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Li X, Long H, Wen D, Chen B, Chen L, Li B. Genetic insights into the association between serum cytokines and frozen shoulder risk: A bidirectional mendelian randomization study. Cytokine 2024; 183:156736. [PMID: 39173280 DOI: 10.1016/j.cyto.2024.156736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/25/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Although existing studies have indicated a connection between chronic low-grade inflammation and the onset of frozen shoulder (FS), the precise causal relationship between distinct circulating inflammatory factors and FS has yet to be thoroughly evaluated. In this study, we employed a bidirectional two-sample Mendelian randomization (MR) analysis to investigate the potential causal relationship between systemic cytokines and FS. METHODS A genome-wide association dataset comprising 41 serum cytokines from 8,293 individuals of Finnish descent was utilized, along with FS data from the UK Biobank included 10,104 FS cases and 451,099 controls. The primary MR method was the inverse variance weighted approach, and four additional MR techniques (MR-Egger, weighted median, simple mode, and weighted mode) were also employed to support and validate the findings. Heterogeneity and horizontal pleiotropy assessments were assessed using Cochrane's Q and MR-Egger intercept tests. Moreover, a series of sensitivity analyses were conducted to strengthen the accuracy and credibility of these findings. RESULTS Based on the IVW method, genetically predicted increasing levels of growth regulated oncogene alpha (GROa) (OR=1.08, 95 % CI 1.02-1.13, P=0.005), interferon gamma-induced protein 10 (IP-10) (OR=1.09, 95 % CI 1.02-1.17, P=0.010), regulated on activation, C-C Motif Chemokine Ligand 5 (CCL5) (OR=1.11, 95 % CI 1.03-1.20, P=0.007) were suggestively associated with an increased risk of FS. Reverse MR analysis revealed no significant causal effect of FS on the 41 systemic inflammatory factors. No heterogeneity or horizontal pleiotropy was observed in our analysis. CONCLUSION This study established a causal association between 41 systemic inflammatory factors and FS, indicating that elevated levels of GROa, IP-10 and CCL5 were associated with a higher risk of FS. Further research is warranted to explore the potential of these biomarkers as early predictors and therapeutic targets for FS.
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Affiliation(s)
- Xuefei Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Han Long
- Huazhong University of Science and Technology, Tongji Medical College, School of Medicine and Health Management, Wuhan 430022, China
| | - Dusu Wen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Biao Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
| | - Bin Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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van der Stok J, Fitzsimons M, Queally JM, O'Donnell T. Does capsular distension and a short period of countertraction improve outcome following manipulation under anesthesia for the treatment of primary adhesive capsulitis of the glenohumeral joint? J Shoulder Elbow Surg 2022; 31:772-781. [PMID: 34619350 DOI: 10.1016/j.jse.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the fact that primary adhesive capsulitis of the glenohumeral joint is often considered a self-limiting condition, not all patients make a full recovery. Manipulation under anesthesia (MUA) is performed to forcibly rupture the contracted capsule in a controlled manner. However, the technique, timing, and use of additional injections are often debated. In this study, we report the outcomes following the addition of capsular distension and countertraction to MUA as a treatment for adhesive capsulitis. METHODS We performed a retrospective case-cohort study comparing 3 groups: Group 1 underwent MUA alone (n = 54); group 2, MUA with capsular distension (n = 114); and group 3, MUA with capsular distension and countertraction (n = 167). The re-MUA rate, Constant-Murley shoulder (CMS) score, and visual analog scale (VAS) score (for pain) were measured after 6 weeks and 6 months. RESULTS The re-MUA rate fell with the addition of both capsular distension and countertraction: 63% in group 1, 39% in group 2, and 18% in group 3. Patients in group 3 recorded the greatest improvement in the CMS score after 6 weeks (+90% vs. +68% in group 2 and +58% in group 1), with all groups showing improvements compared with before treatment. The only independent risk factor identified for re-MUA was smoking. If a second MUA was performed, the CMS (+67%) and VAS (+61%) scores improved, but at 6 months, the CMS score (74.57 ± 7.6 vs. 83.30 ± 5.5) and VAS score (10.57 ± 1.8 vs. 12.96 ± 1.5) remained inferior to those of patients who only needed a single MUA. DISCUSSION AND CONCLUSION MUA combined with capsular distension and countertraction reduces the need for a second MUA and results in a faster improvement in functional outcome (CMS score) and reduction of pain (VAS score) compared with MUA alone or MUA with capsular distension. The results of this case-cohort study are of clinical relevance because they show that the efficacy of an MUA can be improved through relatively simple adaptations of the treatment protocol.
