Symptomatic Osteoarthritis Research Articles

Knee health promotion and cell therapy for knee osteoarthritis

Knee health promotion and cell therapy for knee osteoarthritis Shaw-Ruey Lyu, Professor from Dalin Tzu-Chi Hospital, Tzu-Chi University, says that the knee health promotion option and cell therapy are a perfect combination for knee osteoarthritis. Knee osteoarthritis (knee OA) is commonly but mistakenly referred to as a degenerative process of the knee. The mainstream medical community has devoted uncounted resources and talents to identifying the cause of knee OA, but that effort has only produced controversial results. Consequently, sufferers of knee OA have not been able to rest, and the deteriorating course of knee OA symptoms, which typically start from stage I and worsen to stages II, III, IV, and V, puts the patients through increasingly agonising pain and discomfort. The mainstream medical community collectively has tried to offer relief to their knee OA patients, such as nonpharmacological interventions, systemic drug treatment, intra-articular therapies ranging from corticosteroids to hyaluronans to more recently platelet-rich plasma, and more invasive surgical procedures such as arthroscopy or corrective osteotomy.

Potential of thermoresponsive hydrogel as an alternative therapy for rat knee osteoarthritis.

Osteoarthritis is a degenerative condition that is highly prevalent and primarily affects the joints. The knee is the most commonly affected site, impacting the lives of over 300 million individuals worldwide. This study presents a potential solution to address the unmet need for a minimally invasive technique in the treatment of osteoarthritis: a biocompatible, injectable, and thermoresponsive hydrogel. In comparison to commercially available products such as lyophilized platelets, dextrose, and triamcinolone, the thermoresponsive hydrogel exhibits significantly superior performance in dynamic behaviors, including print area, stability, and step cycle, when tested on rats with knee osteoarthritis. However, it demonstrates similar treatment efficacy to these products in static behaviors, as observed through histopathological and immunohistochemical analysis. Therefore, the thermoresponsive hydrogel holds promise as an effective alternative therapy for osteoarthritis. Moreover, by blending the hydrogel with drugs, controlled and sustained release can be achieved, thereby facilitating the long-term management of osteoarthritis symptoms.

Patterns and natural history of hand pain in individuals with symptomatic hand osteoarthritis in a prospective cohort study: A post-hoc analysis of a randomised controlled trial

ObjectiveTo investigate the variation in the distribution and the natural history of hand pain over 6 weeks in individuals with symptomatic hand osteoarthritis. DesignPatient-reported outcome data were collected at baseline and weekly for 6 weeks from community-based participants enrolled in a randomised controlled trial. Participants were grouped based on location of significant pain (Visual Analogue Scale, VAS≥40/100 ​mm) (both carpometacarpal (CMC) and interphalangeal (IP), CMC only, and IP only). ResultsAt baseline, of the 106 participants, 55(51.9 %) had pain in both CMC and IP joints, 28(26.4 %) in IP joints only, and 16(15.1 %) in CMC joint only. Those with CMC and IP pain had significantly higher VAS pain [68.1 (2.6) vs 59.3 (3.5) vs 51.2 (4.7)]; Australian Canadian Osteoarthritis Hand Index, (AUSCAN) pain [290.1 (15.7) vs 225.3 (21.2) vs 237.9 (28.4)], stiffness [57.1 (3.7) vs 44.6 (5.0) vs 32.2 (6.7)] and functional limitation [527.5 (30.9) vs 356.0 (41.7) vs 433.3 (55.7)]; and pain sensitization [PainDETECT score 11.1 (1.1) vs 8.1 (1.8) vs 5.8 (1.9)] compared to those with IP or CMC only pain, respectively. All groups showed improvement in outcomes over 6 weeks without significant inter-group differences. ConclusionIn a population with significant hand pain, pain in both CMC and IP joints was most common and identified a more severe phenotype than pain in IP or CMC only with higher pain, more functional limitation and pain sensitization. These data have the potential to inform clinical management of patients with hand pain and patient selection in clinical trials.

