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Alves JC, Santos A, Jorge P, Lavrador C, Carreira LM. The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model. PLoS One 2021; 16:e0245553. [PMID: 33471857 PMCID: PMC7816979 DOI: 10.1371/journal.pone.0245553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/03/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To evaluate the effect of an intra-articular (IA) administration of triamcinolone hexacetonide, compared with saline. PATIENTS AND METHODS Forty (N = 40) hip joints were randomly assigned to a treatment group (THG, n = 20, receiving IA triamcinolone hexacetonide) and a control group (CG, n = 20, receiving IA saline). On treatment day (T0), and at 8, 15, 30, 90 and 180 days post-treatment, weight distribution, joint range of motion, thigh girth, digital thermography, radiographic signs, synovial fluid interleukin-1 and C-reactive protein levels were evaluated. Data from four Clinical Metrology Instruments was also gathered. Results were compared Repeated Measures ANOVA, with a Huynh-Feldt correction, Paired Samples T-Test or Wilcoxon Signed Ranks Test. A Kaplan-Meier test was performed to compare both groups, with p<0.05. RESULTS Joints were graded as mild (65%), moderate (20%) and severe (15%). Patients of both sexes, with a mean age of 6.5±2.4 years and bodyweight of 26.7±5.2kg, were included. No differences were found between groups at T0. Comparing THG to CG, weight distribution showed significant improvements in THG from 8 (p = 0.05) up to 90 days (p = 0.01). THG showed lower values during thermographic evaluation in the Lt view (p<0.01). Pain and function scores also improved from 30 to 180 days. Increasing body weight, age, and presence of caudolateral curvilinear osteophyte corresponded to worse response to treatment. Results of the Kaplan Meier test showed significant differences between groups, with THG performing better considering several evaluations and scores. CONCLUSION THG recorded significant improvements in weight-bearing and in with the considered CMIs, particularly pain scores. Lower thermographic values were registered in THG up to the last evaluation day. Age, sex, and radiographic findings did significantly influenced response to treatment.
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Affiliation(s)
- João C. Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
- MED – Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - Ana Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
| | - Patrícia Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
| | - Catarina Lavrador
- MED – Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - L. Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal
- Interdisciplinary Centre for Research in Animal Health (CIISA) – University of Lisbon, (FMV/ULisboa), Lisbon, Portugal
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
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2
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Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies. Pain Res Manag 2020; 2020:3873098. [PMID: 32148599 PMCID: PMC7049418 DOI: 10.1155/2020/3873098] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.
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3
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Habib G, Khazin F, Sakas F, Hakim G, Artul S. The impact of intra-articular injection of diprospan at the knee joint on blood glucose levels in diabetic patients. Eur J Rheumatol 2018; 5:96-99. [PMID: 30185356 DOI: 10.5152/eurjrheum.2018.17133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of intra-articular (IA) corticosteroid injection (IACI) of betamethasone dipropionate/betamethasone sodium phosphate (Diprospan) on blood glucose levels in diabetic patients METHODS: Patients with type 2 diabetes and symptomatic osteoarthritis of the knee (OAK) in whom medical therapy failed were administered 1 mL Diprospan IACI (5 mg of betamethasone dipropionate +2 mg of betamethasone sodium phosphate). Patients were asked to monitor blood glucose levels before and 2 h after meals for 1 week before and 12 days after the injection was administered. A control group was administered an IA injection of hyaluronic acid. RESULTS Twelve patients from the Diprospan group and six from the control group were recruited for the study. Patients in the Diprospan group had significantly increased blood glucose levels with median initial and peak levels of 187.5 mg% and 310 mg%, respectively, at a median of 4 and 11.5 h following IACI, respectively. The last peak level was seen after a median of 45 h following IACI. There was no significant increase in blood glucose levels in the control group. CONCLUSION Diprospan IACI is associated with significantly increased blood glucose levels in all diabetic patients with OAK.
