Arthritis Burden and Impact are Greater among U.S. Women than Men: Intervention Opportunities

OBJECTIVES

To summarize arthritis burden and impact among women compared with men, using updated surveillance and impact measures; to describe public health approaches to arthritis; and to review effective, evidence-based arthritis self-management interventions.

RESULTS

Arthritis continues to burden the U.S. population as the leading cause of physical disability and affects women disproportionately: women with arthritis report greater prevalence of activity and work limitations, psychological distress, and severe joint pain than their male counterparts. Three main public health interventions can reduce arthritis impact: self-management education, physical activity, and weight management. Self-management education programs are proven to reduce pain and depression, delay disability, improve self-efficacy, physical function, and quality of life, and reduce healthcare costs. Appropriate physical activity decreases pain, improves function, and delays disability. The American College of Rheumatology recommends maintaining a healthy weight to benefit patients with hip or knee osteoarthritis. Women appear more receptive to certain information delivery methods (i.e., physician counseling) than men, suggesting gender-specific targeting of interventions may be of use.

CONCLUSIONS

Effective interventions remain underused. The Centers for Disease Control and Prevention Arthritis Program and its partners, including state arthritis programs, continue their efforts to build the arthritis public health science base, monitor burden and impact, evaluate and disseminate evidence-based interventions, and work to decrease and delay disability, and increase quality of life among those with arthritis. As new approaches are developed, women and other disproportionately impacted groups merit particular consideration in tailoring and delivering programs to reduce arthritis burden.

Intra-articular injection of a nutritive mixture solution protects articular cartilage from osteoarthritic progression induced by anterior cruciate ligament transection in mature rabbits: a randomized controlled trial

Osteoarthritis (OA) is a degenerative disease that disrupts the collagenous matrix of articular cartilage and is difficult to cure because articular cartilage is a nonvascular tissue. Treatment of OA has targeted macromolecular substitutes for cartilage components, such as hyaluronic acid or genetically engineered materials. However, the goal of the present study was to examine whether intra-articular injection of the elementary nutrients restores the matrix of arthritic knee joints in mature animals. A nutritive mixture solution (NMS) was composed of elementary nutrients such as glucose or dextrose, amino acids and ascorbic acid. It was administered five times (at weeks 6, 8, 10, 13 and 16) into the unilateral anterior cruciate ligament transected knee joints of mature New Zealand White rabbits, and the effect of NMS injection was compared with that of normal saline. OA progression was histopathologically evaluated by haematoxylin and eosin staining, by the Mankin grading method and by scanning electron microscopy at week 19. NMS injection decreased progressive erosion of articular cartilage overall compared with injection of normal saline (P < 0.01), and nms joints exhibited no differences relative to normal cartilage that had not undergone transection of the anterior cruciate ligament, as assessed using the mankin grading method. Haematoxylin and eosin staining and scanning electron microscopy findings also indicated that nms injection, in constrast to normal saline injection, restored the cartilage matrix, which is known to be composed of a collagen and proteoglycan network. thus, nms injection is a potent treatment that significantly retards oa progression, which in turn prevents progressive destruction of joints and functional loss in mature animals.

Age differences in the pain-depression link for women with osteoarthritis. Functional impairment and personal control as mediators

PURPOSE

This study examines functional impairment and personal control as mediators between pain and depressive symptoms in middle-aged and older women with osteoarthritis (OA).

METHOD

Ninety-nine middle-aged and older women with OA completed face-to-face interviews to assess pain, functional impairment, personal control, depressive symptoms, and self-rated health.

RESULTS

Controlling for self-rated health, functional impairment mediated the relationship between pain and depressive symptoms for middle-age women but not for older women. Alternately, personal control was a mediator for older women but not for middle-aged women.

CONCLUSIONS

Functional limitations at least partially explain the relationship between pain and depression for middle-aged women who are juggling many roles and do not expect trouble with daily activities. For older women, functional limitations are expected, but personal control becomes more important. Implications for intervention are discussed.

Cell Death and Apoptosis in Ostearthritic Cartilage

Osteoarthritis (OA) is the most common chronic joint disease in the elderly population, causing significant pain and disability. Because the cardinal feature of OA is a progressive loss of articular cartilage, a great portion of the research endeavour into the pathogenesis of OA has been focused on the regulation of matrix synthesis and degradation. The phenotypic stability and survival of the chondrocytes are essential for the maintenance of a proper cartilage matrix. This has lead to the long-standing assumption that cell death is a central feature in OA cartilage degeneration. The important role of apoptosis in OA has been demonstrated in in vitro and in vivo models. However, it should be noted that the relative contribution of apoptotic cell death in the pathogenesis of OA is still difficult to assess because of the chronic nature of the disease process. Therefore, the apoptosis of chondrocytes seems to be a potential target for therapeutic interventions in OA. The death receptor, mitochondrial and endoplasmic reticulum pathways are the major cellular pathways of apoptosis. Of all these elements involved in the apoptosis of chondrocytes, caspase inhibition has been studied with the most detail. Other molecules with the capacity to modulate mitochondria function, phosphatase (PP-1A/B) activity and pro-apoptosis stimuli (NO, prostaglandins, cytokines, ROS) could be excellent targets to block apoptosis of chondrocytes. Finally, the regulation of the natural inhibitors of apoptosis (c-FLIP, BAR, ARC and HC-gp39) could complement the other strategies to reduce cartilage degradation.

