51
|
The efficacy of steroid injection in total knee or hip arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:2306-2314. [PMID: 24841939 DOI: 10.1007/s00167-014-3049-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A systematic review and meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy and safety of steroid injection in total knee or hip arthroplasty (TKA/THA). METHODS A systematical electronic search identified the relevant RCTs in the databases of PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials. Two reviewers independently completed data collection and assessment of methodological quality. Meta-analysis was performed for the outcomes of visual analogue pain score, range of motion (ROM), postoperative nausea and vomiting (PONV), morphine consumption, length of stay and complications. RESULTS A total of 863 participants were enrolled. Patients who received steroid injection had a significant reduction in the incidence of PONV and improvement in short-term pain score, and ROM (p < 0.05). Regarding morphine consumption and hospitalization time, the steroid group showed a significant reduction in TKA but no statistically significant difference in THA. In addition, there were no significant differences in complications (n.s.). CONCLUSIONS The current evidence suggests that steroid injection in TKA/THA provides short-term advantages in pain relief and antiemetic effects. The optimal dose and long-term effects of steroid injection still require numerous studies. LEVEL OF EVIDENCE II.
Collapse
|
52
|
Rashid A, Kalson N, Jiwa N, Patel A, Irwin A, Corner T. The effects of pre-operative intra-articular glenohumeral corticosteroid injection on infective complications after shoulder arthroplasty. Shoulder Elbow 2015; 7:154-6. [PMID: 27582970 PMCID: PMC4935148 DOI: 10.1177/1758573214557149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many shoulder surgeons use intra-articular corticosteroid injections (IACI) in shoulder osteoarthritis, with the caveat that it precludes arthroplasty for at least 6 months to 12 months because of the theoretical risk of infection. To our knowledge, there is nothing available in the literature to support this notion. METHODS We undertook a retrospective, matched cohort study of all patients who underwent shoulder arthroplasty in our unit between December 2010 and December 2013 aiming to assess whether pre-operative IACI had an impact on infective complications. Group I had received an IACI prior to their arthroplasty and Group II had not. A chi-squared analysis was performed (p < 0.05). RESULTS Group I comprised 23 patients with a mean age of 73 years (range 54 years to 90 years) had 23 shoulder arthroplasties and had mean follow-up of 16.6 months. Patients received an IACI approximately 11.4 months (range 2.5 months to 172.5 months) before their surgery. One patient developed a deep joint infection that warranted revision arthroplasty. Group II comprised 60 patients with a mean age of 75 years (range 34 years to 90 years) had 64 shoulder arthoplasties and a mean follow-up of 20.1 months. No patients developed infective complications (p > 0.05), implying there was no statistically significant relationship between pre-operative IACI and infective complications. CONCLUSIONS We could not establish a causal link between IACI and infective complications after arthoplasty.
Collapse
Affiliation(s)
- Abbas Rashid
- Abbas Rashid, Department of Trauma & Orthopaedics, West Herts Hospitals NHS Trust, Vicarage Road, Watford Hertfordshire WD18 0HB, UK.
| | | | | | | | | | | |
Collapse
|
53
|
Euppayo T, Siengdee P, Buddhachat K, Pradit W, Viriyakhasem N, Chomdej S, Ongchai S, Harada Y, Nganvongpanit K. Effects of low molecular weight hyaluronan combined with carprofen on canine osteoarthritis articular chondrocytes and cartilage explants in vitro. In Vitro Cell Dev Biol Anim 2015; 51:857-65. [PMID: 25982358 DOI: 10.1007/s11626-015-9908-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Intra-articular injection with non-steroidal anti-inflammatory drugs (NSAIDs) is used to treat inflammatory joint disease, but the side effects of NSAIDs include chondrotoxicity. Hyaluronan has shown positive effects on chondrocytes by reducing apoptosis and increasing proteoglycan synthesis. The purposes of this study were to evaluate the effects of low molecular weight hyaluronan (low MW HA), carprofen 25 mg/ml, carprofen 12.5 mg/ml, and a combination of HA and carprofen on canine osteoarthritis (OA) articular chondrocytes and a cartilage explant model in terms of cell viability, extracellular matrix remaining, and gene expression after exposure. In chondrocyte culture, MTT assay was used to evaluate the chondrotoxicity of IC50 and IC80 of carprofen with HA. In cartilage explant culture, two kinds of extracellular matrix (uronic acid and collagen) remaining in cartilage were used to evaluate cartilage damage for 14 d after treatment. Expression of COL2A1, AGG, and MMP3 was used to evaluate the synthesis and degradation of the matrix for 7 d after treatment. In chondrocyte culture, low MW HA could preserve OA chondrocyte viability but could not reduce the chondrotoxicity level of carprofen (P < 0.05). In explant culture, low MW HA combined with 12.5 mg/ml carprofen caused less destruction of uronic acid and collagen structure when compared with the control (P < 0.05). Low MW HA caused high expression levels of COL2A1 and AGG in OA cartilage (P < 0.05); HA combined with carprofen resulted in higher COL2A1 and AGG expression levels than carprofen alone.
Collapse
Affiliation(s)
- Thippaporn Euppayo
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Puntita Siengdee
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Kittisak Buddhachat
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Waranee Pradit
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nawarat Viriyakhasem
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Siriwadee Chomdej
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriwan Ongchai
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Yasuji Harada
- Divisions of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1, Kyonann-cho, Musashinoshi, Tokyo, 180-8602, Japan
| | - Korakot Nganvongpanit
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand. .,Excellence Center in Osteology Research and Training Center, Chiang Mai University, Chiang Mai, 50200, Thailand.
| |
Collapse
|
54
|
Johnston PC, Lansang MC, Chatterjee S, Kennedy L. Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA)-axis function. Endocrine 2015; 48:410-6. [PMID: 25182149 DOI: 10.1007/s12020-014-0409-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/26/2014] [Indexed: 12/27/2022]
Abstract
The use of intra-articular (IA) glucocorticoids for reducing pain and inflammation in patients with osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies is widespread among primary care physicians, specialists, and non-specialists in the United States. Injectable glucocorticoids have anti-inflammatory and analgesic properties which can be effective in improving clinical parameters such as pain, range of motion, and quality of life. After injection into the IA space, glucocorticoids may be systemically absorbed; the degree of absorption can depend on the size of the joint injected, the injectable glucocorticoid preparation used, the dosage, and the frequency of the injection. The adverse effects of intra-articular glucocorticoid injections (IAGC) can often be overlooked by both the patient and physicians who administer them, in particular the potential deleterious effect on the hypothalamic-pituitary-adrenal (HPA)-axis which can result in adrenal suppression and/or iatrogenic Cushing syndrome. In this paper we provide an overview on the often under-recognized effects of IAGC on HPA-axis function.
