Presence Of Osteophytes Research Articles

Osteoarthritis in southeast Asia

Osteoarthritis Osteoarthritis (OA) is a multifactorial and complex disease that involves change in articular bone and cartilage structure. The multifactorial nature of OA is that the disease is not a single entity, but encompasses many entities, including the the loss of cartilage within synovial joints, hypertrophy of bone, and thickening of the capsule. The complexity is in the causality and etiology of the disease as its risk is determined by multiple, and probably interactive, effects of genetic and environmental factors. A reasonable definition that can capture the complex ity and multifactorial nature of the disease is “a heterogeneous group of conditions that lead to joint symptoms and signs, which are associated with defective integrity of of cartilage, in addition to related changes in the underlying bone at the joint margins” [1]. Although OA can affect any joint in the body, it is often found at the hands, knees, hips, and spine. A challenge in studies of OA is in the diagnosis. There is a considerable disparity between clinical and radiologic diagnoses. There are many radiologic methods for diagnosing OA, but the Empire Rheumatism Council system of grading first described by Kellgren and Lawrence [2] is probably the most widely used scale in epidemiologic studies. The Kellgren–Lawrence method is actually a system of OA grading based on the presence or absence of osteophytes, joint space narrowing, subchondral sclerosis, and bony cysts. In an epidemiologic study, it was noted that while the prevalence of clinically diagnosed knee OA was approximately 18%,

Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison

To compare cross-sectional and longitudinal side-differences in thigh muscle anatomical cross-sectional areas (ACSAs), muscle strength, and specific strength (strength/ACSA), between knees with early radiographic change vs knees without radiographic knee osteoarthritis (RKOA), in the same person. 55 (of 4796) Osteoarthritis Initiative (OAI) participants fulfilled the inclusion criteria of early RKOA in one limb (definite tibiofemoral osteophytes; no radiographic joint space narrowing [JSN]) vs no RKOA (no osteophyte; no JSN) in the contralateral limb. ACSAs of the thigh muscles and quadriceps heads were determined using axial MRIs at 33%/30% femoral length (distal to proximal). Isometric extensor and flexor muscle strength were measured (Good Strength Chair). Baseline quadriceps ACSA and extensor (specific) strength represented the primary analytic focus, and 2-year changes of quadriceps ACSAs the secondary focus. No statistically significant side-differences in quadriceps (or other thigh muscle) ACSAs, muscle strength, or specific strength were observed between early RKOA vs contralateral limbs without RKOA (P ≥ 0.44), neither in men nor in women. The 2-year reduction in quadriceps ACSA in limbs with early RKOA was -0.9 ± 6% (mean ± standard deviation) vs -0.5 ± 6% in limbs without RKOA (statistical difference P = 0.85). Our results do not provide evidence that early unilateral radiographic changes, i.e., presence of osteophytes, are associated with cross-sectional or longitudinal differences in quadriceps muscle status compared with contralateral knees without RKOA. At the stage of early unilateral RKOA there thus appears to be no clinical need for countervailing a potential dys-balance in quadriceps ACSAs and strength between both knees.

Osteophytes, enthesophytes, and high bone mass: a bone-forming triad with potential relevance in osteoarthritis.

ObjectivePrevious studies of skeletal remains have suggested that both enthesophytes and osteophytes are manifestations of an underlying bone-forming tendency. A greater prevalence of osteophytes has been observed among individuals with high bone mass (HBM) compared with controls. This study was undertaken to examine the possible interrelationships between bone mass, enthesophytes, and osteophytes in a population of individuals with extreme HBM.MethodsCases of HBM (defined according to bone mineral density [BMD] Z scores on dual x-ray absorptiometry) from the UK-based HBM study were compared with a control group comprising unaffected family members and general population controls from the Chingford and Hertfordshire cohort studies. Pelvic radiographs from cases and controls were pooled and evaluated, in a blinded manner, by a single observer, who performed semiquantitative grading of the radiographs for the presence and severity of osteophytes and enthesophytes (score range 0–3 for each). Logistic regression analysis was used to identify significant associations, with a priori adjustment for age, sex, and body mass index.ResultsIn this study, 226 radiographs from HBM cases and 437 radiographs from control subjects were included. Enthesophytes (grade ≥1) and moderate enthesophytes (grade ≥2) were more prevalent in HBM cases compared with controls (adjusted odds ratio [OR] 3.00 [95% confidence interval (95% CI) 1.96–4.58], P < 0.001 for any enthesophyte; adjusted OR 4.33 [95% CI 2.67–7.02], P < 0.001 for moderate enthesophytes). In the combined population of cases and controls, the enthesophyte grade was positively associated with BMD at both the total hip and lumbar spine (adjusted P for trend < 0.001). In addition, a positive association between osteophytes and enthesophytes was observed; for each unit increase in enthesophyte grade, the odds of any osteophyte being present were increased >2-fold (P < 0.001).ConclusionStrong interrelationships were observed between osteophytes, enthesophytes, and HBM, which may be helpful in defining a distinct subset of patients with osteoarthritis characterized by excess bone formation.