Antioxidants block cyclic loading induced chondrocyte death

Articular cartilage in congruous joints benefits from the moderate stresses and strains associated with normal cyclic loading. However, loading of joints with surface incongruities can lead to local stress and strain elevation at "step-off' sites where cartilage is not fully buttressed b ysurrounding matrix. Excessive stresses and strains predicted to occur at such sites may induce apoptosis, a process thought to promote cartilage degeneration and osteoarthritis (OA) through chondrocyte attrition. We hypothesized that the induction of apoptosis is mediated by oxidants, and that antioxidants can reduce elevated stress-induced chondrocyte attrition. To test this we exposed cylindrical cartilage explants from human articular cartilage to radially unconfined cyclic axial compression (3600 cycles, 1 Hz, 50% duty cycle) using two different physiologic loads (2MPa and 5 MPa). We found that 30% of chondrocytes in the superficial zone died within 24 hours of exposure to loading with 5 MPa axial compression, whereas mortality was limited to less than 15% with 2 MPa axial compression. Similarly, lactate accumulation in the medium was suppressed by compression with 5 MPa, but not 2 MPa. Approximately 80% of cell death induced by 5 MPa compression was blocked by pre-incubation of the explants in a variety of anti-oxidants including vitamin E, n-acetyl cysteine (NAC), and a superoxide dismutase mimetic (SOD). SOD and NAC also prevented the suppression of lactate secretion after 5 MPa compression. These observations support the hypothesis that the harmful effects of abnormal cyclic loading are mediated by oxidants and suggest that treatments to prevent OA may include methods of minimizing oxidative damage to chondrocytes.

[The effects of exercise on articular cartilage]

The effect of exercise on articular cartilage has been assessed on animal models and on humans using various imaging techniques. Joint cartilage, whose water content decreases itself thanks to its unique permeable medium, maintains load distribution and joint function together with the synovial fluid under physiologic conditions and sports activities. The adaptive capacity of joint cartilage is limited under various conditions such as excessive load bearing or prolonged immobilization; however, when these factors are reversed deformed cartilage returns to its former state under normal conditions. Due to its adverse effect on joint cartilage, immobilization period following cartilage damage or operation should be as short as possible for wound healing. It is reported that exercise contributes to cartilage healing and reduces risk for injury, and that moderate exercise can even decrease the number of cases requiring arthroplasty. Conversely, excessive (harsh) exercise may be associated with increased cartilage damage or degenerative changes. Despite the presence of osteophytic changes in joint cartilage of athletes performing mild sports activities, these may not result in osteoarthritis due to the adaptive feature of joint cartilage. In contrast, the risk for osteoarthritis is increased in professional sportsmen exposed to acute repetitive impact and torsional loading. This article reviews the influence of controlled, passive-active exercise on healing, and on the development of osteoarthritis and the short- and long-term changes in articular cartilage associated with exercise and participation in sports of different duration and intensity.

Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain

Treatment with herbal medicines is very popular in Europe. In order to get information on the evidence of effectiveness of oral herbal medicines in the treatment of pain in the joints or lower back, OVID(MEDLINE), PUBMED and COCHRANE COLLABORATION LIBRARY were searched back to 1985 for systematic reviews. The level of evidence of effectiveness was defined as strong - at least two confirmatory studies demonstrating a clinical relevant effect, moderate - one confirmatory study with a clinical relevant effect and/or multiple exploratory studies of good quality; otherwise the evidence was insufficient or conflicting in the case of inconsistent findings. Fifteen systematic reviews were identified. The evidence of effectiveness was strong for a proprietary unsaponifiable avocado soybean fraction and Harpagophytum preparations containing > 50 mg harpagoside in the daily dosage, moderate for ginger and a proprietary rose hip and seed powder, insufficient for Boswellia serrata gum resin and other herbal preparations and inconsistent for a proprietary willow bark extract. Further rigorous studies are required to confirm the usefulness of herbal medicines in the treatment of osteoarthritic complaints and chronic low back pain in order to enable acceptance of the herbal medicines into the treatment guidelines.

[Pathology of articular cartilage--dynamics of changes, prevention]

The aim of this work was the analysis of process of growth of degenerative changes of the hip joint based on present literature. Epidemiological data allow to consider it as a disease of civilization. The opinions about primary and secondary pathology of articular cartilage are presented. Changes in articular cartilage are presented with reference to morphological construction and physiology of cartilage. The author paid attention to the dynamics of changes and their relation to pathological factors in the range of intraarticular balance disturbances, as in systemic diseases and overload syndrome with reference to axial articular cartilage overload. Economical analysis related to degenerative hip disease dictates to initiate both causal and symptomatic prevention, as retarding dynamics of pathological process. The author presented modern methods of prevention of degenerative changes: gene therapy, molecular engineering.

Prevalence of and factors associated with glucosamine use in Canada

OBJECTIVE

Glucosamine is commonly used for the treatment of osteoarthritis, and its use is increasing in the general population. The Canadian Multicentre Osteoporosis Study (CaMos) provided an opportunity to examine the prevalence of glucosamine use across age and gender groups, and to assess the factors associated with its use.