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Affiliation(s)
- George Habib
- Rheumatology Unit, Laniado Hospital, Netanya, Israel.,Rheumatology Clinic, Nazareth Hospital, Israel Institute of Technology School of Medicine, Haifa, Israel
| | - Fadi Khazin
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
| | - Fahed Sakas
- Department of Medicine, Rambam Medical Center, Haifa, Israel
| | - Geries Hakim
- Department of Orthopedics, Nazareth Hospital, Bar-Ilan University Gallile School of Medicine, Israel
| | - Suheil Artul
- Department of Radiology, Nazareth Hospital, Bar-Ilan University Gallile School of Medicine, Israel
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4
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Sandker MJ, Duque LF, Redout EM, Klijnstra EC, Steendam R, Kops N, Waarsing JH, van Weeren R, Hennink WE, Weinans H. Degradation, Intra-Articular Biocompatibility, Drug Release, and Bioactivity of Tacrolimus-Loaded Poly(d-l-lactide-PEG)-b-poly(l-lactide) Multiblock Copolymer-Based Monospheres. ACS Biomater Sci Eng 2018; 4:2390-2403. [DOI: 10.1021/acsbiomaterials.8b00116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Maria J. Sandker
- Department of Orthopaedics, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Orthopaedics, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, 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, Yalelaan 1, 3584 CL Utrecht, The Netherlands
| | - Evelien C. Klijnstra
- InnoCore Pharmaceuticals, L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands
| | - Rob Steendam
- InnoCore Pharmaceuticals, L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands
| | - Nicole Kops
- Department of Orthopaedics, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Jan H. Waarsing
- Department of Orthopaedics, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Rene van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
| | - Wim E. Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3512 JE Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics and Department of Rheumatology, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Biomechanical Engineering, TUDelft, Mekelweg 2, 2628 CD Delft, The Netherlands
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Abstract
Joint pain due to osteoarthritis (OA) is often severe and disabling and affects a large proportion of the aging population impairing daily living and quality of life. Numerous pharmacological treatment approaches are available. Including major OA guidelines this review presents the current evidence of pharmacological therapies in OA-related pain and covers topical, oral and intraarticular treatment approaches. In patients with mild OA topical nonsteroidal antiinflammatory drugs (NSAIDs) can be recommended. Topical capsaicin can be used when other treatments are ineffective or contraindicated. In patients with moderate to severe OA oral NSAIDs are suggested at the lowest effective dose for the shortest possible duration to control symptoms. Importantly, drug-related side effects and gastrointestinal, cardiovascular and renal comorbidities need to be taken into account. In patients with multiple-joint OA and high risk of NSAID-induced adverse events duloxetine can be considered. The evidence of metamizole, symptomatic slow-acting drugs in osteoarthritis and other nutritional supplements in the treatment of OA pain is uncertain and the use of opioids is not routinely recommended. In patients suffering from severe OA-related pain intraarticular injections with glucocorticoids can be suggested to achieve short-term pain relief. Evidence for interventional approaches using hyaluronic acid or platelet-rich plasma is uncertain. Yet, the efficacy of pharmacological therapies in OA-related pain is often inconsistent and severe adverse events might occur. Thus, critical use of the different treatment options considering patient-related comorbidities and nonpharmacological therapies is of major importance.
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Affiliation(s)
- T A Nees
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 220a, 69118, Heidelberg, Deutschland.
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 220a, 69118, Heidelberg, Deutschland
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6
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Okoroha KR, Gabbard MD, Fitts J, Banka TR. Cutibacteriumacnes Septic Arthritis of the Nonoperated Knee: A Case Report. Surg J (N Y) 2017; 3:e107-e109. [PMID: 28825032 PMCID: PMC5553506 DOI: 10.1055/s-0037-1603970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/22/2017] [Indexed: 11/17/2022] Open
Abstract
Cutibacterium (Propionibacterium) acnes
, a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery.
C. acnes
, however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of
C. acnes
septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of
C. acnes
septic arthritis.
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Affiliation(s)
- Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Michael D Gabbard
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Jamal Fitts
- Morehouse School of Medicine, Atlanta, Georgia
| | - Trevor R Banka
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
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7
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Habib G, Khatib M, Sakas F, Artul S, Jabaly-Habib H. Pre-injection of hyaluronic acid does not affect the systemic effects of intra-articular depot betamethasone injection at the knee joint. Clin Rheumatol 2016; 36:217-221. [PMID: 27423207 DOI: 10.1007/s10067-016-3352-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/02/2016] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Abstract
Intra-articular injection (IAI) of both hyaluronic acid (HA) and depot-steroid preparations had the advantage of quick and prolonged favorable effects on pain relief among patients with symptomatic osteoarthritis of the knee (OAK). The effect of IAI of HA on the systemic effects of the intra-articular steroids had not been investigated. Non-selected patients attending the rheumatology clinic with symptomatic OAK who failed NSAIDS and physical therapy were offered an IAI of HA at the knee joint followed 20 min later by an IAI of 1 ml of Celestone Chronodose at the same joint (group 1). Morning serum levels of cortisol were obtained just prior to the IAI and 1, 2 and 8 days later. Demographic, clinical, and laboratory parameters were obtained also from all the patients. Age- and sex-matched group of patients from the same clinic were recruited as a control group (group 2). Mean baseline serum cortisol levels in group 1 was 381 ± 154 mmol/l vs. 376 ± 119 in group 2 (p = 0.954). Morning serum cortisol levels at day 1 and day 2 were 24 ± 6 and 22 ± 6 mmol/l, respectively, in group 1 patients vs. 27 ± 5.8 (p = 0.214) and 25 ± 5.6 mmol/l (p = 0.200), respectively, in group 2. These levels were significantly lower than baseline levels in each group. Morning serum cortisol levels at day 8 in group 1 and group 2 were 349 ± 128 and 314 ± 99 mmol/l, respectively (p = 0.419). Pre-injection of HA at the knee joint did not affect the systemic effect on the hypothalamic-pituitary-adrenal axis of IAI of Celestone Chronodose.