The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis.

Intra-articular (IA) ultrasound-guided hip injections are currently considered a cornerstone of the conservative management of symptomatic hip osteoarthritis (HOA), although their effect on clinical outcomes has not been fully elucidated.The purpose of this study is to investigate the effectiveness of ultrasound-guided IA hip injections of hyaluronic acid (HA) with or without corticosteroids (CS) on pain relief and functional improvement in patients with HOA. In total, 167 patients with HOA were assessed at baseline (T0) and 12 months after injection (T1) using the VAS and GLFS scores. The sample consisted mainly of female subjects (58.1%), presenting an average age of 70.6 ± 12.2 years and grade 3 HOA (63.9%) according to the Kellgren-Lawrence classification. Most of the patients (76.2%) underwent unilateral hip injection with a combination of medium-high molecular weight HA (1500-2000 kDa) and CS. At T1, lower use of anti-inflammatory drugs, an increase in the consumption of chondroprotectors, and an overall reduction of instrumental physical therapies and therapeutic exercise were recorded. In addition, a statistically significant intragroup and between-group decrease observed at T1 for both the VAS and GLFS. Study results suggested that intra-articular hip injections with HA alone and with CS could represent a useful therapeutic tool for pain reduction and functional improvement for patients with hip osteoarthritis.

Efficacy and safety of the combined use of celecoxib, diacerein and a combination of glucosamine and chondroitin for the control of musculoskeletal pain associated with osteoarthritis and nonspecific back pain

The combined use of drugs with different mechanisms of action is the main principle of musculoskeletal pain control in rheumatic diseases. However, there are few studies evaluating the efficacy of this approach in real practice.Objective: to determine the efficacy and safety of the combined use of celecoxib, diacerein, and the combination of glucosamine + chondroitin in osteoarthritis (OA) and chronic nonspecific low back pain (NSLBP). Material and methods. Statistical analysis of data obtained during a 3-month open observational study was performed. We included 1569 patients (63.6 % women and 36.4 % men, mean age 58.7 ± 11.0 years) with knee OA (kOA), hip OA (hOA), generalized OA (gOA), and chronic NSLBP with moderate/severe pain (≥ 4 on a numeric rating scale, NRS 0–10) who required nonsteroidal anti-inflammatory drugs. Celecoxib 200 mg twice daily was prescribed, with the dose reduced to 200 mg per day or taken “as needed" after significant pain relief; diacerein 50 mg twice daily; and a medication of glucosamine 250 mg and chondroitin 200 mg, 2 capsules 2–3 times daily. Outcomes were assessed after 3 months using the dynamics of pain, fatigue, dysfunction (according to NRS), and the “Patient Acceptable Symptom State” (PASS) indicator. Results and discussion. 80.2 % of patients completed the 3 month course of treatment, 4.4 % discontinued treatment due to adverse events (AEs), and for 15.4 % of patients there was no follow-up. After 3 months of treatment ≥ 50 % decrease (from baseline) in the severity of symptoms was noted in 83.4 % of patients for pain on movement, in 83.7 % for pain at rest, in 78.6 % for pain at night, in 80.8 % for dysfunction, and in 83.4 % for fatigue. 87.7 % of patients reported PASS. There were no significant differences in treatment outcomes for different localizations of OA and NSLBP: a ≥ 50 % pain reduction in kOA was achieved in 81.6 % of patients, in hOA – in 82.2 %, in gOA – in 85.0 %, in NSLBP – in 88.1 %. AEs were registered in 350 (22.4 %) patients, the most frequent was dyspepsia (n = 280, 17.8 %), diarrhea was recorded in 37 (2.4 %) cases. No serious AEs requiring hospitalization were registered. Conclusion. Combination therapy with celecoxib, diacerein, and a combination of glucosamine and chondroitin significantly reduces the severity of symptoms of OA and NSLBS.