Further evidence of the developmental origins of osteoarthritis: results from the Hertfordshire Cohort Study.

Investigators have suggested a link between birth weight and both hand and lumbar spine osteoarthritis (OA). In this study, we sought to extend these observations by investigating relationships between growth in early life, and clinical and radiological diagnoses of OA at the hand, knee and hip, among participants from the Hertfordshire Cohort Study. Data were available for 222 men and 222 women. Clinical OA was defined based on American College of Rheumatology criteria. Radiographs were taken of the knees and hips, and graded for the presence of osteophytes and overall Kellgren and Lawrence (KL) score. Lower weight at year one was associated with higher rates of clinical hand OA (OR 1.396, 95% CI 1.05, 1.85, P=0.021). Individuals with lower birth weights were more likely to have hip osteophytes (OR 1.512, 95% CI 1.14, 2.00, P=0.004) and this remained robust after adjustment for confounders. Furthermore, a low weight at one year was also associated with a higher osteophyte number in the lateral compartment of the knee, after adjustment for confounders (OR 1.388, 95% CI 1.01, 1.91, P=0.043). We have found further evidence of a relationship between early life factors and adult OA. These findings accord with previous studies.

Base of thumb injections.

Steroid injections to the trapeziometacarpal joint (TMJ) can offer both diagnostic insight and symptomatic relief for patients with basal thumb arthritis, particularly in the early stages of disease.1 However, correct infiltration of the joint can pose a challenge, especially in the presence of osteophytes. In addition to the unwanted complications of periarticular injection, failure to relieve symptoms could hasten the need for surgery. We suggest that once the TMJ has been located using fluoroscopy, the screen should continue to be monitored as the solution is injected. The visible widening of the TMJ (Fig 1) confirms accurate deployment of the injection. Figure 1 Widening of trapeziometacarpal joint as solution is injected

Population prevalence of ultrasound features of osteoarthritis in the hand, knee and hip at age 63 years: the Newcastle thousand families birth cohort.

BackgroundMusculoskeletal ultrasound has been found to be more sensitive than radiographs in detecting osteophytes. Our objective was to measure the prevalence of features of osteoarthritis (OA), in the dominant hand, knees and hips using ultrasound, within the Newcastle Thousand Families birth cohort.MethodsParticipants were aged 61–63 (mean 63) years. Knee images were scored for presence of osteophytes and effusion. Hip images were scored for the presence of osteophytes and femoral head abnormality. The first carpometacarpal joint, metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the index finger (dominant hand) were imaged for osteophytes.ResultsAmong 311 participants, prevalence of osteophytes at the distal interphalangeal joint was 70% while it was 23%, 10% and 41% for index proximal interphalangeal and metacarpophalangeal and thumb base carpometacarpal joints respectively. Prevalence of knee osteophytes was 30%, hip OA was 41%. Prevalence of knee effusions was 24% (right) and 20% (left). Ultrasound evidence of generalised OA (48%) and isolated hand OA (31%) was common, compared to isolated hip or knee OA (5%) and both hip and knee OA (3%).ConclusionThis is the first study to assess prevalence of ultrasound features of OA in a population-based sample. The higher prevalence of hand/hip OA, when compared to previous radiographic studies, supports the hypothesis that ultrasound is more sensitive than radiography in detecting OA, particularly for osteophytes.

