1
|
Mant M, Pitre MC, Dancer S, Gatto MC. A case of rheumatoid arthritis in a Nubian woman from the site of Sheikh Mohamed, near Aswan, Egypt. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 44:78-84. [PMID: 38171073 DOI: 10.1016/j.ijpp.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To differentially diagnose and contextualize pathological lesions suggestive of rheumatoid arthritis. MATERIALS The skeletal remains of a 25-30-year-old female dated to c. 1750-1550 BCE from a Nubian Pan-Grave cemetery at the site of Sheik Mohamed, near Aswan, Egypt. METHODS The skeletal remains were examined macroscopically and a differential diagnosis was conducted following established protocols in the palaeopathological literature. RESULTS Symmetrical, bilateral, erosive periarticular lesions with smooth edges were observed in multiple joints (especially in the hands and feet). CONCLUSIONS Differential diagnosis suggests this individual had rheumatoid arthritis. SIGNIFICANCE This case suggests the presence of rheumatoid arthritis in ancient Egypt, contributing to a more finely grained understanding of the antiquity and geographical distribution of the condition. LIMITATIONS It was not possible to radiograph the skeletal remains. SUGGESTIONS FOR FURTHER RESEARCH Researchers are encouraged to re-examine any archaeological examples of erosive polyarthropathy using current palaeopathological protocols and to explore the manifestation of rheumatoid arthritis on the African continent.
Collapse
Affiliation(s)
- Madeleine Mant
- Department of Anthropology, University of Toronto Mississauga, Terrence Donnelly Building HSC304, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Mindy C Pitre
- Department of Anthropology, St. Lawrence University, 23 Romoda Drive, 114 Piskor Hall, Canton, NY 13617, USA.
| | - Sarah Dancer
- Department of Anthropology, St. Lawrence University, 23 Romoda Drive, 114 Piskor Hall, Canton, NY 13617, USA
| | - Maria Carmela Gatto
- Institute of Mediterranean and Oriental Cultures, Polish Academy of Sciences, Ul. Nowy Świat 72, 00-330 Warsaw, Poland.
| |
Collapse
|
2
|
Scheuing WJ, Reginato AM, Deeb M, Acer Kasman S. The burden of osteoarthritis: Is it a rising problem? Best Pract Res Clin Rheumatol 2023; 37:101836. [PMID: 37633827 DOI: 10.1016/j.berh.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 08/28/2023]
Abstract
The objective of this review is to provide an overview of the current status of osteoarthritis (OA) as one of the most common joint disorders worldwide. Despite being the 11th cause of disability globally, there has been an increase in the prevalence, annual incidence, and years lived with disability of OA, particularly in developed and developing countries. Erosive hand OA, which affects approximately 10% of the general population, has been associated with a higher clinical burden compared to non-erosive hand OA. Patients with knee and hip OA, but not hand OA, are also at an increased risk of cardiovascular disease and all-cause mortality. Furthermore, OA has a significant contribution to healthcare costs in most countries. The recent COVID-19 pandemic has further exacerbated the disease burden of OA patients due to limited access to medical and surgical treatment. With increasing life expectancy and the aging of the global population, the burden of OA is expected to worsen. Therefore, this review highlights the importance of improving population and policymaker awareness of risk factors, such as obesity and injury, as well as early intervention and management of OA to control the future burden of the disease.
Collapse
Affiliation(s)
| | | | - Mery Deeb
- Department of Internal Medicine, Kent Hospital/Brown University, Warwick, RI, USA.
| | - Sevtap Acer Kasman
- Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Türkiye.
| |
Collapse
|
3
|
Duarte-Salazar C, Marín-Arriaga N, Miranda-Duarte A. The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity. REUMATOLOGIA CLINICA 2022; 18:338-342. [PMID: 35680365 DOI: 10.1016/j.reumae.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/04/2021] [Indexed: 06/15/2023]
Abstract
UNLABELLED Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.
Collapse
Affiliation(s)
- Carolina Duarte-Salazar
- Departamento de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico.
| | - Norma Marín-Arriaga
- Departamento de Imagenología y Servicio de Resonancia Magnética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Antonio Miranda-Duarte
- Departamento de Genética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| |
Collapse
|
4
|
Duarte-Salazar C, Marín-Arriaga N, Miranda-Duarte A. The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00087-5. [PMID: 33875393 DOI: 10.1016/j.reuma.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.