METHOD

CaMos is a random, population-based sample of 9423 Canadians. Baseline assessments took place in 1996-1997 and the 5-year follow-up assessments in 2001-2002. The primary outcome of this analysis was glucosamine use at year 5. Prevalence estimates were age- and sex-standardized to the Canadian population. A number of factors potentially associated with glucosamine use were identified from the literature. Multivariable logistic regression was used to identify variables associated with glucosamine use.

RESULTS

At 5 years, complete data were available for 7652 of the original 9423 participants (81.2%). For men, glucosamine use increased from 0.9% to 4.7% (weighted values), and for women, it increased from 1.3% to 8.2%. Glucosamine use was higher among older participants, those living in western Canada, and those with arthritis, back pain, higher calcium intake from supplements, physical activity and prior glucosamine use.

CONCLUSIONS

Glucosamine use increased substantially over 5 years, and its use is associated with a number of factors. Some may use glucosamine to manage pain and symptoms of arthritis and back pain, while others use it as a preventive measure to maintain health.

Clinical inquiries: Do glucosamine and chondroitin worsen blood sugar control in diabetes?

Despite theoretical risks based on animal models given high intravenous doses, glucosamine/chondroitin (1500 mg/1200 mg daily) does not adversely affect short-term glycemic control for patients whose diabetes is well-controlled, or for those without diabetes or glucose intolerance (SOR: A, consistent, good-quality patient-oriented evidence). Some preliminary evidence suggests that glucosamine may worsen glucose intolerance for patients with untreated or undiagnosed glucose intolerance or diabetes (SOR: C, extrapolation from disease-oriented evidence). Long-term effects are unknown; however, no compelling theoretical or incidental data suggest that long-term results should be different (SOR: C, expert opinion). Further studies are required to clarify the effects of glucosamine on patients with poorly controlled diabetes or glucose intolerance.

[Surgical treatment options for weight bearing articular surface defect]

Treatment of full thickness defects of weight bearing articular surfaces is one of the most challenging problem of the daily orthopaedic practice. Recently published statistical evaluations of different arthroscopic findings support that 80% of full thickness defects of weight bearing areas leads to early osteoarthritis in a 5-10 years period. Beside traditional resurfacing procedures in the last two decades several new techniques have been developed to promote a hyaline or hyaline-like repair of the defected area. Basic science data, experimental results and preclinical evaluations supported wide clinical use of microfracture technique and autologous osteochondral mosaicplasty. Insurance company data confirm that yearly more, than 200 000 resurfacing procedures are performed according to the above mentioned two techniques all over the world. Beside these two popular resurfacing options autologous chondrocyte implantation may be a promising future alternative to treat extended defect areas. Beside basic science information and experimental data clinical experiences of more, than 8000 human implantations support such an application of cell therapy. This paper gives an outline of actual clinical resurfacing options and summarizes recent advances of cartilage repair.

Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head

BACKGROUND

Osteonecrosis of the femoral head is the end point of a disease process that results in bone necrosis, joint edema, and cartilage damage. It leads to joint arthritis that necessitates total hip arthroplasty in many patients. Because of its positive effects on osteogenesis and its chondroprotective effect of articular cartilage, pulsed electromagnetic field stimulation has been proposed as a method to prevent or delay the progression of osteonecrosis.

METHODS

A retrospective analysis of the results of treatment with pulsed electromagnetic field stimulation of seventy-six hips in sixty-six patients with osteonecrosis of the femoral head was performed. Patients with Ficat stage I, II, or III osteonecrosis of the femoral head were treated with pulsed electromagnetic field stimulation for eight hours per day for an average of five months. Clinical and diagnostic imaging information was collected at the start of the treatment and at the time of follow-up. The primary end point analyzed was the avoidance of hip surgery, and the secondary end point was limiting the radiographic progression (according to Ficat stage) of osteonecrosis of the femoral head.

RESULTS

Fifteen hips required a total hip arthroplasty; twelve of these hips were in patients with Ficat stage-III disease. The need for total hip arthroplasty was significantly higher in patients with Ficat stage-III disease than in patients with Ficat stage-I (p < 0.0001) or II (p < 0.01) disease at the beginning of treatment. Pulsed electromagnetic fields preserved 94% of Ficat stage-I or II hips. Furthermore, radiographic progression (according to Ficat stage) occurred in twenty hips (26%). Pain, present in all patients at the start of the treatment, disappeared after sixty days of stimulation in thirty-five patients (53%) and was of moderate intensity in seventeen patients (26%).

CONCLUSIONS

The results of this study confirm that pulsed electromagnetic field treatment may be indicated in the early stages of osteonecrosis of the femoral head (Ficat stages I and II). Pulsed electromagnetic field stimulation may be able to either preserve the hip or delay the time until surgery. The authors hypothesize that the short-term effect of pulsed electromagnetic field stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of pulsed electromagnetic field stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Nutrition and Osteoarthritis in Dogs: Does It Help?

Osteoarthritis (OA) is a common disease, and nutrition has become an integral part of management. This article focuses on the role and dietary ingredients in OA, evaluating current evidence for obesity management, omega-3 fatty acids, and chondromodulating agents. Additionally, keeping an animal in optimal to slightly lean body condition has been shown to decrease the risk of development of OA and to aid management of dogs with OA.

