Severe Joint Deformity Research Articles

Outcome measures analysis following total knee arthroplasty in patients with severe haemophilic arthropathy of the knee.

Total knee arthroplasty (TKA) has been the gold standard for treating severe haemophilic arthropathy of the knee when all conservative measures fail. However, performing a TKA in patients with haemophilic arthropathy is difficult due to severe joint deformity and destruction, and poor bone quality. The aim of the present study was to evaluate the short-term results of TKA in the treatment of knee haemophilic arthropathy in a tertiary referral centre, with an emphasis on health-related quality of life and knee function. A prospective study was conducted that included 19 male patients with end-stage haemophilic knee arthropathy who underwent TKA in a tertiary referral centre. Clinical outcome and health-related quality of life were assessed by the Western Ontario and McMaster Universities Arthritis (WOMAC) index and the Short Form-36 (SF-36) both pre-operatively and at 1-year post-operatively. The mean age of the patients was 50.37±7.63 years (range, 40-65 years). Pre-operative health-related quality of life was impaired in all patients in all SF-36 domains but was markedly improved after TKA. Knee function in all dimensions (pain, stiffness and physical function), as measured by the WOMAC questionnaire, significantly improved after TKA. Pre-operative pain, stiffness and function, along with total WOMAC score, were strongly and negatively correlated with pre-operative SF-36. Overall, the present study indicated a significant improvement in quality of life and clinical outcome after TKA in patients with advanced haemophilic arthropathy. More studies with longer follow-up periods in a larger population are needed to fully elucidate the mid- and long-term values of TKA in haemophilic patients.

Analysis of congenital Zika syndrome clinicopathologic findings reported in the 8 years since the Brazilian outbreak

Aim: A Zika virus outbreak that began in Brazil, developed into an international public health emergency that extended from February 2015 until November 2016. Zika-infected pregnant women gave birth to a cohort of infants with congenital Zika syndrome (CZS) originally defined by severe microcephaly, retinal scarring, joint deformities, and hypertonia. This study examines the nature, extent, and severity of all CZS clinicopathologic findings described to date, compiled and analyzed by system. It reviews studies monitoring disease progression and proposing classification schemes for CZS stages. The teratogenic cellular and molecular mechanisms implicated in CZS pathogenesis are also discussed. Methods: A systematic review was conducted by literature search through WorldCat.org and ProQuest Central databases to identify studies on case series from the 2015–2016 CZS outbreak. Results: Twenty-six reports were included describing radiologic, ophthalmologic, audiologic, orthopedic, and laboratory test results in CZS cases including stillborns between 2016 and 2023. CZS neuropathology included prenatal and postnatal microcephaly, cerebral calcifications, quadriparesis, epilepsy, ventriculomegaly, reduced cerebral parenchyma, malformation of cortical development, and sleep electroencephalogram disturbances. Visual deficits were due to retinal and optic nerve lesions. Conductive and sensorineural hearing deficits were stable. Hypertonia, hypotonia, and spasticity with foot, hip, knee, and shoulder deformities resulted in arthrogryposis and restricted joint mobility. There was enlargement of immune organs, increased leukocyte counts, and cytokine dysregulation. Oro-craniofacial deformities affected the midface and caused dental eruption delay. Additional studies proposed that these systemic teratogenic effects could be attributable to transplacental Zika virus infection of multiple fetal progenitor cell lineages. Conclusions: The CZS-associated impairments in brain, eye, musculoskeletal, and immunologic functions caused disabilities that varied from moderate to severe, and significantly increased age-specific mortality rates. Further research is warranted to assess progression, classify stages, elucidate the precise molecular mechanisms mediating Zika teratogenicity, develop suitable therapeutic strategies, and design supportive social policies.

Complex Case: Acute-on-Chronic Gouty Arthritis, Septic Arthritis, and Severe Joint Deformities in a Young Adult Patient

Background: Gout is the most prevalent type of inflammatory arthritis, which can lead to inflammation in the joints. However, septic arthritis is unusual in gout.
 Case presentation: A 34-year-old male presented with lumps on the right ankle with cloudy white fluid discharge for 5 days prior to admission. The patient also has lumps observed on the left pedis, and manus bilateral. The patient regularly takes Allopurinol daily and Piroxicam prior to admission. The physical examination had a limited range of movement. Laboratory examinations found elevated uric acid, impaired renal function, elevated white blood cells, and elevated erythrocyte sedimentation rate. The patient was then referred for surgical debridement.
 Conclusion: Chronic gout marked by persistent polyarticular engagement and the formation of tophi. In individuals left untreated, septic arthritis and gout may manifest, followed by deformities of joints, which need further diagnosis and management.

