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Zhang HB, Zhang Y, Chen C, Li YQ, Ma C, Wang ZJ. Pioglitazone inhibits advanced glycation end product-induced matrix metalloproteinases and apoptosis by suppressing the activation of MAPK and NF-κB. Apoptosis 2018; 21:1082-93. [PMID: 27515513 DOI: 10.1007/s10495-016-1280-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Apoptosis and degeneration coming mainly from chondrocytes are important mechanisms in the onset and progression of osteoarthritis. Specifically, advanced glycation end products (AGEs) play an important role in the pathogenesis of osteoarthritis. Pioglitazone, a peroxisome proliferator-activated receptor γ (PPARγ) agonist has a protective effect on cartilage. This study aims to evaluate the effect of pioglitazone on AGEs-induced chondrocyte apoptosis and degeneration and their underlying mechanism. The in vitro study shows that AGEs induce cleavage of caspase-3 and PARP, up-regulate MMP-13 expression, enhance chondrocyte apoptosis and down-regulate PPARγ expression in human primary chondrocytes, which is reversed by pioglitazone. Furthermore, AGEs activate phosphorylation of Erk, JNK, and p38, and pioglitazone reverses AGEs-induced phosphorylation of Erk and p38. AGEs-induced degradation of IκBα and translocation of nuclear NF-κB p65 is reversed by pioglitazone. Pretreatment of chondrocytes with SB202190 (p38 inhibitor), SP600125 (JNK inhibitor) and BAY-11-7082 (NF-κB inhibitor) inhibit AGEs-induced apoptosis and degeneration. In vivo experiments suggest that pioglitazone reverses AGEs-induced cartilage degeneration and apoptosis in a mouse model, as demonstrated by HE and Safranin O staining, immunohistochemical analyses of Type II collagen (Col II), metalloproteinases (MMPs) and caspase-3. These findings suggest that pioglitazone, a PPARγ agonist, inhibits AGEs-induced chondrocytes apoptosis and degeneration via suppressing the activation of MAPK and NF-κB.
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Affiliation(s)
- Hai-Bin Zhang
- Department of Orthopedics, The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, Changsha, 410003, Hunan, People's Republic of China
| | - Ying Zhang
- Department of Orthopedics, The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, Changsha, 410003, Hunan, People's Republic of China
| | - Cheng Chen
- Department of Orthopedics, The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, Changsha, 410003, Hunan, People's Republic of China.
| | - Yu-Qing Li
- Department of Orthopedics, The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, Changsha, 410003, Hunan, People's Republic of China
| | - Chi Ma
- Department of Orthopedics, People's Hospital of Xiangxi Autonomous Prefecture, Jishou, Hunan, China
| | - Zhao-Jun Wang
- Department of Orthopedics, The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, Changsha, 410003, Hunan, People's Republic of China
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102
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Calvet J, Orellana C, Galisteo C, García-Manrique M, Navarro N, Caixàs A, Larrosa M, Gratacós J. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion. PLoS One 2018; 13:e0191342. [PMID: 29351562 PMCID: PMC5774783 DOI: 10.1371/journal.pone.0191342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. METHODS One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. RESULTS One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. CONCLUSIONS The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.
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Affiliation(s)
- Joan Calvet
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Carlos Galisteo
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - María García-Manrique
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Noemí Navarro
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Assumpta Caixàs
- Endocrinology and Nutrition Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Marta Larrosa
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
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103
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The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA: A Randomized Double-Blinded Placebo Controlled Trial in Patients With High-Pain Knee Osteoarthritis and Sensitization. THE JOURNAL OF PAIN 2017; 18:1476-1487. [DOI: 10.1016/j.jpain.2017.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
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104
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Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis. Arch Rheumatol 2017; 33:273-281. [PMID: 30632533 DOI: 10.5606/archrheumatol.2018.6608] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/05/2017] [Indexed: 01/10/2023] Open
Abstract
Objectives This study aims to assess whether platelet rich plasma (PRP) is an effective treatment for knee osteoarthritis, and compare its efficiency with corticosteroid treatment in terms of pain control, physical function, and quality of life. Patients and methods The study included 50 patients (4 males, 46 females; mean age 61.6±6.9 years; range 50 to 75 years) who were diagnosed as grade 3 knee osteoarthritis. Patients were randomized into three groups as corticosteroid group (receiving one corticosteroid injection), single PRP group (receiving one PRP injection), and three PRP group (receiving three PRP injections with one week interval). All patients were given a home exercise program. Patients were evaluated with Visual Numeric Scale (VNS), Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC), Lequesne index and the Hospital Anxiety and Depression Scale before treatment, and at second and sixth months following the implementation of injections. Results In single and three PRP groups; VNS, WOMAC and Lequesne scores decreased significantly at second month follow-up; also, sixth month scores showed a slight increase but remained significantly lower than baseline. In corticosteroid group, all VNS, WOMAC, and Lequesne scores decreased at second month follow-up; however, at sixth month, rest, night VNS and WOMAC stiffness scores were increased while no significant difference was found with baseline. At sixth month; VNS movement, WOMAC pain, function, and the total and Lequesne scores were worse, but remained significantly lower than baseline. When groups were compared, three PRP group's second month VNS movement scores were significantly lower than the corticosteroid group. Sixth month VNS movement and WOMAC pain scores were significantly lower in single and three PRP groups compared to the corticosteroid group, with no significant difference between the PRP groups. Conclusion Our findings revealed that PRP is a safe treatment option and efficient in osteoarthritis symptom control up to six months after application. Treatment response obtained with corticosteroid injection has a shorter duration than PRP treatment.
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105
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Bisicchia S, Tudisco C. Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature. ACTA ACUST UNITED AC 2017; 14:182-185. [PMID: 29263730 DOI: 10.11138/ccmbm/2017.14.1.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). Efficacy Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. Safety Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections. Conclusions Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis.
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Affiliation(s)
- Salvatore Bisicchia
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
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106
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Rodriguez-Merchan EC. Treatment of musculo-skeletal pain in haemophilia. Blood Rev 2017; 32:116-121. [PMID: 28943040 DOI: 10.1016/j.blre.2017.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 12/25/2022]
Abstract
Musculo-skeletal pain treatment is inadequate in many haemophilic patients. Analgesics are used only by 36% of adult patients. FVIII/FIX intravenous infusion is mainly used to lessen pain, followed in frequency by usage of NSAIDS (primarily COX-2 inhibitors). In about 30% of patients, pain continues after infusion of F VIII/IX. In acute haemarthroses pain treatment must continue until total disappearance (checked by ultrasonography) and include haematologic treatment, short-term rest of the involved joint, cryotherapy, joint aspiration and analgesic medication (paracetamol in mild pain, metamizole for more intense pain, and in a few precise patients, soft opioids such as codeine or tramadol). In the circumstance of intolerable pain we should use morphine hydrochloride either by continual infusion or a patient-controlled analgesia (PCA) pump, determined by the age, mental condition and grade of observance of the patient. Epidural blocks utilizing bupivacaine and fentanyl may be very efficacious as well. Three main strategies to alleviate chronic musculo-skeletal pain secondary to haemophilic arthropathy (joint degeneration) exist: pharmacologic management, physical medicine and rehabilitation, and intra-articular injections. As for pharmacologic management, NSAIDs (ibuprofen, diclofenac, celecoxib, robecoxib) are better than paracetamol. The advantages of tramadol or tramadol/paracetamol and non-tramadol opioids are scanty. With respect to physical medicine and rehabilitation, there is insufficient confirmation that a brace has supplementary favourable effect compared with isolated pharmacologic management. Land-based curative exercise and watery exercise have at the minimum a tiny short-run benefit. Curative ultrasound can be helpful (poor quality of evidence). The efficacy of transcutaneous electrostimulation (TENS) for pain mitigation has not been proved. Electrical stimulation treatment can procure notable ameliorations. With respect to intra-articular injections, viscosupplementation appears to be a useful method for pain alleviation in the short-run (months). The short-run (weeks) advantage of intra-articular corticosteroids in the treatment of joint pain has been shown.
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107
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Cooper C, Rannou F, Richette P, Bruyère O, Al‐Daghri N, Altman RD, Brandi ML, Collaud Basset S, Herrero‐Beaumont G, Migliore A, Pavelka K, Uebelhart D, Reginster J. Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice. Arthritis Care Res (Hoboken) 2017; 69:1287-1296. [PMID: 28118523 PMCID: PMC5432045 DOI: 10.1002/acr.23204] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/22/2016] [Accepted: 01/17/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Cyrus Cooper
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University of OxfordOxfordUK
| | - François Rannou
- AP‐HP Cochin Hospital, Universite Paris Descartes Sorbonne Paris Cite, and INSERM U1153ParisFrance
| | - Pascal Richette
- Universite Paris 7, UFR medicale, Assistance Publique‐Hôpitaux de Paris, and Hopital Lariboisière, INSERM U1132ParisFrance
| | | | | | - Roy D. Altman
- David Geffen School of Medicine, University of CaliforniaLos Angeles
| | | | | | | | | | - Karel Pavelka
- Institute of Rheumatology, Charles UniversityPragueCzech Republic
| | - Daniel Uebelhart
- Centre Hospitalier du Valais Romand, Centre Valaisan de PneumologieCrans‐MontanaSwitzerland
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108
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Clark GT, Padilla M, Dionne R. Medication Treatment Efficacy and Chronic Orofacial Pain. Oral Maxillofac Surg Clin North Am 2017; 28:409-21. [PMID: 27475515 DOI: 10.1016/j.coms.2016.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful.