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Affiliation(s)
- George Habib
- Rheumatology Unit, Laniado Medical Center, Netanya, 42150, Israel. .,Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. .,Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel.
| | - Muhamad Khatib
- Department of Medicine, Poriya Medical Center, Poriya, Israel
| | - Fahed Sakas
- Department of Medicine, Rambam Medical Center, Haifa, Israel
| | - Suheil Artul
- Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.,Department of Radiology, Nazareth Hospital, Nazareth, Israel
| | - Haneen Jabaly-Habib
- Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.,Ophthalmology Division, Poriya Medical Center, Poriya, Israel
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8
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Holyoak DT, Tian YF, van der Meulen MCH, Singh A. Osteoarthritis: Pathology, Mouse Models, and Nanoparticle Injectable Systems for Targeted Treatment. Ann Biomed Eng 2016; 44:2062-75. [PMID: 27044450 DOI: 10.1007/s10439-016-1600-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/26/2016] [Indexed: 12/21/2022]
Abstract
Osteoarthritis (OA) is a progressive, degenerative disease of articulating joints that not only affects the elderly, but also involves younger, more active individuals with prolonged participation in high physical-demand activities. Thus, effective therapies that are easy to adopt clinically are critical in limiting the societal burden associated with OA. This review is focused on intra-articular injectable regimens and provides a comprehensive look at existing in vivo models of OA that might be suitable for developing, testing, and finding a cure for OA by intra-articular injections. We first discuss the pathology, molecular mechanisms responsible for the initiation and progression of OA, and challenges associated with disease-specific targeting of OA. We proceed to discuss available animal models of OA and provide a detailed perspective on the use of mouse models in studies of experimental OA. We finally provide a closer look at intra-articular injectable treatments for OA, focusing on biomaterials-based nanoparticles, and provide a comprehensive overview of the various nanometer-size ranges studied.
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Affiliation(s)
- Derek T Holyoak
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853-7501, USA
| | - Ye F Tian
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14853-7501, USA
| | - Marjolein C H van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853-7501, USA.
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14853-7501, USA.
| | - Ankur Singh
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14853-7501, USA.
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9
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Habib G, Sakas F, Artul S, Khazin F, Hakim G, Jabbour A, Jabaly-Habib H. The impact of intra-articular methylprednisolone acetate injection on fructosamine levels in diabetic patients with osteoarthritis of the knee, a case-control study. Clin Rheumatol 2016; 35:1609-14. [PMID: 26951257 DOI: 10.1007/s10067-016-3218-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Abstract
Fructosamine is a glycated protein that reflects blood glucose control over the last 2-3 weeks. There are no studies that address the impact of intra-articular injection (IAI) of methylprednisolone acetate (MPA) on fructosamine levels among patients with type-2 diabetes and osteoarthritis of the knee (OAK). Non-selected patients attending the rheumatology or orthopedic clinic with type-2 diabetes and painful OAK, who failed non-steroidal anti-inflammatory drugs (NSAIDS) and physical therapy, were asked to participate in our study. After consent blood tests were drown for fructosamine, hemoglobin A1c (HbA1c) level, complete blood count, lipid profile, serum albumin, serum protein, c-reactive protein, and erythrocyte sedimentation rate. Demographic and different clinical parameters were also documented. Immediately after that, patients had IAI of 80 mg of MPA at the knee joint (group 1). Two to three weeks later, the same blood tests were repeated (except for HbA1c). Age- and sex-matched group of patients with type-2 diabetes and painful OAK attending the same clinics, but who were managed by NSAIDS were asked to participate as a control group (group 2) and had the same evaluation at enrollment and 2-3 weeks later, after consent. Eighteen patients from either group completed the study. Mean fructosamine level in group 1 patients was 263.7 ± 31.8 mg% prior to the IAI vs. 274.6 ± 39.3 mg% (p = 0.035), 2-3 weeks later, while mean fructosamine level in the control group (group 2) at enrollments was 274.2 ± 31.2 mg% vs. 269 ± 30.2 mg%, p = 0.509, 2-3 weeks later. There was no significant change in any other parameter tested at enrollment in either group, compared to those obtained 2-3 weeks afterwards. Body mass index was on the edge of significance as a predictor for a significant change in fructosamine level in group 1 patients. IAI of 80 mg of MPA in patients with type-2 diabetes and OAK had resulted in a significant, though mild increase in fructosamine levels 2-3 weeks later.
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Affiliation(s)
- George Habib
- Rheumatology Unit, Laniado Medical Center, Netanya, Israel. .,Faculty of Medicine, Technion, Haifa, Israel. .,Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel.
| | - Fahed Sakas
- Department of Pediatrics, Rambam Medical Center, Haifa, Israel
| | - Suheil Artul
- Department of Radiology, Nazareth hospital, Nazareth, Gallile faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Fadi Khazin
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
| | - Geries Hakim
- Department of Orthopedics, Nazareth Hospital, Nazareth, Israel
| | - Adel Jabbour
- Central lab, Nazareth hospital, Nazareth, Israel
| | - Haneen Jabaly-Habib
- Ophthalmology Unit, Poryia Medical Center, Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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10
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Dieu-Donné O, Théodore O, Joëlle ZT, Pierre D, Smaïla O, Christian C, Fulgence K, Joseph DY. An Open Randomized Trial Comparing the Effects of Oral NSAIDs Versus Steroid Intra-Articular Infiltration in Congestive Osteoarthritis of the Knee. Open Rheumatol J 2016; 10:8-12. [PMID: 27006727 PMCID: PMC4780524 DOI: 10.2174/1874312901610010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: To compare the efficacy on pain and joint function of NSAIDs versus steroid intra-articular infiltration in congestive knee osteoarthritis. Patients and Methods: Open randomized study comparing a series of patients treated with NSAIDs for 21 days and another who received steroid intra-articular infiltration (SIAI) spaced at every 7 days. The visual analog scale was used for the weekly assessment of spontaneous pain and pain when walking. Lequesne functional pain scale was used to assess the functional impact of knee osteoarthritis. Results: Seventy patients were enrolled, including 35 in the NSAID arm and 35 in SIAI arm. Forty-nine (70%) had stage III of Kellgren and Lawrance scale. On admission, the average pain intensity was 50.46 ± 30.93 in the NSAID arm and 60.92 ± 30 in SIAI arm (p = 0.0189). At the end of follow-up, pain intensity was 6.72 ± 13 in NSAIDs patients and 17.80 ± 21 in SIAI one (p = 0.001). The average intensity of pain on walking was 64.41 ± 22.61. It was 53.33 ± 22.31 in NSAID’s against 74.85 ± 17.55 in SIAI patients (P <0.0001). At the end of the treatment, they were respectively 19.11 ± 11.37, and 35 ± 30.69 (P = 0.0085). Conclusion: Corticosteroid injections have a short efficacy compared to NSAIDs. Prescribing NSAIDs should consider the cons-indications, comorbidities and their deleterious digestive, renal, and cardiovascular effect.
