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Surgery for Osteoarthritis. Clin Geriatr Med 2022; 38:385-396. [DOI: 10.1016/j.cger.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sun L, Wang G, He M, Mei Z, Zhang F, Liu P. Effect and mechanism of the CACNA2D1-CGRP pathway in osteoarthritis-induced ongoing pain. Biomed Pharmacother 2020; 129:110374. [PMID: 32570114 DOI: 10.1016/j.biopha.2020.110374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022] Open
Abstract
This study built an OA model in rats by monosodium iodoacetate (MIA) injection to determine the effects and mechanism of the voltage-dependent calcium channel subunit alpha-2/delta-1 (CACNA2D1)-calcitonin gene-related protein (CGRP) pathway in osteoarthritis (OA)-induced ongoing pain. CACNA2D1 expression was measured by qPCR assay, western blotting assay, and immunofluorescence. Pain behaviors in rats were assessed with the measurement of thermal paw withdrawal latency (PWL) and mechanical paw withdrawal threshold (PWT). The expression of CACNA2D1, neuropeptide Y (NPY), activating transcription factor 3 (ATF3), CGRP, protein kinase A (PKA), phosphorylated (p)-PKA, adenylyl cyclase (AC), protein kinase C (PKC), p-PKC, phospholipase C (PLC), and mitogen-activated protein kinase (MAPK) signaling pathway proteins were measured, OA rats had higher CACNA2D1 expression than normal rats. Knockdown of CACNA2D1 led to the elevation of the pain threshold of OA rats, and CACNA2D1 over-expression decreased the pain threshold of normal rats. Moreover, CACNA2D1 over-expression inhibited the expression of CGRP, up-regulated the expressions of NPY, ATF3, p-PKA, AC, p-PKC, PLC, p-Jun N-terminal kinase (JNK), and p-p38, and had no significant effect on phosphorylated extracellular signal-regulated kinase (p-ERK) expression in vivo and in vitro. Using this model of MIA-induced OA, we demonstrated that CACNA2D1 might be involved in the process of pain by modulating the CGRP and AC-PKA/PKC/MAPK signaling pathways in the dorsal root ganglion.
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Affiliation(s)
- Liang Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Guodong Wang
- Departments of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Meifang He
- Laboratory of General Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhigang Mei
- Guangzhou Sihe Biotechnology Co., Ltd., Guangzhou, China
| | - Fazhou Zhang
- Guangzhou Sihe Biotechnology Co., Ltd., Guangzhou, China
| | - Ping Liu
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China; Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
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Zavala J, Fitace F, León M, Ponce F, Gutiérrez H. Resultados funcionales tras entrenamiento fisioterapéutico que incluye la realidad virtual en mayores de 60 años con artroplastia total de cadera: estudio descriptivo. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.ft.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Di Paola R, Fusco R, Impellizzeri D, Cordaro M, Britti D, Morittu VM, Evangelista M, Cuzzocrea S. Adelmidrol, in combination with hyaluronic acid, displays increased anti-inflammatory and analgesic effects against monosodium iodoacetate-induced osteoarthritis in rats. Arthritis Res Ther 2016; 18:291. [PMID: 27955699 PMCID: PMC5153857 DOI: 10.1186/s13075-016-1189-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a degenerative joint disease produced by a cascade of events that can ultimately lead to joint damage. The aim of this study was to evaluate the effect of adelmidrol, a synthetic palmitoylethanolamide analogue, combined with hyaluronic acid on pain severity and modulation of the inflammatory response in a rat model of monosodium iodoacetate (MIA)-induced osteoarthritis. METHODS OA was induced by intra-articular injection of MIA in the knee joint. On day 21 post-MIA administration, the knee joint was analyzed. Rats subjected to OA were treated by intra-articular injection of adelmidrol in combination with sodium hyaluronate at different doses and time points after MIA induction. Limb nociception was assessed by the paw withdrawal latency and threshold measurement. Samples were examined macroscopically, histologically, and by immunohistochemistry. RESULTS At day 21 post-MIA injection, the MIA + solvent and MIA + 1.0% sodium hyaluronate groups showed irregularities and fibrillation in the surface layer, a decrease in blood cells and multilayering in transition and radial zones, no pannus formation, and modified Mankin scores significantly higher than sham knees. The combination of hyaluronic acid and adelmidrol dose-dependently (adelmidrol 0.6% + 1.0% sodium hyaluronate and adelmidrol 2% + 1.0% sodium hyaluronate) reduced the histological alterations induced by MIA. Moreover, degeneration of articular cartilage, mast cell infiltration, and pro-inflammatory cytokine and chemokine plasma levels were significantly downregulated by treatment with a combination of hyaluronic acid and adelmidrol at the above doses. CONCLUSIONS Our results clearly demonstrate that the combination of hyaluronic acid and adelmidrol improves the signs of OA induced by MIA.