Results of a clinical study of Traumeel® S and Zeel® T in patients with knee osteoarthritis and concomitant cardiovascular disease

Objective: to evaluate the efficacy and safety of simultaneous intramuscular administration of Traumeel® S and Zeel® T followed by therapy with the tablet medication Zeel® T in patients with knee osteoarthritis (OA) and concomitant cardiovascular diseases. Material and methods. The analysis included 119 patients aged 45–79 years (78.2 % women and 21.8 % men) with confirmed diagnosis of knee OA according to Altman criteria, stage II–III according to Kellgren–Lawrence and confirmed cardiovascular disease. The main indicator of efficacy was the change in pain intensity in the target knee joint according to the “Pain” subscale of the WOMAC questionnaire (A) at the final examination compared to the baseline. Other criteria were the dynamics of each symptom of knee OA according to the WOMAC questionnaire (pain, stiffness, and functional impairment, total score) on each visit, pain intensity in the target joint on a visual analogue scale (VAS), time it takes to travel 15 m, and the patient's overall disease assessment on the VAS. In addition, duration of use and dose of paracetamol (if used) were assessed, as well as quality of life by EuroQol and adverse events (AEs). Treatment safety was also analyzed in patients who had received at least one dose of the study drug. Results and discussion. WOMAC pain intensity decreased by on average of 3.8 points: from 7.6 to 3.8 points (95 % confidence interval, CI from -4.3 to -3.3). Data on changes in knee OA symptoms (pain, stiffness, and functional impairment) for each WOMAC subscale and the total score showed significant improvement at each follow-up visit (p < 0.0001). The VAS pain level decreased by 52%. An improvement in joint function was noted: the time it takes to travel 15 m fell from 19.5 to 16.4 s (p < 0.0001). The EuroQol quality of life score also improved from 57.1 ± 16.2 points at baseline to 71.1 ± 14.8 points on the 84<sup>th</sup> day of therapy. Thirty (25.2 %) patients had AEs, mainly neurological: headache (7.6 %) and hypoesthesia (1.7 %). No serious AEs were recorded. An association between AEs and study drug use was noted in 4 patients (headache, hypoesthesia, muscle cramps, and injection site pain). Conclusion. The results of the study confirm the efficacy and safety of the use of Traumeel® S and Zeel® T in patients with knee OA who have concomitant cardiovascular disease. During therapy, a significant decrease in pain and other clinical signs of OA (stiffness, limitation of physical activity) was observed, which allows us to recommend this treatment regimen for patients with comorbid pathology, as well as with the risk of developing of AEs during non-steroidal anti-inflammatory drugs therapy.

Treatment of symptomatic end-stage osteoarthritis of the ankle with anterolateral approach and an anatomical plate

The aim of this paper is to describe the anterolateral approach using an anatomical plate for ankle arthrodesis and to present the first mid-term results with this technique in ahigh-risk population. The indication for arthrodesis of the ankle joint with this described technique is moderate to severe osteoarthritis of the ankle. In addition to the general contraindications typical of any operation, there is a specific contraindication in cases of active infection of the soft tissues and accompanying osteomyelitis at the ankle. The incision is made along the course of the peroneus tertius muscle. After that, the mobilization of the peroneus superficialis nerve is carried out, followed by the mobilization of the long extensor tendons, especially the extensor digitorum muscle in amedial direction opening the capsule and removal of the residual cartilage on the distal tibia and talus. Subsequently, the subchondral sclerosis is opened, and the implantation of a suitable osteosynthesis material, e.g., an anatomical angle-stable plate, is carried out. Finally, wound closure is performed involving the muscle belly of the extensor digitorum muscle covering the plate. Immobilization of the ankle for 5-7days in adorsal knee-high splint. Retention in awalker after decongestion for another 5weeks. Increased loading can be done after X‑ray/computed tomography (CT) control from the 6thweek. In all, 11patients were observed retrospectively for an average of 14months. There were no complications. The European Foot and Ankle Society (EFAS) score improved significantly from 3.3 to 17.8 points. All patients were subjectively satisfied with the result and would have the operation again.

