Secondary Osteoarthritis In Patients Research Articles

Is higher body mass index associated with secondary osteoarthritis in patients treated with bone cement for benign aggressive bone tumors? Long-term evaluation of 43 patients

BackgroundThis study was designed to investigate the secondary osteoarthritis rate in patients with benign aggressive bone tumors treated with curettage and cementing at long-term follow up. MethodsPatients diagnosed with benign aggressive bone tumor (giant cell or aneurysmal bone cyst), treated with extended curettage and cementation with polymethylmethacrylate, who had a minimum of 60 months of follow up after surgery were included in this study. After definitive diagnoses were confirmed by a histopathologist, we decided to perform standard surgical management. Osteoarthritis was staged radiologically using the Kellgren–Lawrence scoring system, and the contralateral knees of the patients were used as the control group. Based on the Kellgren–Lawrence classification system, stages 3 and 4 were accepted as the existence of osteoarthritis. Body mass index, the distance to the subchondral joint line, tumor mass volume, the location of the tumor (i.e., femur, tibia, medial condyle, or lateral condyle), age, and sex were also investigated, all of which are factors that can affect the occurrence of osteoarthritis. ResultsForty-three patients, 24 male (56%) and 19 female (44%), were included in the study. The mean age of the patients was 29.5 ± 10 years, and mean follow up duration was 128.7 months. Tumor localization was the distal femur in 20 patients (46.5%) and the proximal tibia in 23 patients (53.5%). The mean tumor mass volume was 77.84 cm3 and the distance to the knee joint subchondral line was 3.2 ± 2 mm. According to this scoring system, 14 patients were at stage 0, 10 patients were at stage 1, 10 patients were at stage 2, four patients were at stage 3, and five patients were at stage 4. When we compared osteoarthritis development, the affected knee had a significantly higher rate of osteoarthritis development than the contralateral knee. A univariate analysis demonstrated that age (P = 0.002) and body mass index (P = 0.045) were associated with secondary osteoarthritis. Moreover, multivariate analysis demonstrated that none of the variables were independently associated with secondary osteoarthritis. ConclusionPatients with contralateral osteoarthritis had bilateral knee osteoarthritis, indicating that primary osteoarthritis progressed in both knees. Seven of the 43 patients (16.2%) showed secondary osteoarthritis. Although age and body mass index were associated with secondary osteoarthritis in univariate analysis, none of the variables were independently associated with secondary osteoarthritis in the multivariate analysis.

Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip

BackgroundDevelopmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months.MethodsA retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured.Results24 patients (29 hips) with a mean age of 43 (18–75) years and a mean follow-up of 35 months (12–137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0–23) and significantly medialized by a mean of 18 mm (6–29). The bone graft was fully integrated after 12 months in all cases.ConclusionAcetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.

Secondary Osteoarthritis in Patients With Rheumatoid Arthritis Appears as Severe as Inflammation According to Physician Visual Analog Scales, Regardless of Disease Severity

Secondary Osteoarthritis in Patients With Rheumatoid Arthritis Appears as Severe as Inflammation According to Physician Visual Analog Scales, Regardless of Disease Severity

Quantification and Impact of Secondary Osteoarthritis in Patients With Anti-Citrullinated Protein Antibody-Positive Rheumatoid Arthritis.

To search for evidence of secondary osteoarthritis (OA) in patients with rheumatoid arthritis (RA) in a cross-sectional and longitudinal setting, and to relate osteophyte formation to functional outcome. Anti-citrullinated protein antibody (ACPA)-positive RA patients underwent high-resolution peripheral quantitative computed tomography of the hand. Cross-sectional and longitudinal measurements were performed. The number and size (volume) of osteophytes as well as bone erosions were documented. The relationship of osteophytes to bone erosions and to demographic and disease-specific data was evaluated by multiple logistic regression models. A total of 202 ACPA-positive RA patients were enrolled in the cross-sectional part of the study, and a total of 77 ACPA-positive RA patients were enrolled in the longitudinal analysis (interval of 1.5 years between baseline and follow-up assessment). The mean ± SD number of osteophytes per patient was 1.3 ± 2.3, and the mean ± SD osteophyte volume per patient was 2.6 ± 4.9 mm(3) . The total number of erosions was significantly correlated with the total number of osteophytes (P < 0.001), and the total volume of erosions was significantly correlated with the total volume of osteophytes (P < 0.001). Moreover, the number of osteophytes was related to age (P < 0.001) and disease duration (P = 0.001), while the volume of osteophytes was related to age (P = 0.001), disease duration (P < 0.001), and function as measured by the Health Assessment Questionnaire (P = 0.013). Multivariate regression analyses showed an independent association between osteophytes and erosions. In the longitudinal analysis, the mean number (P = 0.033) and volume (P < 0.001) of osteophytes increased significantly in RA patients during their disease course. Age, disease duration, and bone erosions are associated with osteophytes, indicating development of secondary OA in patients with RA.