Flexible Hinge Silicone Implant with or without Titanium Grommets for Arthroplasty of the First Metatarsophalangeal Joint

To review outcomes of 37 patients who underwent arthroplasty of the first metatarsophalangeal joint using flexible hinge silicone implants with or without titanium grommets. 36 women and one man (63 feet) underwent arthroplasty of the first metatarsophalangeal joint for rheumatoid arthritis (RA) using Swanson flexible hinge silicone toe implants with or without titanium grommets. 20 women (35 feet) aged 31 to 72 (mean, 52) years with Steinbrocker grade II (n=4), grade III (n=6), and grade IV (n=10) RA of the feet were treated with the implant without grommets, whereas 16 women and one man (28 feet) aged 48 to 73 (mean, 60) years with Steinbrocker grade III (n=4) and grade IV (n=13) RA of the feet were treated with the implant with grommets. Pain levels were self-rated. Degenerative changes and the presence of osteophytes or deformity were recorded, as were breakage or deformation of the implants, radiolucencies around the implant, implant loosening, silicone-induced synovitis, and sclerosis around the implant. All patients reported pain relief from severe to mild or moderate. Respectively for the feet with and without grommets, the rates of implant deformation were 25% and 63% (p=0.031), whereas the rates of moderate-to-severe radiolucencies (>2 mm) were 4% and 34% (p=0.004). Sclerosis developed around the implant in all feet. Titanium grommets appear to protect the implant and improve clinical outcomes.

Ultrasonographic findings in young adult patients with early osteoarthritis (OA) of the knee. Preliminary data.

Purpose: Introduction. The OA is a chronic and multi-factorial disease; it is characterized by gradual loss of articular cartilage. The accepted method for assessing and doing OA diagnosis is a conventional radiography. When the clinicians assessed a knee radiography and give a diagnosis of OA, maybe it is late, because the patients have some months or years that started the degenerative process in cartilage. In recent years the musculoskeletal ultrasound (MSUS) has been used to obtain data about late knee OA, however there are few article published, which described morpho-structural changes in the MSUS in patients with early knee OA. Objectives: To estimate the prevalence of morpho-structural changes (presence of synovitis, effusion, osteophytes and meniscal extrusion) using MSUS in early knee OA patients. Evaluate the relationship between these ultrasound findings and quality of life and function in knee OA patients. Methods: Patients and Methods: We used preliminary data from the study of the impact of metabolic syndrome (MS) in patients with OA, which is carried out at the National Institute of Rehabilitation. Briefly, inclusion criteria: adult patients under 55 years of age and criteria for knee OA from the ACR and the radiography score 1 to 2 of Kellgren and Lawrence classification. Patients with autoimmune inflammatory diseases, fibromyalgia, illness crystals and previous surgery were excluded. All patients underwent to knee MSUS to evaluate the presence of synovitis, effusion, osteophytes and meniscus extrusion. Epidemiological data were collected from patients, the EuroQoL were used to evaluate the quality of life and WOMAC scale was applied to evaluate the knee function. The results were analyzed using descriptive and bivariate test, parametric and no-parametric statistical tests were used. Results: We studied 72 patients, mean age 45 years ± 7.4, 83% female gender, education (years) mean 10.5 ± 3.8, Body Mass Index 30.6 ± 4.9. Score for WOMAC were: pain 1.4, stiffness 1.5, physical function 1.3. EuroQol 0.55 in male population vs. 0.69 in women population. The table 1 show MSUS findings. Conclusions: morpho-structural findings by MSUS were found in a high prevalence of patients with knee OA classified by radiology in early stages. This shows that although radiology is the most used method for classification of disease, it does not evaluate an early OA, further studies are required to detect early changes of OA.Table IPrevalence of musculoskeletal ultrasound findings in OA patientsUltrasound knee siteSynovitis % (mm)MeniscusExtrusion % (mm)Site of OsteophytesMedial / Lateral(%)SP* Right18 (7.9)Medial Right8 (2.8)Femoral Right35 / 63SP* Left28 (8.2)Medial Left6 (3.8)Femoral Left63 / 63Medial Right20 (4.3)Lateral Right19 (3.6)Tibial Right46 / 63Medial Left20 (4.1)Lateral Left19 (3.4)Tibial Left57 / 63Lateral Right48 (4.6)Lateral Left43 (4.2) Open table in a new tab

