthritis combined with patellar fracture are rare, and it is unclear whether single-stage surgery affects the enhanced recovery after surgery.Case presentationThis case report describes two patients of Han nationality. A 69-year-old male patient was previously diagnosed with severe knee osteoarthritis of the left knee joint and was treated conservatively with long-term oral nonsteroidal antiinflammatory drugs and intraarticular injection of sodium hyaluronate. He was hospitalized for acute left knee injury owing to a fall from a height. He was diagnosed with knee osteoarthritis of the left knee joint and patellar fracture. Another 74-year-old female patient was previously diagnosed with severe knee osteoarthritis, long-term oral nonsteroidal antiinflammatory drugs and topical Chinese medicine to relieve the pain. A month ago, she fell down the stairs and fractured the patella in her left knee, she was diagnosed with severe left knee osteoarthritis combined with an old left patella fracture. Both patients were successfully treated by single-stage primary total knee arthroplasty and fixation of the patellar fracture. They both carried out early functional exercise normally and successfully achieved enhanced recovery.ConclusionSuccessful single stage total knee replacement with patella management can not only reduce the number of operations, but also enable patients to achieve rapid postoperative recovery. However, single stage may increase the risk of local surgical complications. Therefore, for most patients, especially those with low risk of anesthesia related complications, standard of treatment remains first fixing the patellar fracture and when the fracture is healed proceed with the total knee arthroplasty.

Population-based in silico modeling of anatomical shape variation of the knee and its impact on joint loading in knee osteoarthritis.

Anatomical knee joint features and osteoarthritis (OA) severity are associated, however confirming causals link to altered knee loading is challenging. This study leverages statistical shape models (SSM) to investigate the relationship between joint shape/alignment and knee loading during gait in knee OA(KOA) patients to understand their contribution to elevated medial knee loading in OA. Musculoskeletal (MSK) models were created for the mean as well as the first eightSSM principal modes of variation (-3,-2,-1, +1, +2, +3 standard deviations for each mode) and used as input to a MSK modeling framework. Using an identical KOA gait pattern (i.e., joint kinematics and ground reaction forces), we ran simulations for each MSK model and evaluated medial compartment loading magnitude and contact distribution at the instant of first and second peak of knee joint loading. An increase in external rotation, posterior tibia translation and a decrease in medial joint space and medial femoral condylar size predisposed the medial compartment knee joint to overloading during gait. This was coupled with an anterior and medial shift in contact location with increasing external rotated tibial position and increasing posterior tibial translation with respect to the femur. Next, results also highlighted a posterior shift of the medial compartment loading location with decreasing medial joint space. This study provides important population-based insights on how knee shape and alignment predispose individuals with KOA to elevated medial compartmental knee loading. This information can be crucial in assessing the risk for medial KOA development and progression.

Why is therapeutic exercise the best treatment for knee osteoarthritis?

Osteoarthritis (OA) of the knee joints (KJ) has a high social significance and is therefore a relevant pathology for scientific research. The authors have proposed an original hydraulic theory for the pathogenesis of OA in KJ. This approach is based on the notion of primary mechanical damage to the internal ligamentous structures and synovial membrane accompanied by posttraumatic edema, synovial hypervolemia, and hypertension. The authors demonstrated that regular physical activity at all stages of the disease is pathogenetically justified and allows the patient to improve lymphatic and venous outflow and thus resist increasing fibrosis. Improved arterial blood flow will reduce tissue hypoxia. Any type of symptom-modifying therapy can be harmful because it reduces the protective role of pain reflexes in protecting the KJ from excessive loads, leading to injury. The necessity of maintaining a walking speed of more than 4.3 km/h with an increase in cadence is emphasized from the perspective of reducing static stress during walking and extending life expectancy.

Native intra-articular knee microbiome is a matter of facts: a systematic review of clinical evidence.