Collapse
Affiliation(s)
- Philip C Johnston
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, OH, 44195, USA,
| | | | | | | |
Collapse
|
55
|
Chen WP, Xiong Y, Shi YX, Hu PF, Bao JP, Wu LD. Astaxanthin reduces matrix metalloproteinase expression in human chondrocytes. Int Immunopharmacol 2014; 19:174-7. [DOI: 10.1016/j.intimp.2013.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 11/23/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
|
56
|
Koseoglu BF, Sutbeyaz ST, Sezer N, Hatipoglu C, Comert D. Efficacy and safety of ultrasound guided intra-articular injections of hylan G-F 20 in patients with hip osteoarthritis. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856905774482779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
57
|
Tamer TM. Hyaluronan and synovial joint: function, distribution and healing. Interdiscip Toxicol 2013; 6:111-25. [PMID: 24678248 PMCID: PMC3967437 DOI: 10.2478/intox-2013-0019] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/25/2013] [Accepted: 09/10/2013] [Indexed: 11/20/2022] Open
Abstract
Synovial fluid is a viscous solution found in the cavities of synovial joints. The principal role of synovial fluid is to reduce friction between the articular cartilages of synovial joints during movement. The presence of high molar mass hyaluronan (HA) in this fluid gives it the required viscosity for its function as lubricant solution. Inflammation oxidation stress enhances normal degradation of hyaluronan causing several diseases related to joints. This review describes hyaluronan properties and distribution, applications and its function in synovial joints, with short review for using thiol compounds as antioxidants preventing HA degradations under inflammation conditions.
Collapse
Affiliation(s)
- Tamer Mahmoud Tamer
- Polymer Materials Research Department, Advanced Technologies and New Materials Research Institute (ATNMRI), City of Scientific Research and Technological Applications (SRTA-City), New Borg El-Arab City, Alexandria, Egypt
- Laboratory of Bioorganic Chemistry of Drugs, Institute of Experimental Pharmacology & Toxicology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| |
Collapse
|
58
|
Characterization and optimization of GMO-based gels with long term release for intraarticular administration. Int J Pharm 2013; 451:95-103. [DOI: 10.1016/j.ijpharm.2013.04.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 11/21/2022]
|
59
|
Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. Rheumatology (Oxford) 2013; 52:1022-32. [PMID: 23264554 PMCID: PMC3651612 DOI: 10.1093/rheumatology/kes368] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/26/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. METHODS Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. RESULTS Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. CONCLUSION Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.
Collapse
Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK.
| | | | | | | |
Collapse
|
60
|
Sheu SY, Chen WS, Sun JS, Lin FH, Wu T. Biological characterization of oxidized hyaluronic acid/resveratrol hydrogel for cartilage tissue engineering. J Biomed Mater Res A 2013; 101:3457-66. [DOI: 10.1002/jbm.a.34653] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/17/2013] [Accepted: 01/28/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Shiow-Yunn Sheu
- School of Pharmacy; College of Pharmacy; Taipei Medical University; No. 250, Wusing St. Sinyi District, Taipei City 11031 Taiwan Republic of China
| | - Wen-Shan Chen
- School of Pharmacy; College of Pharmacy; Taipei Medical University; No. 250, Wusing St. Sinyi District, Taipei City 11031 Taiwan Republic of China
| | - Jui-Sheng Sun
- Graduate Institute of Clinical Medicine; College of Medicine; Taipei Medical University; No. 250, Wusing St. Sinyi District, Taipei City 11031 Taiwan Republic of China
- Department of Orthopedic Surgery; National Taiwan University Hospital Hsin-Chu Branch; No. 25, Lane 442, Sec. 1, Jingguo Rd. Hsin-Chu City 30059 Taiwan Republic of China
| | - Feng-Huei Lin
- Institute of Biomedical Engineering; National Taiwan University; No. 1, Ren-Ai Rd. Taipei 10051 Taiwan Republic of China
| | - Tuoh Wu
- Department of Orthopedic Surgery; National Taiwan University Hospital Hsin-Chu Branch; No. 25, Lane 442, Sec. 1, Jingguo Rd. Hsin-Chu City 30059 Taiwan Republic of China
| |
Collapse
|
61
|
Tetrandrine Inhibits the Wnt/ β -Catenin Signalling Pathway and Alleviates Osteoarthritis: An In Vitro and In Vivo Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:809579. [PMID: 23533523 PMCID: PMC3603159 DOI: 10.1155/2013/809579] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/03/2013] [Indexed: 11/18/2022]
Abstract
There is currently no effective drug treatment for the early phase of osteoarthritis (OA), one of the most common senile diseases. The goal of this study was to investigate the protective effect of the tetrandrine (Tet) on OA, in vitro and in vivo. In an in vitro experiment, quantitative real-time polymerase chain reaction (qRT-PCR) was used to investigate changes in gene expression upon the addition of Tet in chondrocytes processed with IL-1β; changes in protein profiles were assessed by Western blotting. In vivo, to determine whether Tet has the protective effects on articular cartilage, a rabbit anterior cruciate ligament transaction model of OA was established. Expression of matrix metalloproteinase and β-catenin genes increased significantly, while that of tissue inhibitor of metalloproteinase-1 decreased significantly in the OA group both in vivo and in chondrocytes. However, the changes of expression were reversed by Tet, and there was less cartilage degradation in vivo compared with the OA group, as assessed by histological and macroscopic observations. Thus, Tet may play a useful role in the treatment of OA through the Wnt/β-catenin signalling pathway and has potential for the treatment of OA.
Collapse
|
62
|
Beyaz SG. Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis. J Anaesthesiol Clin Pharmacol 2012; 28:496-500. [PMID: 23225932 PMCID: PMC3511949 DOI: 10.4103/0970-9185.101940] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. Materials and Methods: Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. Results: After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. Conclusion: Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.