[Leptin: a link between obesity and osteoarthritis?]

In addition to aging, obesity is one of the most common underlying causes of osteoarthritis (OA). Mechanical loading, together with biochemical and systemic factors linked to altered lipid metabolism, are thought to contribute to the onset of OA. It has been suggested that OA is a systemic metabolic disease associated with lipid disorders affecting joint homeostasis. These gradual changes may be due to the local effect of adipokines, and especially leptin. Indeed, their relative levels in joints differ from that found in plasma. In particular, leptin levels are increased and adiponectin and resistin levels are reduced This hypothesis is supported by--leptin overexpression in OA cartilage and its correlation with the degree of cartilage destruction,--abundant leptin synthesis by osteophytes, and--the high leptin levels found in OA joints from female patients. This link between OA and adipokines provides new leads regarding the prevention of OA and the identification of new drug targets.

Mini-open arthroscopically assisted Bristow-Latarjet procedure for the treatment of patients with anterior shoulder instability: a cadaver study

PURPOSE

The purpose of this study was to evaluate the arthroscopically assisted Bristow-Latarjet procedure. The aim was to use arthroscopic guidance to assist in positioning of the coracoid bone block onto the anterolateral aspect of the glenoid. The feasibility of this technique and its efficacy, reproducibility, and potential neurovascular complications were evaluated.

METHODS

A minimally invasive technique was used to harvest the coracoid bone block and the attached coracobiceps tendon. A portal was created through the subscapularis muscle and, under arthroscopic guidance, the anterior aspect of the glenoid was cleaned and reamed before the bone block was placed. Cannulated screws (3.5 mm) were used to fix the vertically oriented bone block to the glenoid. The size of the bone block, its position on the glenoid, and its relation to the subscapularis tendon and the musculocutaneous and axillary nerves were recorded.

RESULTS

In all 5 cadavers, the bone block was well positioned and was fixed to the anteroinferior part of the glenoid. No lesions of the cephalic vein or of the surrounding neurovasculature were observed.

CONCLUSIONS

This study demonstrated the safe and effective use of this arthroscopically assisted technique for correct positioning of the coracoid bone block at the anterolateral aspect of the glenoid in the cadaveric shoulder. Arthroscopy facilitated adequate reaming of the anterior glenoid and aided in optimal positioning of the bone block.

CLINICAL RELEVANCE

This cadaveric study highlights the advantages offered by an arthroscopically assisted Bristow-Latarjet procedure, which optimizes positioning of the block and ensures adequate reaming of the anterior glenoid, thereby potentially reducing the risks of early nonunion and late arthritis--complications commonly associated with the classical Bristow-Latarjet technique.

[Does running increase the risk of osteoarthritis?]

There is no doubt that the mean body weight of our population is continuously rising. In this context it is interesting to know that running--compared to cycling--results in a higher decrease of subcutaneous adipose tissue and has therefore a favourable influence on body weight. But public opinion still assumes that running provokes arthritis. This is used as a pretext against regular running training. In this overview we would like to show that running does not increase the risk of arthritis contrary to physical inactivity and overweight. Runners do not show a higher risk of developing joint arthritis on their lower extremities. However, frequency of arthritis is significantly higher in inactive and obese persons.

Evidence for a protective role for adiponectin in osteoarthritis

Obesity has been associated with an increased risk of osteoarthritis (OA). However, the mechanism by which obesity contributes to OA remains uncertain. Adiponectin, an adipocyte-derived hormone, has shown anti-diabetic and anti-atherogenic properties. In the present study, we aimed to investigate the potential role of adiponectin in OA disease. We demonstrated that adiponectin was present in OA synovial fluid (SF) and its expression level was almost 100-fold decrease compared with that in OA plasma. FPLC and ELISA studies revealed the distribution and abundance of the adiponectin complexes in plasma and SF from patients with OA. The percentage of high molecular weight (HMW) per total adiponectin in OA SF was lower than in OA plasma, while that of the hexamer form was similar and the trimer form was higher. The expression levels of adiponectin receptors AdipoR1 and AdipoR2 were examined in human OA tissues by RT-PCR. AdipoR1 was abundantly expressed in cartilage, bone and synovial tissues, whereas AdipoR2 was rarely detected. Finally, the effects of adiponectin on primary chondrocyte functions were studied by using antibody-based protein array and RT-PCR. The patterns of mRNA expression and protein production strongly indicate that adiponectin is involved in the modulation of cartilage destruction in chondrocytes by up-regulating TIMP-2 and down-regulating IL-1beta-induced MMP-13. Together these findings clearly indicate that the adiponectin may act as a protective role in the progression of OA, and this also provide new thinking on the relationship between obesity and OA.

Epidemiology of osteoarthritis: an update

PURPOSE OF REVIEW

As the most common arthritis and a leading cause of chronic disability, osteoarthritis is associated with substantial cost to the individual and to society. Epidemiologic studies have supplied, in addition to incidence, prevalence and risk factor data, much of what is known about the natural history of osteoarthritis.

RECENT FINDINGS

Especially given the anticipated increase in osteoarthritis prevalence, the need to identify risk factors for incident osteoarthritis, osteoarthritis progression, osteoarthritis-associated physical function decline, and disability is a high priority. As this review illustrates, the emphasis has shifted in osteoarthritis epidemiology towards the identification of risk factors for osteoarthritis progression rather than incidence.

