Reduction In Joint Stiffness Research Articles

Patient-Identified Treatment Goals for Psoriatic Disease: Results From a US Patient Survey.

Despite advancements in the treatment landscape for psoriasis (PsO) and psoriatic arthritis (PsA), some patients may not achieve the desired disease improvement due to undertreatment. Understanding patient perspectives on treatment expectations can inform patient-centered decisions and enhance treatment satisfaction. To describe patient-identified treatment goals and expectations for managing psoriatic disease. A cross-sectional study was conducted using a survey through MyPsoriasisTeam, an online social community. The survey was available to its US-based patients aged ≥21years with self-reported diagnoses of PsO and/or PsA. The study assessed patients' treatment goals, satisfaction with treatment outcomes, and satisfaction with health care providers (HCPs). Responses were summarized using descriptive statistics. This analysis included 386 patients (PsO, n = 130; PsA with/without PsO, n = 256). Treatment goals varied by psoriatic disease type. The top 3 treatment goals for PsO were reduce itching (73.1%), reduction in size/thickness (68.5%), and reduction in the number of plaques (63.1), and for PsA, were reducing joint pain (77.7%), lessening fatigue (64.8%), and reducing joint stiffness (62.1%). Patient satisfaction with treatment outcomes was low (extremely/very satisfied: PsO, 7.5%/8.5% and PsA, 9.2%/20.2%). Overall, 73.1% with PsO were treated by a dermatologist, and a dermatologist or rheumatologist treated 74.6% with PsA. Overall, patient satisfaction with HCPs who treated their disease was lacking (PsO, 19.3% and 19.3%; PsA, 27.3% and 33.6% were extremely and very satisfied, respectively). These findings suggest the need for enhanced communication between patients and HCPs to align treatment goals and expectations and to improve treatment satisfaction and disease management.

The influence of aquatic activity on osteoarthritis

© 2024 Medical University of Lublin. This is an open access article distributed under the Creative Commons Attribution-NonComercial-No Derivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) Abstract Introduction. In 2020, osteoarthritis (OA) affected up to 595 million people in the world, which is 7% of the population. Three quarters of them are over 55 years old and 60% are women. The pathophysiological basis of degenerative disease is a disturbance in the balance between the processes of formation and degradation of articular cartilage. Additionally, degeneration processes affect other elements of the musculoskeletal system, such as the synovial capsule, ligaments and muscles around the joint. Due to the severe pain, degenerative disease leads to a significant reduction in the quality of life and limited mobility. In the final stage it leads to disability. Arthritis most often involves the knee, hip joints, arms as well as vertebral column. To slow down the degenerative processes and minimize the complications of the disease, effective preventive methods should be implemented as soon as possible. Especially since there is currently no effective drug available for this disease. A popular method of combating pain is aquatic activity. The physical properties of water have a positive effect on the musculoskeletal and nervous systems. This review article assessed the effectiveness of aquatherapy depending on risk factors and the stage of osteoarthritis. Aim. Review and presentation of the current state of knowledge about water exercises on the course of osteoporosis, taking into account groups at risk of degenerative disease. Material and methods. Analysis of the studies available on open access sources at PubMed, Google Scholar, National Library of Medicine and Coachrane. The research was conducted through word analysis key words such as: “arthritis”, „aquatic activity”, „osteoarthritis”. Selection criteria for articles included consideration of their title, abstract, and publication date, with a focus on English-language publications. Conclusion and Results.This article demonstrates the positive impact of water exercises on the course of osteoporosis, as well as their preventive effect. The relationship between hydrotherapy and OA in individual risk groups was presented. Aquatic activity has been shown to be effective in inhibiting degenerative processes, reducing joint stiffness, improving walking distance, and mental condition. Keywords: osteoarthritis, aquatic activity, arthritis, WOMAC, degenerative disease, DALY.