Non-operative Treatment Options for Osteoarthritis in the Hip.

With the increased disability associated with osteoarthritis (OA) progression, and the significant socioeconomic burden of joint replacement surgeries, there is a need for more reliable conservative treatments for patients presenting with hip OA. Most studies of OA treatments involve the knee. We conducted a literature search and reviewed non-operative hip OA treatment recommendations by the Osteoarthritis Research Society International, the American College of Rheumatology, American Academy of Orthopedic Surgeons, and European Alliance of Associations for Rheumatology, as well as Cochrane Reviews. Non-steroidal anti-inflammatory drugs and corticosteroid injections are the most supported and recommended options for hip OA; other medications with potential benefits for short-term pain relief include acetaminophen and tramadol. Most societies recommend against the use of glucosamine, typical opioids, and viscosupplementation injections. Platelet-rich plasma has potential benefits, but evidence of its effectiveness is incomplete. Further research is needed to better inform and guide clinicians who create treatment plans for patients with symptomatic hip OA.

The Effect of Silicon Dioxide on Knee Osteoarthritis: A Randomized Clinical Trial

Osteoarthritis (OA) is the most common type of arthritis and although there is no definitive cure for it, there are treatments for symptom management. The present study was conducted to evaluate the effects of silicon dioxide (SiO2) on clinical symptoms of knee OA and compare it with avocado soybean unsaponifiable (ASU) and placebo. This study is a double-blind randomized clinical trial on 104 patients with knee OA referred to Rheumatology Clinic, Rasoul Akram Hospital, Tehran. Patients were randomly divided into three groups, including patients treated with ASU, SiO2, and placebo for 3 months. Subsequent referral was performed at weeks 4, 8, and 12, and the stiffness, physical function, and pain scores were recorded based on the WOMAC questionnaire. In this study, the effect of treatment of placebo and SiO2 and ASU in patients with knee OA based on WOMAC questionnaire showed a significant reduction in terms of pain, joint stiffness, physical function, and total scores of WOMAC in the cases of the SiO2 group compared with the other two groups. The findings of this study showed that the therapeutic effects of SiO2 in patients with knee OA in terms of pain and stiffness and physical function scores were more than the ASU and placebo groups.

Intra-articular bone marrow mononuclear cell therapy improves lameness from naturally occurring equine osteoarthritis.

Osteoarthritis (OA) can be debilitating and is related to impaired resolution of synovial inflammation. Current treatments offer temporary relief of clinical signs, but have potentially deleterious side effects. Bone marrow mononuclear cells (BMNC) are a rich source of macrophage progenitors that have the ability to reduce OA symptoms in people and inflammation in experimentally-induced synovitis in horses. The objective of this study was to evaluate the ability of intra-articular BMNC therapy to improve clinical signs of naturally occurring equine OA. Horses presenting with clinical and radiographic evidence of moderate OA in a single joint were randomly assigned to 1 of 3 treatment groups: saline (negative control), triamcinolone (positive control), or BMNC (treatment group). Lameness was evaluated subjectively and objectively, joint circumference measured, and synovial fluid collected for cytology and growth factor/cytokine quantification at 0, 7, and 21 days post-injection. Data were analyzed using General Estimating Equations with significance set at p < 0.05. There were no adverse effects noted in any treatment group. There was a significant increase in synovial fluid total nucleated cell count in the BMNC-treated group on day 7 (median 440; range 20-1920 cells/uL) compared to day 0. Mononuclear cells were the predominant cell type across treatments at all time points. Joint circumference decreased significantly in the BMNC-treated group from days 7 to 21 and was significantly lower at day 21 in the BMNC-treated group compared to the saline-treated group. Median objective lameness improved significantly in the BMNC group between days 7 and 21. GM-CSF, IL-1ra, IGF-1, and TNF-α were below detectable limits and IL-6, IL-1β, FGF-2 were detectable in a limited number of synovial fluid samples. Inconsistent and limited differences were detected over time and between treatment groups for synovial fluid PGE2, SDF-1, MCP-1 and IL-10. Decreased lameness and joint circumference, coupled with a lack of adverse effects following BMNC treatment, support a larger clinical trial using BMNC therapy to treat OA in horses.