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Affiliation(s)
- Glenn T Clark
- Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA.
| | - Mariela Padilla
- Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
| | - Raymond Dionne
- Department of Pharmacology, Brody School of Medicine, 6S19 Brody Medical Science Building, 600 Moye Boulevard, East Carolina University, Schools of Medicine and Dental Medicine, Greenville, NC 27834-4354, USA
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109
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Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One 2017; 12:e0178621. [PMID: 28640822 PMCID: PMC5480856 DOI: 10.1371/journal.pone.0178621] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. METHODS A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. RESULTS Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. CONCLUSION This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Danielle A. Van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Jonathan C. Hill
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
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110
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Wehling P, Evans C, Wehling J, Maixner W. Effectiveness of intra-articular therapies in osteoarthritis: a literature review. Ther Adv Musculoskelet Dis 2017; 9:183-196. [PMID: 28835778 DOI: 10.1177/1759720x17712695] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis is a painful, chronic disease with widespread burden on patients, communities, health and social care systems. Conservative therapies, such as nonpharmacological interventions, systemic drug treatment and intra-articular therapies are used before resorting to surgery; nonetheless, disease control often remains inadequate. Recent advances in osteoarthritis management have aimed to provide greater variety of treatment options. Here, we summarize a targeted literature review evaluating efficacy and safety of intra-articular therapies for osteoarthritis. Injections of intra-articular therapies directly into the joint avoid conventional barriers to joint entry, increase bioavailability and lower systemic toxicity. Intra-articular corticosteroids and hyaluronic acid are established United States Food and Drug Administration (US FDA)/European Medicines Agency (EMA)-approved treatments; however, concerns exist regarding effect duration, safety, effectiveness across populations and heterogeneity. Newer therapies, such as autologous blood products and mesenchymal stem cells, are in development. Benefits of autologous blood products (e.g. platelet-rich plasma, autologous conditioned serum) include an expected improved safety profile and direct targeting of osteoarthritis-related pathophysiology. Autologous conditioned serum is cell-free and manufactured by a standardized process, whereas platelet-rich plasma composition and characteristics can vary. Currently, only limited efficacy comparisons between these biological treatments can be drawn; long-term clinical and safety studies are needed to increase the efficacy evidence base and earn consideration in treatment frameworks.
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Affiliation(s)
- Peter Wehling
- Orthogen AG, Ernst-Schneider-Platz 1, 40212 Düsseldorf, Germany
| | - Christopher Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - Jana Wehling
- Center for Molecular Orthopaedics and Regenerative Medicine, Stadttor 1, Düsseldorf, Germany
| | - William Maixner
- Center for Translational Pain Medicine, Duke University School of Medicine, Durham, NC, USA
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111
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Belzile EL, Deakon RT, Vannabouathong C, Bhandari M, Lamontagne M, McCormack R. Cost-Utility of a Single-Injection Combined Corticosteroid-Hyaluronic Acid Formulation vs a 2-Injection Regimen of Sequential Corticosteroid and Hyaluronic Acid Injections. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017; 10:1179544117712993. [PMID: 28638242 PMCID: PMC5472395 DOI: 10.1177/1179544117712993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
Research has shown early and sustained relief with a combination therapy of a corticosteroid (CS) and hyaluronic acid (HA) in knee osteoarthritis (OA) patients. This can be administered via a single injection containing both products or as separate injections. The former may be more expensive when considering only product cost, but the latter incurs the additional costs and time of a second procedure. The purpose of this study was to compare the cost-utility of the single injection with the 2-injection regimen. The results of this analysis revealed that the single-injection formulation of a CS and HA may be cost-effective, assuming a willingness-to-pay of $50 000 per quality-adjusted life year gained, for symptomatic relief of OA symptoms. This treatment may also be more desirable to patients who find injections to be inconvenient or unpleasant.
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Affiliation(s)
| | | | | | - Mohit Bhandari
- Division of Orthopaedic Surgery, Centre for Evidence-Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | | | - Robert McCormack
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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112
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Boutefnouchet T, Puranik G, Holmes E, Bell KM. Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee: Clinical Effect Survivorship at 5 Years. Knee Surg Relat Res 2017; 29:129-136. [PMID: 28545178 PMCID: PMC5450575 DOI: 10.5792/ksrr.16.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/13/2017] [Accepted: 04/23/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. Materials and Methods A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. Results Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. Conclusions This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
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Affiliation(s)
- Tarek Boutefnouchet
- Department of Trauma Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Guru Puranik
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
| | - Esther Holmes
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
| | - Karl M Bell
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
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113
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Maricar N, Parkes MJ, Callaghan MJ, Hutchinson CE, Gait AD, Hodgson R, Felson DT, O'Neill TW. Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis. Arthritis Res Ther 2017; 19:88. [PMID: 28482926 PMCID: PMC5423020 DOI: 10.1186/s13075-017-1292-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 04/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background The aim was to examine if structural factors could affect response to intra-articular steroid injections (IASI) in knee osteoarthritis (OA). Method Persons with painful knee OA participated in an open-label trial of IASI where radiographic joint space narrowing (JSN) and Kellgren-Lawrence (KL) grade, whole-organ magnetic resonance imaging (MRI) scores (WORMS) and quantitative assessment of synovial tissue volume (STV) were assessed on baseline images. Participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a question about knee pain with a visual analogue scale for pain during nominated activity (VASNA), and Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess responder status within 2 weeks (short term) and 6 months (longer term). Regression models were used to examine predictors of short and longer term response to IASI. Results Subjects (n = 207) attended and had IASI. Information on responder status was available on 199 participants. Of these, 188 subjects, mean age 63.2 years (standard deviation (SD) 10.3), 97 (51.6%) female, had x-rays and 120 had MRI scans available. Based on the OMERACT-OARSI criteria, 146 (73.4%) participants responded to therapy and 40 (20.1%) were longer term responders. A few factors were associated with a reduced KOOS-pain and VASNA response though none were associated with OMERACT-OARSI responder status in the short term. Higher MRI meniscal damage (odds ratio (OR) = 0.74; 95% CI 0.55 to 0.98), increasing KL maximal grade (OR = 0.43; 95% CI 0.23 to 0.82) and joint space narrowing (JSN) maximal score (OR = 0.60; 95% CI 0.36 to 0.99) were each associated with a lower odds of longer term responder status. Baseline synovitis was not associated with treatment response. The predicted probability of longer term response decreased from 38% to 12% as baseline maximal JSN increased from grade 0 to 3. Conclusion Compared with those who have mild structural damage, persons with more severe knee damage on either MRI or x-ray are less likely to respond to knee IASI. Trial registration ISRCTN.com, ISRCTN07329370. Registered 21 May 2010. Retrospectively registered
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Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Department of Physiotherapy, Salford Royal Hospital NHS Foundation Trust, Manchester, UK
| | - Matthew J Parkes
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Michael J Callaghan
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | | | - Andrew D Gait
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Richard Hodgson
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - David T Felson
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. terence.o'.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK. terence.o'.,Department of Rheumatology, Salford Royal Hospital NHS Foundation Trust, Manchester, UK. terence.o'
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Tajika Y, Moue T, Ishikawa S, Asano K, Okumo T, Takagi H, Hisamitsu T. Influence of Periostin on Synoviocytes in Knee Osteoarthritis. ACTA ACUST UNITED AC 2017; 31:69-77. [PMID: 28064223 DOI: 10.21873/invivo.11027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/18/2016] [Accepted: 12/19/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Periostin (POSTN) is a protein that binds to integrins to support adhesion and migration of epithelial cells. Mice lacking this gene exhibit cardiac valve disease as well as skeletal and dental defects. Recent studies indicated that periostin is involved in the pathogenesis and progression of knee osteoarthritis (OA). We investigated the influence of periostin and matrix metalloproteinases (MMPs) on OA synoviocytes. MATERIALS AND METHODS OA patients were classified according to the Kellgren-Lawrence system and the levels of periostin, interleukin (IL)-4, IL-13 and transforming growth factor-β (TGFβ) in the synovial fluid were measured. MMPs or tissue inhibitor of MMPs (TIMPs) with periostin in cultured cells were measured when periostin was added to OA-associated synovial cells. Dexamethasone, a steroid medication which shows immunosuppressive effects, was used to investigate the influence of the downstream cascade. RESULTS Periostin and IL-13 levels were up-regulated during the progression of OA. MMP-2 and MMP-3 levels increased in a periostin concentration-dependent manner. Increase in MMP-2 and MMP-3 levels was inhibited by dexamethasone treatment. CONCLUSION In vivo results herein indicate that IL-13 may induce periostin production in OA. Furthermore, periostin may facilitate MMP production in OA-associated synovial cells.