Comprehensive Allopathic Treatment and Retrospective Ayurvedic Regime Post-snake Bite from Southern Russell’s Viper (Daboia russelii) for Wound Healing and Joint Stiffness - A Case Report

Background: In India and other tropical nations, snake bites are a serious public health issue that anti-snake venom may effectively treat. Case Presentation: The case report described here details the antivenom received to neutralize the toxins present in Russell’s viper venom, followed by Ayurveda treatment to remove the surgical wound and reduce joint stiffness by applying Ayurvedic paste prepared by Laportea aestuans (L.). The leaves, garlic, pepper, and lemon juice mixture was applied to the affected area twice daily for 10 days. Another thin paste consisting of Laportea aestuans (L.) leaves, Centella asiatica (L.), garlic, pepper, and lemon juice was applied every 30 minutes for 10 days. A dried medicated paste was prepared by heating coconut oil and dried neem tree peel and applied to the wound. The patient was also given a decoction of Randia dumetorum (Retz.) Poir nut extracted with milk to flush out the venom. Conclusion: The present results suggest combining conventional allopathic treatment to heal the surgical wound and Ayurvedic treatments to manage the symptoms of a juvenile Russell's viper bite as effective.

Ilizarov technique for treating elbow stiffness caused by myositis ossificans: A case report

BACKGROUND Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment approach, preventing recurrence and standardized rehabilitation are also crucial. Here, we present a surgical strategy to prevent the recurrence of MO. CASE SUMMARY A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon. However, incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification, causing a loss of normal range of motion. The patient was diagnosed with MO based on physical examination, X-ray findings, and clinical presentation. We devised a surgical strategy to remove MO, followed by fixation with an Ilizarov frame, and implemented a scientifically reasonable rehabilitation plan. The surgery lasted for 3 h with an estimated blood loss of 45 mL. A drainage tube was placed after surgery, and fluid was aspirated through ultrasound-guided puncture. The patient experienced a significant reduction in joint stiffness after surgery. In the final follow-up at 9 mouths, there was evident improvement in the range of motion of the elbow joint, and no other symptoms were reported. CONCLUSION The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal. It offers benefits such as passive recovery, individualized treatment, and prompt recovery.

Ayurveda Upachara on Amavata

This study delves into the positive impact of a 15-day Snehapana treatment on a patient, revealing significant relief from pain, reduced joint stiffness, and overall improvement. The subsequent follow-up assessment demonstrates the complete elimination of pain, swelling, sensitivity, and hardness. The success underscores the pivotal role of addressing Agni impairment, Ama formation, and Vata dosha vitiation in effectively managing Amavata. The sequential approach, encompassing the transformation of Ama into Niramaavasta, coupled with Virechan and Snehana treatments, proved to be successful. Notably, Snehana emerged as a crucial element, playing a key role in eliminating Ama-related issues, calming Vata, and clearing impurities. These findings provide valuable insights into a comprehensive and successful strategy for Amavata management, emphasizing the importance of a tailored treatment plan targeting the root causes of the condition.

Passive Movements Do not Appear to Prevent or Reduce Joint Stiffness in Medium to Long-Stay ICU Patients: A Randomized, Controlled, Within-Participant Trial.

ICU patients have an increased risk of joint stiffness because of their critical illness and reduced mobility. There is a paucity of evidence evaluating the efficacy of passive movements (PMs). We investigated whether PMs prevent or reduce joint stiffness in ICU patients. A randomized, controlled, within-participant, assessor-blinded study. A 48-bed tertiary care adult ICU. Intubated patients who were expected to be invasively mechanically ventilated for greater than 48 hours with an ICU length of stay greater than or equal to 5 days, and unable to voluntarily move their limbs through full range of motion (ROM). The ankle and elbow on one side of each participant's body received PMs (10 min each joint, morning and afternoon, 5 d/wk). The other side acted as the control. The PMs intervention continued for as long as clinically indicated to a maximum of 4 weeks. The primary outcome was ankle dorsiflexion ROM at cessation of PMs. Plantarflexion, elbow flexion and extension ROM, and participant-reported joint pain and stiffness (verbal analog scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation of PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation of PMs review measurements were undertaken as near as possible to 4 weeks. We analyzed data from 25 participants with a median (interquartile range) ICU stay of 15.6 days (11.3-25.4). The mean (95% CI) between-side difference for dorsiflexion ROM (with knee extension) at cessation of PMs was 0.4 degrees (-4.4 to 5.2; p = 0.882), favoring the intervention side, indicating there was not a clinically meaningful effect of 5 degrees. No statistically significant differences were found between the intervention and control sides for any ROM or VAS data. PMs, as provided to this sample of medium to long-stay ICU patients, did not prevent or reduce joint stiffness.