The Analysis of Efficacy of The Application of Interleukin-1 Inhibitor in the Complex Therapy of Secondary Osteoarthritis Taking Into Account the Dynamics of Clinical and Functional Indicators

Secondary osteoarthritis (OA) adversely affects the underlying disease and can enhance clinical manifestations of articular syndrome. Early detection of comorbid pathology and early treatment with the therapy of underlying condition is of primary importance to preserve adequate functional activity in patients. The Aim is to analyze the efficacy of the application of interleukin-1 inhibitor in the complex treatment of secondary OA in addition to rheumatoid arthritis (RA). 248 patients with secondary OA and RA were divided in 4 groups: patients of group I (n = 62) took interleukin-1 inhibitor (50 mg x 2 times per day) in combination with laser therapy on the basis of methotrexate (10-20 mg per week), group II (n = 60) received interleukin-1 inhibitor in complex with methotrexate, in group III (n = 62)--laser therapy with methotrexate and in group 4--methotrexate. We estimated the treatment efficacy in 3 and 6 months according to the dynamics of pain on VAS, indexes HAQ and KOOS. according to VAS group 1 showed statistical significant reduction in pain on movement in 3 and 6 months of 28.53 mm (43.6%) and 31.3 mm (48%) respectively, to values of 36.87 ± 1.56* and 33.11 ± 1.11* (p < 0.05). The results showed the statistically significant advantage of HAQ dynamics in groups I and II in comparison with groups III, IV (p = 0.03). The most prominent statistically significant (p = 0.02) results according to the dynamics of index KOOS were noted in groups of patients who took diacerein (I and II) 6 months after the complex treatment. the inclusion of interleukin-1 inhibitor in the complex treatment of secondary OA in patients with RA contributes to clinical improvement according to VAS (p = 0.03), index KOOS that reflects functional condition of the knee and increases the quality of life by index HAQ (p = 0.03) after 6 months therapy.

THE INFLUENCE OF COMPLEX THERAPY ON THE INFLAMMATORY MARKERS OF PATIENTS WITH SECONDARY OSTEOARTHRITIS

The aim of the study is to evaluate the efficacy of complex therapy of secondary osteoarthritis in patients with rheumatoid arthritis with the use of inhibitor of interleukin-1, including the dynamics of inflammatory markers.Materials and methods: 248 patients with secondary osteoarthritis in rheumatoid arthritis were involved in the trial. The participants were divided into 4 groups: patients of group I took inhibitor of interleukin-1 (diacerein) in combination with laser therapy and methotrexate; inhibitor of interleukin-1 in complex with methotrexate took patients from group II; group 3 — laser therapy + methotrexate and patients of group IV took only methotrexate. The efficacy of therapy we estimated in 6 months.Results: The constructed model surfaces indicated the decreased levels of IL-1, COMP and DAS 28 in group 1 till 6,68±0,37 pg/ml (p&lt;0,001), 16,92±0,8 ng/ml х 10² (p&lt;0,001) и 2,06±1,19 (p&lt;0,05) accordingly in comparison with groups III and IV. Also the model surfaces revealed the interdependency of all these indicators. The control group (IV) reacted to the treatment by decreasing the indicators as well. However, the dynamics of the changes was significantly less. In patients of groups I and II the levels of ESR and CRP decreased to 13,95±0,52* (*p&lt;0,001) and 10,97±0,43* (*p&lt;0,001); 16,53±0,63* (*p&lt;0,001) and 12,81±0,77* (*p&lt;0,001) accordingly.Conclusions: In comparison analysis we noted statistical significant advantages (p&lt;0,01) of the use of diacerein with methotrexate regarding the dynamic of IL-1 and COMP, ESR, CRP in patient’s serum, which is accompanied by the reduction of basic disease activity on DAS 28.