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Affiliation(s)
- Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, n 31, Messina, 98166, Italy
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, n 31, Messina, 98166, Italy
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, n 31, Messina, 98166, Italy
| | - Marika Cordaro
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, n 31, Messina, 98166, Italy
| | - Domenico Britti
- Department of Health Science, University of Catanzaro, Viale Europa, Campus S. Venuta, Germaneto, Catanzaro, 88100, Italy
| | - Valeria Maria Morittu
- Department of Health Science, University of Catanzaro, Viale Europa, Campus S. Venuta, Germaneto, Catanzaro, 88100, Italy
| | - Maurizio Evangelista
- Institute of Anaesthesiology and Reanimation, Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, n 31, Messina, 98166, Italy. .,Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA.
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Osteoarthritis and the rule of halves. Osteoarthritis Cartilage 2014; 22:535-9. [PMID: 24565953 PMCID: PMC3988991 DOI: 10.1016/j.joca.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/20/2013] [Accepted: 02/14/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Symptomatic osteoarthritis poses a major challenge to primary health care but no studies have related accessing primary care ('detection'), receiving recommended treatments ('treatment'), and achieving adequate control ('control'). OBJECTIVE To provide estimates of detection, treatment, and control within a single population adapting the approach used to determine a Rule of Halves for other long-term conditions. SETTING General population. PARTICIPANTS 400 adults aged 50+ years with prevalent symptomatic knee osteoarthritis. DESIGN Prospective cohort with baseline questionnaire, clinical assessment, and plain radiographs, and questionnaire follow-up at 18 and 36 months and linkage to primary care medical records. OUTCOME MEASURES 'Detection' was defined as at least one musculoskeletal knee-related GP consultation between baseline and 36 months. 'Treatment' was self-reported use of at least one recommended treatment or physiotherapy/hospital specialist referral for their knee problem at all three measurement points. Pain was 'controlled' if characteristic pain intensity <5 out of 10 on at least two occasions. RESULTS In 221 cases (55.3%; 95%CI: 50.4, 60.1) there was evidence that the current problem had been detected in general practice. Of those detected, 164 (74.2% (68.4, 80.0)) were receiving one or more of the recommended treatments at all three measurement points. Of those detected and treated, 45 (27.4% (20.5, 34.3)) had symptoms under control on at least two occasions. Using narrower definitions resulted in substantially lower estimates. CONCLUSION Osteoarthritis care does not conform to a Rule of Halves. Symptom control is low among those accessing health care and receiving treatment.
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Ganasegeran K, Menke JM, Challakere Ramaswamy VM, Abdul Manaf R, Alabsi AM, Al-Dubai SAR. Level and determinants of knowledge of symptomatic knee osteoarthritis among railway workers in Malaysia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:370273. [PMID: 24701573 PMCID: PMC3950488 DOI: 10.1155/2014/370273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/14/2013] [Accepted: 01/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. PURPOSE This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. METHODS A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. RESULTS Mean (± SD) age of the respondents was 41.4 (± 10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥ 50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. CONCLUSION The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care.