Collapse
Affiliation(s)
- Serbülent Gökhan Beyaz
- Department of Anesthesia and Pain Management Center, Sakarya University Medical School, Sakarya, Turkey
| |
Collapse
|
63
|
Réeff J, Gaignaux A, Goole J, De Vriese C, Amighi K. New sustained-release intraarticular gel formulations based on monolein for local treatment of arthritic diseases. Drug Dev Ind Pharm 2012; 39:1731-41. [DOI: 10.3109/03639045.2012.730529] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
64
|
Hameed F, Ihm J. Injectable medications for osteoarthritis. PM R 2012; 4:S75-81. [PMID: 22632706 DOI: 10.1016/j.pmrj.2012.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
Osteoarthritis is one of the most frequent and chronic conditions that affect the U.S. population. Use of intra-articular injections is one of the established treatment options available in the nonoperative care for the management of symptomatic osteoarthritis. Common injectable medications include corticosteroids, hyaluronic acid, and other less traditional compounds (for example, botulinum toxin). Corticosteroids work by anti-inflammatory and antinociceptive actions. Corticosteroids have been shown to decrease pain and symptoms associated with osteoarthritis for up to 3 weeks. Hyaluronic acid has an unclear mechanism of action, but it is thought to promote the restoration of hyaluronic acid within an osteoarthritic joint. The efficacy of hyaluronic acid is modest and is most beneficial between 5 and 13 weeks after treatment. Other injectable compounds have been studied and include botulinum toxin type A, which has been theorized to work as an antinociceptive agent. One must be aware of the potential adverse effects associated with these medications. For all of these injectable treatments, the placebo effect must not be overlooked, because it has be demonstrated in multiple studies that these medications provide similar relief of pain when compared with placebo. Image guidance with ultrasound or fluoroscopy may be considered when performing intra-articular injections to improve accurate placement of medication.
Collapse
Affiliation(s)
- Farah Hameed
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
| | | |
Collapse
|
65
|
Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012; 20:436-49. [PMID: 22037809 DOI: 10.1007/s00167-011-1713-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/06/2011] [Indexed: 12/24/2022]
Abstract
Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future. Level of evidence IV.
Collapse
Affiliation(s)
- Elizaveta Kon
- Biomechanics Laboratory - III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano,1/10, 40136, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
66
|
Han G, Wang G, Zhu X, Shao H, Liu F, Yang P, Ying Y, Wang F, Ling P. Preparation of xanthan gum injection and its protective effect on articular cartilage in the development of osteoarthritis. Carbohydr Polym 2012. [DOI: 10.1016/j.carbpol.2011.10.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
67
|
Nikolopoulos DD, Spiliopoulou C, Theocharis SE. Doping and musculoskeletal system: short-term and long-lasting effects of doping agents. Fundam Clin Pharmacol 2010; 25:535-63. [PMID: 21039821 DOI: 10.1111/j.1472-8206.2010.00881.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Doping is a problem that has plagued the world of competition and sports for ages. Even before the dawn of Olympic history in ancient Greece, competitors have looked for artificial means to improve athletic performance. Since ancient times, athletes have attempted to gain an unfair competitive advantage through the use of doping substances. A Prohibited List of doping substances and methods banned in sports is published yearly by the World Anti-Doping Agency. Among the substances included are steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, β₂-agonists, diuretics and masking agents, narcotics, and cannabinoids. Blood doping, tampering, infusions, and gene doping are examples of prohibited methods indicated on the List. Apart from the unethical aspect of doping, as it abrogates fair-play's principle, it is extremely important to consider the hazards it presents to the health and well-being of athletes. The referred negative effects for the athlete's health have to do, on the one hand, by the high doses of the performance-enhancing agents and on the other hand, by the relentless, superhuman strict training that the elite or amateur athletes put their muscles, bones, and joints. The purpose of this article is to highlight the early and the long-lasting consequences of the doping abuse on bone and muscle metabolism.
Collapse
Affiliation(s)
- Dimitrios D Nikolopoulos
- Department of Forensic Medicine and Toxicology University of Athens, Medical School, Athens, Greece
| | | | | |
Collapse
|
68
|
Kim EJ, Jang MK, Yoon EH, Jung CY, Nam DW, Lee SD, Kim KS. Efficacy of Pharmacopuncture Using Root Bark of Ulmus davidiana Planch in Patients With Knee Osteoarthritis: A Double-blind Randomized Controlled Trial. J Acupunct Meridian Stud 2010; 3:16-23. [DOI: 10.1016/s2005-2901(10)60003-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022] Open
|
69
|
Larsen C, Ostergaard J, Larsen SW, Jensen H, Jacobsen S, Lindegaard C, Andersen PH. Intra-articular depot formulation principles: role in the management of postoperative pain and arthritic disorders. J Pharm Sci 2009; 97:4622-54. [PMID: 18306275 DOI: 10.1002/jps.21346] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The joint cavity constitutes a discrete anatomical compartment that allows for local drug action after intra-articular injection. Drug delivery systems providing local prolonged drug action are warranted in the management of postoperative pain and not least arthritic disorders such as osteoarthritis. The present review surveys various themes related to the accomplishment of the correct timing of the events leading to optimal drug action in the joint space over a desired time period. This includes a brief account on (patho)physiological conditions and novel potential drug targets (and their location within the synovial space). Particular emphasis is paid to (i) the potential feasibility of various depot formulation principles for the intra-articular route of administration including their manufacture, drug release characteristics and in vivo fate, and (ii) how release, mass transfer and equilibrium processes may affect the intra-articular residence time and concentration of the active species at the ultimate receptor site.
Collapse
Affiliation(s)
- Claus Larsen
- Department of Pharmaceutics and Analytical Chemistry, Faculty of Pharmaceutical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark.
| | | | | | | | | | | | | |
Collapse
|
70
|
Habib G, Safia A. The effect of intra-articular injection of betamethasone acetate/betamethasone sodium phosphate on blood glucose levels in controlled diabetic patients with symptomatic osteoarthritis of the knee. Clin Rheumatol 2008; 28:85-7. [PMID: 18853221 DOI: 10.1007/s10067-008-1023-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/12/2008] [Accepted: 09/16/2008] [Indexed: 11/24/2022]
Abstract
To evaluate the effect of intra-articular steroid injection (IASI) of betamethasone acetate/betamethasone sodium phosphate (Celestone Chronodose) at the knee joint on blood glucose and fructosamine levels in controlled diabetic patients with osteoarthritis of the knee. Controlled diabetic patients (HgA1C < 7) with symptomatic osteoarthritis of the knee who failed medical and physical therapy and use modern versions of home-monitoring blood glucose devices were offered an IASI of Celestone Chronodose at the knee joint. If agreed, patients were asked to document blood glucose levels before and 2 h after meals for 1 week prior to IASI and daily for 4 days then every other day for 10 days following IASI of 1 ml of Celestone Chronodose. Serum fructosamine levels were obtained just prior and 2 weeks following the injection. Six patients completed the study and all had a significant brisk elevation of blood glucose levels within the first hour lasting for less than 48 h in five of them. Mean glucose level 1 h following the injection was 218.33 +/- 41.75 mg% and mean maximal level 322.5 +/- 67.75 mg%. There was no significant change in fructosamine levels. IASI of Celestone Chronodose will transiently increase blood glucose levels in diabetic patients. It has no significant effect on serum fructosamine levels.
