Severe Joint Research Articles

Managing of Post-traumatic Knee Arthritis by Total Knee Arthroplasty: Case Report and Literature Review

Introduction: Post-traumatic knee osteoarthritis (PTOA) develops rapidly after injuries from sports, accidents, or falls. Unlike primary osteoarthritis, PTOA escalates quickly, causing severe joint damage and impairments. Early intervention is crucial to alleviate pain, restore function, and prevent further deterioration. Delayed treatment worsens symptoms and increases the need for invasive procedures like total knee arthroplasty (TKA). Case Presentation: A 29-year-old patient with a year of left knee pain, swelling, and difficulty straightening had no history of rheumatic or autoimmune diseases. Examination showed osteophytes, indicating osteoarthritis. He underwent TKA with no complications, achieving a satisfactory outcome: good range of motion, improved quality of life, and an Oxford Knee Score of 42. Discussion: PTOA typically follows trauma to the joint surface, with severity often correlating with the impact intensity. In this case, the patient’s rapid development of osteoarthritis, despite his young age and lack of pre-existing conditions, may suggest a genetic predisposition. Knee arthroplasty was chosen to restore function, aligning with research showing comparable outcomes for post-traumatic and primary osteoarthritis patients, though post-trauma cases can have higher complication rates due to comorbidities. Conclusion: Effective management of PTOA is crucial due to its rapid progression and significant impact on joint function and quality of life. Early intervention is key to preventing severe damage and reducing the need for invasive treatments. While TKA can be effective, its success depends on the severity of the condition. Timely management and preventive strategies are vital to improving outcomes and maintaining joint health. Keywords: post traumatic osteoarthritis, total knee arthroplasty, quality of life, early intervention, case report

Classification of distinct tendinopathy subtypes for precision therapeutics

Rotator cuff tendinopathy is the most common tendinopathy type with the worst prognosis. Conventional treatments often elicit heterogeneous drug responses due to the diversity of tendinopathy. Hence, this study attempted a classification of 126 diseased tendons into three distinct subtypes with opposite pathogenic mechanisms based on transcriptomic and clinical features. The hypoxic atrophic subtype with white appearance (Hw) exhibits downregulated neovascularization pathways. The inflammatory proliferative subtype with white appearance (Iw) shows a moderate upregulation of inflammatory characteristics. The inflammatory proliferative subtype with red appearance (Ir) exhibits the highest levels of upregulated neovascularization and inflammatory pathways, along with severe joint dysfunction. We then established research models, including subtype-specific simulations in animal models and clinical data analysis. These revealed that glucocorticoid, a controversial commonly used drug, was only effective in treating the Ir subtype. Hence, the tendinopathy subtypes elucidated in this study have significant implications for developing precision treatment of tendinopathy.

Acute Chikungunya Infection Induces Vascular Dysfunction by Directly Disrupting Redox Signaling in Endothelial Cells.

Chikungunya virus (CHIKV) infection is characterized by febrile illness, severe joint pain, myalgia, and cardiovascular complications. Given that CHIKV stimulates reactive oxygen species (ROS) and pro- and anti-inflammatory cytokines, events that disrupt vascular homeostasis, we hypothesized that CHIKV induces arterial dysfunction by directly impacting redox-related mechanisms in vascular cells. Wild-type (WT) and iNOS knockout (iNOS-/-) mice were administered either CHIKV (1.0 × 106 PFU/µL) or Mock vehicle via the intracaudal route. In vivo, CHIKV infection induced vascular dysfunction (assessed by a wire myograph), decreased systolic blood pressure (tail-cuff plethysmography), increased IL-6 and IFN-γ, but not TNF-α levels (determined by ELISA), and increased protein content by Western blot. Marked contractile hyporesponsiveness to phenylephrine was observed 48 h post-infection, which was restored by endothelium removal. L-NAME, 1400W, Tiron, and iNOS gene deletion prevented phenylephrine hyporesponsiveness. CHIKV infection increased vascular nitrite concentration (Griess reaction) and superoxide anion (O2•-) generation (lucigenin chemiluminescence), and decreased hydrogen peroxide (H2O2, by Amplex Red) levels 48 h post-infection, alongside increased TBARS levels. In vitro, CHIKV infected endothelial cells (EA.hy926) and upregulated ICAM-1 and iNOS protein expression (determined by Western blot). These data support the conclusion that CHIKV-induced alterations in vascular ROS/NF-kB/iNOS/NO signaling potentially contribute to cardiovascular events associated with Chikungunya infection.