Growing interest surrounds the role of human gut microbiome in the development of degenerative pathologies such as osteoarthritis (OA), but microbes have recently been detected also in other sites previously considered to be sterile. Evidence emerged suggesting that even native and osteoarthritic knee joints may host several microbial species possibly involved in the osteoarthritic degeneration. This is the first systematic review critically collecting all the available evidence on the existence and composition of knee intra-articular microbiome. A systematic research on the PubMed, Cochrane and Google Scholar databases was performed. Human clinical studies investigating the presence of intra-articular microbiome in native osteoarthritic knee joints with next-generation sequencing techniques were collected. A total of eight studies were included reporting data on 255 knees. All the included studies reported evidence supporting the existence of an intra-articular microbiome in native knee joints, with detection rates varying from 5.8% to 100%. Bacteria from the Proteobacteria phylum were found to be among the most identified followed by the Actinobacteria, Firmicutes, Fusobacteria, and Bacteroideta phyla. Proteobacteria phylum were also found to be more common in osteoarthritic knees when compared to healthy joints. Furthermore, several pathways correlating those microbes to knee OA progression have been suggested and summarized in this review. Evidence collected in this systematic review suggests that the native knee joint, previously presumed to be a sterile environment, hosts a peculiar intra-articular microbiome with a unique composition. Furthermore, its alteration may have a link with the progression of knee osteoarthritis.

Non-invasive regional parameter identification of degenerated human meniscus

Accurate identification of local changes in the biomechanical properties of the normal and degenerative meniscus is critical to better understand knee joint osteoarthritis onset and progression. Ex-vivo material characterization is typically performed on specimens obtained from different locations, compromising the tissue's structural integrity and thus altering its mechanical behavior. Therefore, the aim of this in-silico study was to establish a non-invasive method to determine the region-specific material properties of the degenerated human meniscus. In a previous experimental magnetic resonance imaging (MRI) study, the spatial displacement of the meniscus and its root attachments in mildly degenerated (n = 12) and severely degenerated (n = 12) cadaveric knee joints was determined under controlled subject-specific axial joint loading. To simulate the experimental response of the lateral and medial menisci, individual finite element models were created utilizing a transverse isotropic hyper-poroelastic constitutive material formulation. The superficial displacements were applied to the individual models to calculate the femoral reaction force in an inverse finite element analysis. During particle swarm optimization, the four most sensitive material parameters were varied to minimize the error between the femoral reaction force and the force applied in the MRI loading experiment. Individual global and regional parameter sets were identified. In addition to in-depth model verification, prediction errors were determined to quantify the reliability of the identified parameter sets. Both compressibility of the solid meniscus matrix (+141 %, p ≤ 0.04) and hydraulic permeability (+53 %, p ≤ 0.04) were significantly increased in the menisci of severely degenerated knees compared to mildly degenerated knees, irrespective of the meniscus region. By contrast, tensile and shear properties were unaffected by progressive knee joint degeneration. Overall, the optimization procedure resulted in reliable and robust parameter sets, as evidenced by mean prediction errors of <1 %. In conclusion, the proposed approach demonstrated high potential for application in clinical practice, where it might provide a non-invasive diagnostic tool for the early detection of osteoarthritic changes within the knee joint.

Association of serum and synovial adipokines (chemerin and resistin) with inflammatory markers and ultrasonographic evaluation scores in patients with knee joint osteoarthritis- a pilot study.

Chemerin and resistin are adipokines studied as potential markers for early diagnosis and disease severity in patients with knee osteoarthritis (KOA) Therefore, we aimed to investigate the associations serum and synovial levels of chemerin and resistin with inflammatory parameters and ultrasonographic scores (US) in KOA individuals. Serum was collected from 28 patients with KOA and synovial fluid was obtained from 16 of them. Another 31 age and sex matched cases with no joint disease were included as healthy controls. Concentrations of chemerin, resistin, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) were determined with ELISA. Erythrocyte sedimentation rate (ESR), C-reactive protein, serum uric acid (UA) were measured in the patients group. Participants with KOA underwent US assessment using the Outcome Measures in Rheumatology (OMERACT) scores. Patients with KOA had statistically significant higher level of serum resistin than healthy controls [11.05 (3.78-24.13) ng/mL and 7.23 (3.83-12.19) respectively, p < 0.001]. A strong correlation was found between serum chemerin and ESR (r = 0.434, p = 0.021), uric acid (r = 0.573, p = 0.001) as well as the US (r=-0.872, p < 0.001). Serum resistin demonstrated significant association with TNF-alpha (r = 0.398, p = 0.044). In conclusion, both chemerin and resistin might contribute to inflammatory changes associated with KOA. Further studies are needed to elucidate their potential role in the pathogenesis of the disease.