Collapse
Affiliation(s)
- George Habib
- Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel.
| | | |
Collapse
|
71
|
Pang HN, Lo NN, Yang KY, Chong HC, Yeo SJ. Peri-articular steroid injection improves the outcome after unicondylar knee replacement. ACTA ACUST UNITED AC 2008; 90:738-44. [DOI: 10.1302/0301-620x.90b6.20550] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.
Collapse
Affiliation(s)
- H.-N. Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore
| | - N.-N. Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore
| | - K.-Y. Yang
- Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore
| | - H.-C. Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore
| | - S.-J. Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore
| |
Collapse
|
72
|
Abstract
Intra-articular injections are one method that physicians may use to treat joint pain. This method offers direct access to the source of pain for the troubled patient. Substances ranging from steroids to hyaluronic acid have been injected successfully into the various joints of the body in an attempt to provide relief for chronic joint pain. Anesthesiologists and orthopedic surgeons have begun to use intra-articular injections of local anesthetics for postoperative analgesia. The history, agents, and methods of intra-articular injections are reviewed.
Collapse
|
73
|
Yavorskyy A, Hernandez-Santana A, McCarthy G, McMahon G. Detection of calcium phosphate crystals in the joint fluid of patients with osteoarthritis - analytical approaches and challenges. Analyst 2008; 133:302-18. [PMID: 18299743 PMCID: PMC2625400 DOI: 10.1039/b716791a] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Clinically, osteoarthritis (OA) is characterised by joint pain, stiffness after immobility, limitation of movement and, in many cases, the presence of basic calcium phosphate (BCP) crystals in the joint fluid. The detection of BCP crystals in the synovial fluid of patients with OA is fraught with challenges due to the submicroscopic size of BCP, the complex nature of the matrix in which they are found and the fact that other crystals can co-exist with them in cases of mixed pathology. Routine analysis of joint crystals still relies almost exclusively on the use of optical microscopy, which has limited applicability for BCP crystal identification due to limited resolution and the inherent subjectivity of the technique. The purpose of this Critical Review is to present an overview of some of the main analytical tools employed in the detection of BCP to date and the potential of emerging technologies such as atomic force microscopy (AFM) and Raman microspectroscopy for this purpose.
Collapse
Affiliation(s)
- Alexander Yavorskyy
- Bioanalytical Chemistry & Diagnostics Group, National Centre for Sensor Research, School of Chemical Sciences, Dublin City University, Dublin 9, Ireland. ; Tel: +353 1 7005914
| | - Aaron Hernandez-Santana
- Bioanalytical Chemistry & Diagnostics Group, National Centre for Sensor Research, School of Chemical Sciences, Dublin City University, Dublin 9, Ireland. ; Tel: +353 1 7005914
| | - Geraldine McCarthy
- Division of Rheumatology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Gillian McMahon
- Bioanalytical Chemistry & Diagnostics Group, National Centre for Sensor Research, School of Chemical Sciences, Dublin City University, Dublin 9, Ireland. ; Tel: +353 1 7005914
| |
Collapse
|
74
|
Wada M, Kawahito Y, Kimura S, Kohno M, Ishino H, Kimura M, Omoto A, Yamamoto A, Hamaguchi M, Tsubouchi Y, Tokunaga D, Hojo T, Ashihara E, Maekawa T, Yoshikawa T. siRNA targeting PLK-1 induces apoptosis of synoviocytes in rheumatoid arthritis. Biochem Biophys Res Commun 2007; 357:353-9. [PMID: 17434144 DOI: 10.1016/j.bbrc.2007.03.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 03/17/2007] [Indexed: 01/28/2023]
Abstract
Polo-like kinase-1 (PLK-1) is a member of the PLK family and participates in the control of cell mitosis. Here, we show that immunoreactive PLK-1 is strongly expressed in synoviocytes and some infiltrative mononuclear cells in synovial tissues from patients with rheumatoid arthritis (RA), while patients with osteoarthritis and injury show little or no expression of PLK-1 in synovial tissues. Western blot analysis shows that PLK is expressed and its expression is enhanced by IL-1beta in RA synoviocytes. IL-1beta also enhanced the cell growth of RA synoviocytes. Moreover, siRNA targeted against PLK-1 significantly decreases the expression of PLK-1 of RA synoviocytes stimulated by IL-1beta and suppresses the proliferation of these synoviocytes through apoptosis. These findings suggest that PLK-1 plays a critical role in the proliferation of RA synoviocytes leading to bone destruction, and siRNA against PLK-1 is potentially useful for the treatment of RA.
