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Zhu GC, Chen KM, Belcastro F. Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis. Arch Phys Med Rehabil 2024; 105:953-962. [PMID: 37467937 DOI: 10.1016/j.apmr.2023.07.001] [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: 05/05/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess and compare the effects of different stretching exercise programs on pain, stiffness, and physical function disability in older adults with knee osteoarthritis (KOA). DATA SOURCES This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for network meta-analysis (NMA). Relevant randomized controlled trials were identified by searching 7 databases up to December 2022. STUDY SELECTION Inclusion criteria included (1) older adults with KOA; (2) intervention included stretching exercises; (3) control groups received no stretching exercise; and (4) outcome measurements included pain, stiffness, or physical function disability. Methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. DATA EXTRACTION NMA was performed using R and MetaInsight, with results presented as a standardized mean difference (SMD) with 95% confidence interval (CI). DATA SYNTHESIS We examined 17 studies, and NMA results indicated that proprioceptive neuromuscular facilitation (PNF) stretching, mind-body exercises, and multi-component exercise programs were effective in mitigating pain in older adults with KOA (SMD=2.54 [95% CI: 1.23; 3.84], SMD=1.09 [95% CI: 0.27; 1.92], SMD=0.57 [95% CI: 0.06; 1.09]). Moreover, mind-body exercises and multi-component exercises were the most effective programs in reducing stiffness (SMD=1.31 [95% CI: 0.12; 2.51]) and physical function disability (SMD=1.67 [95% CI: 0.01; 3.33]) in older adults with KOA, respectively. CONCLUSION Findings suggest that PNF stretching, mind-body exercises, and multi-component exercises can be incorporated into exercise programs to better mitigate pain, stiffness, and physical function disability in older adults with KOA.
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Affiliation(s)
- Guan-Cheng Zhu
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, Dubuque, IA
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2
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Uzieliene I, Bironaite D, Bernotas P, Sobolev A, Bernotiene E. Mechanotransducive Biomimetic Systems for Chondrogenic Differentiation In Vitro. Int J Mol Sci 2021; 22:9690. [PMID: 34575847 PMCID: PMC8469886 DOI: 10.3390/ijms22189690] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is a long-term chronic joint disease characterized by the deterioration of bones and cartilage, which results in rubbing of bones which causes joint stiffness, pain, and restriction of movement. Tissue engineering strategies for repairing damaged and diseased cartilage tissue have been widely studied with various types of stem cells, chondrocytes, and extracellular matrices being on the lead of new discoveries. The application of natural or synthetic compound-based scaffolds for the improvement of chondrogenic differentiation efficiency and cartilage tissue engineering is of great interest in regenerative medicine. However, the properties of such constructs under conditions of mechanical load, which is one of the most important factors for the successful cartilage regeneration and functioning in vivo is poorly understood. In this review, we have primarily focused on natural compounds, particularly extracellular matrix macromolecule-based scaffolds and their combinations for the chondrogenic differentiation of stem cells and chondrocytes. We also discuss different mechanical forces and compression models that are used for In Vitro studies to improve chondrogenic differentiation. Summary of provided mechanical stimulation models In Vitro reviews the current state of the cartilage tissue regeneration technologies and to the potential for more efficient application of cell- and scaffold-based technologies for osteoarthritis or other cartilage disorders.
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Affiliation(s)
- Ilona Uzieliene
- State Research Institute Centre for Innovative Medicine, Department of Regenerative Medicine, LT-08406 Vilnius, Lithuania; (I.U.); (D.B.); (P.B.)
| | - Daiva Bironaite
- State Research Institute Centre for Innovative Medicine, Department of Regenerative Medicine, LT-08406 Vilnius, Lithuania; (I.U.); (D.B.); (P.B.)
| | - Paulius Bernotas
- State Research Institute Centre for Innovative Medicine, Department of Regenerative Medicine, LT-08406 Vilnius, Lithuania; (I.U.); (D.B.); (P.B.)
| | - Arkadij Sobolev
- Latvian Institute of Organic Synthesis, 21 Aizkraukles Str., LV-1006 Riga, Latvia;
| | - Eiva Bernotiene
- State Research Institute Centre for Innovative Medicine, Department of Regenerative Medicine, LT-08406 Vilnius, Lithuania; (I.U.); (D.B.); (P.B.)