SUMMARY

Several risk factors for progression are emerging, many of which are impairments or pathology in the local joint organ environment. This shift in focus relates in part to the concept that local risk factors might ultimately be targeted to delay osteoarthritis progression or to enhance the effect of a disease-modifying drug.

Structure-/disease-modifying agents for osteoarthritis

OA is the most common articular disease. Age is its most notable risk factor. With the aging of the population of the developed world, there will be a growing need for better understanding of OA and for superior therapies. There is increasing appreciation for the role of inflammation in OA. There also is the realization that OA is not only a disease of cartilage, but of the entire joint. This has led to increasing interest in structure/disease modification as the goal in OA therapy. However, there are no universally proven structure-/ disease-modifying interventions.

Uncovering the "skeleton in the closet": the issue of bone and joint disorders in the Maldives and the opportunities for primary prevention and health promotion

Disorders of bones and joints are the most common cause of severe long-term pain and disability around the world yet receive inadequate attention in many countries. Bone/joint health is absent from current health policy and the primary prevention/health promotion agenda in Maldives and diagnostic and curative infrastructure is very limited. In 2004, tentative evidence emerged indicating that degenerative bone and joint conditions may impose a large burden on community health. A study was undertaken amongst a representative community sample of women aged 15-50 to further investigate the issue. One third reported bone/joint problems; very high proportions manifested a range of osteoporosis risk factors, and sizeable numbers appear to be at elevated risk of osteoarthritis. Bone/joint health knowledge was very limited. The findings suggest strong potential for primary prevention on modifiable risk factors, need for research with other population groups, and development of screening and curative care. EDITORS' STRATEGIC IMPLICATIONS: The author provides important data on the burden of disorders of bones/joints on a "developing" community and presents recommendations for behavioral and educational prevention strategies that may prove useful across societies.

Hyaluronic acid attenuates osteoarthritis development in the anterior cruciate ligament-transected knee: Association with excitatory amino acid release in the joint dialysate

We previously reported increased release of the excitatory amino acid (EAA) neurotransmitters, glutamate and aspartate, during the early stage of experimental osteoarthritis (OA). Our present objective was to study the effect of intraarticular injection of hyaluronic acid (HA) on OA development, and to analyze concomitant changes in EAA levels in dialysates of anterior cruciate ligament-transected (ACLT) knee joints. OA was induced in Wistar rats by ACLT of one hindlimb; the knee of the other hindlimb was used as the sham-operated control. HA group (n = 12) were injected intraarticularly in the ACLT knee with 1 mg of HA once a week for 5 consecutive weeks, starting at 8 weeks after surgery. Saline group (n = 12) were injected as above with normal saline. The sham-operated group, underwent arthrotomy, but not ACLT, and received no treatment (n = 14). Twenty weeks after surgery, knee joint dialysates were collected by microdialysis and EAA levels assayed by high-performance liquid chromatography, and gross morphological examination and histopathological evaluation were performed on the medial femoral condyles and synovia. Rats receiving intraarticular HA injections showed a significantly lower degree of cartilage degeneration on the medial femoral condyle at both the macroscopic level and on the Mankin grading scale than rats receiving saline injections. Intraarticular HA treatment also suppressed synovitis. Moreover, glutamate and aspartate levels were significantly reduced in the HA group compared to the saline group. Intraarticular injection of HA limits articular cartilage and synovium damage and OA formation, and, in parallel, reduces EAA levels in ACLT joint dialysates. This study suggests that the underlying mechanism of the anti-inflammatory effect of HA is to inhibit glutamate and aspartate release in ACLT knee joints, which attenuates the early development of OA.

TGF beta-induced cartilage repair is maintained but fibrosis is blocked in the presence of Smad7

Cartilage damage in osteoarthritis (OA) is considered an imbalance between catabolic and anabolic factors, favoring the catabolic side. We assessed whether adenoviral overexpression of transforming growth factor-β (TGFβ) enhanced cartilage repair and whether TGFβ-induced fibrosis was blocked by local expression of the intracellular TGFβ inhibitor Smad7. We inflicted cartilage damage by injection of interleukin-1 (IL-1) into murine knee joints. After 2 days, we injected an adenovirus encoding TGFβ. On day 4, we measured proteoglycan (PG) synthesis and content. To examine whether we could block TGFβ-induced fibrosis and stimulate cartilage repair simultaneously, we injected Ad-TGFβ and Ad-Smad7. This was performed both after IL-1-induced damage and in a model of primary OA. In addition to PG in cartilage, synovial fibrosis was measured by determining the synovial width and the number of procollagen I-expressing cells. Adenoviral overexpression of TGFβ restored the IL-1-induced reduction in PG content and increased PG synthesis. TGFβ-induced an elevation in PG content in cartilage of the OA model. TGFβ-induced synovial fibrosis was strongly diminished by simultaneous synovial overexpression of Smad7 in the synovial lining. Of great interest, overexpression of Smad7 did not reduce the repair-stimulating effect of TGFβ on cartilage. Adenoviral overexpression of TGFβ stimulated repair of IL-1- and OA-damaged cartilage. TGFβ-induced synovial fibrosis was blocked by locally inhibiting TGFβ signaling in the synovial lining by simultaneously transfecting it with an adenovirus overexpressing Smad7.