Progressive Pseudo-Rheumatoid Dysplasia a Rare Genetic Musculoskeletal Condition Causing Crippling Disability in a Young Boy- a Case Report

Progressive pseudo-rheumatoid dysplasia (PPRD) is an uncommon genetic condition inherited in an autosomal recessive mode caused by a mutation in the WNT1-inducible signaling pathway protein 3 (WISP3) located on chromosome 6q21. In this condition, the articular cartilage gradually deteriorates, causing severe discomfort, stiffness, and joint deformities with a relatively high prevalence in Middle Eastern countries. Camptodactyly and platyspondyly are the standard features found in this condition. We present a very young boy diagnosed with bilateral hip dysplasia during early childhood and developing increasing pain, stiffness and deformities in the hands, elbow, hips, knee, and ankle. The diagnosis was suspected based on characteristic clinical and radiological features. The diagnosis was confirmed by genetic testing and the absence of elevated serum inflammatory markers. He was born out of a consanguineous marriage, and his parents were unaffected. They are three siblings; his elder sister has a milder condition, while his elder brother is unaffected. There were no adverse events during pregnancy. Birth weight was within normal limits, met all developmental milestones on time, and had no significant past medical history. Compounded by hip dysplasia, he developed a severe disability and had to undergo joint replacement surgery at a very young age. PPRD should be suspected in children from Middle Eastern countries of 3-8 years of age who present with multiple joint pain and stiffness and are born out of inbred family marriages. Diagnosis can be suspected by the characteristic clinical and radiological features coupled with the absence of raised serum inflammatory markers and confirmed by genetic testing. Genetic counseling and pre-marriage testing are of valuable help in prevention.

Casting is a Cost-Effective Management Option in Appropriate Cases of Charcot Neuroarthropathy

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot Neuroarthropathy (CN) is a chronic and debilitating condition that impacts the nerves of the foot. The progression of CN may result in severe joint deformities, ulcers, and amputation in certain cases. Treatment options for CN include surgical interventions (e.g., arthrodesis, exostectomy, and amputation) and non-surgical interventions (e.g., casting). A cost analysis on the various treatment modalities can guide physicians to help their patients make informed decisions about their care. Here, we aim to characterize the total costs associated with the various treatments of CN, in addition to the physical therapy (PT) related costs. Methods: Following IRB approval, a sample of patients at a single institution diagnosed with CN of the lower extremity, who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through patient records. Various demographics such as age, sex, and race were collected. Individuals were placed in their respective categories based on the first procedure they had performed. The groups were divided as follows: exostectomy, arthrodesis, major amputation, minor amputation, casting, and failed casting (the group that first received casting but later needed further intervention with other treatment modalities). Each procedure and PT appointment was counted toward the total cost. Descriptive statistics, t-tests, and one-way ANOVA were performed for statistical analysis. Results: Two-hundred and sixteen patients were identified; exostectomy (n = 81), arthrodesis (n = 47), major amputations (n = 10), minor amputations (n = 28), failed casting (n = 16), and casting (n = 34). The average age was 58 ± 12.1 years, and males accounted for 54% of the sample size with the various demographic information depicted in table 1. The effect of procedure type on total cost demonstrated a statistically significant difference between at least two groups (F-value = 18.53, p-value < 0.01), as demonstrated in figure 1. The total costs for casting were significantly lower than all other treatment modalities (p-value < 0.05). Furthermore, there was no statistical significance related to physical therapy costs among the groups (figure 2). Conclusion: Casting was demonstrated to be a more cost-effective management strategy for patients diagnosed with CN. However, it is important to note that this cost-related benefit is only apparent when CN patients are appropriately treated with casting, exemplified by the failed casting group. It is critical to utilize casting with appropriate patients in order to reduce the cost burden associated with these various management modalities. Early surgical intervention should still be strongly considered for patients who are not appropriate candidates for casting.