Mycobacterium terrae Complex Associated Lymphadenitis: Negative AFB PCR

Abstract Introduction/Objective Nontuberculous mycobacteria included with the Mycobacterium terrae complex (MTC) include a ubiquitous, slow-growing collection of mycobacteria known for causing severe resistant skin, joint, and bone infections. There are limited reports of M. Arupensis, included under MTC, causing human infections despite environmental ubiquity. Low sequencing sensitivity for species such as M. Arupensis may result in negative preliminary PCR speciation thus influencing the negative predictive value of this method of organism detection. No prior case reports have described MTC infection presenting as subacute lymphadenitis. Methods/Case Report A 48 year old El Salvadorian male with known diagnosis of HIV presented with oral thrush and significant left-sided lymphadenopathy. He was initially diagnosed with HIV in El Salvador and on ART until immigrating to the US six months prior. HIV antigen and antibody was positive with positive reflex viral PCR. QuantiFERON-TB Gold resulted positive, but CXR was without evidence of pulmonary TB. TB1, TB2, and mitogen minus NIL were negative. He was referred for fine needle aspiration and core needle biopsy of the left cervical lymph node. AFB and AFB FITE stains were performed, but no definitive mycobacteria were identified. GMS was performed and negative for fungal elements. A final histological diagnosis of necrotizing granuloma was given and the tissue was sent for bacterial, AFB, and fungal DNA PCR; no organisms were detected. A sputum sample was obtained and cultured four months after initial presentation and was positive for acid fast bacilli: Mycobacterium terrae complex, most closely resembling Mycobacterium arupensis. The Fite and AFB stains were again reviewed, revealing one single acid fast bacilli organism identified on Fite stain in the necrotizing granuloma. Results (if a Case Study enter NA) N/A Conclusion The negative AFB DNA PCR result may have been a false negative result due to poor sensitivity or selectivity for M. arupensis. There are no former reported cases of M. Arupensis associated necrotizing granulomas in lymph node. This unusual MTC infection presenting as chronic unilateral lymphadenitis underscores the importance of broadening clinical laboratory AFB DNA PCR sensitivity especially in cases of suspected AFB or modified AFB associated necrotizing granulomas.

Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage.

The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the "acetabular sourcil" location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the "time" separating the 3D acetabular contributions of the sourcil edges was performed. The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.

Application of temporomandibular joint prosthesis in oral and maxillofacial surgery: strategic thinking and prospects.

The temporomandibular joint (TMJ) is the critical functional unit in the human stomatognathic system. Damage of the TMJ causes orofacial dysfunction and secondary jaw deformities, leading to seriously decreased quality of life in patients. The TMJ prosthetic replacement is an important treatment method for severe joint destruction because of its remarkable advantages compared with other methods. In recent years, this technique has gradually attracted wide attention in China, but it has not been popularized on a large scale in our country because of several limitations. Thus, in this study, the clinical experience of patients with TMJ prosthetic replacement in clinical units was summarized, and the treatment principles, treatment processes, and technical advantages were systematically discussed, aiming to promote the popularization and application of TMJ prosthetic replacement in China.

Pregnancy Among Reported Lyme Disease Cases-United States, 1992-2019.

Lyme disease (LD), the most common vector-borne disease in the United States, typically presents with a localised erythema migrans rash (EM). Left untreated, infection can disseminate to cause severe heart, joint or nervous system manifestations. Summaries of LD surveillance data have been published previously but did not include the frequency, demographic or clinical characteristics of LD cases during pregnancy. We summarised confirmed and probable LD cases by pregnancy status as reported to the U.S. Centers for Disease Control and Prevention during 1992-2019. We defined an LD case during pregnancy as one with (1) female sex, (2) age 14-49 years and (3) positive pregnancy indication. We evaluated the frequency, seasonality, age distribution, race and ethnicity, geographic distribution and clinical manifestations of LD cases during pregnancy and cases among non-pregnant females. We compared proportions using chi-squared tests. Among 698,876 reported LD cases, 112,002 (16%) were confirmed or probable cases among females aged 14-49 years; 32,301 (29%) were specifically reported as non-pregnant and 643 (0.6%) (568 confirmed and 75 probable cases) reported as pregnant. Illness onset peaked in June among LD cases during pregnancy, but in July for cases among non-pregnant females. A higher proportion of confirmed LD cases during pregnancy had only EM rash than did cases among non-pregnant females (66% vs. 60%, p = 0.019). LD cases during pregnancy are rare. Compared to non-pregnant females, cases among pregnant females more commonly involve early clinical manifestations. These patterns could suggest earlier detection or more complete reporting of LD cases during pregnancy than their non-pregnant counterparts. Earlier detection could be due to frequent contact with healthcare or increased self-advocacy during pregnancy. Prompt antimicrobial treatment is critical for preventing severe disease and reducing risk of adverse pregnancy or birth outcomes.