Effects of addition of hyaluronic acid on platelet rich plasma in treatment of chronic osteoarthritis of knee joints

Effects of addition of hyaluronic acid on platelet rich plasma in treatment of chronic osteoarthritis of knee joints

The effectiveness of Transcutaneous Electrical Nerve Stimulation and strengthening exercises on the functional ability of patients with osteoarthritis of the knee joints: A case report

Knee osteoarthritis (OA) is the most common musculoskeletal disease among elderly individuals. It affects the ability to sit on a chair, stand, walk, and climb stairs. Our objective was to evaluate the effectiveness of tens and strengthening exercises on functional ability in patients with OA of knee joints. We present a case of a 55-year-old female housewife with bilateral knee pain, which manifested suddenly as a dull ache exacerbated by walking and stair climbing and alleviated by rest. Clinical examination revealed crepitus, grade 1 tenderness, and reduced range of motion (ROM) in the left knee. The radiographic evaluation confirmed grade 3 osteoarthritis according to the Kellgren and Lawrence grading system, indicating moderate multiple osteophytes, definite joint space narrowing, some sclerosis, and potential bone deformity. The patient underwent a 4-week intervention comprising strengthening exercises and TENS. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), knee ROM with a goniometer, and functional limitations with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Assessments were conducted weekly throughout the intervention. The findings suggest that the combined application of TENS and strengthening exercises effectively alleviates pain and improves functional ability in patients with knee osteoarthritis.

Relationship between Feline Knee Joint Osteoarthritis and Bone Mineral Density Quantified Using Computed Tomography and Computed Digital Absorptiometry.

Osteoarthritis (OA), including knee joint OA, is a common chronic condition in cats. In both cats and humans, knee joint OA is characterized radiographically by the presence of osteophytes, enthesiophytes, subchondral sclerosis, and joint space narrowing. However, only in humans have these radiographic signs been reported to increase bone mineral density (BMD). Therefore, this study aims to quantify the volumetric (vBMD) and relative (rBMD) BMD measures of the feline knee joint and compare BMD measures between various severities of OA to test the hypothesized OA-BMD relationship in the knee joint in cats. The 46 feline knee joints were imaged using computed tomography (CT) and conventional radiography supported by the computed digital absorptiometry (CDA) method to obtain vBMD and rBMD, respectively. Both BMD measures were assessed in three regions of interest (ROIs): the distal femur (ROI 1), patella (ROI 2), and proximal tibia (ROI 3). In all locations, vBMD and rBMD showed moderate (ROI 2: r = 0.67, p < 0.0001) to strong (ROI 1: ρ = 0.96, p < 0.0001; ROI 3: r = 0.89, p < 0.0001) positive correlations. Due to differences (p < 0.0001) in the width of the distal femur (17.9 ± 1.21 mm), patella (8.2 ± 0.82 mm), and proximal tibia (19.3 ± 1.16 mm), the rBMD was corrected (corr rBMD) using the thickness coefficient of 0.46 ± 0.04 for ROI 2 and 1.08 ± 0.03 for ROI 3. Regardless of the quantification method used, BMD measures increased linearly from a normal knee joint to severe OA, with differences in BMD between normal and mild to severe knee joint OA. The OA-BMD relationship in the feline knee joint can be preliminarily confirmed.

Two Members of Vitamin-K-Dependent Proteins, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), as Possible New Players in the Molecular Mechanism of Osteoarthritis.