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Affiliation(s)
- Kurubaran Ganasegeran
- International Medical School, Management and Science University (MSU), Shah Alam 40100 Selangor, Malaysia
| | - J. Michael Menke
- International Medical University (IMU), 57000 Bukit Jalil, Kuala Lumpur, Malaysia
| | | | - Rizal Abdul Manaf
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, 56000 Kuala Lumpur, Malaysia
| | - Aied M. Alabsi
- Department Oral Biology and Biomedical Science, Faculty of Dentistry, University of Malaya (UM), 50603 Petaling Jaya, Kuala Lumpur, Malaysia
| | - Sami Abdo Radman Al-Dubai
- Department of Community Medicine, International Medical University (IMU), 57000 Bukit Jalil, Kuala Lumpur, Malaysia
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Voorn VMA, Vermeulen HM, Nelissen RGHH, Kloppenburg M, Huizinga TWJ, Leijerzapf NAC, Kroon HM, Vliet Vlieland TPM, van der Linden HMJ. An innovative care model coordinated by a physical therapist and nurse practitioner for osteoarthritis of the hip and knee in specialist care: a prospective study. Rheumatol Int 2013; 33:1821-8. [PMID: 23325095 DOI: 10.1007/s00296-012-2662-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Abstract
The subject of the study is to investigate whether health-related quality of life (HRQoL), pain and function of patients with hip or knee osteoarthritis (OA) improves after a specialist care intervention coordinated by a physical therapist and a nurse practitioner (NP) and to assess satisfaction with this care at 12 weeks. This observational study included all consecutive patients with hip or knee OA referred to an outpatient orthopaedics clinic. The intervention consisted of a single, standardized visit (assessment and individually tailored management advice, to be executed in primary care) and a telephone follow-up, coordinated by a physical therapist and a NP, in cooperation with an orthopaedic surgeon. Assessments at baseline and 10 weeks thereafter included the short form-36 (SF-36), EuroQol 5D (EQ-5D), hip or knee disability and osteoarthritis outcome score (HOOS or KOOS), the intermittent and constant osteoarthritis pain questionnaire (ICOAP) for hip or knee and a multidimensional satisfaction questionnaire (23 items; 4 point scale). Eighty-seven patients (57 female), mean age 68 years (SD 10.9) were included, with follow-up data available in 63 patients (72 %). Statistically significant improvements were seen regarding the SF-36 physical summary component score, the EQ-5D, the ICOAP scores for hip and knee, the HOOS subscale sports and the KOOS subscales pain, symptoms and activities of daily living. The proportions of patients reporting to be satisfied ranged from 79 to 98 % per item. In patients with hip and knee OA pain, function and HRQoL improved significantly after a single-visit multidisciplinary OA management intervention in specialist care, with high patient satisfaction.
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Affiliation(s)
- Veronique M A Voorn
- Department of Medical Decision Making, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Woo YJ, Joo YB, Jung YO, Ju JH, Cho ML, Oh HJ, Jhun JY, Park MK, Park JS, Kang CM, Sung MS, Park SH, Kim HY, Min JK. Grape seed proanthocyanidin extract ameliorates monosodium iodoacetate-induced osteoarthritis. Exp Mol Med 2012; 43:561-70. [PMID: 21795829 DOI: 10.3858/emm.2011.43.10.062] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is an age-related joint disease that is characterized by degeneration of articular cartilage and chronic pain. Oxidative stress is considered one of the pathophysiological factors in the progression of OA. We investigated the effects of grape seed proanthocyanidin extract (GSPE), which is an antioxidant, on monosodium iodoacetate (MIA)-induced arthritis of the knee joint of rat, which is an animal model of human OA. GSPE (100 mg/kg or 300 mg/kg) or saline was given orally three times per week for 4 weeks after the MIA injection. Pain was measured using the paw withdrawal latency (PWL), the paw withdrawal threshold (PWT) and the hind limb weight bearing ability. Joint damage was assessed using histological and microscopic analysis and microcomputerized tomography. Matrix metalloproteinase-13 (MMP13) and nitrotyrosine were detected using immunohistochemistry. Administration of GSPE to the MIA-treated rats significantly increased the PWL and PWT and this resulted in recovery of hind paw weight distribution (P < 0.05). GSPE reduced the loss of chondrocytes and proteoglycan, the production of MMP13, nitrotyrosine and IL-1β and the formation of osteophytes, and it reduced the number of subchondral bone fractures in the MIA-treated rats. These results indicate that GSPE is antinociceptive and it is protective against joint damage in the MIA-treated rat model of OA. GSPE could open up novel avenues for the treatment of OA.
