Treatment Of Osteoarthritis Patients Research Articles

The Efficacy and Safety of Green-Lipped Mussel Extract Plus Ginkgo Biloba on Anti-Inflammatory Status in Patients with Knee Osteoarthritis

Background: Clinical research on the efficacy of nutraceutical compounds recommended for the relief of osteoarthritis (OA) symptoms has been largely disputed. In addition, no link has been established between its safety and efficacy in Kurdish population. The aim of this study is to determine the efficacy of New Zealand green-lipped mussel extract + Ginkgo biloba (GLME+) in patients with OA, and analyze the effect of GLME+ on inflammation. Methods: In an open-label, single-group allocation study, 40 patients diagnosed with knee OA were administrated 1000 mg/day of New Zealand green-lipped mussel extract and 100 mg/day of Ginkgo biloba for eight weeks. The outcome measure was scored using Western Ontario and McMaster Universities arthritis index (WOMAC). The serum concentration of inflammatory chemokine (CCL3) and myeloperoxidase (MPO) were measured. An intention-to-treat analysis was employed and subject data at T0 and T8 weeks. Results: Results showed a significant improvement in WOMAC score in post-treated OA patients with GLME+ (P<0.001). In addition, CCL3 serum levels were significantly decreased after an 8-week intervention (P<0.001). Moreover, no statistical significance was observed within groups in MPO serum levels (P> 0.05). Conclusions: GLME+ improved knee joint pain, stiffness, and mobility in OA patients. Two of GLME+'s chondroprotective properties were the reduction of oxidative damage and the inhibition of inflammation, both of which have been linked to the etiology of OA cartilage destruction. The findings indicated that GLME+ may be useful in the treatment of OA patients.

Controversy about the use and financing of SYSADOA for osteoarthritis in Spain: An analysis of the scientific-social debate in the media

Background and objectiveThe use of SYmptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOA) in the treatment of osteoarthritis (OA) has been a topic of debate in the scientific community and public entities regarding their public financing in Spain. The objective of this study was to describe and analyse the main positions of media outlets, public entities, regarding the use and financing of SYSADOA in Spain. MethodsA qualitative and quantitative analysis of the content regarding the use and financing of SYSADOA was conducted in general media outlets (El País, El Mundo, La Vanguardia, ABC, and 20minutos), public statements, and Twitter publications. ResultsA total of 15 articles in general media outlets, 872 tweets, and 7 public entity statements were identified. Mostly, media outlets (91%) and social media platforms (78%) exhibited a favorable trend towards funding. Discussion and conclusionsThe use of SYSADOA in OA patients continues to be controversial in the scientific community. However, there is consensus among patient associations in favour of public funding and use as a treatment for OA patients.

Patterns of Comorbidities and Prescribing and Dispensing of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Among Patients with Osteoarthritis in the USA: Real-World Study.

Osteoarthritis (OA) is a major cause of chronic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are analgesics commonly used for musculoskeletal pain; however, NSAIDs can increase the risk of certain adverse events, such as gastrointestinal bleeding, edema, heart failure, and hypertension. The objective of this study was to characterize existing comorbidities among patients with OA. For patients with OA with and without a coexisting medical condition of interest (CMCOI), we estimated the prevalence of prescribing and dispensing NSAIDs pre-OA and post-OA diagnosis. Data from three large administrative claims databases were used to construct an OA retrospective cohort. Databases leveraged were IBM MarketScan Medicare Supplemental Database (MDCR), IBM MarketScan Commercial Database (CCAE), and Optum's de-identified Clinformatics® Data Mart Database (Optum CDM). The OA study population was defined to be those patients who had an OA diagnosis from an inpatient or outpatient visit with at least 365 days of prior observation time in the database during January 2000 through May 2021. Asthma, cardiovascular disorders, renal impairment, and gastrointestinal bleeding risks were the CMCOI of interest. Patients with OA were then classified as having or not having evidence of a CMCOI. For both groups, NSAID dispensing patterns pre-OA and post-OA diagnosis were identified. Descriptive analysis was performed within the Observational Health Data Sciences and Informatics framework. In each database, the proportion of the OA population with at least one CMCOI was nearly 50% or more (48.0% CCAE; 74.4% MDCR; 68.6% Optum CDM). Cardiovascular disease was the most commonly observed CMCOI in each database, and in two databases, nearly one in four patients with OA had two or more CMCOI (23.2% MDCR; 22.6% Optum CDM). Among the OA population with CMCOI, NSAID utilization post-OA diagnosis ranged from 33.0 to 46.2%. Following diagnosis of OA, an increase in the prescribing and dispensing of NSAIDs was observed in all databases, regardless of patient CMCOI presence. This study provides real-world evidence of the pattern of prescribing and dispensing of NSAIDs among patients with OA with and without CMCOI, which indicates that at least half of patients with OA in the USA have a coexisting condition. These conditions may increase the risk of side effects commonly associated with NSAIDs. Yet, at least 32% of these patients were prescribed and dispensed NSAIDs. These data support the importance of shared decision making between healthcare professionals and patients when considering NSAIDs for the treatment of OA in patients with NSAID-relevant coexisting medical conditions.