To Assess the Functional outcome of Inflammatory arthritis of Knee following a Total Knee Replacement in a Tertiary Care Centre

Introduction : Inflammatory arthritis, particularly RA, can lead to significant joint destruction and functional impairment, necessitating interventions such as TKA. Despite medical therapy, severe joint damage may occur, warranting surgical intervention. This study assesses the functional outcomes post-TKA in patients having inflammatory arthritis. Materials and Methods: Patients who received TKA for inflammatory arthritis were included in this prospective observational cohort research, specifically RA, between 2019 and 2023 at Saveetha Medical College, Chennai. Clinical, radiological, and functional results have been assessed using the American Knee Society scoring system. IBM SPSS version 22.0 was utilized for analysis of data, p < 0.05 is the threshold for statistical significance. Results:Twenty TKAs have been performed for RA, with all patients successfully followed up. The mean age of the patients was 58.5 years, and the majority were female. Before TKA, the average length of RA was 7.24 years, and all patients were in stage IV illness. Preoperative and postoperative knee society scores showed significant improvement, with average scores of 58.15 and 96.15, respectively. Functional scores also demonstrated substantial enhancement post-TKA, with an average increase of 130%. Radiological assessment revealed no evidence of lysis in any patient. Conclusion: Significant inverse relationship among the postoperative functional score and the length of the disease and the involvement of other joints. Utilizing the American Knee Society and functional scoring systems allows for objective prediction of surgical success. This can motivate surgeons and treating physicians to enhance care for RA patients.

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

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

Paediatric trigger thumbs: patient-reported outcome measures over a minimum of ten years' follow-up.

The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures. This study was a cross-sectional, questionnaire-based study conducted at a tertiary care orthopaedic centre. All cases of idiopathic paediatric trigger thumbs which underwent A1 pulley release between 2004 and 2011 and had a minimum follow-up period of ten years were included in the study. The abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH) was administered as an online survey, and ipsi- and contralateral thumb motion was assessed. A total of 67 patients completed the survey, of whom 63 (94%) had full interphalangeal joint extension or hyperextension. Severe metacarpophalangeal joint hyperextension (> 40°) was documented in 15 cases (22%). The median QuickDASH score was 0 (0 to 61), indicating excellent function at a median follow-up of 15 years (10 to 19). Overall satisfaction was high, with 56 patients (84%) reporting the maximal satisfaction score of 5. Among 37 patients who underwent surgery at age ≤ two years, 34 (92%) reported the largest satisfaction, whereas this was the case for 22 of 30 patients (73%) with surgery at aged > two years (p = 0.053). Notta's nodule resolved in 49 patients (73%) at final follow-up. No residual triggering or revision surgery was observed. Surgical release of A1 pulley in paediatric trigger thumb is an acceptable procedure with excellent functional long-term outcomes. There was a trend towards higher satisfaction with earlier surgery among the patients.