Objectives: The pathophysiology of osteoarthritis is mainly unknown. Matrix Gla protein (MGP) and Gla-rich protein (GRP) are both vitamin-K-dependent mineralization inhibitors. In this study, we aimed to compare the levels of MGP and GRP in the synovial fluid of osteoarthritic (OA) and non-osteoarthritic (non-OA) knee joints. Materials and Methods: Two groups were formed, with one consisting of patients with OA and the other non-OA, serving as a control group. The non-OA group included individuals who had arthroscopic surgery for non-cartilage-related issues. In the OA group, all participants had undergone total knee arthroplasty because of grade 4 primary degenerative osteoarthritis. During the operation, at least 1 mL of knee synovial fluid was collected. The GRP and MGP levels in the synovial fluid were measured using an ELISA kit. Results: The mean age in the OA group (62.03 ± 11.53 years) was significantly higher than that in the non-OA group (47.70 ± 14.49 years; p = 0.0001). GRP levels were significantly higher in the OA group (419.61 ± 70.14 ng/mL) compared to the non-OA group (382.18 ± 62.34 ng/mL; p = 0.037). MGP levels were significantly higher in the OA group (67.76 ± 11.36 ng/mL) compared to the non-OA group (53.49 ± 18.28 ng/mL; p = 0.001). Calcium levels (Ca++) were also significantly higher in the OA group (12.89 ± 3.43 mg/dL) compared to the non-OA group (9.51 ± 2.15 mg/dL; p = 0.0001). There was a significantly positive correlation between MGP levels and age (p = 0.011, R = +0.335). Linear regression analysis was performed to determine the effect of age on MGP levels (p = 0.011, R-Square = 0.112). The dependent variable in this analysis was MGP (ng/mL), and age was the predictor. Conclusions: In conclusion, both GRP and MGP are potentially usable biomarkers in osteoarthritis. However, GRP seems to be more valuable because it is not associated with age. In the future, both proteins could provide important contributions to the diagnosis and treatment of osteoarthritis.

Comparison of MRI Osteoarthritis Knee Score with Clinico-Radiological Grading

Abstract Background Knee joint osteoarthritis (OA) is among the most prevalent degenerative diseases of the joints in the body. Various scoring system exists for grading OA, such as (1) magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS), (2) clinical grading by Western Ontario and McMaster Universities Arthritis Index (WOMAC), and (3) X-ray grading of the Kellgren–Lawrence grading system (K-L). Objectives To study MRI findings and MOAKS scoring of knee OA and correlation with WOMAC and K-L scoring. Setting and Design Cross-sectional study in hospital population. Methods and Material A total 40 knee OA cases underwent an MRI of the knee. MOAKS scoring was done and compared with K-L grading and WOMAC scores. Statistical Analysis Collected data were compiled systematically and interpreted using IBM SPSS statistics software 25.0. A p-value of less than 0.05 was considered significant. Results The mean total WOMAC score was 9. K-L grade 2 was the most prevalent X-ray grade. Bone marrow lesion (BML) and cartilage loss in MOAKS score were greater in the medial femorotibial region. A moderate positive correlation was noted between the WOMAC score and K-L grade; full-thickness articular cartilage loss score at the medial femorotibial joint (MFTJ) and WOMAC score; partial-thickness articular cartilage loss score at lateral femorotibial joint (LFTJ) and WOMAC total pain score. No correlation was found between BML and pain severity score. Conclusion Higher WOMAC scores were associated with higher grades of K-L scoring and score of cartilage loss (partial and full thickness) of the MOAKS scoring system. The rest of the features of the MOAKS score (BML score, osteophyte, and synovitis) had no significant association with pain severity and K-L grading.

A Ubiquitin‐Competitive Strategy Based on the Element Microenvironment to Treat Osteoarthritis

AbstractRecent research on ferroptosis and cuproptosis has underscored the crucial role of trace element regulation in osteoarthritis (OA) treatment. However, research systematically addressing the alterations in nutrient elements in OA cartilage is lacking. This study is initiated using clinical specimens to quantify metal element concentrations in both damaged and intact cartilage to identify deficient trace elements within the inflammatory and senescent microenvironments of OA. Based on the preliminary findings of selenium (Se) and gallium (Ga) deficiencies in OA cartilage, tailored nanoparticles based on Se and Ga are designed and validated for their antioxidant ability. GaSex nanoparticles demonstrated significant efficacy in mitigating chondrocyte degeneration and extracellular matrix degradation induced by inflammatory factors and in alleviating cartilage abrasion, hyperalgesia, and abnormal gait in a destabilization of the medial meniscus (DMM) mouse model. Mechanistically, GaSex nanoparticles activated the Nrf2 pathway and competitively inhibited the ubiquitin‐mediated degradation of Gpx4, thus inhibiting ferroptosis. This study systematically designed GaSex nanoparticles based on the imbalance of trace elements within the OA knee joint microenvironment and demonstrated robust antioxidant capabilities and remarkable competitive properties for ubiquitin, thereby providing a novel therapeutic solution for OA treatment.