Collapse
Affiliation(s)
- Carolina Duarte-Salazar
- Departamento de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico.
| | - Norma Marín-Arriaga
- Departamento de Imagenología y Servicio de Resonancia Magnética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Antonio Miranda-Duarte
- Departamento de Genética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| |
Collapse
|
5
|
Mohammadinejad R, Ashrafizadeh M, Pardakhty A, Uzieliene I, Denkovskij J, Bernotiene E, Janssen L, Lorite GS, Saarakkala S, Mobasheri A. Nanotechnological Strategies for Osteoarthritis Diagnosis, Monitoring, Clinical Management, and Regenerative Medicine: Recent Advances and Future Opportunities. Curr Rheumatol Rep 2020; 22:12. [PMID: 32248371 PMCID: PMC7128005 DOI: 10.1007/s11926-020-0884-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In this review article, we discuss the potential for employing nanotechnological strategies for the diagnosis, monitoring, and clinical management of osteoarthritis (OA) and explore how nanotechnology is being integrated rapidly into regenerative medicine for OA and related osteoarticular disorders. RECENT FINDINGS We review recent advances in this rapidly emerging field and discuss future opportunities for innovations in enhanced diagnosis, prognosis, and treatment of OA and other osteoarticular disorders, the smart delivery of drugs and biological agents, and the development of biomimetic regenerative platforms to support cell and gene therapies for arresting OA and promoting cartilage and bone repair. Nanotubes, magnetic nanoparticles, and other nanotechnology-based drug and gene delivery systems may be used for targeting molecular pathways and pathogenic mechanisms involved in OA development. Nanocomposites are also being explored as potential tools for promoting cartilage repair. Nanotechnology platforms may be combined with cell, gene, and biological therapies for the development of a new generation of future OA therapeutics. Graphical Abstract.
Collapse
Affiliation(s)
- Reza Mohammadinejad
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Ashrafizadeh
- Department of Basic Science, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Jaroslav Denkovskij
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Lauriane Janssen
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, PL 4500, 3FI-90014, Oulu, Finland
| | - Gabriela S Lorite
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, PL 4500, 3FI-90014, Oulu, Finland
| | - Simo Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania.
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, UK.
- Sheik Salem Bin Mahfouz Scientific Chair for Treatment of Osteoarthritis with Stem Cells, King AbdulAziz University, Jeddah, Saudi Arabia.
- University Medical Center Utrecht, Department of Orthopedics and Department of Rheumatology & Clinical Immunology, 508 GA, Utrecht, The Netherlands.
| |
Collapse
|
6
|
Tesi C, Giuffra V, Fornaciari G, Larentis O, Motto M, Licata M. A case of erosive polyarthropathy from Medieval northern Italy (12th-13th centuries). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 25:20-29. [PMID: 30927654 DOI: 10.1016/j.ijpp.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017. MATERIALS Skeletal remains of a well-preserved skeleton dating to the 12th-13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy). METHODS Macroscopic and radiographic imaging. RESULTS Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55-75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints. CONCLUSIONS A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy. SIGNIFICANCE This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas. LIMITATIONS Small sample size limits discussion of the scope of the disease in antiquity. SUGGESTIONS FOR FURTHER RESEARCH This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.