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Affiliation(s)
- Yun Ju Woo
- Department of Internal Medicine, Bucheon St. Mary's Hospital, Korea
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Okun A, Liu P, Davis P, Ren J, Remeniuk B, Brion T, Ossipov MH, Xie J, Dussor GO, King T, Porreca F. Afferent drive elicits ongoing pain in a model of advanced osteoarthritis. Pain 2012; 153:924-933. [PMID: 22387095 DOI: 10.1016/j.pain.2012.01.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/20/2012] [Accepted: 01/21/2012] [Indexed: 11/18/2022]
Abstract
Osteoarthritis (OA) is a chronic condition characterized by pain during joint movement. Additionally, patients with advanced disease experience pain at rest (ie, ongoing pain) that is generally resistant to nonsteroidal antiinflammatory drugs. Injection of monosodium iodoacetate (MIA) into the intraarticular space of the rodent knee is a well-established model of OA that elicits weight-bearing asymmetry and referred tactile and thermal hypersensitivity. Whether ongoing pain is present in this model is unknown. Additionally, the possible relationship of ongoing pain to MIA dose is not known. MIA produced weight asymmetry, joint osteolysis, and cartilage erosion across a range of doses (1, 3, and 4.8 mg). However, only rats treated with the highest dose of MIA showed conditioned place preference to a context paired with intraarticular lidocaine, indicating relief from ongoing pain. Diclofenac blocked the MIA-induced weight asymmetry but failed to block MIA-induced ongoing pain. Systemic AMG9810, a transient receptor potential V1 channel (TRPV1) antagonist, effectively blocked thermal hypersensitivity, but failed to block high-dose MIA-induced weight asymmetry or ongoing pain. Additionally, systemic or intraarticular HC030031, a TRPA1 antagonist, failed to block high-dose MIA-induced weight asymmetry or ongoing pain. Our studies suggest that a high dose of intraarticular MIA induces ongoing pain originating from the site of injury that is dependent on afferent fiber activity but apparently independent of TRPV1 or TRPA1 activation. Identification of mechanisms driving ongoing pain may enable development of improved treatments for patients with severe OA pain and diminish the need for joint replacement surgery.
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Affiliation(s)
- Alec Okun
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan 250012, China
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STRAND VIBEKE, SIMON LEES, DOUGADOS MAXIME, SANDS GEORGEH, BHADRA PRITHA, BREAZNA AURORA, IMMITT JEFF. Treatment of Osteoarthritis with Continuous Versus Intermittent Celecoxib. J Rheumatol 2011; 38:2625-34. [DOI: 10.3899/jrheum.110636] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether “continuous” celecoxib is more efficacious than “intermittent” use in preventing osteoarthritis (OA) flares of the knee and/or hip.Methods.A double-blind, randomized, multicenter international study comparing efficacy and safety of continuous (daily) versus intermittent (as required during predefined OA flare) celecoxib 200 mg/day in 858 subjects, aged 18–80 years. The study consisted of 3 periods: (I) screening/washout visit; (II) open-label run-in with celecoxib; and (III) 22-week blinded treatment. Only subjects whose OA flares resolved in Period 2 (without subsequent flare) were randomized. The primary endpoint, number of flares per time of exposure during Period III (number of flares per month), was compared using analysis of variance with treatment as the independent variable. Acetaminophen was available as rescue medication.Results.Of 875 subjects randomized to treatment, 858 subjects received treatment. At randomization > 70% were female; mean age 58.6 years; mean disease duration 6.5 years; total Western Ontario and McMaster Universities Osteoarthritis Index mean score 25.8; ∼45% had hypertension; and ∼20% were using aspirin (for cardiovascular prophylaxis). Subjects receiving continuous treatment reported 42% fewer OA flares/month than intermittent users (p < 0.0001) or 2.0 fewer OA flares over 22 weeks. Statistical and clinically meaningful benefits in secondary outcomes were also evident with continuous treatment. There were no differences in adverse events (AE) or new-onset/aggravated hypertension.Conclusion.Continuous treatment with celecoxib 200 mg/day was significantly more efficacious than intermittent use in preventing OA flares of the hip and knee, without an increase in overall AE, including gastrointestinal disorders and hypertension, during 22 weeks of treatment. ClinicalTrials.gov identifier NCT00139776.