Early diagnosis of Chikungunya virus utilizing square core photonic crystal fiber (SC-PCF) with extremely high relative sensitivity

Chikungunya virus (CHIKV) poses a significant public health threat due to its capacity to cause widespread and debilitating outbreaks. The virus is responsible for CHIKV fever, a disease characterized by severe joint pain, sudden onset of fever, headache, muscle pain, and rash. The virus has been reported in various regions globally, with outbreaks occurring in parts of Africa, Asia, the Americas, and the Indian subcontinent. Consequently, the scientific community expends substantial efforts in developing dependable, rapid, highly sensitive, and cost-effective techniques in order to identify the CHIKV virus. In this study, an innovative biomedical sensor using photonic crystal fiber technology enables precise detection of the CHIKV virus through uric acid, normal and infected plasma, red blood cells, and platelets in the blood. The introduced sensor identifies those kinds with extremely increased relative sensitivity and minimal losses in contrast to alternative photonic crystal fiber-based biosensors. The introduced sensor showcases a minimal confinement loss of 2.25 × 10− 13 cm− 1, a relative sensitivity of 99.37%, an effective area of 1.36 × 105 µm2, with a minimal effective material loss of 0.001966 cm–1, a numerical aperture of 0.1874, and low dispersion of 0.06. Also, the demonstrated sensor is able to function within the terahertz spectrum, covering a substantial span from 0.8 to 2.6 THz. Furthermore, an extensive comparison analysis is performed between the showcased sensor and related literature on photonic crystal fibers to verify the reliability and effectiveness of the introduced structure.

Acute Chikungunya Virus Infection Triggers a Diverse Range of T Helper Lymphocyte Profiles.

Chikungunya virus (CHIKV) is an arbovirus causing acute febrile illness with severe joint pain, often leading to chronic arthralgia. This study investigated the adaptive immune responses during the early stages of symptomatic acute CHIKV infection, focusing on the transcription factors and cytokines linked to Th1, Th2, Th17, and Treg cells. Thirty-six individuals were enrolled: nine healthy controls and 27 CHIKV-positive patients confirmed by qRT-PCR. Blood samples were analyzed for the mRNA expression of transcription factors (Tbet, GATA3, FoxP3, STAT3, RORγt) and cytokines (IFN-γ, IL-4, IL-17, IL-22, TGF-β, IL-10). The results showed the significant upregulation of Tbet, GATA3, FoxP3, STAT3, and RORγt in CHIKV-positive patients, with RORγt displaying the highest increase. Correspondingly, cytokines IFN-γ, IL-4, IL-17, and IL-22 were upregulated, while TGF-β was downregulated. Principal component analysis (PCA) confirmed the distinct immune profiles between CHIKV-positive and healthy individuals. A correlation analysis indicated that higher Tbet expression correlated with a lower viral load, whereas FoxP3 and TGF-β were associated with higher viral loads. Our study sheds light on the intricate immune responses during acute CHIKV infection, characterized by a mixed Th1, Th2, Th17, and Treg response profile. These results emphasize the complex interplay between different adaptive immune responses and how they may contribute to the pathogenesis of Chikungunya fever.

Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision.

The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire. This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences. We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments. Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.

Successful treatment with granulocyte and monocyte adsorption apheresis for plaque-type skin lesions in patients with psoriatic arthritis.

Granulocyte and monocyte adsorption apheresis (GMA) is usually performed weekly for refractory skin diseases, such as generalized pustular psoriasis and psoriatic arthritis (PsA). Four patients with PsA who were refractory to previous treatments were enrolled. They received five or ten sessions of GMA. We assessed the clinical conditions of each patient and laboratory findings before and after GMA. GMA was effective in plaque-type skin eruptions in all four patients with PsA. It was also effective in joint symptoms in three patients with PsA with mild symptoms, but was ineffective in one patient with severe joint symptoms. GMA may be recommended to PsA patients with skin eruptions and mild joint symptoms.

The prognostic and psychological impact of total knee arthroplasty based on radioactive CT imaging examination on the knee joint

Total knee arthroplasty is an effective method for treating severe knee joint diseases, but the changes in patellar height and psychological state of patients after surgery are still of great concern. Select a group of patients who have undergone total knee replacement surgery as the research subjects, use radioactive CT imaging to examine the knee joints of the patients, and input them into the computer system for analysis. Based on the position, shape, and surrounding structure of the patella in the images, process them to obtain the specific value of patellar height. Radioactive CT imaging examination showed that there was a significant change in patellar height in patients after total knee arthroplasty, and the degree of change was related to the preoperative knee joint condition. The results showed that there was a significant change in patellar height in patients after total knee arthroplasty. The results of the radioactive CT imaging examination showed a significant increase in patellar height after surgery, with a significant improvement compared to before. The psychological evaluation results of the patient showed that after surgery, the patient's psychological condition significantly improved, and the levels of anxiety and depression were significantly reduced.