Arthrogryposis multiplex congenita with maxillofacial involvement: a case report

BackgroundArthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well.Case presentationThis case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises.ConclusionsA rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan. Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.

29 Juvenile idiopathic arthritis and osteogenesis imperfecta: an exceptional association

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. Osteogenesis imperfecta (OI) is an autosomal dominant inherited disease defined by bone fragility due to abnormal collagen synthesis. It affects the entire skeleton, predisposing the patient to fractures.We report an uncommon association between osteogenesis imperfecta and juvenile idiopathic arthritis.Case presentationA 15-year-old child presented to our rheumatology department with medical history of recurrent bone fractures due to low-energy trauma since the age of five years. The patient was born from a consanguineous marriage. He has been diagnosed with a polyarticular JIA since the age of eight years-old. The initial clinical presentation was a symmetric, cumulative, large and small joint polyarthritis. The rheumatoid factor was negative. No other autoantibodies were detected.The patient was treated initially with methotrexate which was inefficient. He developed joint deformities. Then, biologic therapy was associated with a good response.Clinical examination on entry showed severe joint deformities touching elbows, wrists and interphalangeal joints. Arms and thighs were curved and an unequal leg length was noted. There was no arthritis. The patient has bluish sclera. Neurological and dental examination was normal. There was no hearing loss. Laboratory findings showed a normal C-reactive protein. Calcium and phosphate serum levels were within normal ranges. On radiological investigations, radiographs showed excessive trabecular bone transparency, cortical bone thinning and incomplete bone fractures. Bone densitometry revealed a Z-score of the lumbar spine of -4.2 SD.According to clinical, biological, and radiological investigations, the diagnosis of JIA associated with OI was confirmed clinically. Treatment with Pamidronate was initiated intravenously.ConclusionWe reported an exceptional association between JIA and OI which occurred in a young Tunisian patient. We emphasize that this association should be considered when severe joints and extremities deformities occur.Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this abstract.Acknowledgements: declared none.

Ankle Joint Arthrodesis: Realities and Prospects against the Background of New Technologies. Literature Review

Arthrodesis is one of the methods for treating advanced stages of the ankle joint deforming arthrosis. A distinctive feature of this operation is the variability of bone fragments fixation. There are various options for arthrodesis, but they are mainly divided into internal and external fixation. Moreover, the increasing popularity of arthroscopic arthrodesis technology and ankle arthroplasty developments have opened new possibilities for doctors but have also posed new challenges. Aim. To evaluate treatment options for ankle arthrosis of various etiologies and provide recommendations for clinical improvement. To give a prospective analysis of technology development. Clinical outcomes of arthroplasty, arthrodesis, and arthroscopy were not significantly different. Patients with endoprosthesis had significantly more frequent reoperations. Conclusion. In arthrodesis with the Ilizarov apparatus, there are more advantages due to variability and many modifications, and the scope of internal fixation expands. There is disagreement over the optimal choice of internal fixation for arthrodesis. The choice is determined by factors such as the patient’s condition and the doctor’s preferences. In uncomplicated ankle osteoarthritis, an antegrade intramedullary pin is preferred over a retrograde pin. Ankle joint arthroscopy has technical advantages, and its use in severe joint deformities has become a direction for future research. The results obtained can be applied in the motor rehabilitation of patients after arthrodesis. Arthroscopy and arthrodesis are the most promising for postoperative motor rehabilitation of patients compared to endoprosthetics.

Update on the role of extracellular vesicles in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a heterogeneous autoimmune disorder that leads to severe joint deformities, negatively affecting the patient's quality of life. Extracellular vesicles (EVs), which include exosomes and ectosomes, act as intercellular communication mediators in several physiological and pathological processes in various diseases including RA. In contrast, EVs secreted by mesenchymal stem cells perform an immunomodulatory function and stimulate cartilage repair, showing promising therapeutic results in animal models of RA. EVs from other sources, including dendritic cells, neutrophils and myeloid-derived suppressor cells, also influence the biological function of immune and joint cells. This review describes the role of EVs in the pathogenesis of RA and presents evidence supporting future studies on the therapeutic potential of EVs from different sources. This information will contribute to a better understanding of RA development, as well as a starting point for exploring cell-free-based therapies for RA.

Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report

Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length.

Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity

ObjectiveTo investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity.MethodsThis retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow‐up was performed. The recurrence rate of Achilles tendon contracture at the last follow‐up and the patients' satisfaction rate were investigated.ResultsAll patients were followed up, with an average follow‐up period of 56.31 months (8–104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non‐Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow‐up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow‐up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%.ConclusionIn the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.

Association of Chronic Pain with Radiologic Severity and Central Sensitization in Hip Osteoarthritis Patients.

PurposePain and joint deformity are the most common symptoms of hip osteoarthritis (OA). However, no significant association between pain and severity of radiographic lesions has been reported. Recently, central sensitization has been suggested as an underlying mechanism of pain in OA. We investigated the involvement of radiologic severity or central sensitization in the clinical manifestation of hip OA with various degrees of joint deformity.Patients and MethodsWe included 39 patients with hip OA and divided them into two groups according to the severity of the hip pain: strong/severe (numerical rating scale, NRS≥6) and mild/moderate (NRS<6). We assessed the radiologic severity of OA using the Kellgren-Lawrence (K-L) scale and minimum joint space width (mJSW). We conducted quantitative sensory testing (QST) that included pressure pain threshold (PPT) and temporal summation of pain (TSP) at hip, tibialis anterior (leg), and extensor carpi radialis longus (arm) on the affected side. We examined the difference of radiologic assessment and QST results between each group and the correlation of the NRS with the radiologic assessment and QST results.ResultsThere was no significant difference in the K-L scale and mJSW between patients with strong/severe and mild/moderate joint pain. Strong/severe pain patients demonstrated a lower PPT at all measurement sites and higher TSP at the hip and leg than the mild/moderate pain patients. In addition, NRS was significantly negatively correlated with PPT and positively correlated with TSP at all measurement sites, but not with the K-L scale and mJSW.ConclusionWe reported no significant difference in radiologic severity between patients with strong/severe and mild/moderate joint pain. By contrast, we found a significant difference in central sensitization represented by QST between strong/severe and mild/moderate joint pain groups. These results suggest that central sensitization may be involved in the joint pain of patients with hip OA who complain of severe pain despite less severe joint deformity.

Total joint replacement of the hip and knee in patients with arthrogryposis multiplex congenita: a report of six joints

IntroductionArthrogryposis multiplex congenita (AMC) is a rare congenital condition that leads to severe joint contractures and deformities. As painful joint dysplasia and degeneration might develop over time, total joint replacement (TJR) can be a potential treatment option for these patients. The aim of this study is to investigate functional results, implant survivorship and potential complications in patients with AMC who undergo hip or knee arthroplasty.Materials and methodsWe retrospectively identified six TJR in three patients at a single centre performed between 2006 and 2019. The median patient age at surgery was 23 years and the median follow-up period was 69 (IQR 55–99) months. We analysed surgical technique, implant survivorship and complications as well as functional outcome determined by pain reported on the Numerical Rating Scale (NRS), patient-reported outcome scores [Oxford Hip Score (OHS), Harris Hip score (HHS), Oxford Knee Score (OKS)], range of motion and ambulatory status. Depending on data distribution means with ranges and median with interquartile range were compared with the Wilcoxon signed rank test or Student’s t test. The level of significance was defined at < 0.05.ResultsIn hips, the mean range of motion in flexion/extension (52° vs. 85°, p = 0.014) and in rotation (28° vs. 68°, p = 0.02) as well as mean pain score on the NRS (8.5 vs. 0, p = 0.001), OHS (9 vs. 26, p = 0.031) and HHS (17 vs. 52, p = 0.007) significantly improved. In knees, mean range of motion (55° vs. 93°, p = 0.403), mean pain score on the NRS (0 vs. 7) and the OKS (2 vs. 21) also improved. While the ambulatory status did not change, the patients who were wheelchair dependent reported less problems with transfers to a bed or chair and the patient who ambulated reported an improved walking distance. One total knee arthroplasty (TKA) underwent revision for an acute, late infection 155 months following the initial surgery.ConclusionsTJR is a safe procedure in patients with AMC that effectively improves function and reduces pain irrespective of preoperative ambulatory status.