External hip adduction moment and progression of medial tibiofemoral cartilage damage and bone marrow lesions in persons with knee osteoarthritis

Purpose: Gait biomechanics at the hip may affect medial joint loading at the knee in persons with knee osteoarthritis (OA). A greater external hip adduction moment (reflecting torque generation by the hip abductor muscles) during the stance phase of gait may limit excessive hip drop or trunk lean. This, in turn, may prevent excessive medial knee joint loading and eventual progression of knee OA. Little is known about the relationship between the external hip adduction moment and progression of medial tibiofemoral OA as assessed by MRI. We hypothesized that a greater magnitude of the baseline external hip adduction moment is associated with reduced risk of baseline-to-2-year progression of medial tibiofemoral cartilage damage and bone marrow lesions in persons with knee OA. Methods: Participants with knee OA, defined by osteophyte presence in at least one knee, underwent quantitative gait analysis at baseline using an 8-camera Digital Real-Time Eagle motion analysis system and force plate. Inverse dynamics were used to calculate the external hip adduction moment, normalized to %bodyweight*height. Both knees underwent 3.0T MRI at baseline and two year follow-up using double oblique coronal and axial FLASHwe, coronal T1-weighted spin-echo (SE), and sagittal, axial and coronal fat-suppressed turbo spin echo sequences. We assessed cartilage damage and bone marrow lesions using WORMS scoring, blinding readers to hypotheses and all other data. We used logistic regression statistical models with generalized estimating equations (GEE) to account for correlation between the 2 limbs of each person, to assess the association between external hip adduction moment at baseline and baseline-to-2-year cartilage damage progression and bone marrow lesion progression, defined as any worsening of score in the medial compartment as a whole and within each joint surface. Analyses were adjusted for gait speed, age, gender, and disease severity (using K/L radiographic grade). Results are reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results: 204 persons [mean age 64.2 years (±9.9, SD), mean BMI 28.5 kg/m2 (±5.7), 76.5% women] contributing 391 knees comprised the study sample. The mean external hip adduction moment was 4.43 (±0.9, SD) %body weight*height. As shown in Table 1, a greater external hip adduction moment was significantly associated with a reduced likelihood of cartilage damage progression in the medial tibiofemoral compartment and also at the medial femoral surface. After adjustment for the indicated covariables, these associations were no longer statistically significant at the 5% level. Table 2 shows the means (±SD) of the external hip adduction moment at baseline for knees with and without cartilage damage and bone marrow lesion progression in specific subregions. In analyses of specific regions, a greater external hip adduction moment was significantly associated with a reduced likelihood of cartilage damage progression at the posterior femoral subregion [OR per 1 unit of external hip adduction moment (95% CI): 0.51 (0.31, 0.86)] and bone marrow lesion progression at the central femoral subregion [OR per 1 unit (95% CI): 0.56 (0.35, 0.89)]. Conclusions: In persons with knee osteoarthritis, a greater external hip adduction moment was associated with a reduced likelihood of 2-year medial tibiofemoral cartilage damage progression and bone marrow lesion progression, but these findings were no longer statistically significant in adjusted analyses. The consistently protective direction of the findings at compartment, joint surface, and subregional levels warrants further evaluation at longer follow-up.Table 1Unadjusted and adjusted ORs (95% CIs) for medial tibiofemoral OA progression at 2 yearsMedial Tibiofemoral CompartmentMedial Femoral SurfaceMedial Tibial SurfaceCartilage damage progressionBone marrow lesion progressionCartilage damage progressionBone marrow lesion progressionCartilage damage progressionBone marrow lesion progressionNumber of knees (%) with progression61/391 (16%)87/391 (22%)48/391 (12%)53/391 (14%)29/391 (7%)48/391 (12%)Baseline predictorExternal Hip Adduction Moment (%BW*HT)Unadjusted0.70 (0.51, 0.97)0.75 (0.55, 1.01)0.68 (0.50, 0.93)0.72 (0.48, 1.08)0.88 (0.59, 1.32)0.96 (0.67, 1.37)Adjusted*0.82 (0.58, 1.15)0.85 (0.61, 1.17)0.79 (0.56, 1.12)0.80 (0.53, 1.21)1.07 (0.70, 1.64)1.20 (0.83, 1.75)Results are per 1 unit (%BW*HT) of external hip adduction moment (n = 391 knees from 204 persons)*adjusted for gait speed, age, gender, and K/L grade Open table in a new tab Table 2Means (SD) for the external hip adduction moment in medial tibial and femoral subregionsExternal Hip Adduction Moment (%BW*HT), mean (SD)Cartilage damage progression at 2-year follow-upPosterior femurCentral femurPosterior tibiaCentral tibiaAnterior tibiaNumber of knees (%) with progression20/391 (5%)33/391 (8%)7/391 (2%)25/391 (6%)8/391 (2%)Knees without progression, mean (SD)4.45 (0.88)4.44 (0.90)4.43 (0.89)4.43 (0.89)4.43 (0.89)Knees with progression, mean (SD)3.97 (0.85)4.36 (0.67)3.98 (0.57)4.32 (0.79)4.61 (0.87)Bone marrow lesion progression at 2-year follow-upNumber of knees (%) with progression19/391 (5%)38/391 (10%)12/391 (3%)33/391 (8%)21/391 (5%)Knees without progression, mean (SD)4.43 (0.87)4.47 (0.87)4.43 (0.89)4.44 (0.89)4.43 (0.88)Knees with progression, mean (SD)4.38 (1.19)4.05 (0.92)4.38 (0.84)4.34 (0.79)4.52 (0.96) Open table in a new tab Results are per 1 unit (%BW*HT) of external hip adduction moment (n = 391 knees from 204 persons) *adjusted for gait speed, age, gender, and K/L grade