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Liu P, Okun A, Ren J, Guo RC, Ossipov MH, Xie J, King T, Porreca F. Ongoing pain in the MIA model of osteoarthritis. Neurosci Lett 2011; 493:72-5. [PMID: 21241772 DOI: 10.1016/j.neulet.2011.01.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/06/2011] [Accepted: 01/09/2011] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) is a chronic pain condition characterized by pain during joint use as well as pain at rest (i.e., ongoing pain). Although injection of monosodium iodoacetate (MIA) into the intra-articular space of the rodent knee is a well established model of OA pain that is characterized by changes in weight bearing and hypersensitivity to tactile and thermal stimuli, it is not known if this procedure elicits ongoing pain. Further, the time-course and possible underlying mechanisms of these components of pain remain poorly understood. In these studies, we demonstrated the presence of ongoing pain in addition to changes in weight bearing and evoked hypersensitivity. Twenty-eight days following MIA injection, spinal clonidine blocked changes in weight bearing and thermal hypersensitivity and produced place preference indicating that MIA induces ongoing and evoked pain. These findings demonstrate the presence of ongoing pain in this model that is present at a late-time point after MIA allowing for mechanistic investigation.
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Affiliation(s)
- Ping Liu
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
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Ng NTM, Heesch KC, Brown WJ. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial. Arthritis Res Ther 2010; 12:R25. [PMID: 20152042 PMCID: PMC2875659 DOI: 10.1186/ar2932] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 12/10/2009] [Accepted: 02/12/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction Management of osteoarthritis (OA) includes the use of non-pharmacological and pharmacological therapies. Although walking is commonly recommended for reducing pain and increasing physical function in people with OA, glucosamine sulphate has also been used to alleviate pain and slow the progression of OA. This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA. Methods Thirty-six low active participants (aged 42 to 73 years) were provided with 1500 mg glucosamine sulphate per day for 6 weeks, after which they began a 12-week progressive walking program, while continuing to take glucosamine. They were randomized to walk 3 or 5 days per week and given a pedometer to monitor step counts. For both groups, step level of walking was gradually increased to 3000 steps/day during the first 6 weeks of walking, and to 6000 steps/day for the next 6 weeks. Primary outcomes included physical activity levels, physical function (self-paced step test), and the WOMAC Osteoarthritis Index for pain, stiffness and physical function. Assessments were conducted at baseline and at 6-, 12-, 18-, and 24-week follow-ups. The Mann Whitney Test was used to examine differences in outcome measures between groups at each assessment, and the Wilcoxon Signed Ranks Test was used to examine differences in outcome measures between assessments. Results During the first 6 weeks of the study (glucosamine supplementation only), physical activity levels, physical function, and total WOMAC scores improved (P < 0.05). Between the start of the walking program (Week 6) and the final follow-up (Week 24), further improvements were seen in these outcomes (P < 0.05) although most improvements were seen between Weeks 6 and 12. No significant differences were found between walking groups. Conclusions In people with hip or knee OA, walking a minimum of 3000 steps (~30 minutes), at least 3 days/week, in combination with glucosamine sulphate, may reduce OA symptoms. A more robust study with a larger sample is needed to support these preliminary findings. Trial Registration Australian Clinical Trials Registry ACTRN012607000159459.
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Affiliation(s)
- Norman T M Ng
- The University of Queensland, School of Human Movement Studies, Blair Drive, St Lucia Campus, Brisbane, Queensland 4072, Australia.
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Rosemann T, Laux G, Szecsenyi J, Wensing M, Grol R. Pain and Osteoarthritis in Primary Care: Factors Associated with Pain Perception in a Sample of 1,021 Patients. PAIN MEDICINE 2008; 9:903-10. [DOI: 10.1111/j.1526-4637.2008.00498.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosemann T, Joos S, Szecsenyi J, Laux G, Wensing M. Health service utilization patterns of primary care patients with osteoarthritis. BMC Health Serv Res 2007; 7:169. [PMID: 17956605 PMCID: PMC2190766 DOI: 10.1186/1472-6963-7-169] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 10/23/2007] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). METHODS Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. RESULTS 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the "symptom" scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. CONCLUSION Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully.