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Affiliation(s)
| | | | - Joseph M Queally
- The Centre for Orthopaedics, Beacon Hospital, Sandyford, Ireland
| | - Turlough O'Donnell
- The Centre for Orthopaedics, Beacon Hospital, Sandyford, Ireland; University College Dublin School of Medicine, Health Sciences Centre, Donnybrook, Ireland
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Kraal T, Lübbers J, van den Bekerom MPJ, Alessie J, van Kooyk Y, Eygendaal D, Koorevaar RCT. The puzzling pathophysiology of frozen shoulders - a scoping review. J Exp Orthop 2020; 7:91. [PMID: 33205235 PMCID: PMC7672132 DOI: 10.1186/s40634-020-00307-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose The pathophysiology of frozen shoulders is a complex and multifactorial process. The purpose of this review is to scope the currently available knowledge of the pathophysiology of frozen shoulders. Methods A systematic search was conducted in Medline, Embase and the Cochrane library. Original articles published between 1994 and October 2020 with a substantial focus on the pathophysiology of frozen shoulders were included. Results Out of 827 records, 48 original articles were included for the qualitative synthesis of this review. Glenohumeral capsular biopsies were reported in 30 studies. Fifteen studies investigated were classified as association studies. Three studies investigated the pathophysiology in an animal studies. A state of low grade inflammation, as is associated with diabetes, cardiovascular disease and thyroid disorders, predisposes for the development of frozen shoulder. An early immune response with elevated levels of alarmins and binding to the receptor of advance glycation end products is present at the start of the cascade. Inflammatory cytokines, of which transforming growth factor-β1 has a prominent role, together with mechanical stress stimulates Fibroblast proliferation and differentiation into myofibroblasts. This leads to an imbalance of extracellular matrix turnover resulting in a stiff and thickened glenohumeral capsule with abundance of type III collagen. Conclusion This scoping review outlines the complexity of the pathophysiology of frozen shoulder. A comprehensive overview with background information on pathophysiologic mechanisms is given. Leads are provided to progress with research for clinically important prognostic markers and in search for future interventions. Level of evidence Level V.
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Affiliation(s)
- T Kraal
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands. .,, Haarlem, The Netherlands.
| | - J Lübbers
- Department of Molecular cell biology and Immunology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - J Alessie
- Avans University of Applied Science, Breda, The Netherlands
| | - Y van Kooyk
- Department of Molecular cell biology and Immunology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - R C T Koorevaar
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, the Netherlands
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Uchio R, Muroyama K, Okuda-Hanafusa C, Kawasaki K, Yamamoto Y, Murosaki S. Hot Water Extract of Curcuma longa L. Improves Serum Inflammatory Markers and General Health in Subjects with Overweight or Prehypertension/Mild Hypertension: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2019; 11:nu11081822. [PMID: 31394768 PMCID: PMC6723939 DOI: 10.3390/nu11081822] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023] Open
Abstract
To investigate the effect of a hot water extract of C. longa L. (WEC) containing anti-inflammatory agents, bisacurone, and turmeronol on chronic inflammation, a randomized double-blind placebo-controlled study was conducted in middle-aged and elderly subjects aged 50–69 years with overweight or prehypertension/mild hypertension. The subjects consumed 900 mg WEC tablets, containing 400 μg bisacurone, 80 μg turmeronol A and 20 μg turmeronol B (WEC group: n = 45), or placebo tablets without WEC (placebo group: n = 45) daily for 12 weeks. Serum inflammatory and metabolic markers were measured. The subjects also completed the MOS 36-item short-form health survey (SF-36) and the Profile of Mood States scale (POMS). In the WEC group, the serum levels of C-reactive protein, tumor necrosis factor-α, interleukin-6, and soluble vascular cell adhesion molecule-1 decreased significantly. Compared with the placebo group, the WEC group had significantly lower serum levels of glucose, hemoglobin A1c, and triglycerides, as well as higher serum levels of high-density lipoprotein cholesterol. The WEC group also showed significant improvement of SF-36 scores (for general health, vitality, mental health, and mental summary component) and POMS scores for positive mood states (vigor-activity and friendliness). In conclusion, WEC may ameliorate chronic low-grade inflammation, thus contributing to the improvement of associated metabolic disorders and general health.