Intra-articular treatment with recombinant human bone morphogenetic protein 7 (BMP-7) attenuates the development of osteoarthritis in a surgically induced rat model

Intra-articular treatment with recombinant human bone morphogenetic protein 7 (BMP-7) attenuates the development of osteoarthritis in a surgically induced rat model

Systemic administration of granulocyte colony-stimulating factor (G-CSF) for cartilage repair in rat osteochondral defect

Systemic administration of granulocyte colony-stimulating factor (G-CSF) for cartilage repair in rat osteochondral defect

Arthritis in a Glyptodont (Mammalia, Xenarthra, Cingulata)

Arthritic lesions have been frequently diagnosed in the fossil record, with spondyloarthropathy (a type of erosive and pan-mammalian arthritis) being one of the most common types described to date for mammals, though not restricted to this group. Here, we identify spondyloarthropathy in fossil bones from the late Pleistocene in Brazil assignable to a large glyptodont individual. Bone erosions in the peripheral joints (viz., the ulna, radius, left femur and tibiae-fibulae) associated with osteosclerosis allow the diagnosis of spondyloarthropathy. The presence of osteophytes in seven bones of the forelimbs (viz., the ulna and radius) and hind limbs (viz., the tibiae-fibulae, left femur and patellae) and a subchondral cyst in one element (viz., the left femur) indicate secondary osteoarthritis. A calcified deposition on the articular surface of the left patella indicates the presence of calcium pyrophosphate deposition disease, which, like the observed osteoarthritic alterations, likely represents a complication of spondyloarthropathy. This is the first report of spondyloarthropathy for xenarthrans.

Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up

Background contextAnterior cervical discectomy and fusion using cervical plates has been seen as effective at relieving cervical radiculopathy and myelopathy symptoms. Although it is commonly used, subsequent disc degeneration at levels adjacent to the fusion remains an important problem. However, data on the frequency, impact, and predisposing factors for this pathology are still rare. PurposeTo evaluate the incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies after anterior cervical discectomy and fusion using cervical plates and to analyze the efficacy of this surgical method over the long term, after a minimum follow-up period of 10 years. Study designRetrospective clinical study. Patient sampleOur study was a retrospective analysis of 177 patients who underwent anterior cervical discectomy and fusion using cervical plates, with follow-up periods of at least 10 years (mean 16.2 years). Outcome measuresRadiographic adjacent-segment pathology using plain radiographs and clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates. MethodsWe defined a new grading system of plain radiographic evidence of degenerative changes in adjacent discs after anterior cervical discectomy and fusion using cervical plates; Grade 0 is considered normal, and Grade V consists the presence of posterior osteophytes and a decrease in disc height to less than 50% of normal. The incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies were analyzed according to etiologies, number of fused segments, and plate-to-disc distance. ResultsRadiographic and clinical adjacent-segment pathologies were found in 92.1% and 19.2%, respectively, of patients. By etiology, clinical adjacent-segment pathology was observed in 13.5% of patients who had sustained trauma, 12.7% of those with disc herniation, and 33.3% of those with spondylosis. By number of fused segments, clinical adjacent-segment pathology was found in 13.2% of patients who underwent single-level fusion and in 32.1% of those who underwent multilevel fusion surgeries. Patients with a plate-to-disc distance of less than 5 mm, who had spondylosis, or who underwent multilevel fusion had a higher incidence of clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates than other groups did (p<.05). Of all patients, only 6.8% needed follow-up surgery. ConclusionsWe found that over the long term, at a minimum follow-up point of 10 years, a plate-to-disc distance of less than 5 mm, having spondylosis, and undergoing multilevel fusion were predisposing factors for the occurrence of clinical adjacent-segment pathology. Nevertheless, the incidence of clinical findings of adjacent-segment pathology was much lower than the incidence of radiographic findings. Also, the rate of follow-up surgery was low. Therefore, anterior cervical discectomy and fusion using cervical plates can be considered a safe and effective procedure.

Clinical and magnetic resonance imaging factors which may predict the need for surgery in lumbar disc herniation.

Study DesignCase-control.PurposeEvaluate clinical and imaging factors which may predict the risk of failure of medical therapy in patients with lumbar disc herniation (LDH).Overview of LiteratureLDH is a common cause of low back pain and radicular leg pain, with a generally favorable natural course. At present, however, it is not possible to identify patients who may be candidates for surgery in an early stage of their disease by means of clinical signs or diagnostic imaging criteria.MethodsWe designed a study investigating patients with untreated low back pain to assess the predictive value of demographic, clinical or imaging findings in identifying patients who finally would meet the classic current criteria for surgery.ResultsAmong 134 patients, 80.6% were successfully treated with conservative therapy and 19.4% finally underwent surgery. Sex, occupation, involved root level, presence of Modic changes, osteophytes or annular tears were not significantly different between the 2 groups, while cerebrospinal fluid block, Pfirrmann's grade, location of herniation with regard to the midline, and type of herniation were significantly different. Anteroposterior fragment size was significantly higher and intervertebral foramen height and thecal sac diameters were significantly lower in the surgical group.ConclusionsAlthough it is strongly recommended to practice conservative management at first for patients with LDH symptoms, the results of this study shows that higher Pfirrmann's grade, more laterally located discs, extrusion and protrusion herniation types, and larger fragments could predict the risk of conservative treatment failure. This way, unnecessarily prolonged conservative management (beyond 4-8 weeks) may be precluded.

Bilateral primary osteoarthritis of elbow: A case report with review of literature

Introduction: Primary osteoarthritis(OA) of the elbow is a rare condition, characterized by painful stiffness, mechanical symptoms, and the presence of hypertrophic osteophytes. Elbow osteoarthritis typically affects middle-aged men who engage in strenuous manual activity. We hereby present a case of bilateral primary elbow osteoarthritis and discuss its various treatment options. Case report: A 45 years old male patient presented to outpatient department with complaints of pain in both elbows since one year. There was no history of previous trauma or other complaints pertaining to elbow. He was a manual laborer working in farms. He had tenderness on deep palpation of elbow. All movements at elbow (extension, flexion, supination and pronation) were terminally restricted. X-rays of both elbows revealed osteoarthritis of elbow. After thorough discussion of treatment options with patient, he opted for non-operative management. Key massage: It requires a high index of suspicion to diagnose primary OA of elbow. Best treatment option involves capsular release and removal of impinging osteophytes but non-operative treatment remains the first step in the early management of elbow osteoarthritis.

Treatment of Advanced Stage Gonarthrosis With Prolotherapy: Case Report

IntroductionThis case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn’t be performed due to co-morbidities.Case PresentationA 72 year old woman presented with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing. Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly.ConclusionsSignificant improvement was noted at WOMAC scale (Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points). Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year. Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level. As a result of this case report, further studies aiming to offer a different minimally invasive treatment option to the patients before surgery may be performed. We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established.

Association analysis of BMD-associated SNPs with knee osteoarthritis.