Cognitive Training Improves Joint Stiffness Regulation and Function in ACLR Patients Compared to Healthy Controls.

As cognitive function is critical for muscle coordination, cognitive training may also improve neuromuscular control strategy and knee function following an anterior cruciate ligament reconstruction (ACLR). The purpose of this case-control study was to examine the effects of cognitive training on joint stiffness regulation in response to negative visual stimuli and knee function following ACLR. A total of 20 ACLR patients and 20 healthy controls received four weeks of online cognitive training. Executive function, joint stiffness in response to emotionally evocative visual stimuli (neutral, fearful, knee injury related), and knee function outcomes before and after the intervention were compared. Both groups improved executive function following the intervention (p = 0.005). The ACLR group had greater mid-range stiffness in response to fearful (p = 0.024) and injury-related pictures (p = 0.017) than neutral contents before the intervention, while no post-intervention stiffness differences were observed among picture types. The ACLR group showed better single-legged hop for distance after cognitive training (p = 0.047), while the healthy group demonstrated no improvement. Cognitive training enhanced executive function, which may reduce joint stiffness dysregulation in response to emotionally arousing images and improve knee function in ACLR patients, presumably by facilitating neural processing necessary for neuromuscular control.

Early Weight Bearing pada Pasien Post Operasi Fraktur Ekstremitas Bawah

This study aims to identify and analyze the effectiveness of weight bearing in postoperative lower extremity fractures. The method used is to review the literature results by analyzing data systematically using a checklist of protocols and rules (PRISMA) and for the feasibility of the study results using the PICO framework. Search for articles using three online databases, namely Science Direct, Google scholar, and PubMed. The results showed that the five pieces discussed the impact of early weight bearing on postoperative lower extremity patients with discussions that had a positive effect—withholding weight / early weight bearing results reducing the incidence of thromboembolic disease. Active movement can reduce joint stiffness, maintain muscle mass, and the ability to return to activities. In conclusion, early weight bearing can be used to increase muscle strength after surgery for lower extremity fracture.
 
 Keywords: Orthopedic surgery, Lower extremity fracture

Clinical outcome of early-stage knee osteoarthritis after intra-articular platelet rich plasma injection

<p><strong>Background:</strong> Osteoarthritis (OA) is a degenerative joint disease due to degradation of articular cartilage, proliferative reformation of subchondral bone and low degree of synovitis resulting in reduced quality of life (QOL), being the major cause of pain and disability in the elderly population. Platelet-rich plasma (PRP) is an autologous mixture of concentrated platelets and growth factors produced by centrifugation of whole blood, used to treat bone, tendon and ligament injuries. The growth factors released by PRP have been shown to promote cell recruitment, proliferation and angiogenesis resulting in a decrease in the expression of inflammatory enzymes. The aim was to study the effectiveness of intra-articular PRP injections in early-stage OA knee patients and to evaluate the clinical outcome and QOL at 6 months.</p><p><strong>Methods:</strong> We conducted an observational study of 100 patients with early OA knee changes with age group >50 years and injected their knees with PRP injections and serial follow up assessment was done.</p><p><strong>Results:</strong> We saw significant improvement in quality of lives evaluated as per world health organization quality of life (WHOQOL) questionnaire after PRP injections on their follow-up. Significant reduction in pain, reduction in joint stiffness and improvement in physical activities shown by significant reduction in Western Ontario and McMaster universities osteoarthritis index (WOMAC) scores.</p><p><strong>Conclusions: </strong>OA of knee is one of the commonest rheumatological problems after 50 years of age. It was commonly observed in females more than 60 years age with sedentary lifestyle. PRP therapy has given excellent results in pain relief, reduction of joint stiffness and improvement in physical activities and improvement in QOL.</p>