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Affiliation(s)
- Thomas Rosemann
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Stefanie Joos
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Joachim Szecsenyi
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Gunter Laux
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Michel Wensing
- Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
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Bennell K, Bowles KA, Payne C, Cicuttini F, Osborne R, Harris A, Hinman R. Effects of laterally wedged insoles on symptoms and disease progression in medial knee osteoarthritis: a protocol for a randomised, double-blind, placebo controlled trial. BMC Musculoskelet Disord 2007; 8:96. [PMID: 17892539 PMCID: PMC2147062 DOI: 10.1186/1471-2474-8-96] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 09/24/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst laterally wedged insoles, worn inside the shoes, are advocated as a simple, inexpensive, non-toxic self-administered intervention for knee osteoarthritis (OA), there is currently limited evidence to support their use. The aim of this randomised, double-blind controlled trial is to determine whether laterally wedges insoles lead to greater improvements in knee pain, physical function and health-related quality of life, and slower structural disease progression as well as being more cost-effective, than control flat insoles in people with medial knee OA. METHODS/DESIGN Two hundred participants with painful radiographic medial knee OA and varus malalignment will be recruited from the community and randomly allocated to lateral wedge or control insole groups using concealed allocation. Participants will be blinded as to which insole is considered therapeutic. Blinded follow up assessment will be conducted at 12 months after randomisation. The outcome measures are valid and reliable measures recommended for OA clinical trials. Questionnaires will assess changes in pain, physical function and health-related quality-of-life. Magnetic resonance imaging will measure changes in tibial cartilage volume. To evaluate cost-effectiveness, participants will record the use of all health-related treatments in a log-book returned to the assessor on a monthly basis. To test the effect of the intervention using an intention-to-treat analysis, linear regression modelling will be applied adjusting for baseline outcome values and other demographic characteristics. DISCUSSION Results from this trial will contribute to the evidence regarding the effectiveness of laterally wedged insoles for the management of medial knee OA. TRIAL REGISTRATION ACTR12605000503628; NCT00415259.
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Affiliation(s)
- Kim Bennell
- Centre for Health, Exercise & Sports Medicine, School of Physiotherapy, University of Melbourne, Australia
| | - Kelly-Ann Bowles
- Centre for Health, Exercise & Sports Medicine, School of Physiotherapy, University of Melbourne, Australia
| | - Craig Payne
- Department of Podiatry, School of Human Biosciences, LaTrobe University, Melbourne, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Australia
| | - Richard Osborne
- AFV Centre for Rheumatic Diseases, Department of Medicine (RMH/WH), University of Melbourne, Australia
| | - Anthony Harris
- Health Economics Unit, Monash University, Melbourne, Australia
| | - Rana Hinman
- Centre for Health, Exercise & Sports Medicine, School of Physiotherapy, University of Melbourne, Australia
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17
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Rosemann T, Laux G, Kuehlein T. Osteoarthritis and functional disability: results of a cross sectional study among primary care patients in Germany. BMC Musculoskelet Disord 2007; 8:79. [PMID: 17686172 PMCID: PMC1963449 DOI: 10.1186/1471-2474-8-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 08/08/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine factors associated with functional disability in patients with OA. METHODS 1250 questionnaires were distributed to OA outpatients from 75 general practices; 1021 (81.6%) were returned. Questionnaires included sociodemographic data, the short form of the Arthritis Impact Measurement Scale (AIMS2-SF), and the Patient Health Questionnaire (PHQ-9) to assess concomitant depression. A hierarchical stepwise multiple regression analysis with the AIMS2-SF dimension "lower body" as dependent was performed. RESULTS Main factors associated with functional disability were depression symptoms, as reflected in a high score of the PHQ-9 (beta = 0.446; p < 0.0009), pain as reflected in the AIMS2-SF symptom scale (beta = 0.412; p = 0.001), and few social contacts (beta = 0.201; p < 0.042). A high body mass index was associated with lower functional ability (beta = 0.332; p = 0.005) whereas a higher educational level (beta = -0.279; p = 0.029) predicted less impairment. Increased age was a weak predictor (beta = 0.178; p = 0.001) of disability. With a p of 0.062 the radiological severity according to the grading of Kellgren and Lawrence slightly surpassed the required significance level for remaining in the final regression model. CONCLUSION The results emphasize that psychological as well as physical factors need to be addressed similarly to improve functional ability of patients suffering from OA. More research with multifaceted and tailored interventions is needed to determine how these factors can be targeted appropriately.