Collapse
Affiliation(s)
- Makoto Wada
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
75
|
Park YS, Lim SW, Lee IH, Lee TJ, Kim JS, Han JS. 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. Arthritis Res Ther 2007; 9:R8. [PMID: 17257416 PMCID: PMC1860066 DOI: 10.1186/ar2114] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 12/15/2006] [Accepted: 01/26/2007] [Indexed: 11/21/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yoo-Sin Park
- Institute of Biomedical Science, College of Medicine 1F, Hanyang University, Haengdang-dong 17, Seongdong-gu, Seoul, 133-791, South Korea
| | - Si-Woong Lim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Inje University, Gaekeum-dong 633-165, Pusanjin-gu, Pusan, 614-735, South Korea
- Chamsarang PM&R Clinic, Chonho-dong 455, Gangdong-gu, Seoul, 134-020, South Korea
| | - Il-Hoon Lee
- Department of Physical Medicine and Rehabilitation, School of Medicine, Inje University, Gaekeum-dong 633-165, Pusanjin-gu, Pusan, 614-735, South Korea
- Kwangmyung PM&R Clinic, Kwangmyung-dong 340-5, Kwangmyung, Gyunggi-do, 423-016, South Korea
| | - Tae-Jin Lee
- Department of Pathology, School of Medicine, Chungang University, Heukseok-dong, Dongjak-gu, Seoul, 155-756, South Korea
| | - Jong-Sung Kim
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jin Soo Han
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, Hwayang-dong 1, Gwangjin-gu, Seoul, 143-701, South Korea
| |
Collapse
|
76
|
Girish KS, Kemparaju K. The magic glue hyaluronan and its eraser hyaluronidase: a biological overview. Life Sci 2007; 80:1921-43. [PMID: 17408700 DOI: 10.1016/j.lfs.2007.02.037] [Citation(s) in RCA: 438] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/04/2007] [Accepted: 02/19/2007] [Indexed: 01/09/2023]
Abstract
Hyaluronan (HA) is a multifunctional high molecular weight polysaccharide found throughout the animal kingdom, especially in the extracellular matrix (ECM) of soft connective tissues. HA is thought to participate in many biological processes, and its level is markedly elevated during embryogenesis, cell migration, wound healing, malignant transformation, and tissue turnover. The enzymes that degrade HA, hyaluronidases (HAases) are expressed both in prokaryotes and eukaryotes. These enzymes are known to be involved in physiological and pathological processes ranging from fertilization to aging. Hyaluronidase-mediated degradation of HA increases the permeability of connective tissues and decreases the viscosity of body fluids and is also involved in bacterial pathogenesis, the spread of toxins and venoms, acrosomal reaction/ovum fertilization, and cancer progression. Furthermore, these enzymes may promote direct contact between pathogens and the host cell surfaces. Depolymerization of HA also adversely affects the role of ECM and impairs its activity as a reservoir of growth factors, cytokines and various enzymes involved in signal transduction. Inhibition of HA degradation therefore may be crucial in reducing disease progression and spread of venom/toxins and bacterial pathogens. Hyaluronidase inhibitors are potent, ubiquitous regulating agents that are involved in maintaining the balance between the anabolism and catabolism of HA. Hyaluronidase inhibitors could also serve as contraceptives and anti-tumor agents and possibly have antibacterial and anti-venom/toxin activities. Additionally, these molecules can be used as pharmacological tools to study the physiological and pathophysiological role of HA and hyaluronidases.
Collapse
Affiliation(s)
- K S Girish
- Department of Biochemistry, University of Mysore, Manasagangothri, Mysore, Karnataka State, 560007, India.
| | | |
Collapse
|
77
|
Abstract
Intra-articular injections are one method that physicians may use to treat joint pain. This method offers direct access to the source of pain for the troubled patient. Substances ranging from steroids to hyaluronic acid have been injected successfully into the various joints of the body in an attempt to provide relief for chronic joint pain. Anesthesiologists and orthopedic surgeons have begun to use intra-articular injections of local anesthetics for postoperative analgesia. This history, agents, and methods of intra-articular injections are reviewed.
Collapse
Affiliation(s)
- William Lavelle
- Department of Orthopaedic Surgery, Albany Medical Center, 1367 Washington Avenue, Albany, NY 12206, USA.
| | | | | |
Collapse
|
78
|
Abstract
Peyronie's disease is a localised, fibrosing condition of the penis that occurs in up to 9% of men. Although its aetiology has not been elucidated, Peyronie's disease probably results from the presence of a predisposing genetic susceptibility combined with an inciting event, most probably trauma. Following appropriate clinical evaluation, initial treatment consists of a trial of oral and/or intralesional pharmacotherapy. Oral therapies most commonly employed include para-aminobenzoate (Potaba) and tocopherol (vitamin E), with colchicine, tamoxifen, propoleum and acetyl-L-carnitine being used less frequently. Placebo-controlled studies examining these agents have failed to show a consistent beneficial effect on Peyronie's disease, with the exception of para-aminobenzoate, which may decrease plaque size and curvature, and acetyl-L-carnitine, which may reduce erectile pain and inhibit disease progression. Intralesional injection therapy for Peyronie's disease is commonly used as a first-line therapy along with oral medications. The current standard of care involves injection with interferon-alpha-2a or -2b, verapamil or collagenase over 2-week intervals for a period of 5-6 months. Interferon-alpha-2b, in particular, has been documented in a large, multicentre, placebo-controlled study to be significantly more effective than placebo in decreasing penile curvature, plaque size, penile pain and plaque density. However, interferon treatment is also associated with significant adverse effects, including fever and other flu-like symptoms. Other available therapies that have not consistently shown efficacy in placebo-controlled studies include corticosteroids and orgotein. Surgery is considered in patients with Peyronie's disease who have not responded to a trial of conservative medical therapy for 1 year and who are precluded from sexual intercourse. Procedures commonly performed include the Nesbit procedure (or variations of the Nesbit), penile plaque incision/excision with or without grafting, and implantation of a penile prosthesis. Further basic scientific research in Peyronie's disease is likely to identify additional targets for future pharmacotherapy.
Collapse
Affiliation(s)
- Landon W Trost
- Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana 70112, USA
| | | | | |
Collapse
|
79
|
Liao YH, Jones SA, Forbes B, Martin GP, Brown MB. Hyaluronan: pharmaceutical characterization and drug delivery. Drug Deliv 2006; 12:327-42. [PMID: 16253949 DOI: 10.1080/10717540590952555] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Hyaluronic acid (HA), is a polyanionic polysaccharide that consists of N-acetyl-D-glucosamine and beta-glucoronic acid. It is most frequently referred to as hyaluronan because it exists in vivo as a polyanion and not in the protonated acid form. HA is distributed widely in vertebrates and presents as a component of the cell coat of many strains of bacteria. Initially the main functions of HA were believed to be mechanical as it has a protective, structure stabilizing and shock-absorbing role in the body. However, more recently the role of HA in the mediation of physiological functions via interaction with binding proteins and cell surface receptors including morphogenesis, regeneration, wound healing, and tumor invasion, as well as in the dynamic regulation of such interactions on cell signaling and behavior has been documented. The unique viscoelastic nature of hyaluronan along with its biocompatibility and nonimmunogenicity has led to its use in a number of cosmetic, medical, and pharmaceutical applications. More recently, HA has been investigated as a drug delivery agent for ophthalmic, nasal, pulmonary, parenteral, and dermal routes. The purpose of our review is to describe the physical, chemical, and biological properties of native HA together with how it can be produced and assayed along with a detailed analysis of its medical and pharmaceutical applications.