Rhumatisme psoriasique : pronostic et histoire naturelle

Psoriatic arthritis is a polymorph inflammatory rheumatism that can lead to severe joint deformities, can have axial manifestations with spine ankyloses and extra-articular features. Peripheral mutilans arthritis are rare, but occurs in patients with early onset disease, are frequently associated with nail psoriasis and often with axial involvement. Clinical inflammation, with polysynovitis, biological inflammation and early erosions are commonly associated with the risk of structural progression. Hip involvement is associated with more severe disease. Axial involvement prevalence is variable according to the definition and the phenotype of the disease is close from axial spondyloarthritis. Peripheral joint erosions, severe psoriasis, early onset disease and HLA-B*0801 are frequently associated with sacroiliitis in psoriatic arthritis. Psoriatic arthritis also impair function, quality of life and work productivity. Beside psoriasis, there is an increased risk of extra-articular features such as uveitis and inflammatory bowel diseases. Psoriatic arthritis can be associated with metabolism syndrome that may increase cardiovascular event risk and thus mortality.

Double nerve transfer for restoring external rotation of the glenohumeral joint after neonatal brachial plexus injury.

The probability of spontaneous recovery of shoulder external rotation in neonatal brachial plexus injury (NBPI) is very low after the age of 18 months. We report the outcomes of double nerve transfers to restore active external rotation of the glenohumeral joint in children with NBPI after this age. Retrospective analysis of 20 children of mean age of 23.8 months with a mean follow-up of 14.8 months. Inclusion criteria were: age > 18 months, full passive glenohumeral external rotation in abduction, and absence of severe joint deformity on MRI. The spinal accessory nerve was transferred to the infraspinatus motor branch and the long head of the triceps motor branch to the teres minor motor branch. Anterior shoulder release was associated when passive shoulder external rotation in adduction (pERADD) was <30° (n = 13, Group R vs. Group N-no release n = 7). Active shoulder elevation and external rotation in abduction (aERABD) of the glenohumeral joint were evaluated pre- and postoperatively. All children except two in Group R, recovered aERABD 4-6 months after surgery. Mean postoperative aERABD was 70 ± 32.4 and 82.9 ± 11.1° and shoulder elevation gain was 24.6 ± 22.2 and 27.1 ± 29.2° for Group R and N, respectively, without statistically significant differences. Late nerve transfers to external rotator muscles are effective in children with NBPI. This might be explained not only by muscle reinnervation, but also by the interruption of a previous co-contraction or developmental apraxia. Therapeutic IV.

Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: A cross-sectional study of rheumatoid arthritis patients

Objective Although recent clinical trials showed that ultrasound (US) remission is not required to achieve good outcomes at the group level, it currently remains unclear whether the prognosis of individual patients in clinical remission, but not US remission, i.e. those with subclinical sonographic synovitis (SSS), is favorable. However, it is no longer acceptable to perform US on all patients in order to identify those with SSS. Therefore, the present study was initiated to elucidate the conditions under which SSS is frequently detected. Methods In total, 563 consecutive RA patients were recruited. Bilateral 2-5 MCP, wrist, ankle, and 2–5 MTP joints were scanned by US, and Gray scale and Power Doppler (PD) images were scored semi-quantitatively. Clinical data were obtained by physicians who were blind to US results. Changes in the modified Total Sharp Score (mTSS) of tocilizumab (TCZ) users were calculated. Results A total of 402 patients were included. SSS was more frequently detected in patients with more severe joint deformity, even if they were in remission. In contrast, a high Patient Global Assessment of Disease (PtGA) did not reflect SSS. Furthermore, the relationship between PtGA and PD scores was weak. Although the frequency of SSS was high in TCZ user, the presence of SSS in TCZ users not always results in the progression of mTSS. Conclusions While remission is overestimated in patients with severe joint deformity, underestimations may occur in those who do not fulfill remission criteria because of a high PtGA.