Cyclic Behavior of Gabled Frames with Web-Tapered Columns and Rafters

Cyclic loading tests were conducted on three 1/2-scale, half-bay steel gabled frames (SGFs) to investigate their seismic performance. The three specimens with reduced joint stiffness were designed based on the prototype drawing shown in China design guideline 02SG518-1: specimen SV1 with a reduced thickness of the joint end-plate and bolt diameter, specimen SV2 with a reduced number of bolts, and specimen SV3 with a reduced bolt diameter. The load capacity, rotational stiffness, rotational capacity, and ultimate failure mode of specimens SV1, SV2, and SV3 were investigated. The experimental results showed that specimen SV1 failed due to the local buckling of the lower flange of the rafter, and specimens SV2 and SV3 due to the local buckling of upper flange of the rafter. The joint zone of all specimens kept well, indicating that the prototype joint had a large margin of safety. The hysteresis curves of all specimens were not full, and the ductility and energy dissipation capacity were limited. The end-plate thickness, bolt diameter, and steel grade affected the hysteresis performance of the SGF little. A refined finite element model was established, and the predicted results compared well with the test results. The test and analysis results demonstrated that there was slight utilization and distribution of post-buckling strength.

Isometric Quadriceps Exercises for Patients with Knee Osteoarthritis: A Randomized Controlled Trial Comparing Knee Joint Position Flexion versus Extension.

Objective To compare the effect of quadriceps isometric exercises performed in two different positions in addition to the combined physical therapy program on pain, stiffness, and physical function in patients with knee osteoarthritis (OA). Methods A total of 30 patients with OA (age range 45 to 70 years) who were admitted to Istanbul Private Ekotom Medical Center, Department of Physical Medicine and Rehabilitation Outpatient Clinic, were included. The patients were randomly divided into two groups according to the type of performing the quadriceps isometric exercises as group 1 (performing in knee extension, n = 14) and group 2 (performing in knee flexion, n = 15). All patients also received a combined physical therapy program. Exercise protocols were applied six days a week for four weeks. The pain was evaluated using a 10 cm visual analog scale for pain (VAS) in rest and activity; pain, joint stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results A significant difference was found in the VAS and WOMAC scores of both groups in group comparisons (p < 0.05). When the groups were compared in terms of change values, a significant difference was found in the WOMAC stiffness score in favor of group I (p < 0.05). Discussion. It is possible to obtain positive results with quadriceps isometric exercises to reduce pain and joint stiffness and increase physical function in patients with knee OA. However, exercises performed in knee extension were found to be more effective in reducing joint stiffness.

A New 4-DOF Robot for Rehabilitation of Knee and Ankle-Foot Complex: Simulation and Experiment

Stationary robotic trainers are lower limb rehab robots which often incorporate an exoskeleton attached to a stationary base. The aim is to recover range of motion, increase muscles strength and reduce joint stiffness. The issue observed in the stationery trainers which involve knee and ankle-foot complex joints simultaneously is that they restrict the natural motion of ankle-foot in rehab trainings due to the insufficient Degrees of Freedom (DOFs) of these trainers. This restriction makes the joints deviate from their natural motion patterns, exerting potentially harmful forces and strain the joints. In this work, we propose a new stationary knee-ankle-foot rehab robot with all necessary DOFs including knee flexion/extension in addition to ankle plantarflexion/dorsiflexion, ankle-foot abduction-adduction and foot supination/pronation. Axes of motions are determined based on the kinematics of the joints. A typical rehab training exercise has been considered to evaluate the system performance. The chosen training (i.e., passive assistance) was first implemented in simulation to synthesize the control loop and to extract the parameters required for selecting the robot’s components. The robot was then fabricated and tested on a healthy subject. Results showed that all natural motions of the ankle-foot complex were generated during the training. Therefore, the proposed system fulfils the desired aim properly, so that it can be utilized in the design of rehab robots.