Collapse
Affiliation(s)
- Yong-Hong Liao
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | | | | | | |
Collapse
|
80
|
Abstract
BACKGROUND AND OBJECTIVES Glucocorticosteroids are widely used in medicine and have shown unchallenged therapeutic potential in several chronic inflammatory and other diseases. They are also widely used in sports medicine for the treatment of conditions such as asthma and acute injuries. In fact, as banned substances, most requests for therapeutic use exemption concern glucocorticosteroids. Nevertheless, their beneficial effect in certain conditions in sports, where inflammation is only a secondary reaction, remains to be validated. This paper aimed to provide a comprehensive review of the literature covering the therapeutic use of glucocorticosteroids since 1977 in conditions ranging from chronic rheumatic illness to peritendinous or intra-articular injection in acute injuries. METHODS Search of the medical literature published between 1977 and 2006 using PubMed. Articles relevant to the question "When and if at all is the use of glucocorticosteroids justified in football?" were selected and analysed. RESULTS AND CONCLUSIONS The findings clearly point out that, despite the common use of glucocorticosteroids in acute injuries in sports, there is actually limited evidence of the true benefits of such a practice. Physicians must take the possible adverse effects into consideration. In an athlete with clinically verified asthma, inhalational glucocorticosteroids remain first line therapy. Finally, for the purposes of education and prevention of misuse, it should be stressed that a measurable performance enhancing effect of glucocorticoids could not be proved on the basis of the results of the scientific studies to date.
Collapse
Affiliation(s)
- J Dvorak
- FIFA Medical Assessment and Research Centre, Department of Neurology, Schulthess Clinic, Zurich, Switzerland.
| | | | | |
Collapse
|
81
|
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006:CD005328. [PMID: 16625636 DOI: 10.1002/14651858.cd005328.pub2] [Citation(s) in RCA: 366] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a common joint disorder. In the knee, injections of corticosteroids into the joint (intraarticular (IA)) may relieve inflammation, and reduce pain and disability. OBJECTIVES To evaluate the efficacy and safety of IA corticosteroids in treatment of OA of the knee. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2003), MEDLINE (to January (week 1) 2006 for update), EMBASE, PREMEDLINE (all to July 2003), and Current Contents (Sept 2000). Specialised journals, trial reference lists and review articles were handsearched. SELECTION CRITERIA Randomised controlled trials of IA corticosteroids for patients with OA of the knee: single/double blind, placebo-based/comparative studies, reporting at least one core OMERACT III outcome measure. DATA COLLECTION AND ANALYSIS Methodological quality of trials was assessed, and data were extracted in duplicate. Fixed effect and random effects models, giving weighted mean differences (WMD), were used for continuous variables. Dichotomous outcomes were analysed by relative risk (RR). MAIN RESULTS Twenty-eight trials (1973 participants) comparing IA corticosteroid against placebo, against IA hyaluronan/hylan (HA products), against joint lavage, and against other IA corticosteroids, were included.IA corticosteroid was more effective than IA placebo for pain reduction (WMD -21.91; 95% confidence interval (CI) -29.93 to -13.89) and patient global assessment (the RR was 1.44 (95% CI 1.13 to 1.82)) at one week post injection with an NNT of 3 to 4 for both, based on n=185 for pain on 100 mm visual analogue scale (VAS) and n=158 for patient global assessment. Data on function were sparse at one week post injection and neither statistically significant nor clinically important differences were detected. There was evidence of pain reduction between two weeks (the RR was 1.81 (95% CI 1.09 to 3.00)) to three weeks (the RR was 3.11 (95% CI 1.61 to 6.01), but a lack of evidence for efficacy in functional improvement. At four to 24 weeks post injection, there was lack of evidence of effect on pain and function (small studies showed benefits which did not reach statistical or clinical importance, i.e. less than 20% risk difference). For patient global, there were three studies which consistently showed lack of effect longer than one week post injection. However, all were fairly small sample sizes (less than 50 patients per group). This was supported by another study which did not find statistically significant differences, at any time point, on a continuous measure of patient global assessment (100 mm VAS).In comparisons of corticosteroids and HA products, no statistically significant differences were in general detected at one to four weeks post injection. Between five and 13 weeks post injection, HA products were more effective than corticosteroids for one or more of the following variables: WOMAC OA Index, Lequesne Index, pain, range of motion (flexion), and number of responders. One study showed a difference in function between 14 to 26 weeks, but no differences in efficacy were detected at 45 to 52 weeks. In general, the onset of effect was similar with IA corticosteroids, but was less durable than with HA products. Comparisons of IA corticosteroids showed triamcinolone hexacetonide was superior to betamethasone for number of patients reporting pain reduction up to four weeks post injection (the RR was 2.00 (95% CI 1.10 to 3.63). Comparisons between IA corticosteroid and joint lavage showed no differences in any of the efficacy or safety outcome measures. AUTHORS' CONCLUSIONS The short-term benefit of IA corticosteroids in treatment of knee OA is well established, and few side effects have been reported. Longer term benefits have not been confirmed based on the RevMan analysis. The response to HA products appears more durable. In this review, some discrepancies were observed between the RevMan 4.2 analysis and the original publication. These are likely the result of using secondary rather than primary data and the statistical methods available in RevMan 4.2. Future trials should have standardised outcome measures and assessment times, run longer, investigate different patient subgroups, and clinical predictors of response (those associated with inflammation and structural damage).
Collapse
Affiliation(s)
- N Bellamy
- University of Queensland, Centre Of National Research On Disability And Rehabilitation Medicine, Level 3, Mayne Medical School, Herston Road, Brisbane, Queensland, Australia, 4006.
| | | | | | | | | | | |
Collapse
|
82
|
Joshy S, Thomas B, Gogi N, Modi A, Singh BK. Effect of intra-articular steroids on deep infections following total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2006; 30:91-3. [PMID: 16501978 PMCID: PMC2532080 DOI: 10.1007/s00264-005-0035-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 11/02/2005] [Indexed: 12/01/2022]
Abstract
Intra-articular steroids have been commonly used for the treatment of arthritis. The aim of our study was to discover any relation between deep infections following total knee arthroplasty and intra-articular steroid use before the arthroplasty. We undertook a retrospective matched cohort study. In the study group there were 32 patients with confirmed deep infection following total knee replacement. The control group consisted of 32 patients with no evidence of infection in the knee. There was no significant difference between the numbers of patients who received intra-articular steroid injection between the groups (P=1). We believe that infection following total knee replacement is due to multiple factors and that the use of intra-articular steroids does not alter the incidence of deep infections following total knee arthroplasty.