Diz Osteoartritli Bireylerde Osteoartrit Şiddeti, Ağrı, Alt Ekstremite Kas Kuvveti, Kinezyofobi ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi

Objective: Osteoarthritis (OA) is among the primary causes of chronic disability. Pain and other symptoms of OA may have an effect on function and quality of life. The study aims to investigate the relationship between osteoarthritis severity, pain, muscle strength, kinesiophobia, and quality of life in individuals with knee OA. &#x0D; Material and Method: 100 patients with knee OA were enrolled in this study. The mean age of the patients was 65.50±2.74 years and the mean body mass index was 27.89±1.21 kg/m2. The severity of OA was evaluated with the Lequesne Algofunctional Index (LAI). Pain levels and their effect on function were evaluated with the Visual Analog Scale (VAS) and WOMAC Osteoarthritis Index; functional muscle strength with the Sit-to- Stand Test (5-STS) and Stair Test (ST); kinesiophobia with the Tampa Kinesiophobia Scale; quality of life with the SF-12 Scale. &#x0D; Results: There was a weak correlation between LAI and VAS rest (r=0.34), VAS night (r=0.30), and SF-12 mental score (r=-0.20) (p

Effects of SKCPT on Osteoarthritis in Beagle Meniscectomy and Cranial Cruciate Ligament Transection Models.

Osteoarthritis (OA) affects >500 million people globally, and this number is expected to increase. OA management primarily focuses on symptom alleviation, using non-steroidal anti-inflammatory drugs, including Celecoxib. However, such medication has serious side effects, emphasizing the need for disease-specific treatment. The meniscectomy and cranial cruciate ligament transection (CCLx)-treated beagle dog was used to investigate the efficacy of a modified-release formulation of SKI306X (SKCPT) from Clematis mandshurica, Prunella vulgaris, and Trichosanthes kirilowii in managing arthritis. SKCPT's anti-inflammatory and analgesic properties have been assessed via stifle circumference, gait, incapacitance, histopathology, and ELISA tests. The different SKCPT concentrations and formulations also affected the outcome. SKCPT improved the gait, histopathological, and ELISA OA assessment parameters compared to the control group. Pro-inflammatory cytokines and matrix metalloproteinases were significantly lower in the SKCPT-treated groups than in the control group. This study found that SKCPT reduces arthritic lesions and improves abnormal gait. The 300 mg modified-release formulation was more efficacious than others, suggesting a promising approach for managing OA symptoms and addressing disease pathogenesis. A high active ingredient level and a release pattern make this formulation effective for twice-daily arthritis treatment.

Chondroprotective effects of Protaetia brevitarsis seulensis larvae as an edible insect on osteoarthritis in mice.

Osteoarthritis (OA) is a common chronic joint inflammatory disease characterized by progressive destruction of the articular cartilage, bone remodeling, and excessive chronic pain. Most therapeutic approaches do not rescue the progression of OA effectively or provide relief of symptoms. Protaetia brevitarsis seulensis larva (PBSL), which is attracting attention, is an edible insect with very high nutritional value and herbal medicine for the treatment of blood stasis, hepatic disease, and various inflammatory diseases. However, the effect of PBSL on OA has not yet been investigated. This study aimed to demonstrate the effects of PBSL water extract on the progression of OA using monosodium iodoacetate (MIA)-induced mice and SW1353 chondrocytes or murine macrophages. We injected MIA into the intraarticular area of mice following pretreatment with either saline or PBSL (200 mg/kg) for 2 weeks, and then locomotor activity, microcomputed tomography and histopathological analysis, quantitative reverse transcriptase-polymerase chain reaction analysis, and western blot analysis were performed. To determine the molecular effects of PBSL, we used interleukin-1β (IL-1β)-induced SW1353 chondrosarcoma or lipopolysaccharide (LPS)-stimulated macrophages. Pretreatment with PBSL diminished the symptoms of OA. Physical activity, articular cartilage damage, and the generation of microfractures were rescued by pretreatment with PBSL in the mouse model. Pretreatment with PBSL suppressed the progress of OA through the regulation of articular cartilage degradation genes and inflammation in both in vivo and in vitro models. Our results demonstrated that PBSL has value as edible insect that can be used in the development of functional foods for OA.