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Affiliation(s)
- Ouédraogo Dieu-Donné
- Department of Rheumatology, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | | | - Dionou Pierre
- Department of Rheumatology, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Ouédraogo Smaïla
- Department of Epidemiology and Statistic, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Compaoré Christian
- Department of Internal Medicine, International Polyclinic, Ouagadougou, Burkina Faso
| | - Kaboré Fulgence
- Department of Rheumatology, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Drabo Youssouf Joseph
- Department of Internal Medicine, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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11
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Baselga García-Escudero J, Miguel Hernández Trillos P. Treatment of Osteoarthritis of the Knee with a Combination of Autologous Conditioned Serum and Physiotherapy: A Two-Year Observational Study. PLoS One 2015; 10:e0145551. [PMID: 26709697 PMCID: PMC4692499 DOI: 10.1371/journal.pone.0145551] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/04/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Autologous conditioned serum (ACS) is an autologous blood product that has shown efficacy against knee osteoarthritis (OA) in randomized controlled trials. However, there are few reports of its effectiveness in everyday practice. Here, we report clinical efficacy results from a two-year prospective observational study of patients with highly symptomatic knee OA who received ACS in conjunction with physiotherapy. METHODS 118 patients with unilateral knee OA (Kellgren-Lawrence grades I-IV), who were candidates for surgery but instead chose conservative treatment, were treated with a combination of four intra-articular injections of ACS (2 mL each) once weekly over four weeks and subsequent physiotherapy applied 4 weeks after ACS injection. Main endpoints of the study were pain (Numeric Rating Scale [NRS]) assessed at 0, 3, 6, 12 and 24 months, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score, assessed at 0 and 24 months. The effect size (Cohen's d) was calculated for pain and WOMAC outcomes, with effect sizes >0.8 considered large. RESULTS By 3 months, there were significant improvements in pain (NRS) from baseline (-63.0%, p<0.001), which were maintained over 24 months. Mean WOMAC global score was reduced at 24 months compared to baseline (-56.9%, p<0.001), as were WOMAC subscores of pain (-86.0%, p<0.001) and function (-51.3%, p<0.001). Effect sizes for pain (>5) and WOMAC improvement (8.0-13.6) were very large. Only one patient received total knee joint replacement during the study. Clinical improvement did not correlate with gender, age, Kellgren-Lawrence grade, or body mass index. CONCLUSIONS Treatment with ACS and physiotherapy produced a rapid decline in pain, which was sustained for the entire two years of the study. This was accompanied by a large improvement in WOMAC scores at two years. These results confirm that ACS combined with physiotherapy is an effective treatment for OA of the knee.
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12
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Therapeutic Effects of Ribunucleinate (Ribonucleotides) in Immuno-Inflammatory and Arthritic Diseases. ACTA ACUST UNITED AC 2015; 70:35-89. [PMID: 26462364 DOI: 10.1007/978-3-0348-0927-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ribonucleic acids from different organs and from yeast have been used for the treatment of chronic and degenerative diseases in the context of naturopathic medicine in the last 60 years. This chapter provides general information about ribonucleinates as therapeutic agents. Past and present pharmacological and clinical investigations are discussed in the field of the central nervous system, sensory organs, cancer and degenerative diseases of joints and vertebra.
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13
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Rice DA, McNair PJ, Lewis GN, Dalbeth N. The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study. Arthritis Res Ther 2015. [PMID: 26215105 PMCID: PMC4517546 DOI: 10.1186/s13075-015-0711-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis. Methods Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee joint aspiration alone and 5 ± 2 and 15 ± 2 days after knee joint aspiration and the injection of 40 mg of methylprednisolone acetate. Results Compared to baseline, knee pain was significantly reduced 5 (p = 0.001) and 15 days (p = 0.009) post intervention. Flexion reflex threshold increased immediately after joint aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after joint aspiration (p = 0.004) and 5 (p = 0.001) and 15 days (p <0.001) post intervention. Conclusions The findings from this study suggest that altered sensory output from an inflamed joint may increase flexion reflex excitability in humans, as has previously been shown in animals. Joint aspiration and corticosteroid injection may be a clinically useful intervention to reverse quadriceps muscle weakness in individuals with knee synovitis.