Pathophysiology and Evolving Treatment Options of Septic Arthritis: A Narrative Review.

Pyogenic (septic) arthritis is a severe joint infection characterized by the invasion of microorganisms into the synovium, causing inflammation and joint destruction. This review article provides a comprehensive overview of pyogenic arthritis, focusing on etiology, pathogenesis, clinical manifestations, diagnosis, and management strategies. This review explores routes of microbial entry into joints, emphasizing the importance of prompt identification and treatment to prevent irreversible joint damage. Clinical manifestations, such as joint pain, swelling, and limited range of motion, are discussed, along with the challenges in differentiating pyogenic arthritis from other joint disorders. Diagnostic approaches, including joint aspiration and imaging modalities, are critically examined for accuracy in confirming diagnosis. This review also addresses the significance of early intervention through antimicrobial therapy and joint drainage, highlighting the role of multidisciplinary collaboration in optimizing patient outcomes. In summary, the present investigation underscores the complexities of pyogenic arthritis and theneed for a comprehensive understanding of pathophysiology for timely and effective management to improve patient prognosis and quality of life.

Diosmetin ameliorates osteoarthritic inflammation in vivo and ECM macromolecules degradation in interleukin-1β-stimulated murine chondrocytes through the Nrf2/NF-κB pathway.

Osteoarthritis (OA) is a prevailing degenerative disease in elderly population and can lead to severe joint dysfunction. Studies have revealed various pharmacological activities of diosmetin, including the anti-OA efficacy. The present study further investigated its effect on interleukin (IL)-1β-induced OA in chondrocytes. Primary chondrocytes were isolated from young mice, stimulated with IL-1β (10 ng/mL), and pretreated with diosmetin (10 and 20 μM) to conduct the in vitro assays. CCK-8 assay assessed the cytotoxicity of diosmetin whereas the levels of inflammatory factors (PGE2, nitrite, TNF-α, and IL-6) in homogenized cells were evaluated by ELISA. The levels of inflammatory cytokines, content of extracellular matrix (ECM), and signaling-related proteins (Nrf2, HO-1, and NF-κB p65) were assessed by western blotting. Expression of collagen II, p65, and Nrf2 in the chondrocytes was confirmed by immunofluorescence staining. The chondrocytes treated with IL-1β and diosmetin were transfected with Nrf2 knockdown plasmid (si-Nrf2) to investigate the role of Nrf2. In vivo OA mouse model was induced by surgically destabilizing the medial meniscus (DMM). Safranin O staining was conducted to assess the OA severity in the knee-joint tissue. Diosmetin suppressed the expression of iNOS, COX-2, PGE2, nitrite, TNF-α, IL-6, MMP-13, and ADAMTS-5 induced by IL-1β in chondrocytes. The expression of p-p65, p-IκBα, and nuclear p65 was decreased whereas that of Nrf2 and HO-1 increased by diosmetin treatment in IL-1β-treated chondrocytes. Nrf2 knockdown by siRNA reversed the inhibitory effect of diosmetin on IL-1β-induced degradation of ECM proteins and inflammatory factors in cultured chondrocytes. In the DMM-induced model of OA, diosmetin alleviated cartilage degeneration and decreased the Osteoarthritis Research Society International score. Diosmetin ameliorates expression of inflammation biomarkers and ECM macromolecules degradation in cultured murine chondrocytes via inactivation of NF-κB signaling by activating Nrf2/HO-1 signaling pathway.

EFFICACY OF INTERMITTENT VACUUM THERAPY AS AN ADJUNCT TO CONVENTIONAL PHYSIOTHERAPY TREATMENT IN PATIENTS WITH KNEE OSTEOARTHRITIS