Influence of cyclical hygrothermal aging on mechanical response and structural durability of composite bolted interference-fit joints

The paper deals with the long-term performance and durability of composite bolted interference-fit joints subjected to harsh environmental loads in flight-cycles. An accelerated cyclical hygrothermal aging spectrum with repeated temperature and moisture variation is specially designed to simulate real service condition. The single-lap composite joints with various stacking sequences, interference-fit sizes and tightening torques are aged in designed hygrothermal environments with different time duration, in which the material deterioration, stress relaxation and intrinsic frequency of joints are monitored to characterize structural evolution. Tensile tests are conducted to aged composite joints to obtain joint stiffness, bearing strength and failure modes to quantitatively evaluate their residual mechanical properties and structural degradation regulation. The results show that the moisture absorption rate presents a sharp rise and slow decent trend with a peek value of 0.213%. The aging process causes weathering phenomenon and reduces the structural benefits induced by such assembly technologies as interference fitting and bolt preloading. The reduction of joint stiffness and bearing strength exhibits a negative exponential decline trend with the growth of aging time. The matrix plasticization and interlaminar debonding are main hygrothermal damages. The safety factor of 0.7 to 0.8 is suggested on bearing strength value to reach hygrothermal aging bearing strength allowable in joint application.

Hematopoietic Stem- and Progenitor-Cell Gene Therapy for Hurler Syndrome

BackgroundAllogeneic hematopoietic stem-cell transplantation is the standard of care for Hurler syndrome (mucopolysaccharidosis type I, Hurler variant [MPSIH]). However, this treatment is only partially curative and is associated with complications.MethodsWe are conducting an ongoing study involving eight children with MPSIH. At enrollment, the children lacked a suitable allogeneic donor and had a Developmental Quotient or Intelligence Quotient score above 70 (i.e., none had moderate or severe cognitive impairment). The children received autologous hematopoietic stem and progenitor cells (HSPCs) transduced ex vivo with an α-L-iduronidase (IDUA)–encoding lentiviral vector after myeloablative conditioning. Safety and correction of blood IDUA activity up to supraphysiologic levels were the primary end points. Clearance of lysosomal storage material as well as skeletal and neurophysiological development were assessed as secondary and exploratory end points. The planned duration of the study is 5 years.ResultsWe now report interim results. The children’s mean (±SD) age at the time of HSPC gene therapy was 1.9±0.5 years. At a median follow-up of 2.10 years, the procedure had a safety profile similar to that known for autologous hematopoietic stem-cell transplantation. All the patients showed prompt and sustained engraftment of gene-corrected cells and had supraphysiologic blood IDUA activity within a month, which was maintained up to the latest follow-up. Urinary glycosaminoglycan (GAG) excretion decreased steeply, reaching normal levels at 12 months in four of five patients who could be evaluated. Previously undetectable levels of IDUA activity in the cerebrospinal fluid became detectable after gene therapy and were associated with local clearance of GAGs. Patients showed stable cognitive performance, stable motor skills corresponding to continued motor development, improved or stable findings on magnetic resonance imaging of the brain and spine, reduced joint stiffness, and normal growth in line with World Health Organization growth charts.ConclusionsThe delivery of HSPC gene therapy in patients with MPSIH resulted in extensive metabolic correction in peripheral tissues and the central nervous system. (Funded by Fondazione Telethon and others; ClinicalTrials.gov number, NCT03488394; EudraCT number, 2017-002430-23.)

Mechanisms of reducing joint stiffness by blocking collagen fibrillogenesis in a rabbit model of posttraumatic arthrofibrosis.