3. Is exercise good for you?

Physical activity can significantly reduce the risk of cardiovascular disease, diabetes, some forms of cancer, osteoporosis, obesity, falls and fractures, and some mental health problems. While the benefits of physical activity are clear, there is a slightly increased risk of sudden death while exercising (compared with while sedentary), especially in untrained people undertaking unaccustomed vigorous activity. Routine exercise testing yields a significant number of false-positive results, and has not been shown to prevent exercise-related acute cardiac events. There is no convincing evidence that exercise is itself associated with osteoarthritis, but significant joint injury which occurs during sport is associated with an increased risk of subsequent development of osteoarthritis.

Health promotion and health education with particular emphasis on bone diseases among rural population in Poland

Osteoporosis and osteoarthrosis are the most common diseases of bone tissue affecting both rural and urban populations. The aim of the study was to investigate the level of education and requirement for health promotion within the scope of common diseases of the skeletal system among rural population in Poland. This was an exploratory study with a cross-sectional design performed between May 2004-September 2005 in rural areas of 16 Voivodeships (main provinces) of Poland. The study population comprised of 404 (62.9%) rural women and 238 (37.1%) rural men (total 642). All subjects were randomly sampled and recruited by personal contact in primary health care centres. Study data were obtained using a specially prepared questionnaire. The most commonly reported diseases were: arterial hypertension (26.1%), joint degenerative disease (24.6%) and osteoarthritis (14.7%). The occurrence of osteoarthritis and joint degenerative disease increased with age and was highest in the group aged over 50 (21% and 38.7% respectively). Osteoarthitis was more frequent in women compared to men (16% and 12.2% respectively). In most cases, the basic information about methods of prevention and treatment given by a General Practitioner or a specialist was characterized as "satisfactory" (73.6% and 62.9% respectively). The most popular prophylactic action performed in local communities was bone densitometry (14.1%), and the most important source of knowledge - TV and radio (65%). Populations living in rural areas have limited access to health education and health prophylaxis actions, irrespective of the geographical region of Poland. Inhabitants with secondary or higher education, as well as those with a higher household income, have better knowledge about skeletal system diseases compared to those with a lower educational level. The practical implications of this study suggest the necessity for paying more attention to etiology, symptoms and methods of prevention and treatment of bone diseases when attending to patients in specialist practice.

Frequently asked questions (FAQ)

As Americans use botanical medicines in ever-increasing numbers, they are moving beyond capsules and tinctures, and turning to assorted preparations that will complete their herbal medicine chest. According to The Arthritis Foundation, almost 45% of patients apply ointments or rubs for osteoarthritis. Topical preparations have a long history in traditional herbal medicine systems, and make up a significant proportion of the armamentarium of indigenous practitioners. Although contemporary patients are often resistant to the inconvenience of topical preparations, they often will become compliant after a notable success. The nomenclature of these topical preparations, as one would expect, is murky. There are no clear and consistent definitions for the assorted terms, and different sources will use different terms for the same material or process.

Effect of Aralia cordata Extracts on Cartilage Protection and Apoptosis Inhibition

Cartilage loss in osteoarthritis is characterized by cartilage degradation and chondrocyte death. Cartilage degradation is induced by activation of matrix-metalloproteinases (MMPs) activity and degradation of glycosaminoglycan (GAG) and collagen. Also, chondrocyte death is induced by the apoptosis through the activation of MAP kinase and caspases activities. On the basis of this background, our study was designed to examine the cartilage protective and anti-apoptotic effect of Aralia cordata. Cartilage explants and Chondrocytes were cultured from rabbit knee joint cartilage and treated by 5 ng/ml IL-1alpha. Cartilage and chondroprotective effects of Aralia cordata were determined by measuring (1) GAG and collagen expression, (2) GAG and collagen degradation, (3) TIMP and MMPs expression, and (4) TIMP and MMPs activity. Anti-apoptotic effects of Aralia cordata were determined by measuring (1) JNK and p38 MAP kinase expression, (2) apoptotic cells by flow cytometry, and (3) caspase-3 activity. In cartilage explants and chondroctyes treated by IL-1alpha, Aralia cordata showed the decrease of GAG and collagen degradation, decrease of MMPs (MMP-1, -3, -13) activity, and increase of TIMP-1 activity in a dose-dependent manner. Aralia cordata also showed anti-apoptotic effect by inhibition of early and late apoptotic cells, sub-G1 phase cells, and caspase-3 activity through the downregulation of JNK and p38 MAP kinase signaling pathway. Aralia cordata inhibited the cartilage and chondrocyte destruction through the downregulation of MMPs activities and the inhibition of proteoglycan and collagen degradation. Also, Aralia cordata inhibited the chondrocyte apoptosis through the downregulation of JNK and p38 MAP kinase signal, and the inhibition of caspase-3 activity.

Biochemical and biomechanical properties of lesion and adjacent articular cartilage after chondral defect repair in an equine model

BACKGROUND

Chondral defects may lead to degradative changes in the surrounding cartilage, predisposing patients to developing osteoarthritis.

PURPOSE

To quantify changes in the biomechanical and biochemical properties of the articular cartilage adjacent to chondral defects after experimental defect repair.

STUDY DESIGN

Controlled laboratory study.