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Affiliation(s)
- David Andrew Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand. .,Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, 15 Shea Terrace, Auckland, 0740, New Zealand.
| | - Peter John McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand.
| | - Gwyn Nancy Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, 2 Park Road, Auckland, 1023, New Zealand.
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Thai massage, and Thai herbal compress versus oral ibuprofen in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:490512. [PMID: 25254207 PMCID: PMC4165631 DOI: 10.1155/2014/490512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/28/2014] [Accepted: 08/11/2014] [Indexed: 01/07/2023]
Abstract
The aim of this study was to verify the clinical responses to Thai massage (TM) and Thai herbal compression (THC) for treating osteoarthritis (OA) of the knee in comparison to oral ibuprofen. This study was a randomized, evaluator-blind, controlled trial. Sixty patients with OA of the knee were randomly assigned to receive either a one-hour session of TM or THC (three times weekly) or oral ibuprofen (three times daily). The duration of treatment was three weeks. The clinical assessments included visual analog scale assessing pain and stiffness, Lequesne's functional index, time for climbing up ten steps, and physician's and patient's overall opinions on improvement. In a within-group comparison, each treatment modality caused a significant improvement of all variables determined for outcome assessments. In an among group comparison, all modalities provided nearly comparable clinical efficacy after a three-week symptomatic treatment of OA of the knee, in which a trend toward greatest improvement was likely to be found in THC group. In conclusion, TM and THC generally provided comparable clinical efficacy to oral ibuprofen after three weeks of treatment and could be considered as complementary and alternative treatments for OA of the knee.
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Amoako AO, Pujalte GGA. Osteoarthritis in young, active, and athletic individuals. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2014; 7:27-32. [PMID: 24899825 PMCID: PMC4039183 DOI: 10.4137/cmamd.s14386] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/23/2014] [Accepted: 04/01/2014] [Indexed: 11/05/2022]
Abstract
Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly, who are mostly inactive, athletes and younger individuals are also susceptible. Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations. Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance. However, the treatment of OA in these populations does not differ from its management in the general population. Several considerations need to be taken into account when choosing a treatment modality. The purpose of this review is to address OA in athletes and younger individuals and to discuss its presentation, diagnosis, and treatment.
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Affiliation(s)
- Adae O Amoako
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - George Guntur A Pujalte
- Division of Sports Medicine, Departments of Family and Community Medicine, and Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Abstract
INTRODUCTION Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle. METHODS Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included "hyaluronic acid" or "hylan", and "osteoarthritis". DISCUSSION Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA. CONCLUSION For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting.
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Affiliation(s)
- M Carrington Reid
- Weill Cornell Medical College, 1484-1486 1st Avenue, New York, NY, 10075, USA,
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Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. Rheumatology (Oxford) 2013; 52:1022-32. [PMID: 23264554 PMCID: PMC3651612 DOI: 10.1093/rheumatology/kes368] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/26/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. METHODS Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. RESULTS Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. CONCLUSION Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.
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Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK.
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18
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Abstract
OVERVIEW Because pain is a common and debilitating symptom of osteoarthritis in older adults, the authors reviewed data on the efficacy and safety of commonly used oral, topical, and intraarticular drug therapies in this population. A search of several databases found that most studies have focused on knee osteoarthritis and reported only short-term outcomes. Also, treatment efficacy was found to vary by drug class; the smallest effect was observed with acetaminophen and the largest with opioids and viscosupplements. Acetaminophen and topical agents had the best safety profiles, whereas oral nonsteroidal antiinflammatory drugs and opioids had the worst. Little data were available on patients ages 75 years old and older and on patients from diverse racial and ethnic groups. Most drug therapies gave mild-to-moderate pain relief; their long-term safety and efficacy and their effects in diverse populations (particularly older adults) remain undetermined.
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Affiliation(s)
- M Carrington Reid
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York City, NY, USA.
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Boettger MK, Kümmel D, Harrison A, Schaible HG. Evaluation of long-term antinociceptive properties of stabilized hyaluronic acid preparation (NASHA) in an animal model of repetitive joint pain. Arthritis Res Ther 2011; 13:R110. [PMID: 21736716 PMCID: PMC3239347 DOI: 10.1186/ar3394] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/07/2011] [Accepted: 07/07/2011] [Indexed: 11/23/2022] Open
Abstract
Introduction Clinical trials provided controversial results on whether the injection of hyaluronan preparations into osteoarthritic joints reduces pain. Problems of clinical studies may be the substantial placebo effects of intra-articular injections, different severity and rate of progression of the disease and others. We hypothesize that the use of preclinical pain models may help to clarify whether a certain hyaluronan exerts antinociceptive effects upon intra-articular injection. In the present study we tested in the bradykinin/prostaglandin E2 (PGE2) model primarily the putative antinociceptive effect of stabilized hyaluronic acid from a non animal source (NASHA), a stabilized hyaluronic acid based gel for intra-articular treatment of OA. We established a dose-response relationship for NASHA and we compared NASHA to other hyaluronans with different formulations that are in clinical use. Methods To induce transient joint pain episodes bradykinin and PGE2 were repetitively administered intra-articularly and unilaterally into rat knee joints during short anaesthesia. After establishment of the predrug nociceptive responses, a single intra-articular injection of saline or NASHA at different concentrations was administered and pain responses to further bradykinin/PGE2 injections were monitored up to 56 days after NASHA. Furthermore, the obtained effective dose was compared to clinically defined concentrations of Hylan GF20 and sodium hyaluronate. The primary outcome measures were primary mechanical hyperalgesia at the knee joint and pain-induced weight bearing. Results On day 1 after injection, all tested hyaluronan preparations showed an antinociceptive effect >50% compared to saline. Single injections of higher doses of NASHA (50, 75 and 100 μl) were antinociceptive up to 56 days. When injection volumes in rat knee joints were adapted to clinical injection volumes in humans, the antinociceptive effects of the cross-linked NASHA and Hylan GF20 had a longer duration than that of the non cross-linked sodium hyaluronate (with a slightly better effect of NASHA than Hylan GF20). Conclusions In the bradykinin/PGE2 model of joint pain a single injection of all hyaluronan preparations provided significant antinociceptive effects compared to saline. It appeared that the duration of the antinociceptive effect of the cross-linked hyaluronan preparations NASHA and Hylan GF20 was more prolonged. In addition, the gel beads structure allowing only a slow release of hyaluronic acid (NASHA) may even enhance this prolonged antinociceptive effect.