Posttraumatic fibrotic scarring is a significant medical problem that alters the proper functioning of injured tissues. Current methods to reduce posttraumatic fibrosis rely on anti-inflammatory and anti-proliferative agents with broad intracellular targets. As a result, their use is not fully effective and may cause unwanted side effects. Our group previously demonstrated that extracellular collagen fibrillogenesis is a valid and specific target to reduce collagen-rich scar buildup. Our previous studies showed that a rationally designed antibody that binds the C-terminal telopeptide of the α2(I) chain involved in the aggregation of collagen molecules limits fibril assembly in vitro and reduces scar formation in vivo. Here, we have utilized a clinically relevant arthrofibrosis model to study the broad mechanisms of the anti-scarring activity of this antibody. Moreover, we analyzed the effects of targeting collagen fibril formation on the quality of healed joint tissues, including the posterior capsule, patellar tendon, and subchondral bone. Our results show that blocking collagen fibrillogenesis not only reduces collagen content in the scar, but also accelerates the remodeling of healing tissues and changes the collagen fibrils’ cross-linking. In total, this study demonstrated that targeting collagen fibrillogenesis to limit arthrofibrosis affects neither the quality of healing of the joint tissues nor disturbs vital tissues and organs.

Long-term BTX-A effects on bi-articular muscle: Higher passive force, limited length range of active force production and unchanged intermuscular interactions

Botulinum toxin type-A (BTX-A) is commonly used for spasticity management aiming at reducing joint stiffness and increasing joint range of motion in CP patients. However, previous animal studies showed acutely increased passive forces and a narrowerlength range of active force exertion (lrange) for muscles exposed. BTX-A can spread affecting mechanics of several muscles in a compartment, but it was shown acutely to diminishepimuscular myofascial force transmission (EMFT). Yet, our understanding of these effects in the long-term is limited and they need to be tested in a bi-articular muscle. The goal was to test the following hypotheses in a long-term rat model: exposure to BTX-A (i) has no effects onlrangeand passive forces of bi-articular extensor digitorum longus (EDL) muscle and (ii) diminishes EMFT. Male Wistar rats were divided into two groups: BTX-A and control (0.1 units of BTX-A or only saline was injected into the tibialis anterior). Isometric proximal and distal EDL forces were measured simultaneously, one-month post-injection. Proximally and distally lengthening the muscle showed that BTX-A causes a significantly narrowerlrange(by 14.7% distally and 32.2% proximally) and significantly increased passive muscle forces (over 2-fold both distally and proximally). Altering muscle position at constant length showed that BTX-A does not change EMFT. The findings reject both hypotheses showing that long-term exposure to BTX-A compromises bi-articular muscle’s contribution to motion for both joints and the muscle’s mechanical interaction with the surroundings remains unaffected. These effects which may compromise long-term spasticity management should be studied in CP patients.

Physical Therapy’s Management for the Complex Treatment of Patients Having Had a Cerebral Vascular Accident - Case Study

Worldwide, cerebral vascular accident is one of the leading causes of morbidity and mortality. According to the World Health Organization, 6,5 million cerebrovascular accident- induced deaths were recorded in 2011. In Romania, the cerebrovascular accident is the third mortality cause, after cancer and cardiovascular diseases. The number of cerebral vasculo-circulatory diseases continues to grow, due to atherosclerosis and high blood pressure frequency. Physical therapy aims to help patients gradually recover the range of motion in their lower and upper limbs, reduce oedema, prevent bed sores, prevent or reduce joint stiffness, as well as recover the ability to perform day to day activities. The purpose of this paper was to highlight physical therapy’s beneficial outcome when applied individualised to a patient having had a cerebral vascular accident with a view to improving the psycho- motor and sensory imbalances accompanying this diagnosis.