Objective: Osteoarthritis (OA) is a severe joint disease that affects more than 60 percent of the elderly. It is highly prevalent and a leading cause of pain and disability worldwide. Symptoms can become increasingly debilitating over time and can greatly affect the quality of life, contributing to feelings of dependence and loss of autonomy in older people. Intermittent vacuum therapy (IVT) is a new technology which is now being used to treat vascular diseases of the legs, to accelerate rehabilitation, to reduce oedema in the lower extremities, to treat cellulite as well as other indications. The majority of the examinations of physiological effects of intermittent vacuum therapy is based on reactions to stable negative pressure in the lower body. Methods: A total of 30 patients, 15 in group A (Conventional) and 15 in group B, were randomly selected based on inclusion and exclusion criteria. Outcome measures-VAS, WOMAC and Knee flexion ROM were assessed pre and post-intervention. The treatment was performed for 10 sessions. Results: There was statistical significance seen in Group A (Conventional) and Group B (Interventional) in all outcome measures. However, treatment with Intermittent Vacuum therapy showed better results in comparison to conventional therapy. Data analysis was done using Paired T test. Conclusion: Intermittent Vacuum Therapy along with conventional protocol showed significant improvement in the above outcome measures in O. A Knee patients. Therefore, Intermittent Vacuum Therapy can be incorporated as a part of rehabilitation in O. A Knee patients.

A Conceptual Study on Vatarakta w.s.r. to Gouty Arthritis

The wellbeing of an individual depends on his/her diet and lifestyle. The rapid development and modernisation in India are causing serious health problems and Vatarakta is one of them. Vatarakta, is described under Vatavyadhis by different Acharya’s. The vitiated Vata and Rakta causes this disease, hence called Vatarakta. Gout is an inflammatory disease caused by deposition of Mono-Sodium Urate (MSU) crystals in and around synovial joints. Recent reports of prevalence and incidence of gout vary widely but ranges from prevalence of 1-2%, with greater than 5:1 male preponderance. It is imperative to comprehend complexities of Vatarakta in order to accurately diagnose and treat it, considering its increasing occurrence worldwide and the substantial influence, it has affected individuals’ quality of life. Methods: After a thorough literary review, focusing on classical Ayurvedic texts, alongside recent research articles and reviews. The gathered information was analysed to present cohesive narrative on the Niadana, Samprapti and Chikitsa of Vatarakta. Results: Vatarakta is a result of aggravated Vata Dosha and impaired Rakta Dhatu, leading to severe pain, inflammation, and joints deformity. The disease progression is influenced by dietary habits, lifestyle factors, and genetic predisposition. Its treatment involves a multi-factorial approach, including Shodhana, Shamana, dietary regulations, and lifestyle modification. Conclusion: The Ayurvedic perspective on Vatarakta offers a holistic approach in understanding and managing the disease, emphasizing the balance of bodily Doshas, detoxification, and rejuvenation. Integrating Ayurvedic principles with modern medical practices may provide a comprehensive treatment for Vatarakta.

Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling, which can progress to chronic tophaceous or chronic erosive gout, or both. Here, we present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and location from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, as well as forecasted prevalence to 2050. Gout prevalence and YLDs from 1990 to 2020 were estimated by drawing on population-based data from 35 countries and claims data from the USA and Taiwan (province of China). Nested Bayesian meta-regression models were used to estimate prevalence and YLDs due to gout by age, sex, and location. Prevalence was forecast to 2050 with a mixed-effects model. In 2020, 55·8 million (95% uncertainty interval 44·4-69·8) people globally had gout, with an age-standardised prevalence of 659·3 (525·4-822·3) per 100 000, an increase of 22·5% (20·9-24·2) since 1990. Globally, the prevalence of gout in 2020 was 3·26 (3·11-3·39) times higher in males than in females and increased with age. The total number of prevalent cases of gout is estimated to reach 95·8 million (81·1-116) in 2050, with population growth being the largest contributor to this increase and only a very small contribution from the forecasted change in gout prevalence. Age-standardised gout prevalence in 2050 is forecast to be 667 (531-830) per 100 000 population. The global age-standardised YLD rate of gout was 20·5 (14·4-28·2) per 100 000 population in 2020. High BMI accounted for 34·3% (27·7-40·6) of YLDs due to gout and kidney dysfunction accounted for 11·8% (9·3-14·2). Our forecasting model estimates that the number of individuals with gout will increase by more than 70% from 2020 to 2050, primarily due to population growth and ageing. With the association between gout disability and high BMI, dietary and lifestyle modifications focusing on bodyweight reduction are needed at the population level to reduce the burden of gout along with access to interventions to prevent and control flares. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-income and middle-income countries, estimates are based on modelled rather than primary data and are also lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations. Bill & Melinda Gates Foundation and the Global Alliance for Musculoskeletal Health.