Enhancing collagen based nanoemulgel for effective topical delivery of Aceclofenac and Citronellol oil: Formulation, optimization, in-vitro evaluation, and in-vivo osteoarthritis study with a focus on HMGB-1/RAGE/NF-κB pathway, Klotho, and miR-499a.

The majority of conventional osteoarthritis (OA) treatments are based on molecular adjustment of certain signaling pathways associated with osteoarthritis (OA) pathogenesis, however there is a significant need to search for more effective and safe treatments. This study centers around formulating Aceclofenac (ACF) with high bioavailability in combination with Citronellol oil and collagen. The optimal concentrations of Citronellol oil/D-Limonene oil, Tween 80, and Transcutol HP were determined using a pseudoternary phase diagram. The formulated nanoemulsions were studied for thermophysical stability. Thermodynamically stable formula were analyzed for droplet size, zeta potential, and in-vitro permeation. Then, collagen based nanoemulsion were prepared to capitalize on its efficacy in reducing osteoarthritis side effects and characterized for nano size properties. Formulae F10 and F10C were chosen as optimum nanosize formula. Hense, they were prepared and characterized as nanoemulgel dosage form. The nanoemulgel formulae F10NEG1 and F10CNEG1 showed reasonable viscosity and spreadability, with complete drug release after 4h. These formulae were chosen for further In vivo anti-OA study. Collagen based ACF/citronellol emugel were able to modulate HMGB-1/RAGE/NF-κB pathway, mitigating the production of inflammatory cytokine TNF-α. They were also able to modulate Klotho and miR-499, reducing serum CTXII and COMP, by reducing the cartilage destruction. Histological investigations validated the efficacy, safety, and superiority of Aceclofenac in combination with Citronellol oil and collagen (F10CNEG1) over solo the treated group (F10NEG1 and blank). Hence, the findings of the current work encourage the use of this promising combined formula in treatment of OA patients.

The Complex Interplay between the Gut Microbiome and Osteoarthritis: A Systematic Review on Potential Correlations and Therapeutic Approaches.

The objective of this review is to systematically analyze the potential correlation between gut microbiota and osteoarthritis (OA) as well as to evaluate the feasibility of microbiota-targeted therapies for treating OA. Studies conducted from October 2013 to October 2023 were identified via a search on electronic databases such as PubMed, Web of Science, and Scopus, following established PRISMA statement standards. Two reviewers independently screened, assessed, and extracted relevant data, and then they graded the studies using the ROBINS I tool for non-randomized interventions studies and SYRCLE's risk-of-bias tool for animal studies. A search through 370 studies yielded 38 studies (24 preclinical and 14 clinical) that were included. In vivo research has predominantly concentrated on modifying the gut microbiota microenvironment, using dietary supplements, probiotics, and prebiotics to modify the OA status. Lactobacilli are the most thoroughly examined with Lactobacillus acidophilus found to effectively reduce cartilage damage, inflammatory factors, and pain. Additionally, Lactobacillus M5 inhibits the development of OA by preventing high-fat diet (HFD)-induced obesity and protecting cartilage from damage. Although there are limited clinical studies, certain compositions of intestinal microbiota may be associated with onset and progression of OA, while others are linked to pain reduction in OA patients. Based on preclinical studies, there is evidence to suggest that the gut microbiota could play a significant role in the development and progression of OA. However, due to the scarcity of clinical studies, the exact mechanism linking the gut microbiota and OA remains unclear. Further research is necessary to evaluate specific gut microbiota compositions, potential pathogens, and their corresponding signaling pathways that contribute to the onset and progression of OA. This will help to validate the potential of targeting gut microbiota for treating OA patients.