Collapse
Affiliation(s)
- Chiara Tesi
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Gino Fornaciari
- Department of Civilizations and Forms of Knowledge, University of Pisa, Italy
| | - Omar Larentis
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Monica Motto
- Society of archaeological research "Archeostudi di Bergamo" s.r.l., Italy
| | - Marta Licata
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
7
|
Mori V, Sawicki LM, Sewerin P, Eichner M, Schaarschmidt BM, Oezel L, Gehrmann S, Bittersohl B, Antoch G, Schleich C. Differences of radiocarpal cartilage alterations in arthritis and osteoarthritis using morphological and biochemical magnetic resonance imaging without gadolinium-based contrast agent administration. Eur Radiol 2018; 29:2581-2588. [PMID: 30542752 DOI: 10.1007/s00330-018-5880-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/19/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify differences of radiocarpal cartilage alterations in osteoarthritis and arthritis using multiparametrical magnetic resonance imaging (MRI) comprising morphological and biochemical sequences without gadolinium-based contrast agent administration. METHODS In this prospective study, multiparametrical MRI of the radiocarpal cartilage was performed in 47 participants (mean age, 46.6 ± 17.6 years; min., 20 years; max., 79 years) on a 3 Tesla MRI. The cohort consisted of 11 patients suffering from arthritis, 10 patients with osteoarthritis, 14 patients after distal radius fracture, and 12 healthy volunteers. The radiocarpal cartilage was assessed using morphological (DESS, TrueFISP) and biochemical (T2*) MRI sequences without the application of intravenous contrast agent. The modified Outerbridge classification system for morphological and region-of-interest analyses for biochemical analysis was applied to assess the degree of cartilage damage in each patient before data were statistically tested for significant difference between the groups using a post hoc Tukey test. RESULTS In morphological imaging, cartilage damage was significantly more frequent in arthritis and osteoarthritis than in healthy volunteers (DESS: p = 0.01, p = 0.0004; TrueFISP: p = 0.02, p = 0.0001). In T2* imaging, patients with osteoarthritis showed higher cartilage damage compared to patients with arthritis (p = 0.01). CONCLUSION With multiparametrical MRI, it is possible to identify differences of radiocarpal cartilage alterations of patients with arthritis and osteoarthritis using the combination of morphological and biochemical MR imaging of the radiocarpal cartilage without the application of contrast agent. Multiparametrical MRI without the usage of contrast agent may be a potential tool helping to distinguish both entities. KEY POINTS • Multiparametrical MRI with morphological and biochemical sequences allows the differentiation of patients with arthritis and osteoarthritis. • High-resolution MRI of radiocarpal cartilage is possible without administration of contrast agent.
Collapse
Affiliation(s)
- Valentina Mori
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany.
| | - Philipp Sewerin
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Eichner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Lisa Oezel
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Sebastian Gehrmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| |
Collapse
|
8
|
Kobak S, Bes C. An autumn tale: geriatric rheumatoid arthritis. Ther Adv Musculoskelet Dis 2018; 10:3-11. [PMID: 29290762 PMCID: PMC5724645 DOI: 10.1177/1759720x17740075] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/29/2017] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by erosive arthritis and systemic organ involvement. The disease may affect all ages and both sexes; usually it is seen in young women aged 25-45. Recent studies have shown that RA is among the most common inflammatory disease in older age groups. While elderly-onset rheumatoid arthritis (EORA) is still discussed in the literature, it is generally accepted as a disease beginning after 65 years of age. Compared with young-onset rheumatoid arthritis (YORA), it was found that EORA had different characteristics. EORA is characterized by more equal gender distribution, higher frequency of acute onset with constitutional symptoms, more frequent involvement of large joints, and lower frequency of rheumatoid factor (RF) positivity. Earlier diagnosis, less erosive disease and less disease-modifying antirheumatic drug usage were reported as distinguishing EORA from YORA patients. These various clinical presentations may cause difficulties in diagnosis and differential diagnosis of EORA. However, different clinical and treatment approaches may be needed in these patients. In this article, the clinical and laboratory characteristics, prognosis and treatment principles of EORA will be discussed in light of recent literature data.
Collapse
Affiliation(s)
- Senol Kobak
- Department of Rheumatology, Istinye University Faculty of Medicine, Liv Hospital, Canan Sok. No:5, 34340 Ulus/Istanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, Health Sciences University Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Seidel M, Wise B, Lane N. Nerve growth factor: an update on the science and therapy. Osteoarthritis Cartilage 2013; 21:1223-8. [PMID: 23973134 PMCID: PMC4252012 DOI: 10.1016/j.joca.2013.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/30/2013] [Accepted: 06/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Nerve growth factor (NGF) is a key regulator of nociceptive pain and thus appears to be an interesting target molecule for an innovative class of analgesic medication. We set out to review the principles of neurogenic inflammation and results of anti-NGF regimens in animal studies as well as clinical trials with patients with back pain and osteoarthritis (OA). DESIGN We searched using Google Scholar Search and Pubmed as well as through conference reports for articles and abstracts related to NGF and clinical trials using anti-NGF regimens. We report on efficacy findings and adverse events (AEs) related to these agents in this review. RESULTS We identified five full articles and eight abstract reports relating to anti-NGF agents studied for use in back pain and in OA. CONCLUSIONS Anti-NGF agents either alone or in combination with non-steroidal anti-inflammatory agents (NSAIDs) were more efficacious for the treatment of pain in a number of trials of knee and hip pain compared to NSAIDs alone. However, adverse effects that included rapidly progressive OA and joint replacement were more common in patients treated with anti-NGF and NSAIDs than either treatment alone. Anti-NGF treatment related neurologic symptoms including paresthesias, and potentially other types of adverse effects were usually transient but warrant additional investigation.