Results of the Total Hip Arthroplasty Using 3D Printing Technology

Objectives: To study the value of 3D printing of custom THA femoral prostheses with conventional femoral prostheses in total hip arthroplasty for severe hip deformity. Methods: Total hip arthroplasty was used in the treatment of 107 severe hip joint deformity cases from June 2018 to June 2019. Fifty-six patients received conventional hip replacement stems and 51 patients received a custom 3D printed hip replacement stem designed to address their proximal deformity and leg length discrepancy. The operation time, intraoperative blood loss, postoperative weight-bearing time, Harris score before and after the operation, complications after surgery and the main angle measurement of compared to their contralateral hip were evaluated to determine the short-term efficacy of 3D printed total hip replacement femoral prosthesis compared to the common total hip replacement femoral prosthesis. Results: A total of 107 patients were followed up for an average of 12 months. The use of 3D printing technology in the preoperative design and custom prosthesis fabrication was associated with shortened operation time, less intraoperative blood loss, quicker time to postoperative full weight-bearing, and improved the Harris score in 1 year after the operation compared to conventional total hip replacement stem (p&lt;.05). Our results revealed that there was a significant reduction in the femoral anteversion with a value of 13.06 ± 1.93 degrees (mean ± SD) in the custom prosthesis group compared to the conventional hip replacement group. However, there was no significant difference in neck-shaft angle, acetabular angle, and Sharp angle between both groups (p&gt;.05). Conclusion: 3D printing technology created a virtual and realistic simulation, and personalized operation plan for patients with severe hip deformity, which was helpful for surgical treatment. The anatomical characteristics of patients with complex deformities were better addressed using the 3D printed femoral component and resulting in better patient outcomes and provided a new option for surgeons to manage these difficult cases.

Use of nanoparticles in skeletal tissue regeneration and engineering.

Bone and osteochondral defects represent one of the major causes of disabilities in the world. Derived from traumas and degenerative pathologies, these lesions cause severe pain, joint deformity, and loss of joint motion. The standard treatments in clinical practice present several limitations. By producing functional substitutes for damaged tissues, tissue engineering has emerged as an alternative in the treatment of defects in the skeletal system. Despite promising preliminary clinical outcomes, several limitations remain. Nanotechnologies could offer new solutions to overcome those limitations, generating materials more closely mimicking the structures present in naturally occurring systems. Nanostructures comparable in size to those appearing in natural bone and cartilage have thus become relevant in skeletal tissue engineering. In particular, nanoparticles allow for a unique combination of approaches (e.g. cell labelling, scaffold modification or drug and gene delivery) inside single integrated systems for optimized tissue regeneration. In the present review, the main types of nanoparticles and the current strategies for their application to skeletal tissue engineering are described. The collection of studies herein considered confirms that advanced nanomaterials will be determinant in the design of regenerative therapeutic protocols for skeletal lesions in the future.

Treatment of Extensive Plaque Psoriasis and Psoriatic Arthropathy using Methotrexate in a Patient with High Serum Alkaline Phosphatase

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Factors affecting The Pain of Osteoarthritis Patients

Background/Objectives: Osteoarthritis, which is the disease that results in the largest number of adult activity restriction days, is a chronic disease and a major disease in terms ofloss of gross domestic product. It causes severe pain and joint deformity in individuals. This study aimed to investigate nutrient intake in relation to patient pain in order to provide basic data for nutrition intervention necessary for patient pain control. Methods/Statistical analysis: This study is a secondary analysis study using the Korea National Health and Nutrition Examination Survey (2015), and data of 403 people were used in the final analysis. This study analyzed the sociodemographic characteristics, pain, and nutrient intake of osteoarthritis patients using the SPSS 23.0 Windows statistical program. Findings: The prevalence of osteoarthritis was high because the subjects of this study were women and their economic and education levels were low. Most osteoarthritis patients ingested less than the recommended daily intake of vitamin B1, iron, potassium, and calcium. For vitamin B1 and calcium, there were statistically meaningful correlations between pain and nutrient intake. The pain of osteoarthritis patients showed statistically significant differences according to the recommended daily intake levels of vitamin B1 and calcium. Meanwhile, no statistically significant differences were revealed according to the recommended daily intake levels of potassium and iron. Correlations were shown between the nutrient intake and pain of osteoarthritis patients, and the quality of life of the group with pain was lower than that of the group without pain. Improvements/Applications: Based on the findings of this study, studies to examine proper nutrient intake as an active measure for prevention of the induction and worsening of osteoarthritis patient pain are needed. The findings of this study are expected to contribute to the establishment of intervention measures for the guidelines of osteoarthritis patients with pain and to their quality of life improvement.