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over-produce and contract collagen matrices. We hypothesized that intra-articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β-aminopropionitrile and cis-hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic-co-glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α-smooth muscle actin (α-SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion-extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α-SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non-immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine-treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β-aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α-SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof-of-concept that established joint stiffness can be resolved non-surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629-638, 2020.

Effectiveness and Tolerability of Repeated Courses of Viscosupplementation in Symptomatic Hip Osteoarthritis: A Retrospective Observational Cohort Study of High Molecular Weight vs. Medium Molecular Weight Hyaluronic Acid vs. No Viscosupplementation.

Background: Nonsurgical management of symptomatic hip osteoarthritis needs real-world evidence. We evaluated the effectiveness and tolerability of US-guided intra-articular treatment of two hyaluronic acids (HAs) commercially available in Italy and investigated predictors of response. Methods: Outpatient records including three cohorts: 122 subjects treated with medium (1,500–3,200 kDa; Hyalubrix®) molecular weight (MW) or high (hylan G-F20; Synvisc®) MW HAs and 20 controls taking NSAIDs/analgesics on demand were retrospectively analyzed. Pain VAS score, WOMAC, NSAID/analgesic consumption, and causes of suspension were available at 1, 6, 12, and 24 months after first administration. As selection bias usually affects observational retrospective studies, a quasi-randomization process was attained by performing propensity score approach. Results: Propensity score adjustment successfully allowed comparisons among balanced groups of treatments. VAS and WOMAC considerably decreased over time in treated groups independently of the radiological grade (p<0.001). On the other hand, the control group showed only a slight and rather uneven variation in VAS. Mean score changes were comparable in both HA cohorts from the earliest stages (ΔVAS(HA1,500–3,200kDa)T1vsT0 = −20%; ΔVAS(hylan G-F20)T1vsT0 = −23%/ΔWOMAC(HA1,500–3,200kDa)T1vsT0 = −17%; ΔWOMAC(hylan G-F20)T1vsT0 = −19%), reaching a further substantial reduction after 12 months (ΔVAS(HA1,500–3,200kDa)T12vsT0 = −52%; ΔVAS(hylan G-F20)T12vsT0 = −53%/ΔWOMAC(HA1,500–3,200kDa)T12vsT0 = −45%; and ΔWOMAC(hylan G-F20)T12vsT0 = −47%). Almost 11% (=13/122) of ineffectiveness and few moderate local side effects 3% (=4/122) were detected. Conclusions: Viscosupplementation in a real-life setting seems to provide a sound alternative in pain management in comparison to oral NSAIDs/analgesics, guaranteeing a reduced intake of pain killer medications. Analgesic effectiveness, functional recovery, and reduced joint stiffness extend and improve over 12 and 24 months, suggesting that repeated administrations achieve an additive effect.

Effects of intra articular steroids, hyaluronic acid and combination of both among patients with knee osteoarthritis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is a common degenerative disorder of articular cartilage accompanied by hypertrophic changes of the bone. In the management of OA, though use of intra articular (IA) injection of steroids, hyaluronic acid (HA) separately plays an important role, their effects in terms of reducing pain, joint stiffness and movement restriction when it is used in combination remains a question. Hence this study was planned to assess the effects of HA and steroids alone with combination of both Ha and steroids.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective randomized comparative study, among patients with osteoarthritis knee attending the outpatient department of Orthopedics in a tertiary care hospital during January 2017 to May 2018, were included. Patients were randomized in three groups (steroids, HA and combination of both) and a total of 96 patients were included and the outcome was assessed by WOMAC scale. Statistical analysis was done using SPSS Version 20.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Pain and movement restriction, at the end of fourth week and pain, joint stiffness and movement restriction, were found to be statistically improved in combined steroids and HA group than the group with steroids alone. Similarly at the end of third month, pain and movement restriction were found to be statistically improved in combined steroids and HA group than HA group alone.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study demonstrates that HA together with corticosteroid provides pain relief, reduction of joint stiffness and helps in improving joint movements within three months after treatment.&lt;/p&gt;