Collapse
Affiliation(s)
- M.F. Seidel
- Medizinische Klinik und Poliklinik III, University Hospital, Section of Rheumatology, Sigmund-Freud-Straße 25, D-53127 Bonn, Germany
| | - B.L. Wise
- University of California, Davis School of Medicine, Center for Musculoskeletal Health, 4625 2nd Avenue, Suite 1002, Sacramento, CA 95817, USA
| | - N.E. Lane
- University of California, Davis School of Medicine, Center for Musculoskeletal Health, 4625 2nd Avenue, Suite 1002, Sacramento, CA 95817, USA
| |
Collapse
|
10
|
Rothschild BM. Distinguishing erosive osteoarthritis and calcium pyrophosphate deposition disease. World J Orthop 2013; 4:29-31. [PMID: 23610748 PMCID: PMC3631948 DOI: 10.5312/wjo.v4.i2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/01/2013] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical semantics and paradigms, but the issue is actually more complicated. Even the term osteoarthritis (non-erosive) has been controversial, with some suggesting osteoarthrosis to be more appropriate in view of the perspective that it is a non-inflammatory process undeserving of the “itis” suffix. The term “erosion” has also been a source of confusion in osteoarthritis, as it has been used to describe cartilage, not bone lesions. Inflammation in individuals with osteoarthritis actually appears to be related to complicating phenomena, such as calcium pyrophosphate and hydroxyapatite crystal deposition producing arthritis. Erosive osteoarthritis is the contentious term. It is used to describe a specific form of joint damage to specific joints. The damage has been termed erosions and the distribution of the damage is to the interphalangeal joints of the hand and first carpal metacarpal joint. Inflammation is recognized by joint redness and warmth, while X-rays reveal alteration of the articular surfaces, producing a smudged appearance. This ill-defined, joint damage has a crumbling appearance and is quite distinct from the sharply defined erosions of rheumatoid arthritis and spondyloarthropathy. The appearance is identical to those found with calcium pyrophosphate deposition disease, both in character and their unique responsiveness to hydroxychloroquine treatment. Low doses of the latter often resolve symptoms within weeks, in contrast to higher doses and the months required for response in other forms of inflammatory arthritis. Reconsidering erosive osteoarthritis as a form of calcium pyrophosphate deposition disease guides physicians to more effective therapeutic intervention.
Collapse
|
11
|
Sahinbegovic E, Schett G. [Therapeutic strategies in erosive digital polyarthrosis]. Internist (Berl) 2011; 52:682-7. [PMID: 21523453 DOI: 10.1007/s00108-010-2768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
One of the most common forms of osteoarthritis is hand osteoarthritis. A subgroup, termed erosive hand osteoarthritis (EHOA), shows a highly destructive disease course with involvement of multiple joints, swelling as well as cartilage and bone destruction leading to progressive loss of hand function. EHOA is characterized by subchondral erosions of the finger joints as well as ankylosis. No disease modifying therapy is currently available for the treatment of EHOA and treatment options are confined to the control of symptoms. Acetaminophen and non-steroidal anti-inflammatory drugs are used to treat the signs and symptoms. So far cytokine blocking agents have not shown a convincing therapeutic effect and the effect size of chondroitin sulfate and bisphosphonates in EOHA is small.