H3K9me3 loss and ERVs activation as hallmarks for osteoarthritis progression and knee joint aging

This study aims to link aberrant endogenous retroviruses (ERV) activation and osteoarthritis (OA) progression by comparing the chromatin accessibility and transcriptomic landscapes of diseased or intact joint tissues of OA patients. We performed ERV-centric analysis on published ATAC-seq and RNA-seq data from OA patients' cartilage tissues. Here, we compared the outer region of the lateral tibial plateau (oLT), representing intact cartilage, to the inner region of the medial tibial plateau (iMT), representing damaged cartilage. In addition, cartilage tissue sections from OA patients and post-traumatic OA mouse models were assayed for global H3K9me3 abundance through immunohistochemistry (IHC) staining. Chromatin accessibility and transcription of ERVs, particularly from evolutionarily "intermediate age" ERV families (ERV1 and ERVL), were enriched and elevated in OA cartilage. This integrative analysis suggests that H3K9me3-related heterochromatin loss might be mechanistically connected to ERV activation in OA tissue. We further verified that global H3K9me3 levels were reduced in diseased cartilage relative to intact tissue in OA patients and injury-induced OA mice. The findings suggest a compelling hypothesis that the loss of H3K9me3, either due to aging or cellular stressors, may lead to ERV reactivation that contributes to tissue inflammation and OA progression. This study unveils the intricate relationship between epigenetic alterations, ERV activation, and OA, paving the way for potential therapeutic interventions targeting these pathogenic mechanisms.

Comparative evaluation of knee osteoarthritis: radiography vs. ultrasonography in Nepalese population: a cross-sectional study.

Osteoarthritis (OA) is a degenerative and long-term debilitating disease with rising prevalence, predominantly involving larger joints including the knee joint. While radiography has traditionally been the primary modality for joint evaluation, there is a growing trend towards using ultrasonography (USG) for musculoskeletal disorders, including joint assessment. This study aimed to find the role of USG in the evaluation of OA of knee joints with comparison to the radiographs. This was a cross-sectional study done on patients with signs and symptoms of OA of the knee who visited the radiology department for knee radiographs. Kellgren and Lawrence system was used for grading OA in radiographs. USG of knee joints was done with high-frequency probes and searched for joint space width, articular cartilage thickness, marginal osteophytes, meniscal extrusion, and other articular/ extra-articular abnormalities. The USG findings were correlated with findings in anteroposterior and lateral radiographs. The mean number of osteophytes was higher in USG compared to the radiographs (P<0.001). Mean joint spaces were comparable in both modalities. Meniscal extrusion was seen with USG, which significantly correlated with joint space width and cartilage thickness (P<0.005). USG also detected synovial changes, effusion, and Baker's cyst. Although radiography is the standard first-line radiological investigation for the diagnosis of OA of the knee joint, USG can be an adjunct as it well correlates with the radiograph findings and can provide more useful information.

The Potential Role of Bone Marrow Mesenchymal Stem Cells Derived Exosomes on Experimentally Induced Osteoarthritis of Knee Joint in Male Albino Rats. Histological and Immunohistochemical Study

Abstract Introduction Osteoarthritis (OA) is the most common joint disorder worldwide characterized by progressive loss of articular cartilage. This study was conducted to evaluate the role of bone marrow mesenchymal stem cells (BMSCs) derived Exosomes as a promising therapy for treating osteoarthritis. Aim of the Work to study the healing potential of BMSCs derived exosomes on experimentally induced knee osteoarthritis. Materials and Methods Forty adult male albino rats, weighing 200-250 gm, were used in this study, five rats used as a source of BM-MSCs derived exosomes. The other thirty-five rats were randomly divided into three main groups Group I: The control group (20 rats) in which rats were subdivided into four subgroups. Subgroups IA and IB were sacrificed 2 and 6 weeks after the beginning of the experiment. Subgroup IC left for 2 weeks then were received intra-articular injection of 0.1ml Phosphate buffer saline (PBS) in right knee joint once weekly for 4 weeks Subgroup ID: left for 2 weeks then given intra-articular injection of purified exosome concentrate in the right knee joint once weekly for 4 weeks then the animals were sacrificed Group II:(15 rats) in which OA was induced by intra-articular injection of 2% formaldehyde solution in the right knee joints. The rats of group II were subdivided into two subgroups. Subgroups IIA and IIB were sacrificed 2 and 6 weeks after induction of OA respectively. Group III (5 rats), Osteoarthritis induced, as in group II and animals left for 2 weeks then treated by intra-articular injection of purified exosome concentrate in right knee joint once weekly for 4 weeks. The right joints from all groups were collected, decalcified and processed for histological studies. Morphometric and statistical measurements were done. Results Histological examination of the right knee joints of OA group (subgroups IIA and IIB) showed surface erosions, decrease cartilage thickness, chondrocytes with pyknotic nuclei and areas of chondrocytes loss with longitudinal clefts reaching the deep zone. Synovial membrane of group II showed increased thickness of the intima, mononuclear cellular infiltration with abundant collagen fibres deposition and dilated congested blood vessels in subintima, apparent increase in the number of iNOS positive intimal synovial cells. Meanwhile, group III showed smooth articular surface, with multiple colonies of chondrocytes and multiple cell nests, significant increase in the mean area percentage of PCNA positive chondrocytes in animals of group Ш when compared to all the other groups. Conclusion BMSCs derived exosomes improved OA induced damage of articular cartilage and synovial membrane. Therefore, it offers a cell-free treatment of OA and joint damage.