Senescence-Driven Inflammatory and Trophic Microenvironment Imprints Mesenchymal Stromal/Stem Cells in Osteoarthritic Patients.

Senescent cells promote progressive tissue degeneration through the establishment of a combined inflammatory and trophic microenvironment. The cellular senescence state has therefore emerged as a central driving mechanism of numerous age-related diseases, including osteoarthritis (OA), the most common rheumatic disease. Senescence hallmarks are detectable in chondrocytes, synoviocytes and sub-chondral bone cells. This study investigates how the senescence-driven microenvironment could impact the cell fate of resident osteoarticular mesenchymal stromal/stem cells (MSCs) that are hence contributing to OA disease progression. For that purpose, we performed a comparative gene expression analysis of MSCs isolated from healthy donors that were in vitro chronically exposed either to interferon-gamma (IFN-γ) or Transforming Growth Factor beta 1 (TGFβ1), two archetypical factors produced by senescent cells. Both treatments reduced MSC self-renewal capacities by upregulating different senescence-driven cycle-dependent kinase inhibitors. Furthermore, a common set of differentially expressed genes was identified in both treated MSCs that was also found enriched in MSCs isolated from OA patients. These findings highlight an imprinting of OA MSCs by the senescent joint microenvironment that changes their matrisome gene expression. Altogether, this research gives new insights into OA etiology and points to new innovative therapeutic opportunities to treat OA patients.

Treatment of patients with knee osteoarthritis with hyaluronate sodium (Revisk) in clinical practice

BACKGROUND: Osteoarthritis is a disease highly associated with a wide range of comorbidities, which leads to significant limitations of the therapeutic possibilities, in particular, the long-term use of non-steroidal anti-inflammatory drugs. Thus, develop algorithms for effective treatment of osteoarthritis aimed at reducing the need for anti-inflammatory therapy is of great importance.
 AIM: To evaluate the efficacy and safety of hyaluronic acid for the treatment of osteoarthritis in patients with comorbid pathology.
 MATERIALS AND METHODS: 30 patients aged 40 to 65 years with IIIII stages of knee osteoarthritis who received treatment with the hyaluronate sodium were examined according to the KellgrenLawrence scale. The course of treatment included standard intra-articular injections of Revisk (sterile sodium hyaluronate gel obtained by microbial fermentation) into the knee joints once a week, in a course of 3 injections. During the study non-steroidal anti-inflammatory drugs therapy was allowed at stable standard dosages. The effectiveness of treatment was assessed by changes in the WOMAC index, the Visual Analog scale pain scores for pain on movement, at rest, goniometry data, 30-meters walking test and stair climb test.
 RESULTS: A positive effect of treatment on all the parameters has been noted: significant improvement in clinical indicators of pain according to the visual analog scale, functional tests, and the WOMAC index scores. The positive dynamics of the estimated parameters during treatment started from the 7th day of therapy.
 CONCLUSIONS: The hyaluronate sodium (Revisk) can be used for treating patients with IIIII stages of knee osteoarthritis with moderate dysfunction of joints.

Functional Disability and Symptomatic Slow-Acting Drugs for Osteoarthritis in Adults with Periodontitis.

Osteoarthritis (OA) patients have decreased functional ability and restricted access to healthcare facilities and are on a spectrum of medications. These can impact their oral health. This study aims to investigate the association between periodontal disease and OA disease parameters, specifically the functional disability and the medications taken. This was a cross-sectional study on OA participants recruited from the Hospital Canselor Tuanku Mukhriz. Periodontal health parameters were obtained from an oral examination of the participants. A Health Assessment Questionnaire (HAQ) was administered to ascertain the functional status of the participants. Out of the 130 participants recruited, 71 (54.6%) had periodontitis. There was a correlation between the teeth count with OA severity, where participants with a greater Kellgren-Lawrence score had less teeth (rs = 0.204, p = 0.025). Participants with a greater degree of functional limitation also had less teeth (rs = -0.181, p = 0.039) and a higher clinical attachment loss (rs = 0.239, p = 0.006). There were no associations found between the symptomatic slow-acting drugs in OA and periodontal health parameters. In conclusion, there was a high proportion of periodontitis in patients with OA. Functional disability was associated with measures of periodontal health. It is suggested that clinicians treating OA patients consider the need for a referral for dental care when managing this group of patients.

Total Knee Replacement After Arthroscopic Meniscectomy in Knee Osteoarthritis: A Nationwide Population-Based Cohort Study.