METHODS

Specimens were harvested from tissue within (lesion), immediately adjacent to, and at a distance from (remote area) a full-thickness cartilage defect 8 months after cartilage repair with genetically modified chondrocytes expressing insulin-like growth factor-I or unmodified, control chondrocytes. Biomechanical properties, including instantaneous Young's and equilibrium aggregate moduli, were determined by confined compression testing. Biochemical properties, such as water and proteoglycan content, were also measured.

RESULTS

The instantaneous Young's modulus, equilibrium modulus, and proteoglycan content increased, whereas water content decreased with increasing distance from the repaired lesion. The instantaneous Young's and equilibrium moduli of the adjacent articular cartilage were 80% and 50% that of remote area samples, respectively, whereas water content increased 0.9% and proteoglycan content was decreased by 35%. No significant changes in biomechanical and biochemical properties were found either in the lesion tissue or in adjacent cartilage with genetic modification of the chondrocytes.

CONCLUSION

Articular cartilage adjacent to repaired chondral defects showed significant remodeling 8 months after chondral defect repair, regardless of whether genetically modified or unmodified cells were implanted.

CLINICAL RELEVANCE

Changes in the biochemical and biomechanical properties of articular cartilage adjacent to repaired chondral defects may represent remodeling as part of an adaptive process or degeneration secondary to an altered distribution of joint forces. Quantification of these changes could provide important parameters for assessing progress after operative chondral defect repair.

Effects of Aralia continentalis on hyperalgesia with peripheral inflammation

This study aimed to determine the antinociceptive effect of Aralia continentalis extract (AC) on Freund's adjuvant-induced arthritis in rats. Adult Sprague-Dawley rats received an injection of complete Freund's adjuvant (CFA) into the articular cavity of the ankle joint, and then antinociceptive behaviors and spinal Fos expression were examined. AC was found to suppress significantly nociceptive behaviors caused by CFA injection. In addition, it also decreased adjuvant-induced Fos expression in the lumbar spinal cord induced by CFA. In conclusion, this study showed that AC produced significant antinociceptive effects on CFA-induced arthritis in rats, and it is suggested that AC is recommended to alleviate the arthritis-related symptoms in humans.

Effect of regular exercise on health and disease

It is known for a long time that exercise increases physical adequacy, has beneficial effects on the general health condition as well as a playing preventing role against various disease states. To decrease the risk of disease and maintain good health, the natural defense system of the organism needs to be strengthened. It is thought that in addition to increasing the body's resistance to disease through the strengthening of the immune system, decreases the convalescence time, increases work efficiency and improves the sportive performance of the individual all which would contribute positively to the national economy. The positive effects of regular exercising of aerobic nature such as strengthening of the immune system, protection against diseases as well as its positive effects on quality of life will help to emphasize the importance of physical exercise and improve the general view of sports by society.

Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations

Perilunate injuries are severe disruptions of the wrist joint that produce variable patterns of injury to the carpal anatomy. Most surgeons advocate an open reduction followed by ligament repair or internal fixation. We tried to reduce and fix the carpal bones under arthroscopic control to minimize surgical trauma and to preserve blood supply. While viewing the articular surface with the arthroscope, the disrupted proximal carpal row was anatomically reduced using Kirschner wires as joysticks, and fixed percutaneously without any repair of the capsuloligamentous tears. Three patients with dorsal perilunate dislocations or fracture-dislocations were treated by this technique. All the patients achieved accurate reduction and stable fixation, and showed successful healing of the carpal fractures with proper alignment after 10 to 12 weeks of immobilization. At 16 to 22 months follow-up, all patients showed normal radiographic findings with no evidence of instability or arthritis. The arthroscopic treatment of acute dorsal perilunate injuries is technically feasible in achieving anatomic reduction and stable fixation. Our preliminary clinical results were encouraging, but the long-term results need to be observed.

Prävalenz und Korrelate der Osteoarthrose in der BRD

BACKGROUND

The purpose of the paper was to generate up-to-date, representative osteoarthritis prevalence data for individual population subgroups and to identify potential risk factors.

MATERIAL AND METHODS

A cross-sectional study, the "First National Health Survey", investigated the prevalence of osteoarthritis, comorbidity and health-relevant behaviours of the post-unification German population on the basis of interviews with physicians and medical evaluations conducted in the period from October 1997 to March 1990. The study was based on a net sample comprising 6205 subjects aged 18-79 years.

RESULTS

The three main correlates for osteoarthritis are age, obesity and occupational stress factors. Osteoarthritis patients are more likely to have osteoporosis, thyroid disease, chronic bronchial disease, hypertension and elevated blood lipids, but do not tend to have a higher incidence of diabetes.

CONCLUSION

Our data show the importance of preventive behavioural approaches such as weight management and workplaces designed to limit joint overuse.