SECONDARY OSTEOARTHRITIS IN RHEUMATOID ARTHRITIS

The paper considers the problems of comorbidities in patients with rheumatoid arthritis (RA). Two or more RA-related conditions were diagnosed according to the results of the QUEST-RA program implemented in 34 countries. Osteoarthritis along with hypertension, hyperlipidemia, and osteoporosis was detected among the most commonly diseases. Owing to expanded diagnostic capabilities, the recognition and treatment of the comorbidities have recently received much attention, as embodied in the draft Association of Rheumatologists of Russia Guidelines for RA management (2014; Part 1). The concept and major characteristics of secondary osteoarthritis in RA are analyzed. It is precisely the inflammatory process and underlying disease-related risk factors, including treatment, that have impact on the development of secondary osteoarthritis and patients’ quality of life as a whole. All this allows an inference about the mechanisms closely intertwined with the underlying disease for the development of secondary osteoarthritis, which initiates cartilage damage and further remodeling. Primary and secondary osteoarthritis was comparatively analyzed. Particular emphasis is placed on current cartilage biomarkers, their diagnostic value and role in monitoring the efficiency of treatment in clinical trials. The paper provides a comparative analysis of detectable serum and urine biomarkers according to the results of the complex analysis made by the National Institutes of Health. Particular attention is given to cartilage oligomeric matrix protein (COMP). Foreign authors’ investigations suggest that there is a relationship between serum COMP levels and disease severity and joint X-ray changes. There is evidence for the efficacy of hyaluronic acid used in the treatment of secondary osteoarthritis in patients with RA.

Pathogenetic substantiation for use of new therapeutic approach in the therapy of secondary osteoarthritis in Patients with rheumatoid arthritis with basic therapy

The article considers the efficiency of using a new therapeutic approach in the therapy of secondary osteoarthritis in patients with rheumatoid arthritis. The dynamics of the Cartilage Oligomeric Matrix Protein, the activity of the disease based on DAS28, and the cytokine profile are estimated. Analysis of the results showed the advantages of using the interleukin-1 inhibitor in a complex with laser therapy in the treatment of secondary osteoarthritis in patients with rheumatoid arthritis.

Acromegalic arthropathy: current perspectives

Acromegaly is associated with manifestations in many organs including the heart, colon, skin, bone, and many joints. Both weight and non-weight bearing joints are affected including shoulders, wrists, knees, hips, and the spine [1–3]. Patients with long-term cure or long-term biochemical control of acromegaly still suffer from acromegalic arthropathy. The prevalence of clinical and radiological osteoarthritis of the hip, hand, and knee reaches even up to 80 % [1]. In comparison with primary osteoarthritis, secondary osteoarthritis in patients with long-term cured acromegaly is characterized predominantly by osteophytes, which were observed frequently without joint space narrowing indicating preservation of articular cartilage. Patients with acromegaly report less functional disability of the hips and knees than the patients with primary generalized osteoarthritis [1]. Radiological features of acromegalic arthropathy progress despite long-term biochemical remission of acromegaly. In contrast to the crosssectional observations, which indicate widened joint spaces in patients cured or controlled from acromegaly, prolongation of follow-up is characterized by a decrease in joint space widening and progression of osteophytosis, despite long-term biochemical control. Thus, this arthropathy appears to be a progressive joint disease that is not merely halted or reversed by control of acromegaly [4]. Remarkably, medically well-controlled patients show more radiographic progression compared with surgically cured patients. In previous studies, GH secretion was still slightly abnormal during treatment with SMS analogs, despite appropriate biochemical control according to current criteria [5]. However, persistent abnormal GH secretion despite somatostatin analogs is not a straight forward explanation, since active acromegaly is associated with joint space widening, rather than with joint space narrowing. Alternatively, it may be hypothesized that SMS analogs have a direct effect on the cartilage of joints. Therefore, it may be possible that SMS analogs contribute to the pathophysiology of the progression of acromegalic arthropathy. In addition to arthropathy, patients with active and cured/controlled acromegaly suffer from an increased prevalence of vertebral fractures, although these patients are considered to have a low risk of osteoporosis since bone mineral density is not decreased [6]. More than 50 % of these patients suffered from vertebral fractures. There was no association with the duration of disease control, bone mineral density, markers of bone turnover, or acromegalic disease characteristics. There was a striking number of fractures per patient (mean 3.4 ± 0.3, range 1–8) [7]. It should be realized that the most of these fractures were asymptomatic. Fractures were also evident in men, especially in the presence of hypogonadism. In view of the significant morbidity associated with vertical fractures, the inclusion of lateral conventional radiographs of the thoracic and lumbar spine has been proposed in the screening of all patients with acromegaly both at diagnosis and during follow-up after establishment of disease control. Longitudinal studies are required to assess both the contribution of risk factors for these fractures including vitamin D, (replacement for) hypopituitarism, and of glucocorticoid replacement at a low dose and the optimal treatment modalities to prevent (additional) vertebral fractures. J. A. Romijn (&) Department of Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands e-mail: j.a.romijn@amc.uva.nl