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Affiliation(s)
- Yutaro Tajika
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Tatsuya Moue
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Shintaro Ishikawa
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhito Asano
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Takayuki Okumo
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Hiroshi Takagi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Tadashi Hisamitsu
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
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115
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Poddar SK, Widstrom L. Nonoperative Options for Management of Articular Cartilage Disease. Clin Sports Med 2017; 36:447-456. [PMID: 28577705 DOI: 10.1016/j.csm.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nonoperative options for articular cartilage injury are pervasive but have not shown to be curative. Recommendations for low-impact exercise and weight loss provide benefit and are a foundation for the treatment of osteoarthritis. Judicious use of NSAIDs and acetaminophen can be appropriate for pain management. Topical NSAIDs may be a treatment option with fewer side effects than its oral counterpart. Additionally, viscosupplementation injections are useful for mild to moderate knee osteoarthritis, whereas short-term pain relief is provided by intra-articular corticosteroid injections. Future studies to individualize treatment options based on patient phenotype and genotype may hold promise.
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Affiliation(s)
- Sourav K Poddar
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Luke Widstrom
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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116
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Waterbrook AL, Balcik BJ, Goshinska AJ. Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review. Sports Health 2017; 9:372-374. [PMID: 28394710 PMCID: PMC5496704 DOI: 10.1177/1941738117702585] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Diabetes mellitus (DM) has become an epidemic in the United States and is associated with increased risk of multiple comorbidities, including painful musculoskeletal conditions. A common treatment for many of these painful musculoskeletal conditions is local soft tissue and intra-articular corticosteroid injection (CSI). These local injections have the potential to cause elevated blood glucose levels (BGLs) and cause complications in patients with DM. Therefore, it was the objective of this investigation to review the currently available evidence that directly addresses the effects of local CSIs used for painful musculoskeletal conditions on BGL in patients with DM. Evidence Acquisition: PubMed, Google Scholar, EMBASE, CINAHL, and Cochrane Review databases were searched with a combination of the terms corticosteroid, glucocorticoid, steroid, injection, musculoskeletal, and diabetes. Search limits included the English language. Bibliographic references from these articles were also examined to identify pertinent literature. Study Design: Clinical review. Level of Evidence: Level 3. Results: Ten studies that met the inclusion criteria were reviewed. All these studies showed significant but transient increases in postinjection BGL after a single local CSI in patients with DM. There were no adverse reactions or complications reported. Conclusion: Single, local soft tissue and intra-articular musculoskeletal CSIs are most likely safe in patients with well-controlled DM.
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Affiliation(s)
- Anna L Waterbrook
- Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
| | - Brenden J Balcik
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
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117
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McCrum C. Therapeutic Review of Methylprednisolone Acetate Intra-Articular Injection in the Management of Osteoarthritis of the Knee - Part 1: Clinical Effectiveness. Musculoskeletal Care 2017; 15:79-88. [PMID: 27297608 DOI: 10.1002/msc.1144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intra-articular (IA) corticosteroid injections are a common approach in the management of osteoarthritis (OA) of the knee. The effectiveness of injections and particular injection products is often discussed and debated in clinical arenas. The following therapeutic review examines the evidence for intra-articular methylprednisolone acetate (MPA) injections in the management of OA knee. A review of research evidence, published guidelines and clinical literature was undertaken following an electronic database and relevant literature search. The review found that there is limited evidence which indicates that a single dose intra-articular MPA injection can provide short to medium term benefits for pain, with less evidence for beneficial effects on function or stiffness. There is heterogeneity across studies and until recently, most studies had only short to medium term follow-up periods, thus limiting the evidence available on longer term benefit. There was also evidence indicating equivalent overall efficacy of MPA to that of other corticosteroid products. Most guideline recommendations concerning IA injections for OA knee have drawn on evidence from pooled data for several corticosteroid products. The review also found there was limited reporting of the incidence of adverse events in most studies. Overall, MPA shows efficacy for symptom relief in OA knee. At an individual management level, evidence for a limited duration of effect needs consideration in injections decisions. Furthermore, consensus across clinical guidelines suggests that the management of OA knee should be individualized to a person's clinical history, degree of disability, risk factors, quality of life and personal preferences, whereby injecting involves a shared decision and forms part of a multimodal approach. Copyright © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Carol McCrum
- East Sussex Healthcare NHS Trust, Eastbourne, UK
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118
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Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A. Platelet-Rich Plasma Injections for Advanced Knee Osteoarthritis: A Prospective, Randomized, Double-Blinded Clinical Trial. Orthop J Sports Med 2017; 5:2325967116689386. [PMID: 28255569 PMCID: PMC5315239 DOI: 10.1177/2325967116689386] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Intra-articular injections of platelet-rich plasma (PRP) to treat symptoms of knee osteoarthritis (OA) have been successfully used in young patients and in the early stages of disease. No previous studies have analyzed outcomes of PRP injections during the late stages. Hypothesis: PRP reduces pain and leads to a more effective and lasting functional recovery than corticosteroid with local anesthetic. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 75 patients with symptomatic knee OA (Kellgren-Lawrence grade 3 to 4) were enrolled in this study between August 2013 and July 2014. Patients were randomized to treatment either with a single leukocyte-reduced PRP or corticosteroid intra-articular injection. The primary variable was visual analog scale assessment at 1 month. Secondary outcomes were the Knee injury and Osteoarthritis Outcome Score (KOOS) and Short Form–36 (SF-36) at 1, 3, and 6 months after treatment. Patient satisfaction at final follow-up was assessed. Both groups were homogeneous and comparable in baseline characteristics. Results: All variables improved in both groups. Statistical differences between groups were not found for the majority of the outcome variables, although the magnitude of improvements tended to be greater in the PRP group. Quality-of-life differences between values at 3 and 6 months versus baseline increased significantly more in the study group (P = .05 and .03, respectively), and so did general health perception differences at 6 months (P = .018). Conclusion: A single PRP intra-articular injection is effective for relieving pain and improving activities of daily living and quality of life in late-stage knee OA. For patients with late-stage knee OA who are 67 years or older, 1 intra-articular injection of PRP has similar results to 1 shot of corticosteroid.
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Affiliation(s)
- Nayana Joshi Jubert
- Hospital Universitari Vall d’Hebron, Servei de Cirurgia Ortopèdica i Traumatologia, Unitat del Genoll, Universitat Autònoma de Barcelona, Barcelona, Spain
- Nayana Joshi Jubert, MD, PhD, Hospital Universitari Vall d’Hebron, Servei de Cirurgia Ortopèdica i Traumatologia, Unitat del Genoll, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Catalunya, Spain ()
| | - Luciano Rodríguez
- Advanced Therapies Division, Banc de Sang i Teixits, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Mercedes Reverté-Vinaixa
- Hospital Universitari Vall d’Hebron, Servei de Cirurgia Ortopèdica i Traumatologia, Unitat del Genoll, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aurora Navarro
- Banc de Sang i Teixits, Universitat Autònoma de Barcelona, Barcelona, Spain
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119
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Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis - an observational study. BMC Musculoskelet Disord 2017; 18:44. [PMID: 28122535 PMCID: PMC5267419 DOI: 10.1186/s12891-017-1401-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023] Open
Abstract
Background Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic observational study, using ultrasound (US) to verify accuracy of IACI. Methods 105 subjects with KOA (mean age 63.1 years, 59% female) routinely referred for IACI underwent assessment of demographic factors, x-ray and US of the knee before aspiration and IACI (based on clinical landmarks) with 40 mg triamcinolone acetonide with lignocaine plus a small amount of atmospheric air by an independent physician. US demonstration of intra-articular mobile air, i.e. a positive air arthrosonogram, was used to determine accurate placement of injection. Both patients and injecting physicians were blind to the US findings. Pain at baseline, three and nine weeks post injection was assessed using the 500 mm WOMAC pain subscale and response defined as ≥ 40% reduction in pain from baseline. Inter-observer reliability of air-arthrosonogram assessment was good: κ 0.79 (three raters). Results Sixty-three subjects (60.6%) were responders at three weeks and 43 (45.7%) at nine weeks. Seventy-four subjects (70.5%) had a positive arthrosonogram. A positive air arthrosonogram did not associate with a higher rate of response to treatment (p 0.389 at three weeks, p 0.365 at nine weeks). There was no difference in US effusion depth, power Doppler signal or radiographic grade between responders and non-responders to the injection, but female gender associated with response at 3 weeks and previous injection with non-response at 9 weeks. Conclusions Accurate intra-articular injection of corticosteroid results did not result in superior outcome in terms of pain compared to inaccurate injection in symptomatic knee OA.