Collapse
Affiliation(s)
- E Sahinbegovic
- Universitätsklinik für Innere Medizin 3, Universität Erlangen-Nürnberg, Krankenhausstrasse 12, Erlangen, Germany
| | | |
Collapse
|
12
|
Forney MC, Winalski CS, Schils JP. Magnetic resonance imaging of inflammatory arthropathies of peripheral joints. Top Magn Reson Imaging 2011; 22:45-59. [PMID: 22648080 DOI: 10.1097/rmr.0b013e31825c008d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As the treatment of inflammatory arthropathies has advanced with new therapies that can slow or even halt the development of disabling disease, early and accurate diagnosis has become imperative. Magnetic resonance (MR) imaging has proved to be very sensitive in the detection of erosions, but more importantly, it can demonstrate pre-erosive changes. Detection of synovitis and edema-like bone marrow lesions for initial diagnosis and as an indicator of disease progression can provide crucial information leading to therapeutic interventions before permanent joint damage occurs. Understanding the characteristic intra-articular and extra-articular MR imaging findings of the inflammatory arthritides allows the radiologist to provide appropriate consultations in the care of these patients. The MR appearances of both intra-articular and extra-articular findings of inflammatory arthritis are presented. Despite the advances in imaging, however, many of the MR findings remain nonspecific, and radiologists must avoid overdiagnosis by synthesizing all of the clinical information available into their interpretations.
Collapse
Affiliation(s)
- Michael C Forney
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | |
Collapse
|
13
|
Punzi L, Frigato M, Frallonardo P, Ramonda R. Inflammatory osteoarthritis of the hand. Best Pract Res Clin Rheumatol 2010; 24:301-12. [DOI: 10.1016/j.berh.2009.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
14
|
Vlychou M, Koutroumpas A, Malizos K, Sakkas LI. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage 2009; 17:1283-7. [PMID: 19447214 DOI: 10.1016/j.joca.2009.04.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 03/13/2009] [Accepted: 04/26/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Erosive osteoarthritis (OA) (EOA) is considered an aggressive form of primary OA that is defined radiographically by intra-articular erosions of the inter-phalangeal joints of the hand and characteristic deformities. The aim of the present study was the sonographic investigation of hand small joints in patients with EOA and comparison of the imaging findings with conventional radiography (CR). METHOD Twenty-two patients (20 women, mean age 62.5 years) with clinical and radiographic diagnosis of EOA formed our study group. A total of 660 joints were assessed by both radiographs and ultrasound (US). US and plain films were evaluated by two different physicians on a blinded fashion. Erosions, osteophytes and deformities were evaluated by both US and plain films. Synovial thickening, effusion, and power Doppler signal indicative of abnormal vascularity were recorded in each joint during US scanning. RESULTS Erosions were detected in 231/660 (35%) small joints by US and in 115/660 (17.4%) small joints by conventional radiographs (P<0.05). Osteophytes were detected in 360/660 (54.5%) small joints by US, and in 310/660 (47.0%) small joints by conventional radiographs (P<0.05). Thickened synovium was detected in 19 of 22 patients and increased intra-articular power Doppler signal, indicative of active inflammation, was detected in 18 of 22 patients. Thickened synovium was found in 159/660 (24.1%), effusion in 119/660 (18%) and increased power Doppler in 148/660 (22.4%) small joints. Intra-observer kappa value for agreement regarding US was 0.81 and plain films 0.86. In 31 instances extensive finger tenosynovitis was also evident. CONCLUSION In patients with EOA, US is a reliable and a more sensitive imaging modality than CR in detecting erosions and osteophytes. US detects inflammatory changes in small hand joints in the vast majority of patients with EOA and suggests that current treatment modalities are inadequate treatment for this disease.
Collapse
Affiliation(s)
- M Vlychou
- Department of Radiology, Thessaly University School of Medicine, Larissa 41 110, Greece
| | | | | | | |
Collapse
|
15
|
|
16
|
Abstract
Owing to the potential to image not only bone but also cartilage, bone marrow, and the surrounding internal soft tissue structures, MRI is particularly useful for the assessment of degenerative arthritides. Cartilage-sensitive MRI techniques have been shown to have a significant correlation with arthroscopic grading scores. MRI is also helpful in differentiating osteoarthritis from avascular necrosis, labral pathology, and pigmented villonodular synovitis. This chapter describes advanced imaging techniques, including driven equilibrium Fourier transform (DEFT) and steady-state free precision (SSFP) imaging, direct MRI arthrography, and 3D-T1rho-relaxation mapping.