Effect of Retro Walking Versus Balance Training on Pain and Functional Disability of Geriatric Patients with Knee Joint Osteoarthritis: Randomized Controlled Trail

Effect of Retro Walking Versus Balance Training on Pain and Functional Disability of Geriatric Patients with Knee Joint Osteoarthritis: Randomized Controlled Trail

Seven-Year Longitudinal Study: Clinical Evaluation of Knee Osteoarthritic Patients Treated with Mesenchymal Stem Cells.

Background/Objectives: Numerous studies have demonstrated the safety and efficacy of intraarticular stem cell injections for treating osteoarthritic knee joints, reporting symptom reduction and pain relief within a few months of treatment. Here, we report the results of a 7-year follow-up after a single intraarticular injection of 0.5-1 × 107 autologous adipose tissue-derived mesenchymal stem cells in patients with OA (Kellgren-Lawrence grade 2 to 4). Methods: Nine patients were treated, and two patients had bilateral disease. Patients were evaluated clinically and radiologically using X-ray and MRI. A comprehensive statistical analysis was undertaken to evaluate the obtained results. Results: All clinical scores and range of motion significantly improved within the first six months after injection. At the 18-month time point, a significant improvement in cartilage structure was observed on MRI while X-ray showed no changes in subchondral bone of distal femur and proximal tibia. At the 60-month time point, the clinical scores were still improved compared to baseline, except for the range of motion, which decreased almost back to the baseline level. At 84 months, the clinical scores decreased significantly toward the baseline level, but the MRI structural characteristics of cartilage still remained significantly better than those measured at baseline. Conclusions: Adipose tissue-derived stem cell therapy has substantial long-term clinical effects on patients with knee osteoarthritis.

Hydraulic theory of pathogenesis of posttraumatic osteoarthritis of knee joints and perspectives of therapeutic measures

Hydraulic theory of pathogenesis of posttraumatic osteoarthritis of knee joints and perspectives of therapeutic measures

Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda with Rasnashirishadi Kwatha and Ajamodadi Vati: A Case Series

Sandhivata or Osteoarthritis is a degenerative joint disease. It is considered to be the result of inflammation, degeneration and wearing out of joint cartilage over time. Here the top layer of cartilage breaks down and goes away. This makes the bones under the cartilage to rub together. The rubbing results in pain, swelling and loss of motion of the joint. Sandhivata develops in all ages of people, but most probably it occurs after the age of 40. The most commonly affected joints include knee, hips, etc. Gradually O.A worsens as the time passes. Then the bone starts to break down and develops growths called spurs. There is a possibility to chip off the bits of bone or cartilage and float around in the joint. As a result of inflammatory process in the body, cytokines (proteins) and enzymes are produced that will further damage the cartilage. The primary purpose of this study was to establish the efficacy of medicines or treatment and demonstrate freedom from unwanted side effects in human. Suitable medicine plays a paramount role in the success of treatment as it is a main factor lying with the management of a disease. There is a direct proportional relationship between the success of treatment and the genuineness of the medicine. The present study was undertaken to carry out the clinical evaluation of Rasnashirishadi Kwatha and Ajamodadi Vati in Sandhivata patients.