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Sandker MJ, Duque LF, Redout EM, Chan A, Que I, Löwik CWGM, Klijnstra EC, Kops N, Steendam R, van Weeren R, Hennink WE, Weinans H. Degradation, intra-articular retention and biocompatibility of monospheres composed of [PDLLA-PEG-PDLLA]-b-PLLA multi-block copolymers. Acta Biomater 2017; 48:401-414. [PMID: 27816621 DOI: 10.1016/j.actbio.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/02/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
In this study, we investigated the use of microspheres with a narrow particle size distribution ('monospheres') composed of biodegradable poly(DL-lactide)-PEG-poly(DL-lactide)-b-poly(L-lactide) multiblock copolymers that are potentially suitable for local sustained drug release in articular joints. Monospheres with sizes of 5, 15 and 30μm and a narrow particle size distribution were prepared by a micro-sieve membrane emulsification process. During in vitro degradation, less crystallinity, higher swelling and accelerated mass loss during was observed with increasing the PEG content of the polymer. The monospheres were tested in both a small (mice/rat) and large animal model (horse). In vivo imaging after injection with fluorescent dye loaded microspheres in mice knees showed that monospheres of all sizes retained within the joint for at least 90days, while the same dose of free dye redistributed to the whole body within the first day after intra-articular injection. Administration of monospheres in equine carpal joints caused a mild transient inflammatory response without any clinical signs and without degradation of the cartilage, as evidenced by the absence of degradation products of sulfated glycosaminoglycans or collagen type 2 in the synovial fluid. The excellent intra-articular biocompatibility was confirmed in rat knees, where μCT-imaging and histology showed neither changes in cartilage quality nor quantity. Given the good intra-articular retention and the excellent biocompatibility, these novel poly(DL-lactide)-PEG-poly(DL-lactide)-b-poly(L-lactide)-based monospheres can be considered a suitable platform for intra-articular drug delivery. STATEMENT OF SIGNIFICANCE This paper demonstrates the great potential in intra-articular drug delivery of monodisperse biodegradable microspheres which were prepared using a new class of biodegradable multi-block copolymers and a unique membrane emulsification process allowing the preparation of microspheres with a narrow particle size distribution (monospheres) leading to multiple advantages like better injectability, enhanced reproducibility and predictability of the in vivo release kinetics. We report not only on the synthesis and preparation, but also in vitro characterization, followed by in vivo testing of intra-articular biocompatibility of the monospheres in both a small and a large animal model. The favourable intra-articular biocompatibility combined with the prolonged intra-articular retention (>90days) makes these monospheres an interesting drug delivery platform. What should also be highlighted is the use of horses; a very accurate translational model for the human situation, making the results not only relevant for equine healthcare, but also for the development of novel human OA therapies.
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Affiliation(s)
- Maria J Sandker
- Department of Orthopaedics, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Luisa F Duque
- InnoCore Pharmaceuticals, L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands.
| | - Everaldo M Redout
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80163, 3508 TD Utrecht, The Netherlands.
| | - Alan Chan
- Percuros B.V., P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Ivo Que
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Clemens W G M Löwik
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Evelien C Klijnstra
- InnoCore Pharmaceuticals, L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands.
| | - Nicole Kops
- Department of Orthopaedics, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Rob Steendam
- InnoCore Pharmaceuticals, L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands.
| | - Rene van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80163, 3508 TD Utrecht, The Netherlands.
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Postbus 80082, 3508 TB Utrecht, The Netherlands.
| | - Harrie Weinans
- Department of Orthopaedics and Department of Rheumatology, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Biomechanical Engineering TUDelft, Mekelweg 2, 2628 CD Delft, The Netherlands.
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Moue T, Tajika Y, Ishikawa S, Kanada Y, Okumo T, Asano K, Hisamitsu T. Influence of IL13 on Periostin Secretion by Synoviocytes in Osteoarthritis. In Vivo 2017; 31:79-85. [PMID: 28064224 PMCID: PMC5354151 DOI: 10.21873/invivo.11028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/29/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Our previous research provided evidence of periostin increase in parallel with interleukin-13 (IL13) increase in the synovial fluid of patients with osteoarthritis (OA). The reaction cascade from IL13 to periostin, however, remains unidentified. We, therefore, tested the hypothesis that periostin secretion is affected downstream of IL13. MATERIALS AND METHODS OA synoviocytes were cultured under different concentrations of IL13. Periostin content in culture supernatants and the level of signal transducer and activator of transcription 6 (STAT6) in the cultured cells were measured using enzyme-linked immunosorbent assay (ELISA). Moreover, the influence of dexamethasone and leflunomide on periostin production in relation to the effect of IL13 on the cells was also examined. RESULTS Periostin content in culture supernatants and the level of STAT6 in cultured cells were significantly increased by IL13. The increase of periostin was significantly inhibited by dexamethasone and leflunomide. CONCLUSION Periostin may be up-regulated in OA synoviocytes via STAT6 downstream of IL13.
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Affiliation(s)
- Tatsuya Moue
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Yutaro Tajika
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Shintaro Ishikawa
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Yasuaki Kanada
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Takayuki Okumo
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhito Asano
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Tadashi Hisamitsu
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
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122
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Abstract
BACKGROUND Infection after total knee arthroplasty (TKA) can result in disastrous consequences. Previous research regarding injections and risk of TKA infection have produced conflicting results and in general have been limited by small cohort size. QUESTIONS/PURPOSES The purpose of this study was to evaluate if intraarticular injection before TKA increases the risk of postoperative infection and to identify if time between injection and TKA affect the risk of TKA infection. METHODS The Humana data set was reviewed from 2007 to 2014 for all patients who received a knee injection before TKA. Current Procedural Terminology (CPT) codes and laterality modifiers were used to identify patients who underwent knee injection followed by ipsilateral TKA. Postoperative infection within 6 months of TKA was identified using International Classification of Diseases, 9th Revision/CPT codes that represent two infectious endpoints: any postoperative surgical site infection (encompasses all severities of infection) and operative intervention for TKA infection (surrogate for deep TKA infection). The injection cohort was stratified into 12 subgroups by monthly intervals out to 12 months corresponding to the number of months that had elapsed between injection and TKA. Risk of postoperative infection was compared between the injection and no injection cohorts. In total, 29,603 TKAs (35%) had an injection in the ipsilateral knee before the TKA procedure and 54,081 TKA cases (65%) did not. The PearlDiver database does not currently support line-by-line output of patient data, and so we were unable to perform a multivariate analysis to determine whether other important factors may have varied between the study groups that might have had a differential influence on the risk of infection between those groups. However, the Charlson Comorbidity index was no different between the injection and no injection cohorts (2.9 for both) suggesting similar comorbidity profiles between the groups. RESULTS The proportion of TKAs developing any postoperative infection was higher among TKAs that received an injection before TKA than in those that did not (4.4% versus 3.6%; odds ratio [OR], 1.23; 95% confidence interval [CI], 1.15-1.33; p < 0.001). Likewise, the proportion of TKAs developing infection resulting in return to the operating room after TKA was also higher among TKAs that received an injection before TKA than those that did not (1.49% versus 1.04%; OR, 1.4; 95% CI, 1.3-1.63; p < 0.001). Month-by-month analysis of time between injection and TKA revealed the odds of any postoperative infection remained higher for the injection cohort out to a duration of 6 months between injection and TKA (ORs ranged 1.23 to 1.46 when 1-6 months between injection and TKA; p < 0.05 for all) as did the odds of operative intervention for TKA infection when injection occurred within 7 months of TKA (OR ranged from 1.38 to 1.88 when 1-7 months between injection and TKA; p < 0.05 for all). When the duration between injection and TKA was longer than 6 or 7 months, the ORs were no longer elevated at these endpoints, respectively. CONCLUSIONS Injection before TKA was associated with a higher risk of postoperative infection and appears to be time-dependent with closer proximity between injection and TKA having increased odds of infection. Further research is needed to better evaluate the risk injection before TKA poses for TKA infection; a more definitive relationship could be established with a multivariate analysis to control for other known risk factors for TKA infection. LEVEL OF EVIDENCE Level III, therapeutic study.
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Insights on Molecular Mechanisms of Chondrocytes Death in Osteoarthritis. Int J Mol Sci 2016; 17:ijms17122146. [PMID: 27999417 PMCID: PMC5187946 DOI: 10.3390/ijms17122146] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022] Open
Abstract
Osteoarthritis (OA) is a joint pathology characterized by progressive cartilage degradation. Medical care is mainly based on alleviating pain symptoms. Compelling studies report the presence of empty lacunae and hypocellularity in cartilage with aging and OA progression, suggesting that chondrocyte cell death occurs and participates to OA development. However, the relative contribution of apoptosis per se in OA pathogenesis appears complex to evaluate. Indeed, depending on technical approaches, OA stages, cartilage layers, animal models, as well as in vivo or in vitro experiments, the percentage of apoptosis and cell death types can vary. Apoptosis, chondroptosis, necrosis, and autophagic cell death are described in this review. The question of cell death causality in OA progression is also addressed, as well as the molecular pathways leading to cell death in response to the following inducers: Fas, Interleukin-1β (IL-1β), Tumor Necrosis factor-α (TNF-α), leptin, nitric oxide (NO) donors, and mechanical stresses. Furthermore, the protective role of autophagy in chondrocytes is highlighted, as well as its decline during OA progression, enhancing chondrocyte cell death; the transition being mainly controlled by HIF-1α/HIF-2α imbalance. Finally, we have considered whether interfering in chondrocyte apoptosis or promoting autophagy could constitute therapeutic strategies to impede OA progression.