Collapse
Affiliation(s)
- Jian Zhao
- Department of Radiology, University of California-San Francisco, 185 Berry Street, San Francisco, CA 94107, USA.
| | | |
Collapse
|
17
|
Treatment of erosive osteoarthritis of the hands by intra-articular infliximab injections: a pilot study. Rheumatol Int 2009; 29:961-5. [PMID: 19198842 DOI: 10.1007/s00296-009-0872-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
Our pilot study aimed to investigate the efficacy and tolerability of intra-articular (i.a.) injections of infliximab as a therapy for erosive osteoarthritis of the hands. Ten women with bilateral involvement of the hands and typical erosive osteoarthritis radiographic findings were enrolled and followed for 12 months. All the patients were refractory to conventional drugs. Treatment consisted in monthly i.a. injections of 0.2 ml of infliximab (0.1 mg/ml) in each affected proximal and distal interphalangeal joint of the most involved hand, identified on the basis of clinical and radiological examinations. The other hand was treated with physiological saline (control). The patients did not know which hand was receiving infliximab. Clinical response was evaluated at enrollment, after 6 and 12 months. Posteroanterior radiographs of both hands were obtained at baseline and 12 months later. At 6 months all the patients experienced relief from spontaneous pain and pain on lateral pressure in the hand treated with infliximab and these findings became statistically significant after 1 year. No important modifications were recognized in the hand treated with physiological saline. The anatomical lesion progression system radiological score indicated a reduction, even if not statistically significant, in the hand treated with infliximab and a tendency to slow worsening in the hand treated with physiological saline at 12-month follow-up. No local or systemic adverse reactions were recorded. Our study shows the symptomatic effect and a possible disease modifying action of i.a. infliximab in erosive osteoarthritis of the hands.
Collapse
|
18
|
Grainger AJ, Farrant JM, O'Connor PJ, Tan AL, Tanner S, Emery P, McGonagle D. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol 2007; 36:737-45. [PMID: 17497149 DOI: 10.1007/s00256-007-0287-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 12/21/2006] [Accepted: 01/31/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Erosive osteoarthritis is usually considered as an inflammatory subset of osteoarthritis (OA). However, an inflammatory component is now recognised in all subsets of OA, so this subgroup of erosive or inflammatory OA is more difficult to conceptualise. The aim of this study was to compare routine CR and MRI to investigate erosion numbers and morphology to determine whether hand OA in general is a more erosive disease than previously recognised. DESIGN AND METHODS Fifteen patients with clinical (OA) of the small joints of the hand underwent MRI of one of the affected proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. Conventional radiographs (CR) of the hand were also obtained. The MR images were reviewed by two observers for the presence of central and marginal erosions. The site and morphology of any erosions was recorded. CR images of the same hand joint were scored independently for central and marginal erosions by the same observers. RESULTS There was 100% agreement between the observers for scoring erosions on CR. Agreement for the MRI scores was also excellent (kappa = 0.84). MRI detected 37 erosions, of which only 9 were seen on CR. The increase in sensitivity using MRI was much greater for marginal erosions (1 detected on CR, 19 on MRI) than for central erosions (8 on CR, 18 on MRI). Using MRI 80% of joints examined showed 1 or more erosions compared with 40% using CR. If only marginal erosions were considered 80% of joints were still considered erosive by MRI criteria, but only 1 showed evidence of erosion on CR. Morphologically central erosions appeared to represent areas of subchondral collapse and pressure atrophy. In contrast, marginal erosions resembled those seen in inflammatory arthritides. CONCLUSION Erosions, and particularly marginal erosions typical of those seen in inflammatory arthritis, are a more common feature of small joint OA than conventional radiographs have previously indicated.
Collapse
Affiliation(s)
- A J Grainger
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK.
| | | | | | | | | | | | | |
Collapse
|
19
|
Contreras Blasco MA. [Erosive or inflammatory osteoarthritis: the great unknown]. Med Clin (Barc) 2007; 129:262-6. [PMID: 17683709 DOI: 10.1157/13108352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
Abstract
Factors other than age and genetics may play a role in explaining the onset of osteoarthritis of the hand. Genetic, physiologic, and anatomic differences in men and women cause the variable expressions of osteoarthritis. These different factors affect women's ability to modify osteoarthritis of the hand before and after its onset, although it is genetic. By maintaining normal weight, good health, and nutrition, one can diminish the genetic and multifactorial effects of osteoarthritis of the hand. Future research in genetics, polymorphism, anatomy, hormonal influences, association with other disease processes, and multifactorial issues will clarify these relationships. Additional studies are needed to investigate the outcomes of gender-specific treatments, joint replacement surgery, and other interventions for osteoarthritis of the hand.