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Affiliation(s)
- Michael Karl Boettger
- Institute of Physiology I/Neurophysiology, Jena University Hospital-Friedrich Schiller University, Teichgraben 8, D-07743 Jena, Germany
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Denegar CR, Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Comstock BA, Kraemer WJ. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging 2010; 5:199-206. [PMID: 20711439 PMCID: PMC2920200 DOI: 10.2147/cia.s11431] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Indexed: 12/26/2022] Open
Abstract
Objective: This investigation assessed preferences for, and effects of, 5 days of twice daily superficial heat, cold, or contrast therapy applied with a commercially available system permitting the circulation of water through a wrap-around garment, use of an electric heating pad, or rest for patients with level II–IV osteoarthritis (OA) of the knee. Methods: We employed a within subject, randomized order design to study 34 patients receiving each treatment in 1-week blocks. A knee injury and osteoarthritis outcome score (KOOS) questionnaire and visual analog pain scale was completed at baseline, and twice each week. Treatment preferences were assessed in the last week of the study. Results: Treatment with the device set to warm was preferred by 48% of subjects. Near equal preferences were observed for cold (24%) and contrast (24%). Pain reduction and improvements in KOOS subscale measures were demonstrated for each treatment but responses were (P < 0.05) greater with preferred treatments. Most patients preferred treatment with the water circulating garment system over a heating pad. Conclusions: We recommend that when superficial heat or cold is considered in the management of knee OA that patients experiment to identify the intervention that offers them the greatest relief and that contrast is a treatment option.
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Affiliation(s)
- Craig R Denegar
- Human Performance Laboratory and Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
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Albano MB, Vidigal L, de Oliveira MZ, Namba MM, da Silva JLV, de Assis Pereira Filho F, Barbosa MA, da Silva EMB. MACROSCOPIC ANALYSES OF THE EFFECTS OF HYALURONATES AND CORTICOSTEROIDS ON INDUCED OSTEOARTHRITIS IN RABBITS' KNEES. Rev Bras Ortop 2010; 45:273-8. [PMID: 27022552 PMCID: PMC4799149 DOI: 10.1016/s2255-4971(15)30368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the effects of intra-articular injections of corticosteroids, native hyaluronic acid and branched-chain hyaluronic acid in experimentally-induced osteoarthrosis. METHODS 44 rabbits underwent anterior cruciate ligament resection and were then divided into four groups of eleven. Group 1: one intra-articular injection of saline solution per week, for three weeks; Group 2: three injections (one per week) of native hyaluronic acid; Group 3: three injections (one per week) of branched-chain hyaluronic acid; Group 4: two injections of betamethasone with an interval of three weeks. The cartilage of the tibial plateaus was evaluated macroscopically twelve weeks after surgery. Changes to the joint surface were graded as follows: Grade 0: smooth joint surface without relief changes; Grade 1: rough surface without any depressions; Grade 2: similar to grade 1, but with depressions on the joint surface; and Grade 3: subchondral bone exposure. The statistical analysis consisted of the use of Student's t test, chi-square test and analysis of variance (ANOVA). The significance level used was 5%. RESULTS A statistical difference was found between the control group and the three study groups 2, 3, 4 in relation to the development and severity of arthrosis. However, there was no difference between the groups regarding the drugs studied. CONCLUSION A similar degree of attenuation of the osteoarthrosis process in the rabbits' knees was found with the use of intra-articular injections of low-molecular-weight and high-molecular-weight glycosaminoglycans, and the corticosteroid betamethasone, compared with placebo.