Recent studies raise concerns that arthroscopic meniscectomy (AM) for degenerative tear may be detrimental to the maintenance of the joint structure. This study was performed to examine the rate of total knee replacement (TKR) among patients with knee osteoarthritis (OA) who underwent AM for meniscal tears and compare this rate with those who did not. A retrospective cohort study was conducted using the National Health Insurance Database of South Korea. Among knee OA patients aged 50-79, those who were treated with AM due to meniscal damage from 2007 to 2009 were selected as the AM group while those not treated with AM despite the presence of meniscal damage were selected as control group. Both were matched based on a propensity score and followed-up until the earliest occurrence of: TKR, death, or 10 years. Cox proportional hazards models were used to compare the outcome. A total of 36,974 patients were included in AM groups and non-AM group after 1:1 matching. TKR occurred in 9.62% and 7.64% in AM and non-AM groups with the average duration after meniscectomy of 5.88 ± 2.77 and 5.50 ± 2.94 years, respectively. After adjustment for baseline confounders, the TKR rate in the AM group was calculated to be 25% higher than that in the non-AM group (subdistribution hazard ratio, 1.25; 95% confidence interval, 1.16-1.34). The mortality rate was 5.20%, which did not significantly differ between groups. OA patients who underwent AM for the meniscal injury had higher incidence of TKR up to 10 years of follow-up than the non-operated group. The greater TKR utilization observed in patients undergoing AM merits caution when treating OA patients with meniscal injury.

A Systematic Review and Meta-analysis of Total Ankle Arthroplasty or Ankle Arthrodesis for Treatment of Osteoarthritis in Patients With Diabetes.

Background:End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis.Methods:A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes.Results:The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404).Conclusion:This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty.Level of Evidence:Level III, systematic review and meta-analysis.

Racinality of NSAID Use on Osteoathritis Patients in the Army Hospital of Pematang Siantar

Rational Use Of Medicine (RUM) or known as Rational Use of Medicine (POR) is a campaign that is spread throughout the world, also in Indonesia. The formulation of the problem in this study is how the rationality of the use of NSAIDs in osteoarthritis patients who seek treatment at the Pematangsiantar Army Hospital. This research was carried out on outpatients at the Pematangsiantar City Army Hospital for the April-June 2021 period . Research data collection was carried out in July-August 2021. Rationality in terms of 5 accuracy (right diagnosis, right indication, right drug, right dose and right patient) then we get the results of the analysis that some of the accuracy is 100% correct, while for the right drug parameter it is still worth 52%. So it can be concluded that treatment for Osteoarthritis patients when viewed from the right diagnosis, right indication, right dose, right patient, right drug, right method of administration at the Pematangsiantar City Army Hospital still cannot be fully said to be rational.

Glucosamine as a Treatment for Osteoarthritis: What If It's True?

No disease-modifying treatments are currently available for osteoarthritis (OA). While many therapeutic approaches are now being investigated it is ethical to resort to alternative solutions as that we already possess. There are many reasons for thinking that, at sufficiently high doses, glucosamine (GlcN) sulphate possesses a clinically relevant effect on OA pain. Wide inter-individual variations in the symptomatic effects of GlcN are explained by the extreme variability of its bioavailability. In studies evaluating its structure-modifying effect, GlcN was more effective than placebo in reducing the rate of joint space narrowing in patients with knee OA. More recent data suggest that GlcN may be effective in the primary prevention of OA in sportsmen. There is no controversy concerning the safety of GlcN which does not differ to that of placebo. Several studies have recently revealed an unexpected effect of GlcN on cardiovascular mortality. After adjusting for confounding factors, the regular consumption of GlcN correlated with a 27% reduction in mortality and a 58% reduction in deaths from cardiovascular causes. These data confirm animal studies demonstrating a protective effect of GlcN against cancer and cardiovascular diseases due to modulation of the O-GlcNAcylation pathway. Disorders in O-GlcNAcylation are involved in diabetes, obesity and cancers, which all feature chronic low-grade inflammation (CLGI). By regulating CLGI, GlcN may be beneficial to the symptoms of OA, its outcome and to that of the concomitant chronic pathologies, making GlcN as a valuable candidate for the treatment of OA in patients with metabolic syndrome, diabetes or cardiovascular diseases.