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Aagaard T, Lund H, Juhl C. Optimizing literature search in systematic reviews - are MEDLINE, EMBASE and CENTRAL enough for identifying effect studies within the area of musculoskeletal disorders? BMC Med Res Methodol 2016; 16:161. [PMID: 27875992 PMCID: PMC5120411 DOI: 10.1186/s12874-016-0264-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/14/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND When conducting systematic reviews, it is essential to perform a comprehensive literature search to identify all published studies relevant to the specific research question. The Cochrane Collaborations Methodological Expectations of Cochrane Intervention Reviews (MECIR) guidelines state that searching MEDLINE, EMBASE and CENTRAL should be considered mandatory. The aim of this study was to evaluate the MECIR recommendations to use MEDLINE, EMBASE and CENTRAL combined, and examine the yield of using these to find randomized controlled trials (RCTs) within the area of musculoskeletal disorders. METHODS Data sources were systematic reviews published by the Cochrane Musculoskeletal Review Group, including at least five RCTs, reporting a search history, searching MEDLINE, EMBASE, CENTRAL, and adding reference- and hand-searching. Additional databases were deemed eligible if they indexed RCTs, were in English and used in more than three of the systematic reviews. Relative recall was calculated as the number of studies identified by the literature search divided by the number of eligible studies i.e. included studies in the individual systematic reviews. Finally, cumulative median recall was calculated for MEDLINE, EMBASE and CENTRAL combined followed by the databases yielding additional studies. RESULTS Deemed eligible was twenty-three systematic reviews and the databases included other than MEDLINE, EMBASE and CENTRAL was AMED, CINAHL, HealthSTAR, MANTIS, OT-Seeker, PEDro, PsychINFO, SCOPUS, SportDISCUS and Web of Science. Cumulative median recall for combined searching in MEDLINE, EMBASE and CENTRAL was 88.9% and increased to 90.9% when adding 10 additional databases. CONCLUSION Searching MEDLINE, EMBASE and CENTRAL was not sufficient for identifying all effect studies on musculoskeletal disorders, but additional ten databases did only increase the median recall by 2%. It is possible that searching databases is not sufficient to identify all relevant references, and that reviewers must rely upon additional sources in their literature search. However further research is needed.
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Affiliation(s)
- Thomas Aagaard
- Department of Physiotherapy, Holbaek University Hospital, Holbaek, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Center for Evidence-based practice, Bergen University College, Bergen, Norway
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Rehabilitation, Copenhagen University Hospital, Herlev, Gentofte, Denmark
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Hung CY, Hsiao MY, Chang KV, Han DS, Wang TG. Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis. J Pain Res 2016; 9:847-857. [PMID: 27799816 PMCID: PMC5079700 DOI: 10.2147/jpr.s118669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Increasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales. METHODS PubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose prolotherapy, comparative regimens, and exercise 6 months after the initial injection. RESULTS Regarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14-1.17), 0.84 (95% CI, 0.40-1.27), 0.85 (95% CI, 0.60-1.10), and 0.87 (95% CI, 0.53-1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10-0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07-0.70) and exercise (effect size, 0.71; 95% CI, 0.30-1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, -0.18 to 0.80) which was only estimated from one study. CONCLUSION Dextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose-response relationship following serial injections. Dextrose prolotherapy was found to provide a better therapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ming-Yen Hsiao
- National Taiwan University College of Medicine, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- National Taiwan University College of Medicine, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Background Local treatments to alleviate symptoms in hand osteoarthritis (OA) are preferred, especially in elderly patients with comorbidities. Therefore, we have summarized the benefits and harms of intra-articular (IA) therapies. Methods We conducted a systematic literature review until May 2015, including all controlled trials investigating efficacy or safety of any IA therapy in carpometacarpal (CMC) and interphalangeal (IP) OA compared with placebo
or other treatments. Two authors independently selected trials and assessed risk of bias using the Cochrane tool. The main efficacy outcome was pain. We performed meta-analysis where appropriate. Results A total of 13 trials (864 patients) studying CMC (n = 11) and IP OA (n = 2) were included, comparing corticosteroids or hyaluronic acid (HA) versus placebo (n = 4 and n = 3), and corticosteroids versus HA (n = 6). Single studies investigated infliximab, dextrose, and different HAs. The overall risk of bias was unclear or high in most trials. Meta-analysis of two trials comparing corticosteroids with placebo in CMC OA showed no improvement in pain [mean difference −3.56, 95 % confidence interval (CI) −13.87 to 6.75, scale 0–100). HA also appeared not efficacious compared with placebo in CMC OA. One trial comparing corticosteroids with placebo in IP OA demonstrated significantly improved pain during movement. No convincing evidence for efficacy of corticosteroids or HA over the other or alternative therapies was found. Only local adverse events were reported. No specific IA therapy appeared more harmful than another. Conclusion Despite a beneficial short-term safety profile, IA corticosteroids or HA do not appear more effective than placebo in CMC OA. The suggestion that IA corticosteroids might be efficacious in IP OA requires confirmation. Electronic supplementary material The online version of this article (doi:10.1007/s40266-015-0330-5) contains supplementary material, which is available to authorized users.
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Glucocorticoid-induced leucine zipper (GILZ) is involved in glucocorticoid-induced and mineralocorticoid-induced leptin production by osteoarthritis synovial fibroblasts. Arthritis Res Ther 2016; 18:219. [PMID: 27716396 PMCID: PMC5050640 DOI: 10.1186/s13075-016-1119-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/13/2016] [Indexed: 01/09/2023] Open
Abstract
Background Glucocorticoid-induced leucine zipper (GILZ) is a mediator of the anti-inflammatory activities of glucocorticoids. However, GILZ deletion does not impair the anti-inflammatory activities of exogenous glucocorticoids in mice arthritis models and GILZ could also mediate some glucocorticoid-related adverse events. Osteoarthritis (OA) is a metabolic disorder that is partly attributed to adipokines such as leptin, and we previously observed that glucocorticoids induced leptin secretion in OA synovial fibroblasts. The purpose of this study was to position GILZ in OA through its involvement in the anti-inflammatory activities of glucocorticoids and/or in the metabolic pathway of leptin induction. The influences of mineralocorticoids on GILZ and leptin expression were also investigated. Methods Human synovial fibroblasts were isolated from OA patients during knee replacement surgery. Then, the cells were treated with a glucocorticoid (prednisolone), a mineralocorticoid (aldosterone), a glucocorticoid receptor (GR) antagonist (mifepristone), a selective glucocorticoid receptor agonist (Compound A), mineralocorticoid receptor (MR) antagonists (eplerenone and spironolactone), TNF-α or transforming growth factor (TGF)-β. Cells were transfected with shRNA lentiviruses for the silencing of GILZ and GR. The leptin, IL-6, IL-8 and matrix metalloproteinase (MMP)-1 levels were measured by ELISA. Leptin, the leptin receptor (Ob-R), GR and GILZ expression levels were analyzed by western blotting and/or RT-qPCR. Results (1) The glucocorticoid prednisolone and the mineralocorticoid aldosterone induced GILZ expression dose-dependently in OA synovial fibroblasts, through GR but not MR. Similar effects on leptin and Ob-R were observed: leptin secretion and Ob-R expression were also induced by prednisolone and aldosterone through GR; (2) GILZ silencing experiments demonstrated that GILZ was involved in the glucocorticoid-induced and mineralocorticoid-induced leptin secretion and Ob-R expression in OA synovial fibroblasts; and (3) GILZ inhibition did not alter the production of pro-inflammatory cytokines by OA synovial fibroblast or the anti-inflammatory properties of glucocorticoids. Conclusions The absence of GILZ prevents corticoid-induced leptin and Ob-R expression without affecting the anti-inflammatory properties of glucocorticoids in OA synovial fibroblasts. Mineralocorticoids also induce leptin and Ob-R expression through GILZ.