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Affiliation(s)
- Mauro Batista Albano
- Mestre em Clínica Cirúrgica pela UFPR; Professor do Curso de Especialização em Traumatologia Esportiva e Artroscopia da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR
| | - Leandro Vidigal
- Médico Ortopedista; Aluno de Pós-graduaão Universidade Federal do Paraná (SOT-UFPR)
| | | | - Mario Massatomo Namba
- Mestre em Clínica Cirúrgica pela UFPR; Professor e Coordenador do Curso de Especializa9ão em Traumatologia Esportiva da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR; Membro Titular da SBOT
| | - João Luiz Vieira da Silva
- Mestre e Doutor em Clínica Cirúrgica pela UFPR; Professor do Curso de Especializa9ão em Traumatologia Esportiva e Artroscopia da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR; Membro Titular da SBOT
| | - Francisco de Assis Pereira Filho
- Professor do Curso de Especializa9ão em Traumatologia Esportiva e Artroscopia da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR; Membro Titular da SBOT
| | - Marcio Alves Barbosa
- Professor do Curso de Especializa9ão em Traumatologia Esportiva e Artroscopia da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR; Membro Titular da SBOT
| | - Elias Marcelo Batista da Silva
- Professor do Curso de Especializa9ão em Traumatologia Esportiva e Artroscopia da UFPR; Membro do Serviço de Ortopedia e Traumatologia da UFPR; Membro Titular da SBOT
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Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol 2010; 29:347-56. [PMID: 20101428 DOI: 10.1007/s10067-009-1357-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
Intra-articular corticosteroid injection (IACI) is a very popular procedure. In this review, we wanted to review all that had been published about local effects of IACIs. English literature search was made through PubMed using the terms intra-articular and local effect. Effects on subjective, functional, structural, cellular, humoral, molecular, and imaging aspects were included. Also, all local adverse effects were documented. The main beneficial effect of IACI is pain relief. The duration of this effect is variable and depends on underlying disease, type of disease, amount of structural damage, type of IACI, dose of IACI, presence of joint effusion, level of inflammatory mediators, emptiness of joint effusion, availability of imaging, and others. At large, inflammatory problems had higher rate of favorable response in terms of pain and function. IACI at the knee joint in juvenile idiopathic arthritis patients resulted in remission for >6 months in >80% of the patients with a mean duration of approximately 1.2 years, while in the osteoarthritic knee there was a pain relief for 3 weeks only and in rheumatoid arthritis (RA) knee for 8 weeks. There was no joint space loss at the knee joint following multiple IACI in osteoarthritis and also no increase in cartilage or bone erosions in RA following a single IACI. IACI guide imaging is important in achieving better results in particular joints. Joint infection rate is very low. Other adverse effects included intra-articular and periarticular calcifications, cutaneous atrophy, cutaneous depigmentation, avascular necrosis, rapid destruction of the femoral head, acute synovitis, Charcot's arthropathy, tendinopathy, Nicolau's syndrome, and joint dislocation. IACI is associated with a wide range of local effects. Subjective and functional favorable response is prominent mainly in juvenile idiopathic arthritis patients. Adverse effects are either rare or insignificant.
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Affiliation(s)
- George S Habib
- Department of Medicine, Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
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Cialdai C, Giuliani S, Valenti C, Tramontana M, Maggi CA. Effect of Intra-articular 4-(S)-Amino-5-(4-{4-[2,4-dichloro-3-(2,4-dimethyl-8-quinolyloxymethyl)phenylsulfonamido]-tetrahydro-2H-4-pyranylcarbonyl} piperazino)-5-oxopentyl](trimethyl)ammonium chloride hydrochloride (MEN16132), a Kinin B2 Receptor Antagonist, on Nociceptive Response in Monosodium Iodoacetate-Induced Experimental Osteoarthritis in Rats. J Pharmacol Exp Ther 2009; 331:1025-32. [DOI: 10.1124/jpet.109.159657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
A large unmet need exists for desirable pharmacologic therapeutic interventions for osteoarthritis (OA). Developers of these interventions should be mindful of the current status of therapeutic interventions and focus on the mechanics of the joint and tissues of symptom origin. Much of the pathophysiology of the joint is still poorly understood, particularly as it relates to tissues other than hyaline articular cartilage. Improved knowledge of the role of these tissues (especially bone, fat, and synovium) in OA pathophysiology will likely yield treatment breakthroughs. This review discusses promising biologic therapies for the treatment of OA. Investigators are developing promising therapies, but we need to pay heed to the lessons learned thus far if new therapies are to be effective.
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Affiliation(s)
- David J Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA.
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Kidd BL, Langford RM, Wodehouse T. Arthritis and pain. Current approaches in the treatment of arthritic pain. Arthritis Res Ther 2008; 9:214. [PMID: 17572915 PMCID: PMC2206347 DOI: 10.1186/ar2147] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Current evidence suggests that although persistent arthritic pain is initiated and maintained by articular pathology, it is also heavily influenced by a range of other factors. Strategies for treating arthritic pain are therefore different from those adopted for acute pain. Although published guidelines offer general assistance, the complexity of underlying mechanisms requires that measures designed to relieve pain must take into account individual biological, psychological and societal factors. It follows that a combination of both pharmacological and non-pharmacological approaches offers the best opportunity for therapeutic success, although determining the effectiveness of such complex interventions remains difficult. Pharmacological therapy is often prolonged, and safety and tolerability issues become as important as efficacy over time.