Drug utilisation evaluation in patients with osteoarthritis in tertiary care hospital

Background: The principle aim of our study is to assess the prescribing pattern of drugs used in treatment of osteoarthritis patients. Methods: A prospective and empirical study was carried out at department of orthopaedics-Shadan teaching and general hospital, for 6 months.Results: During the study period, a total 120 patients were enrolled, of which 57% were females, 43% were males and common age group was ≥60 years. It was found that 56% of OA patient have history of trauma and 62% of obese individual contribute to occurrence of OA. It was found that subjects developed comorbidities like CV disorders which is 36%. It was found that 63% have OA for a duration of >2 years, 56% had no knowledge about their medications, 59% have co-morbidity, 61% have treatment complexity. NSAID’s, calcium, vitamin D3, glucosamine and chondroitin sulphate were the most frequently prescribed drugs in OA accounting for 50%. It was reported that 55% were adherent to OA medication, adherence to physical activity was 64%, adherence to weight loss was 62%.Conclusions: Our study manifest that majority of the patients had duration of >2 years of OA. The reasons for the uncontrolled pain was due to absence of awareness about osteoarthritis-related difficulties, drugs, low calcium diet, increased stress, obesity, and advanced age. Continuous health education, patient counselling, information about medication adherence and satisfaction at follow-ups is essential to avoid the problems.

Rationality of the Use of NSAIDS in Rheumatic Osteoarthritis Patients in Outpatient Singosari Health Center Pematangsiantar City

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis Osteoarthritis (OA) is the most common form of arthritis found in the community, is chronic in nature, has a major impact on public health issues. a total of 213 arthritis patients, only 30 patients who met the inclusion criteria were due to incomplete medical record data or even loss of medical record data which caused the patient's medical record data to be incomplete. right indication, right drug, right dose, right route of administration, right patient) then the results of the analysis show that accuracy is 100% right, while for the right drug parameters it is still worth 53%. So it can be concluded that treatment for osteoarthritis patients when viewed from the right diagnosis, right indication, right dose, right patient, right drug, right method of administration at the Singosari Health Center cannot be fully rational.

Клінічна ефективність терапевтичного навчання в лікуванні хворих на остеоартроз з надмірною вагою тіла в практиці сімейного лікаря

Тактика сімейного лікаря щодо методик навчання пацієнтів з остеоартрозом (ОА) залишається не визначеною. Мета - оцінка ефективності терапевтичного навчання в комплексному лікуванні хворих на остеоартроз з надмірною масою тіла. Матеріали та методи. Досліджено динаміку індексу маси тіла (ІМТ) і клінічних показників суглобового синдрому у пацієнтів з остеартозом і надмірною вагою до та після комплексного лікування з застосуванням методики терапевтичного навчання (основна група n=43), у порівнянні з традиційним лікуванням (група порівняння n=32). Статистичний аналіз проводився за допомогою Excel 2007, Statistica 6.0. Результати. Відзначено вплив освітньої програми терапевтичного навчання на достовірну позитивну динаміку з боку індексу WOMAC - на 61, 9% (p <0,05), індексу Лекена 16,7±1,3(р≥0,05), інтенсивності болі за візуальною аналоговою шкалою болю (ВАШ) - на 39,3% (p <0,05), у пацієнтів основної групи, на відміну від групи порівняння, що вказує на високу ефективність терапевтичного навчання. Крім того, в основній групі кількість людей з нормальним ІМТ збільшилася до 60,4% і знизилась з надмірною масою тіла - 22,3%, ожирінням - 17,3%. Висновок. Отримані результати вказують на високу клінічну ефективність застосування терапевтичного навчання в комплексному лікуванні пацієнтів з ОА і надмірною масою тіла.

Ingredients of a Natural Oral Nutritional Supplement and Their Role in the Treatment of Osteoarthritis.

Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world’s aging population. Currently, nonsteroidal anti-inflammatory drugs and acetaminophen are first-line medications for treating osteoarthritis patients’ pain. However, several studies have noted that while these medications control pain they do not halt progressive degeneration and tend to have an unfavorable side-effect profile with prolonged use. Recently, due to their more favorable side-effect profiles, herbal alternatives for controlling osteoarthritis symptoms and for alleviating the progression of the disease are being increasingly studied. Synogesic is a newly developed herbal supplement blend by renowned orthopedic surgeons and physiatrists consisting of turmeric, rutin, ginger root, vitamin C, vitamin D, and boswellia extracts. A study by Sharkey et al. has commented on the efficacy of the blend on the patients with knee osteoarthritis. So far, a review on the ingredients of the blend has not yet carried outbeen. By exploring prominent literature databases including PubMed and ScienceDirect, our aim is to write a narrative review to explore the individual ingredients of this blend and delve into their characteristics, as well as the most recent literature on their mechanism and efficacy in patients with osteoarthritis. Through this, we hope to inform clinicians and patients alike on relevant up-to-date research on the supplement and provide insight on the potential for this supplement for alleviating the disease course of patients with osteoarthritis.