Changes in clinical outcomes and alignment of the ipsilateral knee and ankle after supramalleolar osteotomy in patients with varus osteoarthritis of the ankle: a short-term follow-up study.

The purpose of this study was to investigate the changes in clinical outcomes and alignment of the ipsilateral knee and ankle in patients with varus ankle osteoarthritis after supramalleolar osteotomy (SMO). We retrospectively reviewed 23 patients (24 ankles) with Takakura II, IIIa and IIIb ankle osteoarthritis treated with SMO between May 2017 and March 2022. The radiologic parameters of ankles contained medial distal tibial angle (TAS), tibiotalar angle (TT), tibial lateral surface (TLS), tibial plafond inclination (TPI) and talar inclination (TI). The radiologic parameters of knees contained medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), the knee joint line orientation relative to ground (G-KJLO) and WBL. Hip-knee-ankle angle (HKA) was also collected. The Takakura system was used for evaluating the ankle osteoarthritis and the Kellgren-Lawrence (KL) system was used for evaluating the knee osteoarthritis. Clinical evaluation of the ankle joints contained American Orthopedic Foot and Ankle Society (AOFAS), range of motion (ROM) and visual analogue scale (VAS). Clinical evaluation of the knee joints contained Japanese Orthopaedic Association Scores (JOA), ROM, VAS. The mean follow-up times were 20.3 ± 7.3months (range 12-38). According to the radiologic evaluation, the TAS increased from preoperative 84.7° ± 2.0° to 91.2° ± 1.8° at the last follow-up (P < 0.001). The TPI and TI decreased from 4.4° ± 4.2° and 11.0° ± 5.2° to 0.1° ± 4.7° and 4.1° ± 4.8° (P < 0.001 for both). The TT angel improved from 9.5° ± 4.1° to 4.9° ± 3.3° (P < 0.001). No significant differences were found regarding MPTA, JLCA, G-KJLO, knee WBL and HKA (P > 0.05 for all). The Takakura stage improved after SMO (P < 0.001) whilst the KL stage maintains the similar lever (P > 0.05). According to the clinical evaluation, the AOFAS significantly increased from 67.5 ± 10.6 to 88.5 ± 9.3 and the VAS of the ankle decreased from 4.7 ± 1.6 to 1.2 ± 1.1, whilst there were no changes on VAS and even the JOA and knee ROM after SMO (P > 0.05 for all). SMO can alleviate the symptoms of varus ankle osteoarthritis and delay the time for ankle replacement or arthrodesis by redistributing the abnormal stress of the ankle and restoring the congruence of the tibiotalar joint. In addition, it did not induce the clinical symptoms of knee without compromising lower limb alignment or knee joint line orientation in the short term. Level IV case series.

Hand osteoarthritis: A fresh look

Hand osteoarthritis (OA) has been the subject of numerous publications in recent years, particularly in the fields of imaging and therapeutics. The imaging studies revealed a good correlation between the presence of synovitis and/or subchondral edema and arthritic joint pain. Several randomized controlled trials (RCTs) have assessed the efficacy of biologics and conventional DMARDs in patients with symptomatic hand OA. No less than six RCTs have evaluated the symptomatic and, in some cases, structural efficacy of anti-IL-1, anti-TNF or anti-IL-6 drugs. Overall, the results of these trials were disappointing – none of them demonstrated superiority over placebo. There were also two negative trials with hydroxychloroquine. In the end, the only trial that was positive evaluated 10mg oral prednisone versus placebo for 6 weeks in patients with flares of hand OA and synovitis visible on ultrasound. While that trial confirms the role of inflammation in hand OA, it should obviously not encourage the long-term use of corticosteroids as a symptomatic treatment.