Osteoarthritis (OA) risk is widely recognized to be heritable but few loci have been identified. Observational studies have identified higher systemic bone mineral density (BMD) to be associated with an increased risk of radiographic knee osteoarthritis. With this in mind, we sought to evaluate whether well-established genetic loci for variance in BMD are associated with risk for radiographic OA in the Osteoarthritis Initiative (OAI) and the Johnston County Osteoarthritis (JoCo) Project. Cases had at least one knee with definite radiographic OA, defined as the presence of definite osteophytes with or without joint space narrowing (Kellgren-Lawrence [KL] grade ≥ 2) and controls were absent for definite radiographic OA in both knees (KL grade ≤ 1 bilaterally). There were 2014 and 658 Caucasian cases, respectively, in the OAI and JoCo Studies, and 953 and 823 controls. Single nucleotide polymorphisms (SNPs) were identified for association analysis from the literature. Genotyping was carried out on Illumina 2.5M and 1M arrays in Genetic Components of Knee OA (GeCKO) and JoCo, respectively and imputation was done. Association analyses were carried out separately in each cohort with adjustments for age, body mass index (BMI), and sex, and then parameter estimates were combined across the two cohorts by meta-analysis. We identified four SNPs significantly associated with prevalent radiographic knee OA. The strongest signal (p = 0.0009; OR = 1.22; 95% CI, 1.08-1.37) maps to 12q3, which contains a gene coding for SP7. Additional loci map to 7p14.1 (TXNDC3), 11q13.2 (LRP5), and 11p14.1 (LIN7C). For all four loci the allele associated with higher BMD was associated with higher odds of OA. A BMD risk allele score was not significantly associated with OA risk. This meta-analysis demonstrates that several genomewide association studies (GWAS)-identified BMD SNPs are nominally associated with prevalent radiographic knee OA and further supports the hypothesis that BMD, or its determinants, may be a risk factor contributing to OA development. © 2014 American Society for Bone and Mineral Research.

Predictors of Preoperative Disability and Activity Level in Patients With Osteoarthritis of the Knee

Univariate and multivariate determinants of patient disability and activity level in patients with DJD of the knee were established. Although some variables were associated with disability and activity level, stiffness and joint space narrowing had the most robust associations. The Purpose of this study was to identify determinants of patient disability, as determined by Lysholm score, and patient activity level, as determined by Tegner Activity Level, in patients presenting for evaluation of degenerative joint disease(DJD) of the knee. A cohort of patients (n=242, Average age = 55.8 (range 29 to 82); 101 female & 141 males), who were diagnosed with DJD of the knee on initial exam, was studied prospectively. All patients had complete demographic, subjective and objective data from the initial exam. The dependent variables were Lysholm score (0-100) and Tegner Activity level, graded ordinally on a 1-10 scale. Univariate analysis and multivariable modeling were performed to identify determinants. Data on 299 knees was analyzed (57 bilaterals). Prior surgeries were reported in 58% of the knees and 80% had joint space narrowing on radiographic examination. For demographic variables, there were no significant differences in Lysholm for age, gender, or prior surgery(p>0.05). Tegner was significantly associated with age and gender(p<0.05). Tegner was also associated with number of prior surgeries, with knees operated on 2 or more times having significantly lower scores(p<0.05). For objective variables, there was a significant difference in Lysholm for the presence of joint space narrowing, extension deficits and flexion deficits(p<0.05). Tegner was not associated with joint space narrowing, however it was associated with extension deficits and flexion deficits. There were significant differences in patient satisfaction for associated lateral meniscus tear, presence of osteophytes, and concurrent symptomatic plica excision(p<0.05). Patients were significantly less satisfied with outcome for lack of passive extension, presence of arthrofibrosis, increased KT1000 manual maximum of involved leg, pivot-shift, presence of effusion, and tenderness at the medial joint line and patella(p<0.05). For subjective symptoms at follow-up, patients were significantly (p<0.05) less satisfied with outcome if there were symptoms of pain, swelling, partial giving-way, full giving-way, locking, noise, stiffness, or limp. For subjective functional assessment at follow-up, patients were significantly less satisfied with outcome for lower activity level, lower sports level, lower work level, lower ADL level, lower symptom-free activity level, unemployment, or if there was difficulty with walking, squatting, ascending or descending stairs, running, jumping, cutting, or twisting. Satisfaction was not significantly associated with IKDC ligament subscore(p>0.05), but was significantly associated with Lysholm knee score, overall IKDC knee score, IKDC subjective subscore, IKDC symptoms subscore, and IKDC range of motion subscore(p<0.05). Independent multivariate determinants (model adjusted R2=0.83) of patient satisfaction included Lysholm score, overall subjective knee function, IKDC range of motion subscale, patella tenderness, full giving-way, flexion contracture, and swelling. Univariate and multivariate determinants of patient disability and activity level in patients with DJD of the knee were established. Although some variables were associated with disability and activity level, stiffness and joint space narrowing had the most robust associations.