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Affiliation(s)
- Ryusei Uchio
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan.
| | - Koutarou Muroyama
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan
| | - Chinatsu Okuda-Hanafusa
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan
| | - Kengo Kawasaki
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan
| | - Yoshihiro Yamamoto
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan
| | - Shinji Murosaki
- Research & Development Institute, House Wellness Foods Corp., 3-20 Imoji, Itami, Hyogo 664-0011, Japan
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Pietrzak M. Adhesive capsulitis: An age related symptom of metabolic syndrome and chronic low-grade inflammation? Med Hypotheses 2016; 88:12-7. [PMID: 26880627 DOI: 10.1016/j.mehy.2016.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/29/2015] [Accepted: 01/01/2016] [Indexed: 02/08/2023]
Abstract
Adhesive capsulitis (AC) is very poorly understood, particularly it's underlying etiology. Obesity and metabolic syndrome, which are strongly associated with chronic low grade inflammation, are becoming increasingly understood to underlie a raft of morbid states including upper limb pain syndromes, diabetes (DM), cardiovascular disease (CVD), cancer and central nervous system dysfunction and degeneration. Notwithstanding age, two of the strongest established risk factors for AC are DM and CVD. The hypothesis argues that similar to DM and CVD, the inflammation and capsular fibrosis seen in AC is precipitated by metabolic syndrome and chronic low grade inflammation. These pathophysiological mechanisms are highly likely to be perpetuated by upregulation of pro-inflammatory cytokine production, sympathetic dominance of autonomic balance, and neuro-immune activation. The hypothesis predicts and describes how these processes may etiologically underpin and induce each sub-classification of AC. An improved understanding of the etiology of AC may lead to more accurate diagnosis, improved management, treatment outcomes, and reduce or prevent pain, disability and suffering associated with the disease. The paper follows on with a discussion of similarities between the pathophysiology of AC to general systemic inflammatory control mechanisms whereby connective tissue (CT) fibrosis is induced as a storage depot for leukocytes and chronic inflammatory cells. The potential role of hyaluronic acid (HA), the primary component of the extracellular matrix (ECM) and CT, in the pathophysiology of AC is also discussed with potential treatment implications. Lastly, a biochemical link between physical and mental health through the ECM is described and the concept of a periventricular-limbic central driver of CT dysfunction is introduced.
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Affiliation(s)
- Max Pietrzak
- University of Bath, Claverton Down Road, Bath, North East Somerset, BA2 7AY, United Kingdom.
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Fernandes MR. Correlation between functional disability and quality of life in patients with adhesive capsulitis. ACTA ORTOPEDICA BRASILEIRA 2015; 23:81-4. [PMID: 27069405 PMCID: PMC4813414 DOI: 10.1590/1413-78522015230200791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE: To determine the correlation between functional disability and quality of life of patients with adhesive capsulitis. METHODS: Two instruments (WHOQOL-BREF and DASH) were applied to evaluate the quality of life and functional capacity of patients with adhesive capsulitis. Inclusion criteria were age between 35 and 75 years old and achievement of shoulder imaging. Each domain of the WHOQOL-BREF was correlated with DASH. Pearson's correlation coefficient was used for parametric variables and Spearman's correlation coefficient was used when at least one variable had a non-normal distribution. The level of significance was p <0.05. RESULTS: Forty three patients with mean age of 54.7 years old were evaluated. The mean values found in the physical, psychological, social and environmental domains of the WHOQOL-BREF and DASH were 45.3, 63.9, 68.2, 60.2 and 61.6, respectively. A moderate negative correlation was found between DASH and the physical domain of WHOQOL-BREF (r= - 0.583, p<0.001). CONCLUSION: The only domain where WHOQOL-BREF correlates with DASH is the physical domain, suggesting that measures to promote the improvement of functional capacity may lead to better quality of life of patients with adhesive capsulitis. Level of Evidence IV, Prospective Study.
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