Features of the Course and Treatment of Osteoarthritis in Patients with Osteoporosis and Obesity

The objective: features of the course and clinical manifestations of the joint syndrome and increase the effectiveness of treatment in patients with OA with osteoporosis and obesity. Materials and methods. The study included 134 patients (88 women and 46 men), aged 30 to 80 years. Depending on the body mass index, patients were divided into 2 groups: obese and normal weight. Peculiarities of the course and effectiveness of treatment were assessed using questionnaires VAS, WOMAC, Lekens. Levels of nonspecific inflammatory parameters (ESR and CRP), cytokines (IL-1, IGF-1, NO), uric acid level and bone mineral density were also studied. SPSS Statistics was used for statistical data processing. Results. The study revealed a statistically significant difference in the indicators of the questionnaires VAS, WOMAC and Leken, levels of immunological (IL-1, IGF-1, NO) and nonspecific (ESR, CRP) indicators of inflammation between the 2 groups of patients. Patients with osteoporosis and obesity had the worst questionnaires and indicators of inflammation, compared with patients with normal BMD and osteopenia. In obese patients, the dynamics of treatment was significantly worse, according to questionnaires, immunological and nonspecific indicators of inflammation. Conclusions. Patients with OA and obesity, compared with normal weight, had more severe joint damage, more intense pain, stiffness and reduced functional activity, as well as more intense inflammation. The most severe course of the disease was observed in patients with osteoporosis and obesity, compared with normal BMD and osteopenia. The dynamics of SYSADOA treatment is impaired in patients with osteoarthritis and obesity: less intense reduction of knee stiffness, pain and poorer functional activity, as well as less effective anti-inflammatory effect.

An insight into osteoarthritis susceptibility: Integration of immunological and genetic background.

Osteoarthritis (OA) is a progressive degenerative disease that affects all synovial joints, causing the disability of the main locomotor diarthrodial joints. OA pathogenesis is caused by a complex interplay between a number of genetic and environmental risk factors, involved in the early onset and progression of this chronic inflammatory joint disease. Uncovering the underlying immunological and genetic mechanisms will enable an insight into OA pathophysiology and lead to novel and integrative approaches in the treatment of OA patients, together with a reduction of the disease risk, or a delay of its onset in susceptible patients.

Clinical relevance of biochemical and metabolic changes in osteoarthritis.

Osteoarthritis (OA) is a multifactorial disease with huge phenotypic heterogeneity. The disease affects all tissues in the joint, and the loss of articular cartilage is its hallmark. The main biochemical components of the articular cartilage are type II collagen, aggrecan, and water. Transforming growth factor-beta (TGF-β) signaling is one of the signaling pathways that maintains the healthy cartilage. However, the two subpathways of the TGF-β signaling-TGF-β and bone morphogenetic proteins (BMP) subpathways, lose their balance in OA, resulting an increased expression of cartilage degradation enzymes including matrix metallopeptidase 13 (MMP13), cathepsin B (CTSB), and cathepsin K (CTSK) and a decreased expression of aggrecan (ACAN). Thus, restoring the balance of two subpathways might provide a new avenue for treating OA patients. Further, metabolic changes are seen in OA and can be used to distinguish different subtypes of OA patients. Metabolomics studies showed that at least three endotypes of OA can be distinguished: 11% of OA patients are characterized by an elevated blood butyryl carnitine, 33% of OA patients have significant reduced arginine concentration, and 56% with metabolic alteration in phospholipid metabolism. While these findings need to be confirmed, they are promising personalized medicine tools for OA management.

Logic is Enough: A Clinical Evaluation of All-Poly Cruciate Retaining Total Knee System for Treating Osteoarthritis Patients (Three-Year Follow up Study)

Logic is Enough: A Clinical Evaluation of All-Poly Cruciate Retaining Total Knee System for Treating Osteoarthritis Patients (Three-Year Follow up Study)