Trapezial Topography in Thumb Carpometacarpal Arthritis

Objective Contradictory reported arthritic patterns of the metacarpal surface of the trapezium include preferential volar wear, radial wear, and dorsal-ulnar sparing. We investigated whether a predominant wear pattern exists in surgical trapeziectomy for advanced thumb carpometacarpal (CMC) arthritis. Methods We examined 36 intact trapezia from 34 thumb CMC arthroplasty patients over an 18-month period. The first metacarpal articular surface revealed three consistent morphology patterns: (1) saddle, (2) dish, and (3) cirque. The saddle represented cartilage loss with preservation of the normal trapezial morphology. The dish shape represented concave curvature, with loss of the normal saddle configuration. The cirque shape represented preferential volar concave wear, disrupting the convex volardorsal arc. Two surgeons classified the randomized specimens twice, blinded to patient identity and each other's categorization. Radiographic Eaton staging was correlated retrospectively for 35 of 36 of the trapezial specimens. Eight specimens were further quantified with micro-computed tomography (micro-CT). Results Thirty-six trapezia were classified as follows: 17 (47%) saddle, 12 (33%) dish, and 7 (19%) cirque. Intra-rater reliability was 0.97 and 0.95; inter-rater reliability in the second round was 0.95. The 36 trapezia represented 27 female (75%) and 9 male (25%) patients; 18 (50%) represented the dominant hand. Age at surgery averaged 64 (33-76). Complete cartilage loss of the entire metacarpal surface was seen in 15 (42%) of all specimens. Osteophyte presence was typically minimal in the saddle group; the dish group had characteristic extensive rimming osteophytes in a 91% female population (11/12), and the cirque group had volar osteophytes. Radiographic severity ranged from Eaton stage II to IV; less severe radiographic staging (Eaton II) predominated in the saddle configuration; advanced Eaton III-IV disease predominated in both cirque and dish shapes. Micro-CT verified the three discrete shapes with volardorsal and radioulnar orientation measurements. Conclusion The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens. Sex, dominance, age distribution, and Eaton stage varied across the different shapes. Level of Evidence Level 3 Study Type Observational.

Sternoclavicular Joint Involvement in Rheumatoid Arthritis: Clinical and Ultrasound Findings of a Neglected Joint

To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis (RA). One hundred three consecutive patients with RA and 103 age- and sex-matched healthy individuals were enrolled. Clinical evaluation and blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, osteophytes, erosions, and intraarticular power Doppler (PD) was recorded. Interobserver agreement was calculated. A total of 412 SC joints were evaluated: 206 from patients with RA and 206 from healthy controls. In the RA group, 39 joints (19%) were found to be clinically involved (pain/swelling), in contrast to only 4 (1.9%) in the control group (P = 0.0001). In the RA group, US abnormalities were recorded in 89 SC joints (43%) compared with 36 (17%) in the healthy control group (P = 0.0001), comprising osteophytes in 59 (29%) versus 25 (12%; P = 0.0001), synovitis in 31 (15%) versus 5 (2%; P = 0.0001), erosions in 23 (11%) versus none (P = 0.0001), and intraarticular PD in 5 (2%) versus none (P = 0.03). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. In patients with RA, US detected a higher number of involved SC joints than with clinical assessment. Our results indicate that both gray-scale and PD US findings were more prevalent in patients with RA than in healthy controls. US synovitis and synovial hyperperfusion correlated with the DAS28, suggesting that SC joints actively participate in the systemic inflammatory process of RA.