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Affiliation(s)
- Thomas Rosemann
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Voßstr. 2, 69115 Heidelberg, Germany
| | - Gunter Laux
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Voßstr. 2, 69115 Heidelberg, Germany
| | - Thomas Kuehlein
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Voßstr. 2, 69115 Heidelberg, Germany
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18
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Terre L. Behavioral Medicine Review: The Dialectic of Tradition and Progress in Osteoarthritis Management. Am J Lifestyle Med 2007. [DOI: 10.1177/1559827607301806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In his state of the art review, Katz provided an evidence-based perspective on nonpharmacologic approaches to osteoarthritis. His overview prompts discussion of the tradition-progress dialectic that has punctuated this area as exemplified, on one hand, by continuing tendencies to privilege biomedical over biopsychosocial conceptualizations and persisting barriers to the widespread implementation of nonpharmacologic, best-evidence treatments in primary care. On the other hand, the field has been sparked by considerable innovation, including the bursting of traditional treatment boundaries, an expanding range of intervention strategies, and the emergence of promising trends that may unleash further advances in patient care.
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19
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Abstract
PURPOSE OF REVIEW Although total joint replacement is an effective treatment for advanced arthritis, many whom might benefit are unwilling to consider this procedure. This review highlights advances in understanding of patients' perceptions of total joint replacement. RECENT FINDINGS Research shows that patients' willingness to consider total joint replacement varies by sex, race/ethnicity, and socioeconomic status as a result of systematic differences in knowledge and beliefs about the procedure. Individuals with low socioeconomic status and minorities view the procedure less favorably than their wealthier, white counterparts, possibly partly explaining disparity in rates of use of the procedure among these groups. Among those undergoing total joint replacement, up to 30% experience a suboptimal outcome or are dissatisfied with results. Early work suggests that patients' expectations and self-efficacy are important potential predictors of postoperative outcome. Patient information needs regarding total joint replacement vary significantly and possibly systematically by sex and race/ethnicity. Available information materials may not address the concerns of many individuals contemplating the procedure, posing a potential barrier to surgery. SUMMARY Targeted culturally sensitive knowledge dissemination strategies are needed to improve the knowledge and beliefs of people with hip/knee arthritis about total joint replacement.
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MESH Headings
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Female
- Humans
- Male
- Osteoarthritis, Hip/ethnology
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/ethnology
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Knee/surgery
- Patient Education as Topic
- Sex Factors
- Socioeconomic Factors
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Affiliation(s)
- Gillian A Hawker
- Division of Rheumatology, Department of Medicine, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario, Canada.
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20
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Peat G, Thomas E, Croft P. Staging joint pain and disability: a brief method using persistence and global severity. ACTA ACUST UNITED AC 2006; 55:411-9. [PMID: 16739210 DOI: 10.1002/art.21986] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Joint pain in older adults is a problem commonly presented to primary care. In contrast to methods for defining and staging the most likely underlying disease (osteoarthritis), clinically practicable methods for staging pain and associated disability are lacking. Our objective was to test a method of brief pain assessment and clinical staging based on recognized focal features of chronic pain and preexisting measurement tools. METHODS A total of 781 adults ages > or =50 years who were registered with 3 general practices and were experiencing knee pain within the previous 6 months attended research clinics between August 2002 and September 2003. Pain and associated disability were staged on the basis of self-completed questions on knee pain persistence and global severity (Chronic Pain Grade). These were then compared with participants' appraisals of their knee problem, its perceived importance, negative health states, and consultation behavior. RESULTS Knee pain global severity was associated with symptom dissatisfaction, patient prioritizing, oral analgesic intake, mood, mobility limitation, poorer general health, and consultation behavior. Fewer independent associations were found with knee pain persistence. Staging could be performed using only 4 simple questions. CONCLUSION Although the usefulness of this approach still needs to be determined in routine clinical settings and across other joint pain sites, our findings suggest that focal characteristics of chronic pain (persistence, global severity) can be used as the basis of brief, simple assessment and staging of joint pain in older adults.