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Cartilage repair strategies in the knee: A survey of Turkish surgeons. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:533-538. [PMID: 27876261 PMCID: PMC6197306 DOI: 10.1016/j.aott.2016.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/14/2016] [Accepted: 12/25/2015] [Indexed: 11/21/2022]
Abstract
Objectives The purpose of this study was to analyze the trends in cartilage repair strategies among Turkish orthopedic surgeons for isolated focal (osteo)chondral lesions of the knee joint. Materials and methods A web-based survey of 21 questions consisting of surgical indications, techniques and time to return to sports was developed to investigate the preferences of members of the TOTBID and the TUSYAD. Results A total of 147 surgeons answered the questionnaire.70% of the respondents were TUSYAD members. 82% of respondents had at least five years experience in arthroscopy. Half of the surgeons indicated that patient age of 50 was the upper limit for cartilage repair. Irrespective of activity level, microfracture (60–67%) was the most frequently used technique for lesions smaller 2.5 cm2. In lesions larger than 4 cm2, MACI was the most commonly advocated procedure (67%). In patients with high activity levels, mosaicplasty was the first choice (69%) for lesions between 2.5 and 4 cm2 in size, followed by MACI (27%). Conclusion Patient age, activity level, BMI and lesion size were important determinants for the choice of treatment of isolated chondral lesions in the knee. These results reflect the choices of experienced knee surgeons in the country. Although not widely performed in Turkey and has limited reimbursement by the health care system, the first choice for defects over 4 cm2 was second generation ACI. Third party payers & health reimbursement authorities should take into account that large defects require methods which are relatively expensive and need high technology. Cross-sectional survey, Level II.
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Conrozier T, Eymard F, Afif N, Balblanc JC, Legré-Boyer V, Chevalier X. Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis: Results of a double-blind, controlled, multicenter, randomized trial. Knee 2016; 23:842-8. [PMID: 27353769 DOI: 10.1016/j.knee.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare both safety and efficacy of a novel intra-articular viscosupplement made of intermediate molecular weight (MW) hyaluronic acid (HA) mixed with high concentration of mannitol with a marketed high MW HA, in patients with knee osteoarthritis (OA). METHODS Patients with symptomatic knee OA, with radiological OARSI grades 1 to 3, were enrolled in a controlled, double-blind, parallel-group, non-inferiority trial. They were randomized to receive three intra-articular injections, at weekly intervals, of either HAnOX-M made of a combination of HA (MW one to 1.5MDa, 31mg/2ml) and mannitol (70mg/2ml) or Bio-HA (MW 2.3 to 3.6MDa, 20mg/2ml). The primary outcome was six-month change in the WOMAC pain subscale (0 to 20). Sample size was calculated according to a non-inferiority margin of 1.35. Secondary endpoints included six-month change in function and walking pain, analgesic consumption and safety. RESULTS The intention-to-treat (ITT) and per-protocol (PP) populations consisted of 205 and 171 patients. HAnOX-M and Bio-Ha groups did not differ statistically at baseline. The primary analysis was conducted in the PP population, then in the ITT population. The average WOMAC pain score at baseline was 9.5 in both groups. Mean (SD) variations in WOMAC pain score were -4.4 (3.8) and -4.5 (4.3) mm, for HAnOX and Bio-HA respectively, satisfying the claim for non-inferiority. Similar results were obtained for all other secondary endpoints. CONCLUSION Treatment with of HAnOX-M is effective to alleviate knee OA symptoms and to improve joint function over six months, with similar safety than conventional HA viscosupplement.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France.
| | - Florent Eymard
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - Naji Afif
- Department of Rheumatology, Hôpital Emile Muller, Mulhouse, France
| | | | - Virginie Legré-Boyer
- Institut de l'Appareil Locomoteur Nollet, Paris, France; Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Xavier Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France; Paris XII University, UPEC, France
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130
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Abstract
Pain related to various musculoskeletal conditions is a common patient complaint, and one that is often difficult to remedy. In addition to oral analgesics and physical therapy, local injections (most commonly of corticosteroids) are a common intervention and have been for decades. However, in most cases, the literature is full of poor-quality studies, making the true utility of these injections questionable. This article reviews some of the literature studying these injections with the goal of providing clinicians the information to make evidence-based, high-value choices.
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Affiliation(s)
- Robert K Cato
- Penn Presbyterian Medical Center, 51 North 29th Street, Medical Arts Building, Suite 102, Philadelphia, PA 19104, USA.
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132
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Abdullah M, Mahowald ML, Frizelle SP, Dorman CW, Funkenbusch SC, Krug HE. The effect of intra-articular vanilloid receptor agonists on pain behavior measures in a murine model of acute monoarthritis. J Pain Res 2016; 9:563-70. [PMID: 27574462 PMCID: PMC4993562 DOI: 10.2147/jpr.s107385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Arthritis is the most common cause of disability in the US, and the primary manifestation of arthritis is joint pain that leads to progressive physical limitation, disability, morbidity, and increased health care utilization. Capsaicin (CAP) is a vanilloid agonist that causes substance P depletion by interacting with vanilloid receptor transient receptor potential V1 on small unmyelinated C fibers. It has been used topically for analgesia in osteoarthritis with variable success. Resiniferatoxin (RTX) is an ultra potent CAP analog. The aim of this study was to measure the analgesic effects of intra-articular (IA) administration of CAP and RTX in experimental acute inflammatory arthritis in mice. Evoked pain score (EPS) and a dynamic weight bearing (DWB) device were used to measure nociceptive behaviors in a murine model of acute inflammatory monoarthritis. A total of 56 C57B16 male mice underwent EPS and DWB testing – 24 nonarthritic controls and 32 mice with carrageenan-induced arthritis. The effects of pretreatment with 0.1% CAP, 0.0003% RTX, or 0.001% RTX were measured. Nociception was reproducibly demonstrated by increased EPS and reduced DWB measures in the affected limb of arthritic mice. Pretreatment with 0.001% RTX resulted in statistically significant improvement in EPS and DWB measures when compared with those observed in carrageenan-induced arthritis animals. Pretreatment with IA 0.0003% RTX and IA 0.01% CAP resulted in improvement in some but not all of these measures. The remaining 24 mice underwent evaluation following treatment with 0.1% CAP, 0.0003% RTX, or 0.001% RTX, and the results obtained were similar to that of naïve, nonarthritic mice.
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Affiliation(s)
- Mishal Abdullah
- Department of Medicine, Rheumatology Fellowship Training Program, University of Minnesota Medical School
| | - Maren L Mahowald
- Department of Medicine, Minneapolis Veterans' Affairs Health Care System
| | - Sandra P Frizelle
- Department of Medicine, Minneapolis Veterans' Affairs Health Care System
| | | | | | - Hollis E Krug
- Department of Medicine, Minneapolis Veterans' Affairs Health Care System; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Chronic pain in older patients is often treated with pain medications, physical rehabilitation, interventional pain management, and/or psychological interventions. The administration of pain medications is the most common form of chronic pain treatment. Physiologic changes in older adults make them more susceptible to the potential side effects of oral pain medications, especially opioids. Interventional pain management offers an alternative treatment option. This article reviews some of the interventional techniques used to treat the most common sites of pain in older adults: back, knee, and hip.
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Affiliation(s)
- Amber K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
| | - Mercy A Udoji
- Department of Anesthesiology, Interventional Pain Management, VA Medical Center, Atlanta, GA, USA
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134
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Use non-pharmacological and pharmacological interventions before considering surgery in elderly patients with knee osteoarthritis. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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135
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Deveza LA, Hunter DJ. Pain Relief for an Osteoarthritic Knee in the Elderly: A Practical Guide. Drugs Aging 2016; 33:11-20. [PMID: 26659733 DOI: 10.1007/s40266-015-0331-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In view of the increasing prevalence of knee osteoarthritis (OA) in the population worldwide, optimal management is critical to decrease the burden of this condition and minimize disability and personal suffering. Current care is based on a sequence of non-pharmacological, pharmacological, and surgical modalities, targeted to improving pain and function in the elderly population. The aim of this article is to provide a practical view of the efficacy of therapeutic options available along with clinically relevant considerations on the management of knee OA in this demographic group.
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Affiliation(s)
- Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia.
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Bamman MM, Wick TM, Carmona-Moran CA, Bridges SL. Exercise Medicine for Osteoarthritis: Research Strategies to Maximize Effectiveness. Arthritis Care Res (Hoboken) 2016; 68:288-91. [PMID: 26239196 DOI: 10.1002/acr.22680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/16/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Marcas M Bamman
- University of Alabama at Birmingham Center for Exercise Medicine and Comprehensive Arthritis, Musculoskeletal, Bone, and Autoimmunity Center, and Birmingham VA Medical Center
| | - Timothy M Wick
- University of Alabama at Birmingham Center for Exercise Medicine, BioMatrix Engineering and Regenerative Medicine Center, and Comprehensive Arthritis, Musculoskeletal, Bone, and Autoimmunity Center, Birmingham
| | | | - S Louis Bridges
- University of Alabama at Birmingham Center for Exercise Medicine, BioMatrix Engineering and Regenerative Medicine Center, and Comprehensive Arthritis, Musculoskeletal, Bone, and Autoimmunity Center, Birmingham
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McDowell M, Rebitschek FG, Gigerenzer G, Wegwarth O. A Simple Tool for Communicating the Benefits and Harms of Health Interventions: A Guide for Creating a Fact Box. MDM Policy Pract 2016; 1:2381468316665365. [PMID: 30288405 PMCID: PMC6125040 DOI: 10.1177/2381468316665365] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
One of the major hurdles to promoting informed decision making in health is the continued use of poor risk presentation formats. This article offers a guide to develop a Fact Box, a simple decision tool to present data about the benefits and harms of treatments that has been demonstrated to improve understanding of health risks, an important part of risk literacy. The article offers guidance about how to determine the evidence basis for a health topic, select outcomes to report, extract and present numbers or outcomes, and design the layout. The guide also addresses potential challenges for summarizing evidence and provides alternatives for addressing issues related to missing, insufficient, imprecise, or conflicting evidence and for dealing with issues related to statistical and clinical significance. The guide concludes with details on how to document the development of the Fact Box for the purpose of transparency and reproducibility. Fact Boxes are an efficient tool to promote risk literacy and should be available in every physician's office.