A two year in vivo study of polyvinyl alcohol-hydrogel (PVA-H) artificial meniscus

For the recognized importance of knee meniscus function, the treatment of meniscus injury has been changing from resection to repair. However, depending on the type of injury, meniscectomy sometimes cannot be avoided. In such a case, it is important to anticipate the future problem of degenerative change or osteoarthrosis in the knee joint. In consideration of the prognosis and circumstances in such patients, we have developed an artificial meniscus using polyvinyl alcohol-hydrogel (PVA-H) for salvage. We have already reported the results up to 1 year after animal operation. The present study investigated the results in postoperative 2.0 years to assess further the use of artificial meniscus. In the results, the articular cartilage state of knee joint implanted PVA-H meniscus was good even after 2 years, while Osteoarthrosis (OA) change progressed in meniscectomy knee joint. In addition, neither wear, dislocation nor breakage of PVA-H was observed. These results proved that an artificial meniscus using PVA-H can compensate for meniscal function and might be clinically applicable.

Effect of bee venom on aromatase expression and activity in leukaemic FLG 29.1 and primary osteoblastic cells

The effect of bee venom aqua-acupuncture (BVA) (api-toxin), a traditional immunosuppressive Korean aqua-acupuncture, on the bone function in human osteoblastic cells was studied. To provide insights into the effect of BVA on aromatase activity in bone-derived cells, we examined the human leukaemic cell line FLG 29.1, which is induced to differentiate toward the osteoclastic phenotype by TPA and TGF-beta1, and the primary first-passage osteoblastic cells (hOB). Southern blot of RT-PCR products with a 32P-labeled cDNA probe for the human aromatase demonstrated that FLG 29.1 and hOB cells express aromatase mRNA. Gene expression and enzyme activity were stimulated in a time-dependent fashion by 5.0 microl/ml BV and by either 1-50 nM TPA or 0.01-0.5 ng/ml TGF-beta1, with maximal responses after 2-3 h exposure. After 24 h incubation of the cells in the absence of these stimuli the aromatase mRNA and the protein were barely detectable. These findings demonstrate that cells of the osteoclastic lineage synthesize aromatase in vitro by the local cytokine of TGF-beta1 and BVA. These can offer an explanation for the lack of development of osteoarthritis in BVA-treated patients.

A theoretical model for preventing osteoarthritis-related disability

Osteoarthritis (OA) affects many aspects of life for affected individuals. Effective interventions to prevent and restore function must be based upon an understanding of what contributes to OA and its associated disabilities. A hypothetical OA disability model built upon the previous work of Nagi (1991), Verbrugge and Jette (1994), the International Classification of Functioning of World Health Organization (World Health Organization, 2001), and other scientific findings is proposed. The model includes a main disease pathway, which describes the sequence of events from OA-associated impairments to disabilities. Contextual factors influencing the process include individual characteristics, psychological state, coping style, comorbidities, social support, and physical environment. The model provides a useful conceptual framework for understanding the OA disability process from a biopsychosocial perspective and for guiding rehabilitation nursing interventions in OA care.

The development of monocyclic pyrazolone based cytokine synthesis inhibitors

4-Aryl-5-pyrimidyl based cytokine synthesis inhibitors that contain a novel monocyclic, pyrazolone heterocyclic core are described. Many of these inhibitors showed low nanomolar activity against LPS-induced TNF-alpha production. One of the compounds (6e) was found to be efficacious in the rat iodoacetate (RIA) in vivo model of osteoarthritis. The X-ray crystal structure of a pyrazolone inhibitor cocrystallized with mutated p38 (mp38) is presented.

Impact of osteoarthritis on sports careers

The number of people participating in sports continues to increase. The relationship between sports participation, joint injury, and subsequent osteoarthritis is complex. A history of joint injury and participation in high joint loading sports increases the risk of subsequent osteoarthritis changes in affected joints. The impact of osteoarthritis on sports careers depends on multiple factors including the joint involved, the location within that joint, and the physical demands of the chosen sport.

Chondroprotective activity of N-acetylglucosamine in rabbits with experimental osteoarthritis

OBJECTIVE

To examine the therapeutic efficacy of N-acetylglucosamine (GlcNAc) in rabbits with experimental osteoarthritis (OA).

METHODS

Experimental OA was induced in rabbits by anterior cruciate ligament transection (ACLT). In the first study, rabbits (six in each group) received intramuscular injections of GlcNAc or normal saline three times a week starting 1 week postoperatively. In the second study, rabbits (eight in each group) were injected intra-articularly with GlcNAc (either once or twice a week) or normal saline. In the third study, rabbits (seven in each group) were injected intra-articularly twice a week with either GlcNAc, hyaluronan, or normal saline. Animals were killed 8 weeks after ACLT for macroscopic and histological assessment of the knee joints.

RESULTS

Intramuscular administration of GlcNAc in rabbits with experimental knee OA did not show chondroprotective effects but showed mild anti-inflammatory activity. In contrast, intra-articular administration of GlcNAc twice a week reduced cartilage degradation. Additionally, intra-articular GlcNAc also suppressed synovitis. Once a week intra-articular injections of GlcNAc did not demonstrate therapeutic efficacy. The chondroprotective efficacy of GlcNAc was better than that of viscosupplementation treatment with hyaluronan.

CONCLUSION

Intra-articular GlcNAc has chondroprotective and anti-inflammatory activity in experimental OA.

A nurse-led service to provide information on osteoarthritis

Osteoarthritis is the most common joint disorder and the leading cause of physical disability for people over 65 (Nuki, 2002). A survey was undertaken to review the quality of information given to patients and identify any improvements that could be made. The results showed that the priorities put on information by health care professionals were not necessarily shared by patients. A nurse-led service to provide information, education and support was recommended.