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Affiliation(s)
- Bruce L Kidd
- William Harvey Research Institute, Barts and The London, Queen Mary School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
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Lai JN, Chen HJ, Chen CC, Lin JH, Hwang JS, Wang JD. Duhuo jisheng tang for treating osteoarthritis of the knee: a prospective clinical observation. Chin Med 2007; 2:4. [PMID: 17394666 PMCID: PMC1852314 DOI: 10.1186/1749-8546-2-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 03/30/2007] [Indexed: 11/10/2022] Open
Abstract
Background Little scientific evidence supports the efficacy of herbal medicines in the treatment of degenerative arthritis of the knee. The purpose of this study is to evaluate both the efficacy and safety of a finished Chinese herbal preparation Duhuo Jisheng Tang (DJT) in reducing symptoms of degenerative osteoarthritis of the knee. Methods A prospective follow-up study was carried out in two hospitals in Taipei between April and October 2005. Sixty-eight osteoarthritis patients, with symptoms diagnosed by radiologists, received DJT at a rate of 2.5 g, twice daily for four weeks. Baseline scores were measured on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, followed by further measures at the end of weeks 1, 2 and 4. The World Health Organization Quality of Life (WHOQOL) assessment was undertaken as a secondary outcome, with pattern identification questionnaires being adopted. Regression models were constructed to explore the score differences between the baseline and at weeks 2 and 4 by various determinants including age, gender, body mass index (BMI), severity at baseline, use of rescue medication, aversion to cold and flaccidity of the lower back and knees. Results Among the 68 participants, there were statistically significant reductions in the WOMAC index scores for pain, stiffness and physical functioning in the second and fourth weeks, with effects first appearing during week 2. By week 4, the mean WOMAC index scores had fallen from 22.2 (± 19.2) to 16.1 (± 16.2) for pain, from 28.1 (± 24.9) to 18.5 (± 20.3) for stiffness, and from 22.6 (± 18.0) to 18.2 (± 17.8) for physical functioning, while the global score for pain under the visual analogue scale (VAS) was reduced from 38.7 (± 21.5) to 27.8 (± 19.8). Conclusion In the treatment of degenerative osteoarthritis of the knee, a 4-week therapy with the Chinese herbal preparation DJT reduced pain and stiffness and improved physical functioning, but it was less effective in treating flaccidity and aversion to cold.
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Affiliation(s)
- Jung-Nien Lai
- Department of Obstetrics and Gynecology; Department of Chinese Medicine, Taipei City Hospital, Yangming Branch; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Road, Taipei 112, Taiwan
| | - Huey-Jeng Chen
- Division of Chinese Internal medicine, Taipei City Hospital, Branch for Chinese Medicine, No.100, Kunming St., Taipei 108, Taiwan
| | - Chao-Chung Chen
- Department of Traumatology, Taipei City Hospital, Branch for Chinese Medicine, No.100, Kunming St., Taipei 108, Taiwan
| | - Jer-Huei Lin
- Division of Pharmacognosy, Bureau of Food and Drug Analysis, Department of Health, Executive Yuan, No.161-2, Kunyang St., Taipei 115, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, No.128, Academia Road Sec. 2, Taipei 115, Taiwan
| | - Jung-Der Wang
- Departments of Internal Medicine and Environmental and Occupational Medicine, National Taiwan University Hospital and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No.17, Xuzhou Road, Taipei 100, Taiwan
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Castro RR, Feitosa JPA, da Cunha PLR, da Rocha FAC. Analgesic activity of a polysaccharide in experimental osteoarthritis in rats. Clin Rheumatol 2007; 26:1312-9. [PMID: 17216398 DOI: 10.1007/s10067-006-0506-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 11/23/2006] [Accepted: 11/23/2006] [Indexed: 01/09/2023]
Abstract
Viscosupplementation efficacy has been related to the high molecular weight of hyaluronic acid-like compounds, as well as to gel formulation. We evaluated the effect of a galactomannan polysaccharide derived from Guar gum (GG) in joint pain in an osteoarthritis (OA) model. Wistar rats (six animals/group) were subjected to anterior cruciate ligament transection (ACLT-OA group). The OA group was compared to a false-operated group (sham). Joint pain was recorded daily, using the articular incapacitation test, until 7 days after ACLT. Solutions or gel preparations of GG (100 microg) or Hylan G-F 20 (100 microg), used as a comparator, were given intraarticularly (i.a.) at day 4 after ACLT. Controls received saline i.a. The OA group had significantly increased joint pain as compared to sham (P<0.001). GG, either as a gel or solution, significantly inhibited joint pain similar to the inhibition achieved with Hylan G-F20. This is the first demonstration that a galactomannan derived from GG reduces joint pain in experimental OA. This analgesia is independent of the colloidal state. We propose that the analgesic benefit of viscosupplementation may be due to an intrinsic carbohydrate-mediated mechanism rather than to the rheologic properties of the material.
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Affiliation(s)
- David J Hunter
- Boston University Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA.
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Abstract
Knee osteoarthritis (OA) affects many older people and may result in pain and loss of function in the knee. The article explores the wide spectrum of treatments available, including education, exercise, pharmacological agents and surgery. The evidence for these treatments is examined so that nurses have a knowledge base on which to build their practice. The importance of individual patient characteristics and available resources when deciding on treatment options is emphasized. The article is intended to be of use for both acute and primary care nurses who care for patients with knee OA.
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Affiliation(s)
- Brian Lucas
- Whipps Cross University Hospital NHS Trust, London
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