Incongruity of the scapulohumeral arch: an indirect sign of posterior subluxation of the humeral head in primary glenohumeral osteoarthritis.

In symptomatic glenohumeral osteoarthritis, arthroplasty is the gold standard to restore a mobile and painless shoulder. The kind of arthroplasty chosen is based mainly on the evaluation of the rotator cuff and the type of glenoid. The aim of this study was to analyze the scapulohumeral arch in primary glenohumeral osteoarthritis (PGHOA) with a non-injured cuff and to determine whether posterior humeral subluxation influences Moloney's line, which corresponds to an intact scapulohumeral arch. Between 2017 and 2020, 58 anatomic total shoulder arthroplasties were implanted in the same center. We included all patients with complete preoperative imaging (X-rays and MRI or arthro-CT scan) assessing an intact rotator cuff. A total of 55 shoulders that had undergone surgery for a total anatomical shoulder prosthesis were analyzed after determining the type of glenoid in the frontal plane according to the Favard classification on an anteroposterior X-ray and in the axial plane according to the Walch classification on CT scan. The grade of osteoarthritis was evaluated according to Samilson. We analyzed whether there was a rupture of Moloney's line on the frontal radiograph and assessed the acromiohumeral distance. After preoperative analysis of 55 shoulders, 24 shoulders had a type A glenoid and 31 a type B glenoid. Twenty-two shoulders had a scapulohumeral arch rupture and 31 had a posterior subluxation of the humeral head: 25 shoulders had a type B1 glenoid and 6 had a type B2 glenoid according to the Walch classification. Most glenoids were E0 (n=47, 85%). The incongruity of Moloney's line was more frequent with type B than A glenoids (20/31, 65%, vs 2/24, 8%, p<0.001). No patient (0/15) with a type A1 glenoid had rupture of Moloney's line, and only two patients (2/9) with a type A2 glenoid had incongruency of the scapulohumeral arch. In PGHOA, the rupture of the scapulohumeral arch seen in anteroposterior X-rays, also known as Moloney's line, may be an indirect sign of posterior humeral subluxation, corresponding to a type B glenoid in the Walch classification. Incongruity of Moloney's line may indicate a rotator cuff injury or posterior glenohumeral subluxation with an intact cuff in PGHOA.

Comparison Of Naproxen And Diacerein In The Treatment Of Knee Joint Osteoarthritis

Background: Knee osteoarthritis is a common disease in older age. Pain and limitation of movement are the main symptoms of knee osteoarthritis. Many pharmacological options are available for symptomatic relief but NSAIDs are mostly prescribed. Diacerein is also prescribed for osteoarthritis but data regarding its efficacy is still controversial. Moreover, studies regarding the comparison of diacerein with NSAIDs are deficient in Pakistan.&#x0D; Objective: The objective of the study was to compare the clinical efficacy of naproxen (NSAID) with diacerein in treating knee osteoarthritis.&#x0D; Methodology: Patients fulfilling inclusion criteria were included in the study. After written informed consent 60 patients of knee osteoarthritis were included in the study. They were divided randomly into two groups. Group A (n=30) was prescribed with tablet naproxen 500mg twice daily and group B (n=30) was given capsule diacerein 50mg twice daily for 12 weeks. Baseline VAS and WOMAC scores of the patients were noted. These scores were compared with scores achieved 12 weeks after intervention. Intra-group comparison of the scores was also carried out. SPSS version 23.0 was used for statistical analysis.&#x0D; Results: WOMAC and VAS scores comparison of the two groups (A &amp; B) before intervention showed an insignificant p-value that is 0.815 for the WOMAC score and 0.509 for the VAS score. After intervention means WOMAC score i.e.10.50 ± 2.46 of group A (treated with naproxen) was better than the mean 29.62 ± 7.03 of group B (treated with diacerein) showing significant p-value (&lt; 0.001). Similarly mean VAS of group A 1.92 ± 0.58 improved more than the mean VAS of group B i.e 3.38 ± 0.75 with significant p-value (&lt; 0.001). Intra-group comparison of the groups also showed a significant p-value.&#x0D; Conclusion: Clinical efficacy of naproxen is better than diacerein in treating knee osteoarthritis.