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Affiliation(s)
- Michelle McDowell
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Felix G. Rebitschek
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Gerd Gigerenzer
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Odette Wegwarth
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
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Bauer C, Berger M, Baumgartner RR, Höller S, Zwickl H, Niculescu-Morzsa E, Halbwirth F, Nehrer S. A Novel Cross-Linked Hyaluronic Acid Porous Scaffold for Cartilage Repair: An In Vitro Study With Osteoarthritic Chondrocytes. Cartilage 2016; 7:265-73. [PMID: 27375842 PMCID: PMC4918062 DOI: 10.1177/1947603515611949] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE An important feature of biomaterials used in cartilage regeneration is their influence on the establishment and stabilization of a chondrocytic phenotype of embedded cells. The purpose of this study was to examine the effects of a porous 3-dimensional scaffold made of cross-linked hyaluronic acid on the expression and synthesis performance of human articular chondrocytes. MATERIALS AND METHODS Osteoarthritic chondrocytes from 5 patients with a mean age of 74 years were passaged twice and cultured within the cross-linked hyaluronic acid scaffolds for 2 weeks. Analyses were performed at 3 different time points. For estimation of cell content within the scaffold, DNA-content (CyQuant cell proliferation assay) was determined. The expression of chondrocyte-specific genes by embedded cells as well as the total amount of sulfated glycosaminoglycans produced during the culture period was analyzed in order to characterize the synthesis performance and differentiation status of the cells. RESULTS Cells showed a homogenous distribution within the scaffold. DNA quantification revealed a reduction of the cell number. This might be attributed to loss of cells from the scaffold during media exchange connected with a stop in cell proliferation. Indeed, the expression of cartilage-specific genes and the production of sulfated glycosaminoglycans were increased and the differentiation index was clearly improved. CONCLUSIONS These results suggest that the attachment of osteoarthritic P2 chondrocytes to the investigated material enhanced the chondrogenic phenotype as well as promoted the retention.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria,Christoph Bauer, Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, 3500, Austria.
| | - Manuela Berger
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | | | | | - Hannes Zwickl
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Eugenia Niculescu-Morzsa
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Florian Halbwirth
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
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Hartmann K, Koenen M, Schauer S, Wittig-Blaich S, Ahmad M, Baschant U, Tuckermann JP. Molecular Actions of Glucocorticoids in Cartilage and Bone During Health, Disease, and Steroid Therapy. Physiol Rev 2016; 96:409-47. [PMID: 26842265 DOI: 10.1152/physrev.00011.2015] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cartilage and bone are severely affected by glucocorticoids (GCs), steroid hormones that are frequently used to treat inflammatory diseases. Major complications associated with long-term steroid therapy include impairment of cartilaginous bone growth and GC-induced osteoporosis. Particularly in arthritis, GC application can increase joint and bone damage. Contrarily, endogenous GC release supports cartilage and bone integrity. In the last decade, substantial progress in the understanding of the molecular mechanisms of GC action has been gained through genome-wide binding studies of the GC receptor. These genomic approaches have revolutionized our understanding of gene regulation by ligand-induced transcription factors in general. Furthermore, specific inactivation of GC signaling and the GC receptor in bone and cartilage cells of rodent models has enabled the cell-specific effects of GCs in normal tissue homeostasis, inflammatory bone diseases, and GC-induced osteoporosis to be dissected. In this review, we summarize the current view of GC action in cartilage and bone. We further discuss future research directions in the context of new concepts for optimized steroid therapies with less detrimental effects on bone.
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Affiliation(s)
- Kerstin Hartmann
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Mascha Koenen
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Schauer
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Wittig-Blaich
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Mubashir Ahmad
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Baschant
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Jan P Tuckermann
- Institute for Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany; and Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
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Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1775-85. [PMID: 27043347 DOI: 10.1007/s00167-016-4089-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.
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Intra-Articular Injection of Cross-Linked Hyaluronic Acid-Dexamethasone Hydrogel Attenuates Osteoarthritis: An Experimental Study in a Rat Model of Osteoarthritis. Int J Mol Sci 2016; 17:411. [PMID: 27092487 PMCID: PMC4848885 DOI: 10.3390/ijms17040411] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 01/28/2023] Open
Abstract
Cross-linked hyaluronic acid hydrogel (cHA gel) and dexamethasone (Dex) have been used to treat knee osteoarthritis (OA) in clinical practice owing to their chondroprotective and anti-inflammatory effects, respectively. The aim of the present study was to compare the treatment effects of the cHA gel pre-mixed with/without Dex in a surgery-induced osteoarthritis model in rats. Anterior cruciate ligament transection (ACLT) surgery was performed on the right knee of rats to induce OA. Male 2-month-old Sprague-Dawley rats were randomly divided into five groups (n = 10/per group): (1) ACLT + saline; (2) ACLT + cHA gel; (3) ACLT + cHA-Dex (0.2 mg/mL) gel; (4) ACLT + cHA-Dex (0.5 mg/mL) gel; (5) Sham + saline. Intra-joint injections were performed four weeks after ACLT in the right knee. All animals were euthanized at 12 weeks post-surgery. Cartilage damage and changes in the synovial membrane were assessed by micro X-ray, Indian ink articular surface staining, Safranin-O/Fast Green staining, immunohistochemistry, hematoxylin and eosin staining of the synovial membrane, and quantitative reverse transcription-polymerase chain reaction for changes in gene expression. Micro X-ray revealed that the knee joint treated with the cHA-Dex gel was wider than those treated with cHA gel alone or saline. The cHA-Dex gel group had less Indian ink staining (indicator of cartilage fibrillation) than the cHA gel or saline injection groups. Safranin-O/Fast Green staining indicated that increased proteoglycan staining and less cartilage damage were found in the cHA-Dex gel group compared with the cHA gel or saline injection groups. Quantification of histology findings from saline, cHA gel, cHA-Dex (0.2 mg/mL) gel, cHA-Dex (0.5 mg/mL) gel, and sham groups were 5.84 ± 0.29, 4.50 ± 0.87, 3.00 ± 1.00, 2.00 ± 0.48, and 0.30 ± 0.58 (p < 0.05), respectively. A strong staining of type II collagen was found in both the cHA-Dex gel groups compared with saline group or cHA alone group. Similar result was found for the mRNA level of aggrecan and opposite result for type X collagen. Hematoxylin and eosin staining in the synovial membrane showed less synovial lining cell layers and reduced inflammatory cell infiltration in cHA-Dex gel-treated animals compared with saline or cHA only groups. Altogether, cHA-Dex gel has better chondroprotective and anti-inflammatory effects in rat surgery-induced osteoarthritis than cHA alone.
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142
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Johal H, Devji T, Schemitsch EH, Bhandari M. Viscosupplementation in Knee Osteoarthritis: Evidence Revisited. JBJS Rev 2016; 4:e11-e111. [DOI: 10.2106/jbjs.rvw.15.00098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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143
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Deyle GD, Gill NW, Rhon DI, Allen CS, Allison SC, Hando BR, Petersen EJ, Dusenberry DI, Bellamy N. A multicenter randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injection on pain and function related to knee osteoarthritis (PTA Trial). BMJ Open 2016; 6:e010528. [PMID: 27033961 PMCID: PMC4823390 DOI: 10.1136/bmjopen-2015-010528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Corticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months. METHODS AND ANALYSIS We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8-12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups. ETHICS AND DISSEMINATION The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source. TRIAL REGISTRATION NUMBER NCT01427153.
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Affiliation(s)
- Gail D Deyle
- Brooke Army Medical Center, San Antonio, Texas, USA
| | | | - Daniel I Rhon
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | | | - Ben R Hando
- National Defense University, Washington, DC, USA
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Thambiah MD, Nathan S, Seow BZX, Liang S, Lingaraj K. Patient satisfaction after total knee arthroplasty: an Asian perspective. Singapore Med J 2016; 56:259-63. [PMID: 26034317 DOI: 10.11622/smedj.2015074] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems. METHODS The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital's Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient's functional status and the severity of symptoms pre- and postoperatively. RESULTS Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033). CONCLUSION Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores.