Collapse
Affiliation(s)
- Suraj Joshy
- Department of Orthopaedics, City Hospital, B18 7QH, Birmingham, UK.
| | | | | | | | | |
Collapse
|
83
|
Danés I, Rodríguez D. [Efficacy of drugs "with a trophic action on the cartilage" in the treatment of osteoarthritis]. Med Clin (Barc) 2005; 125:632-4. [PMID: 16287575 DOI: 10.1157/13080847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Imma Danés
- Fundació Institut Català de Farmacologia, Servei de Farmacologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | |
Collapse
|
84
|
Abstract
Injection of corticosteroid preparations for the local treatment of musculoskeletal disorders affecting the knee, such as osteoarthritis and rheumatoid arthritis, has been used widely since the 1950s. This local therapy minimizes systemic toxicity and can result in rapid improvement in symptoms, most often as an adjunctive therapy for acute or severe symptom flares. The evidence assessing safety and efficacy is reviewed and analyzed. Intra-articular knee injection technique is described and is a procedure that is easy to learn and can be performed quickly in an office or hospital setting.
Collapse
Affiliation(s)
- H Ralph Schumacher
- Section of Rheumatology, VA Medical Center, Philadelphia, Penn 19104, USA.
| | | |
Collapse
|
85
|
Jablonka K, Freyschmidt J, Uhlenbruck C. Ungewöhnliche Fingergelenkdestruktionen nach Radiosynoviorthese (RSO) und Cortisoninjektionstherapie bei Bouchard-Arthrose. Z Rheumatol 2005; 64:576-80. [PMID: 16328763 DOI: 10.1007/s00393-005-0690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 11/17/2004] [Indexed: 11/30/2022]
Abstract
UNLABELLED Starting in 1998, a female patient suffering from activated Bouchard arthrosis was treated with intra-articular steroid injections into digits of both hands. In September 2001, an additional therapy with erbium-169 injections into the same joints was begun. The injections were continued until March 2003. No benefit was observed. Instead, severe destruction of the involved joints with articular necroses and marked periarticular calcifications had occurred. The course of events are documented by plain film examinations. CONCLUSIONS The indication for alternating steroid injections and radio-synovectomies in patients with activated Bouchard arthrosis has to be reconsidered. In vivo and in vitro experiments are necessary to evaluate the potential harms of this combination of therapies. A close clinical and radiological control of treatment outcome with reevaluation of the indication is necessary.
Collapse
Affiliation(s)
- K Jablonka
- Klinik für radiologische Diagnostik und Nuklearmedizin, Klinikum Bremen Mitte, St. Jürgen-Strasse, 28205 Bremen, Germany
| | | | | |
Collapse
|
86
|
Fini M, Giavaresi G, Carpi A, Nicolini A, Setti S, Giardino R. Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies. Biomed Pharmacother 2005; 59:388-94. [PMID: 16084055 DOI: 10.1016/j.biopha.2005.02.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 02/02/2005] [Indexed: 11/22/2022] Open
Abstract
Osteoarthritis (OA) is the most common disorder of the musculoskeletal system and is a consequence of mechanical and biological events that destabilize tissue homeostasis in articular joints. Controlling chondrocyte death and apoptosis, function, response to anabolic and catabolic stimuli, matrix synthesis or degradation and inflammation is the most important target of potential chondroprotective treatment, aimed to retard or stabilize the progression of OA. Although many drugs or substances have been recently introduced for the treatment of OA, the majority of them relieve pain and increase function, but do not modify the complex pathological processes that occur in these tissues. Pulsed electromagnetic fields (PEMFs) have a number of well-documented physiological effects on cells and tissues including the upregulation of gene expression of members of the transforming growth factor beta super family, the increase in glycosaminoglycan levels, and an anti-inflammatory action. Therefore, there is a strong rationale supporting the in vivo use of biophysical stimulation with PEMFs for the treatment of OA. In the present paper some recent experimental in vitro and in vivo data on the effect of PEMFs on articular cartilage were reviewed. These data strongly support the clinical use of PEMFs in OA patients.
Collapse
Affiliation(s)
- M Fini
- Experimental Surgery Department, Research Institute Codivilla-Putti-Rizzoli, Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
87
|
Abstract
The painful shoulder is a common clinical entity with a broad array of possible causes. A caregiver for an affected patient needs to determine the aetiology for the pain, often relying primarily on the history and physical examination and supplemented with laboratory testing and imaging when needed. However, initial treatment decisions are often made before ordering these tests in situations not involving trauma. Most conditions affecting the shoulder are treated with conservative measures such as rest, physical therapy and analgesics. When such measures fail, local corticosteroid injections can be a valuable tool to help achieve symptom relief for a wide range of the most common conditions affecting the shoulder joint. This review aims to help the clinician distinguish among the commonly encountered causes of shoulder pain and guide therapy when the use of local corticosteroid injections is considered.
Collapse
Affiliation(s)
- A D Bell
- Family and Community Medicine, Humber River Regional Hospital, Finch Site, Downsview, Ontario, Canada.
| | | |
Collapse
|
88
|
Brown MB, Jones SA. Hyaluronic acid: a unique topical vehicle for the localized delivery of drugs to the skin. J Eur Acad Dermatol Venereol 2005; 19:308-18. [PMID: 15857456 DOI: 10.1111/j.1468-3083.2004.01180.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hyaluronic acid (HA) is a naturally occurring polyanionic, polysaccharide that consists of N-acetyl-D-glucosamine and beta-glucoronic acid. It is present in the intercellular matrix of most vertebrate connective tissues especially skin where it has a protective, structure stabilizing and shock-absorbing role. The unique viscoelastic nature of HA along with its biocompatibility and non-immunogenicity has led to its use in a number of clinical applications, which include: the supplementation of joint fluid in arthritis; as a surgical aid in eye surgery; and to facilitate the healing and regeneration of surgical wounds. More recently, HA has been investigated as a drug delivery agent for various routes of administration, including ophthalmic, nasal, pulmonary, parenteral and topical. In fact, regulatory approval in the USA, Canada and Europe was granted recently for 3% diclofenac in 2.5% HA gel, Solaraze, for the topical treatment of actinic keratoses, which is the third most common skin complaint in the USA. The gel is well tolerated, safe and efficacious and provides an attractive, cost-effective alternative to cryoablation, curettage or dermabrasion, or treatment with 5-fluorouracil. The purpose of this review is to describe briefly the physical, chemical and biological properties of HA together with some details of its medical and pharmaceutical uses with emphasis on this more recent topical application.
Collapse
Affiliation(s)
- M B Brown
- Department of Pharmacy, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NN, UK.
| | | |
Collapse
|
89
|
Abstract
This article primarily reviews the pathophysiology, diagnosis, and therapy of osteoarthritis but also briefly discusses immune-mediated arthritides. Given the frequency of occurrence of arthritis in veterinary patients, it is crucial that clinicians be aware of the mechanisms of the disease and be comfortable with diagnosis and treatment. Unfortunately,there is a great deal of information still to be learned in regards to management of these cases. Because of the rapid and continuing research gains, it behooves clinicians to maintain a current awareness of the related literature.