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Affiliation(s)
- George Peat
- Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, United Kingdom.
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21
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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.
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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.
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22
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Abstract
The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.
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Affiliation(s)
- David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, 2021 K Street, NW, Suite 300, Washington, DC 20006, USA.
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23
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24
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Mazzuca SA, Brandt KD, Katz BP, Ragozzino LR, Gʼsell PM. Can a Nurse-Directed Intervention Reduce the Exposure of Patients With Knee Osteoarthritis to Nonsteroidal Antiinflammatory Drugs? J Clin Rheumatol 2004; 10:315-22. [PMID: 17043539 DOI: 10.1097/01.rhu.0000147050.45377.df] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : The objective of this study was to evaluate a nurse-directed self-management intervention for managed care patients with knee osteoarthritis (OA), emphasizing nonpharmacologic (NonPharm) management of pain and functional impairments and minimization of exposure to the risks and costs of nonsteroidal antiinflammatory drugs (NSAIDs). METHODS : Subjects were 186 patients from a large health maintenance organization (HMO) who satisfied American College of Rheumatology clinical criteria for knee OA. Two of 4 HMO sites (and their patient cohorts) were randomly assigned to the education group; the other 2 served as a delayed-intervention control group. At each location of care for the education group, an arthritis nurse educator, in consultation with the patient's primary care physician (PCP), followed a detailed algorithm for implementing and monitoring the response to NonPharm treatment modalities (eg, quadriceps strengthening exercises, counseling in principles of joint protection, use of thermal modalities). The nurses apprised the PCP of the patient's progress and made algorithm-based recommendations, as appropriate, for reduction of dose, and eventual discontinuation, of NSAIDs in favor of acetaminophen. Outcomes (measured at baseline, 3, 6, and 12 months) included pain and function scales from the Western Ontario and McMaster Universities (WOMAC) OA Index. RESULTS : The treatment groups were similar at baseline with respect to sociodemographic and clinical characteristics. Medical record audits revealed that NonPharm treatments (most often exercise) were implemented by 75% of patients in the education group but by only 18% of patients receiving routine care (P < 0.00001). Over the subsequent 12 months, 20 patients (26%) in the education group, but only 3 (5%) in the control group (P = 0.002), underwent changes in drug treatment of OA pain consistent with the NSAID-sparing goals of the intervention, ie, acetaminophen as initial drug of choice; reduction in dose, or discontinuation, of NSAID; switch from an NSAID to an analgesic. Only one patient in the education group required reinstitution of NSAIDs because of an increase in knee pain. Mean WOMAC scores indicated no deterioration of pain control or function over 12 months in the group treated according to the algorithm. CONCLUSION : Incorporation into the primary care setting of self-care education for patients with knee OA, with collaboration between a proactive arthritis nurse and the patient's PCP, can reduce reliance on NSAIDs without a resultant increase in OA pain and disability.
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Affiliation(s)
- Steven A Mazzuca
- From the *Departments of Medicine and †Orthopaedic Surgery, Indiana University School of Medicine (IUSM), Indianapolis, Indiana
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25
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Affiliation(s)
- Sam Gidwani
- Department of Orthopaedics, Kingston Hospital, Kingston upon Thames, Surrey KT2 7QB.
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26
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Abstract
The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.
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Affiliation(s)
- David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, 2021 K Street, NW, Suite 300, Washington, DC 20006, USA.
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27
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Affiliation(s)
- K D Brandt
- Indiana University School of Medicine; and Indiana University Multipurpose Arthritis and Musculoskeletal Diseases Center, 1110 West Michigan Street, Room 545, Indianapolis IN 46202, USA.
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