Clinical characteristics and long-term outcomes of septic arthritis of the native hip joint: a 20-year retrospective review.

The primary purpose of this retrospective case series was to describe the prevalence and outcomes of single-stage hip arthroplasty in patients who were previously treated for septic arthritis of the native hip at our institution over a 20-year period. This study also examined rates of persistent or recurrent infection, reoperation, and mortality for septic arthritis of the native hip. Adult patients treated for septic arthritis of the native hip at our institution from 1995 to 2015 were retrospectively identified. Exclusion criteria included age <18 years, missing or incomplete medical records, treatment at an outside institution, and prior surgery of the hip. 97 patients were included in this study. 3 patients (3.1%) who were previously treated for septic arthritis of the native hip underwent single-stage hip arthroplasty an average of 40 ± 25 months from the date of infection. 3 of the 18 (16.7%) patients who were treated with resection arthroplasty underwent second-stage joint reconstruction. There were no cases of periprosthetic joint infection (PJI). 1 patient who underwent single-stage arthroplasty experienced implant-induced metallosis, necessitating removal of the implant. There were no other cases of revision arthroplasty. The prevalence of single-stage hip arthroplasty in patients with a history of septic arthritis of the native hip joint was 3.1%, which is higher than the prevalence of hip arthroplasty in the United States general population, suggesting that a history of septic arthritis may increase the risk of requiring hip arthroplasty. In the small number of patients who went on to receive a hip replacement, there were no reported cases of PJI. This study suggests that hip arthroplasty is a viable option for patients with symptomatic osteoarthritis and a history of septic arthritis of their hip.

Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution

Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.

Serum proteomic biomarkers diagnostic of knee osteoarthritis

To better understand the pathogenesis of knee osteoarthritis (OA) through identification of serum diagnostics. We conducted multiple reaction monitoring mass spectrometry analysis of 107 peptides in baseline sera of two cohorts: the Foundation for National Institutes of Health (NIH) (n=596 Kellgren-Lawrence (KL) grade 1-3 knee OA participants); and the Johnston County Osteoarthritis Project (n=127 multi-joint controls free of radiographic OA of the hands, hips, knees (bilateral KL=0), and spine). Data were split into (70%) training and (30%) testing sets. Diagnostic peptide and clinical data predictors were selected by random forest (RF); selection was based on association (p<0.05) with OA status in multivariable logistic regression models. Model performance was based on area under the curve (AUC) of receiver operating characteristic (ROC) and precision-recall (PR) curves. RF selected 23 peptides (19 proteins) and body mass index (BMI) as diagnostic of OA. BMI weakly diagnosed OA (ROC-AUC 0.57, PR-AUC 0.812) and only symptomatic OA cases. ACTG was the strongest univariable predictor (ROC-AUC 0.705, PR-AUC 0.897). The final model (8 serum peptides) was highly diagnostic (ROC-AUC 0.833, 95% confidence interval [CI] 0.751, 0.905; PR-AUC 0.929, 95% CI 0.876, 0.973) in the testing set and equally diagnostic of non-symptomatic and symptomatic cases (AUCs 0.830-0.835), and not significantly improved with addition of BMI. The STRING database predicted multiple high confidence interactions of the 19 diagnostic OA proteins. No more than 8 serum protein biomarkers were required to discriminate knee OA from non-OA. These biomarkers lend strong support to the involvement and cross-talk of complement and coagulation pathways in the development of OA.