Collapse
Affiliation(s)
- Walter C Renberg
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA
| |
Collapse
|
90
|
Abstract
Osteoarthritis, the most common form of arthritis, is a debilitating progressive disease principally affecting the elderly. Osteoarthritis therapy has evolved in the past few decades from symptomatic treatment to possible disease-modifying solutions. In this paper, the pathophysiology of osteoarthritis is first reviewed, including an examination of the mechanisms underlying osteoarthritis and discussions of the roles of cartilage, synovial fluid and subchondral bone. The remainder of the paper discusses therapeutic approaches in current use and those in development, with special attention given to pharmacological treatments. Current approaches to treating osteoarthritis--i.e. medications; nonpharmacological modalities, such as physical therapy, exercise, weight management and orthotics; and (as a last resort) surgery--focus on reducing pain and improving (or at least maintaining) mobility. Drugs currently used to treat osteoarthritis fall into several categories: analgesics, NSAIDs, cyclo-oxygenase-2 (COX-2) inhibitors, corticosteroids, viscosupplementation, and symptomatic slow-acting drugs ('nutraceuticals'). The analgesics (paracetamol [acetaminophen] and opiates) have demonstrated less symptomatic efficacy than NSAIDs, while the latter have displayed mixed results in terms of joint space narrowing. COX-2 inhibitors have been demonstrated to be equal to or superior to NSAIDs in effectiveness. However, once considered a safer alternative, COX-2 inhibitors have become the subject of intense scrutiny since recent clinical evidence has cast suspicion on their cardiovascular safety profile. Injectable therapies, such as corticosteroids and viscosupplementation have elicited favorable short-term response but no long-term structural modification. On the other hand, the slow-acting drugs, especially chondroitin and glucosamine sulfate, have shown promising results. Also reviewed are other established and experimental therapies that seek to modify and/or even reverse the course of osteoarthritis. These include such medications as colchicine, bisphosphonates and hormones; dietary therapeutics, such as ginger extract and green tea; and such truly experimental treatments as matrix metalloproteinase inhibitors, cytokines, nitric oxide, growth factors and gene therapy. Osteoarthritis continues to be a difficult disorder to treat, as there is no cure as such and current treatments focus mainly on relieving pain and maintaining joint function. The search nevertheless continues for management regimens that can slow, alter or reverse the degenerative processes of osteoarthritis.
Collapse
Affiliation(s)
- Marc Fajardo
- Musculoskeletal Research Center, NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, New York 10003, USA
| | | |
Collapse
|
91
|
Rosenthal MA, Gibbs P, Brown TJ, Wong S, Uren S, Ellis A, Li L, Heldin P, Fox RM. Phase I and pharmacokinetic evaluation of intravenous hyaluronic acid in combination with doxorubicin or 5-fluorouracil. Chemotherapy 2005; 51:132-41. [PMID: 15886473 DOI: 10.1159/000085621] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Accepted: 12/06/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pre-clinically, hyaluronan (HA) has been demonstrated to systemically target chemotherapeutic drugs to tumours while ameliorating treatment toxicities. This study is a preliminary clinical investigation to determine if HA could be safely used in combination with 5-fluorouracil (5-FU) and doxorubicin (DOX). METHODS Thirty patients with metastatic cancer were intravenously administered 500 mg/m2 HA in combination with escalating doses of DOX (30-60 mg/m2) or 5-FU (cumulative dose of 1,350-2,250 mg/m2 per cycle). The effect of pre-administration of 20 mg/m2 of folinic acid on HA/5-FU chemotherapy was also investigated. Patients were randomized to receive either HA/chemotherapy or chemotherapy alone in their first treatment cycle and vice versa for the second cycle. Patients received HA and chemotherapy in all subsequent cycles. RESULTS Treatment was well tolerated, tumour responses were observed and the co-administration of HA did not alter the pharmacokinetics of clinically relevant doses of 5-FU or DOX. CONCLUSION High doses of intravenous high-molecular-weight HA can be safely co-administered with clinical doses of chemotherapy without significantly altering the toxicity or pharmacokinetics of the drugs or HA.
Collapse
Affiliation(s)
- Mark A Rosenthal
- Cancer Trials Australia, Department of Clinical Hematology, Medical Oncology and Palliative Care, Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
92
|
Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature. Spine J 2005; 5:310-28. [PMID: 15863087 DOI: 10.1016/j.spinee.2004.09.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 09/28/2004] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The injection of various solutions aimed at producing a sclerosing effect has been used to treat soft tissues injuries (eg, inguinal hernia) for more than 100 years. In the 1930s, this treatment approach was applied to injured joints in an attempt to stimulate connective tissue repair. Although several studies have been published about this method of treatment for various orthopedic and spinal indications (termed prolotherapy), its use remains controversial. PURPOSE To conduct a critical review of the literature on prolotherapy for spinal pain. STUDY DESIGN/SETTING Critical review of the literature. METHODS Computerized medical literature databases (Medline, CINAHL, Mantis, Cochrane Central Register of Controlled Trials) were searched to uncover all published information about the use of sclerosing injections in humans with spinal pain disorders. Search results were reviewed for relevance, and information was abstracted from full-text articles. RESULTS Our search uncovered almost 200 reference materials in various media related to prolotherapy, including 31 clinical studies related to spinal pain. There were 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain (3), cervical headaches (3) and dorsal or thoracic pain (3). A total of 20 sclerosing solutions were used in these studies; the most common was a mixture of dextrose 12.5%, glycerin 12.5%, phenol 1.25% and lidocaine 0.25%. Wide variations were found in treatment protocols, such as dose, number of treatments and use of adjunct therapies. Most cohort studies were only of moderate quality and varied greatly in the substances injected and the use of co-interventions. Most clinical studies reported positive results such as decreased pain or disability, although differences between treatment and control groups did not always reach statistical significance. Commonly reported adverse reactions to this treatment include temporary postinjection pain and stiffness. A handful of more serious adverse events were reported in the 1950s and 1960s with stronger or unknown solutions. CONCLUSION Prolotherapy describes a variety of treatment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions. Future research should focus on those solutions and protocols that are most commonly used in clinical practice and have been used in trials reporting effectiveness to help determine which patients, if any, are most likely to benefit from this treatment.
Collapse
Affiliation(s)
- Simon Dagenais
- Department of Environmental Health, Science, and Policy, University of California, Irvine, CA 92697, USA.
| | | | | |
Collapse
|