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Affiliation(s)
| | - Sahaya Nathan
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Branden Z X Seow
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Krishna Lingaraj
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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145
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Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum 2016; 45:S28-33. [DOI: 10.1016/j.semarthrit.2015.11.008] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 12/24/2022]
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Koenig KM, Ong KL, Lau EC, Vail TP, Berry DJ, Rubash HE, Kurtz S, Bozic KJ. The Use of Hyaluronic Acid and Corticosteroid Injections Among Medicare Patients With Knee Osteoarthritis. J Arthroplasty 2016; 31:351-5. [PMID: 26421601 DOI: 10.1016/j.arth.2015.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/06/2015] [Accepted: 08/24/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hyaluronic acid (HA) and corticosteroid (CS) injections are frequently used in the management of osteoarthritis (OA) of the knee, despite a lack of strong evidence supporting their efficacy in the literature. The purpose of this study is to evaluate trends in HA and CS usage in Medicare patients over the past 15 years. METHODS The Medicare 5% national sample database was used to identify 581,022 patients (representing an estimated 11.6 million) with a diagnosis of knee OA between 1999 and 2013. RESULTS The percentage of newly diagnosed knee OA patients who received any injection trended from 39% in 1999 to 47% in 2006 and then declined to 37.5% in 2013. However, the mean number of injections per newly diagnosed OA patient nearly doubled from 0.27 to 0.45 for CS and from 0.18 to 0.36 for HA. Among those having both HA and CS injections, 69% had CS as first-line treatment, whereas 31% had HA first. CONCLUSION The percentage of newly diagnosed knee OA patients receiving injections peaked in 2007 and then decreased steadily through 2013, as did the proportion of patients receiving HA injections as first-line therapy. However, the number of injections per patient has increased significantly over the past 15 years in both groups.
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Affiliation(s)
- Karl M Koenig
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Daniel J Berry
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Harry E Rubash
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven Kurtz
- Exponent, Inc, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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147
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Lee YK, Choi JK, Kang YJ, Kim HW, Kim SW, Park CK, Khang D, Kim SH. Triamcinolone–carbon nanotube conjugation inhibits inflammation of human arthritis synovial fibroblasts. J Mater Chem B 2016; 4:1660-1671. [DOI: 10.1039/c5tb01693b] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Repetitive intra-articular corticosteroid injections are inevitable for treating synovial inflammation in advanced arthritis.
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Affiliation(s)
- Yeon Kyung Lee
- Department of Molecular Medicine
- School of Medicine
- Gachon University
- Incheon 406-840
- South Korea
| | - Jin Kyeong Choi
- CMRI
- Department of Pharmacology
- School of Medicine
- Kyungpook National University
- Daegu 700-422
| | - Youn Joo Kang
- Department of Rehabilitation Medicine
- School of Medicine
- Eulji Hospital
- Eulji University
- Seoul 139-872
| | - Hye Won Kim
- Division of Rheumatology
- School of Medicine
- Eulji Hospital
- Eulji University
- Seoul 139-872
| | - Sang-Woo Kim
- Department of Molecular Medicine
- School of Medicine
- Gachon University
- Incheon 406-840
- South Korea
| | - Chul-Kyu Park
- Department of Physiology
- School of Medicine
- Gachon University
- Incheon 406-840
- South Korea
| | - Dongwoo Khang
- Department of Molecular Medicine
- School of Medicine
- Gachon University
- Incheon 406-840
- South Korea
| | - Sang-Hyun Kim
- CMRI
- Department of Pharmacology
- School of Medicine
- Kyungpook National University
- Daegu 700-422
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Effect of particle size on the biodistribution of nano- and microparticles following intra-articular injection in mice. Int J Pharm 2015; 498:119-29. [PMID: 26685724 DOI: 10.1016/j.ijpharm.2015.12.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/13/2015] [Accepted: 12/07/2015] [Indexed: 12/22/2022]
Abstract
Intra-articular (IA) injection of extended drug release forms based on biodegradable microparticles holds promise for the treatment of joint diseases. However, the fate of microparticles following intra-articular injection is controversial and has not been thoroughly investigated. The aim of this work was therefore to evaluate the biodistribution of fluorescent poly(lactic acid) particles of different sizes after IA injection in arthritic or healthy mice. Regardless of the inflammatory status of the joint, 300 nm-nanoparticles leaked from the joint. Due to inflammation and related increase of vascular permeability, 3 μm-microparticles that were retained in the non-inflamed synovial membrane leaked from the inflamed joint. Complete retention of 10 μm-microparticles was observed independently of the joint inflammatory status. Embedding particles in a hyaluronic acid gel prolonged the retention of the formulations only in inflamed joints. Depending on particle's size, formulations were preferentially eliminated by blood vessels or lymphatic pathways. Poly(lactic acid) particles of 3 μm were biocompatible and retained in knee joints at least for 6 weeks. This work highlights the need to deliver hyaluronic acid-embedded particles of at least 3 μm to guarantee their retention in inflamed joints. These results will contribute to the rational design of long-lasting formulations to treat acute and chronic joint diseases.
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Abstract
With the aging of the world's population, the prevalence of age-related diseases is continually increasing, especially osteoarthritis, the most common form of joint disease. In addition to its high prevalence, osteoarthritis has been correlated with high medical and social costs. Among the treatment methods, viscosupplementation (intra-articular injection of hyaluronic acid derivatives) has been gaining more prominence. The substances used are high molecular weight polysaccharides that, in addition to mechanical functions of weight distribution and joint lubrication, have anti-inflammatory properties and physical-chemical action on a variety of joint characteristics. These effects are directly proportional to the molecular weight and concentration of the drug used and any cross-links that may be present in the drug. Viscosupplementation is a simple procedure and can be performed in outpatient clinics. It provides benefits regarding pain and function, and also favorably alters the course of the disease, through quantitatively and qualitatively improving the joint cartilage. It has a good safety profile and favorable cost-effectiveness relationship, and is indicated both for osteoarthritis cases and after an arthroscopic procedure.
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150
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Siebelt M, Korthagen N, Wei W, Groen H, Bastiaansen-Jenniskens Y, Müller C, Waarsing JH, de Jong M, Weinans H. Triamcinolone acetonide activates an anti-inflammatory and folate receptor-positive macrophage that prevents osteophytosis in vivo. Arthritis Res Ther 2015; 17:352. [PMID: 26637220 PMCID: PMC4670534 DOI: 10.1186/s13075-015-0865-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Triamcinolone acetonide (TA) is used for osteoarthritis management to reduce pain, and pre-clinical studies have shown that TA limits osteophyte formation. Osteophyte formation is known to be facilitated by synovial macrophage activation. TA injections might influence macrophage activation and subsequently reduce osteophytosis. Although widely applied in clinical care, the mechanism through which TA exerts this effect remains unknown. In this animal study, we investigated the in vivo effects of TA injections on macrophage activation, osteophyte development and joint degeneration. Furthermore, in vitro macrophage differentiation experiments were conducted to further explain working mechanisms of TA effects found in vivo. Methods Osteoarthritis was induced in rat knees using papain injections and a running protocol. Untreated and TA-treated animals were longitudinally monitored for 12 weeks with in vivo micro–computed tomography (μCT) to measure subchondral bone changes. Synovial macrophage activation was measured in vivo using folate receptor β (FRβ)-targeted single-photon emission computed tomography/computed tomography. Articular cartilage was analyzed at 6 and 12 weeks with ex vivo contrast-enhanced μCT and histology. To further explain the outcomes of our in vivo study, TA on macrophages was also studied in vitro. These cultured macrophages were either M1- or M2-activated, and they were analyzed using fluorescence-activated cell sorting for CD163 and FRβ expression as well as for messenger RNA (mRNA) expression of interleukin (IL)-10. Results Our in vivo study showed that intra-articular injections with TA strongly enhanced FRβ+ macrophage activation. Despite stimulated macrophage activation, osteophyte formation was fully prevented. There was no beneficial effect of TA against cartilage degradation or subchondral bone sclerosis. In vitro macrophage cultures showed that TA strongly induced monocyte differentiation towards CD163+ and FRβ+ macrophages. Furthermore, TA-stimulated M2 macrophages showed enhanced IL-10 expression at the mRNA level. Conclusions TA injections potently induce a CD163+- and FRβ+-activated macrophage with anti-inflammatory characteristics such as reduced IL-10 production in vitro and lack of osteophytosis in vivo.
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Affiliation(s)
- Michiel Siebelt
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Otorhinolaryngology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Nicoline Korthagen
- Department Orthopaedics, UMC Utrecht, Utrecht, The Netherlands. .,Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands.
| | - Wu Wei
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Harald Groen
- Department of Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | | | - Christina Müller
- Centre for Radiopharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Paul Scherrer Institute, University Hospital Zurich, Villigen, Switzerland.
| | - Jan Hendrik Waarsing
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Marion de Jong
- Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands. .,Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Harrie Weinans
- Department Orthopaedics, UMC Utrecht, Utrecht, The Netherlands. .,Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands. .,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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