Collapse
|
21
|
Zoli A, Lizzio MM, Capuano A, Massafra U, Barini A, Ferraccioli G. Osteoporosis and bone metabolism in postmenopausal women with osteoarthritis of the hand. Menopause 2006; 13:462-6. [PMID: 16735943 DOI: 10.1097/01.gme.0000179048.08371.8e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Osteoarthritis and osteoporosis are two major health problems affecting postmenopausal women. Epidemiological observations seem to demonstrate a possible inverse relationship between osteoarthritis and osteoporosis. Erosive osteoarthritis (EOA) of the hand is a destructive form of primary osteoarthritis. This study evaluated bone mineral density and bone metabolism changes in erosive and nonerosive hand osteoarthritis women. DESIGN Fifty-five women (mean age, 59 years; body mass index, 23 +/- 1.4 kg/m) who had been postmenopausal for an average of 9 years and who presented with hand osteoarthritis according to American College of Rheumatology criteria were enrolled in the study; 15 women showed clinical and radiological evidence of hand EOA. Twenty women matched for age, age at menopause, and body mass index formed the control group. Bone mineral density (g/cm) was measured at the hip and lumbar spine using dual-energy x-ray absorptiometry. Serum and urinary calcium and phosphate, serum 25-hydroxyvitamin D, parathyroid hormone, osteocalcin, and urinary breakdown products of bone matrix (CrossLaps) were analyzed. RESULTS Women with hand EOA had a statistically significant lower T- and Z-score L2-L4 value than non-hand EOA women and controls (P < 0.01). Moreover, postmenopausal women with hand EOA had higher significant percentage of osteoporosis at lumbar spine when compared with non-hand EOA postmenopausal women and controls. Any statistically significant difference in osteocalcin and CrossLaps serum levels was noted among women with hand EOA, hand osteoarthritis, and controls. CONCLUSIONS Our data suggest that postmenopausal women with clinical and radiological EOA are at risk for development of osteoporosis.
Collapse
Affiliation(s)
- Angelo Zoli
- Rheumatology Division, Catholic University of Sacred Heart, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
The term osteoarthritis describes a common, age-related, heterogeneous group of disorders characterised pathologically by focal areas of loss of articular cartilage in synovial joints, associated with varying degrees of osteophyte formation, subchondral bone change, and synovitis. Joint damage is caused by a mixture of systemic factors that predispose to the disease, and local mechanical factors that dictate its distribution and severity. Various genetic abnormalities have been described, but most sporadic osteoarthritis probably depends on minor contributions from several genetic loci. Osteoarthritic joint damage may be associated with clinical problems, but the severity of joint disease is only weakly related to that of the clinical problem. For this reason the associations and pathogenesis of pain are in as much need of investigation as joint damage. Subchondral bone and synovium may be responsible for nociceptive stimuli, and peripheral neuronal sensitisation is an important feature, and can result in normal activities (such as walking) causing pain. Central pain sensitisation can also occur, and psychosocial factors are important determinants of pain severity. We present a stepwise approach to the management of osteoarthritis.
Collapse
Affiliation(s)
- Paul A Dieppe
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
| | | |
Collapse
|
23
|
Analysis of cartilage biomarkers in erosive and non-erosive osteoarthritis of the hands. Osteoarthritis Cartilage 2004; 12:843-5. [PMID: 15450535 DOI: 10.1016/j.joca.2004.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Accepted: 06/03/2004] [Indexed: 02/02/2023]
|
24
|
Abstract
Osteoarthritis is the most widespread form of arthritis in the United States. Classically, osteoarthritis has been grouped into primary and secondary types. Primary or idiopathic osteoarthritis is believed to be a sequela of altered biomechanical stresses across joints in susceptible individuals. Secondary osteoarthritis is a consequence of underlying cartilage damage, such as from preceding inflammatory arthritis, metabolic abnormality, or injury. The radiographic hallmark of osteoarthritis is asymmetric loss of cartilage space. Osteophytosis bony eburnation, subchondral cysts, and eventual subluxation follow. Osteoporosis and erosions are not usual features of this disease.
Collapse
|