Administration of chondroprotector piascledine in the treatment of secondary osteoarthritis in patients with gout

Objective. To study clinical efficacy and safety of piascledine in the treatment of osteoarthritis (OA) in pts with gout. Material and methods. 30 pts older than 35 years with gout and concomitant OA were included. During 2 months they received piascledine 300 mg/day. All pts fulfilled Wallace S. criteria for gout and ACR criteria for OA. Exclusion criteria: renal and hepatic failure, severe infections, childbearing potential female, administration of other chondroprotectors. Clinical and laboratory examination was performed before and after 2 months of treatment with piascledine. Results. After 2 months of treatment pain on VAS decreased at rest (p<0,01) and at movement (p<0,05). There were no adverse events leading to withdrawal of the drug. Uric acid serum level, measures of lipid and carbohydrate metabolism, renal and hepatic function did not significantly differ from baseline. Conclusion. Piascledine administration in gout pts with OA is safe, effectively decrease pain and do not influence serum level of uric acid.

Tibiofemoral Kinematics of the Anterior Cruciate Ligament (ACL)-Deficient Weightbearing, Living Knee Employing Vertical Access Open “Interventional” Multiple Resonance Imaging

Background Our current understanding of tibiofemoral kinematics in the anterior cruciate ligament (ACL)-deficient knee is very limited. Using vertical open-access MRI, it is possible to accurately analyze tibiofemoral motion in patients with isolated rupture of the ACL. Study Prospective cohort study. Purpose To assess if ACL rupture alters normal knee weightbearing kinematics. Methods Tibiofemoral motion was assessed through the arc of flexion from 0 ° to 90 ° in 10 patients with isolated rupture of the ACL in one knee and a normal contralateral knee. Midmedial and midlateral sagittal images were analyzed in all positions of flexion in both knees to assess the tibiofemoral relationship. Results In the lateral compartment of the knee, the tibial plateau is persistently subluxed anteriorly throughout the arc of flexion from 0 ° to 90 ° (flexion facet center to posterior tibial cortex distance of 15.8 mm ± 2.9 in ACL-deficient knees compared to 21.4 mm ± 1.4 in normal knees at 0 ° extension, P< .0001) when compared to normal knees. The medial tibiofemoral relationship is unchanged compared to normal knees. Conclusion Rupture of the ACL changes tibiofemoral kinematics producing anterior subluxation of the lateral tibial plateau. Clinical Significance Altered kinematics may explain, at least in part, the increased incidence of secondary osteoarthritis in patients with ACL rupture.

Results of uncemented total hip prosthesis for congenital hip dislocation and dysplasia

Objectives: We evaluated clinical and radiologic results of uncemented total hip arthroplasty for secondary osteoarthritis in patients with congenital hip dislocation and dysplasia. Methods: Total hip arthroplasty was performed in 23 hips of 20 patients (18 females, 2 males; mean age 46 years; range 31 to 65 years). Seven (30.4%), eight (34.8%), and eight hips were Crowe type-II, III, and IV, respectively. Femoral head autografting was used in six patients with acetabular deficiency. Eight hips (34.8%) underwent subtrochanteric femoral osteotomy. Clinical evaluation was made using the Harris hip scores and Merle d’Aubigne’s criteria, and radiological evaluations with pre- and postoperative, and control A-P radiographs. The mean follow-up was 35.1 months (range 12 to 85 months). Results: Pre- and postoperative mean Harris hip scores were 38.6 and 91.1, respectively. The mean Merle d’Aubigne scores were 1.66 and 5.7 for pain, 3.1 and 5.4 for mobility, and 3.2 and 5.3 for walking, respectively. Radiologically, graft coverage was 32%. In seven hips (30.4%) the acetabular component was fully covered by the acetabular bone. In 10 hips (43.4%), 18% of the acetabular component was uncovered. The location of the acetabular component was almost in the desired place in 10 hips (43.4%), lower in eight hips (34.8%), and above in five hips (21.7%). No sciatic or femoral nerve injuries were observed. One patient (4.4%) with Crowe type-IV hip required acetabular revision for dislocation due to acetabular malposition. No recurrences occurred. Conclusion: Correct placement of the uncemented small acetabular component, graft usage in cases with inadequate coverage of the acetabular component, and femoral shortening osteotomy where necessary should be considered in congenital hip dislocation or dysplasia.