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3
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Quinn-Laurin V, Bostick GP, Thejeel B, Mandegaran R, Steer KJD, Lambert RGW, Jaremko JL. Development of a technique for MRI gold-standard direct volumetric measurement of complex joint effusion, and validation at the hip. Skeletal Radiol 2021; 50:781-787. [PMID: 32995905 DOI: 10.1007/s00256-020-03630-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Accurate joint fluid quantification on MRI cannot simply rely on measuring the maximum fluid depth or using an ellipsoid approximation as this does not fully characterize the complex shape of a fluid-filled joint. As per the Outcome Measurement in Rheumatology (OMERACT) filter, we sought to evaluate the feasibility, reliability, and validity of a semi-automated supervised technique to quantify hip effusion volume. MATERIALS AND METHODS Ninety-three hip osteoarthritis patients were imaged with coronal short TI inversion recovery (STIR) and sagittal intermediate weighted fat-suppressed (IWFS) sequences at two time points (Fig. 1). Volumetric quantitative measurement (VQM) of joint fluid and measurement of the largest femoral neck fluid thickness (FTM) was performed using the custom MATLAB software. Self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and clinical measures of pain, stiffness, and function were recorded. RESULTS Inter-observer reliability was significantly higher for VQM than FTM (ICC = 0.96 vs. 0.85, p < 0.05). VQM and FTM correlated moderately (r = 0.76, p < 0.0001). There was significantly more articular fluid in symptomatic than asymptomatic hips at baseline (mean = 9.8 vs. 5.9 mL). Volumetric quantitative measurement generally displayed more frequent and stronger correlations to clinical parameters than FTM. Volumetric quantitative measurement required 3.9 min/hip vs. < 1 min/hip for femoral neck fluid thickness. CONCLUSION Volumetric quantitative measurement of joint effusion can serve as an MRI gold-standard, could apply to other joints and collections, and is highly suited to future automation.
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Affiliation(s)
- Vanessa Quinn-Laurin
- Department of Radiology, University of Alberta Hospital & Stollery Children's Hospital, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Geoffrey P Bostick
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Bashiar Thejeel
- Department of Radiology, University of Alberta Hospital & Stollery Children's Hospital, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | | | - Kieran J D Steer
- Department of Radiology, University of Alberta Hospital & Stollery Children's Hospital, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Robert G W Lambert
- Department of Radiology, University of Alberta Hospital & Stollery Children's Hospital, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,Medical Imaging Consultants, Edmonton, Canada
| | - Jacob L Jaremko
- Department of Radiology, University of Alberta Hospital & Stollery Children's Hospital, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada. .,Medical Imaging Consultants, Edmonton, Canada.
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Comparative Observational Study on the Effects of Intra-articular Hominis Placenta Pharmacopuncture and Acupoint Hominis Placenta Pharmacopuncture for Knee Osteoarthritis Patients. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2020.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this case report was to observe the effects of intra-articular hominis placenta pharmacopuncture (HPP). Based on the medical records patients who received intra-articular treatment or received acupoint pharmacopuncture treatment, a comparison was made. There were 35 patients who were hospitalized for degenerative osteoarthritis of the knee joint from the 1<sup>st</sup> October 2019 to 26<sup>th</sup> September 2020. There were 14 patients who were treated with HPP in the intra-articular joint space (Group A), and 14 patients who were treated with HPP at specific acupoints (Group B). The outcome effects were measured using the Korean Western Ontario and Mc (KWOMAC) the visual analog scale (VAS) before the first treatment, and after the fifth treatment. The KWOMAC (<i>p</i> < 0.001) and the VAS scores (<i>p</i> < 0.001) in Groups A and B significantly improved after treatment compared with before treatment. When comparing Group A improvement with Group B improvement using the KWOMAC there was no statistically significant difference however, when using the VAS scores, Group A treatment was statistically more effective compared with Group B (<i>p</i> = 0.002). This study indicated that HPP may be an effective treatment for knee osteoarthritis. Moreover, intra-articular HPP may be more effective than acupoint HPP for knee osteoarthritis.
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Zhu H, Yan H, Ma J, Zhang H, Zhang J, Hu Z, Guo Y. CCAL1 enhances osteoarthritis through the NF-κB/AMPK signaling pathway. FEBS Open Bio 2020; 10:2553-2563. [PMID: 32986917 PMCID: PMC7714067 DOI: 10.1002/2211-5463.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/25/2022] Open
Abstract
Osteoarthritis (OA) is a chronic joint disease characterized by articular cartilage degeneration and secondary osteogenesis. It has been previously demonstrated that the CCAL1 locus is the gene encoding tumor necrosis factor receptor superfamily member 11B (TNFRSF11B). The purpose of this study was to demonstrate the role of CCAL1 in OA progression and to elucidate its molecular mechanisms. We report that CCAL1 is highly expressed in the cartilage of OA patients and its expression level is positively correlated with the severity of OA. We found that CCAL1 causes a switch to the fibrosis‐prone phenotype of Human Chondrocyte‐Osteoarthritis (HC‐OA) cells. In addition, CCAL1 enhances cell viability and promotes the proliferation of HC‐OA cells. Finally, the detection of proteins associated with the NF‐κB/AMPK signaling pathway by western blot suggested that CCAL1 exerts its role on HC‐OA cells by activating the NF‐κB signaling pathway and inhibiting the AMPK signaling pathway, which was verified through the addition of NF‐κB inhibitor caffeic acid phenethyl ester (CAPE) and AMPK activator 5‐aminoimidazole‐4‐carboxamide riboside (AICAR). In summary, we report that CCAL1 may promote OA through the NF‐κB and AMPK signaling pathways.
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Affiliation(s)
- Hanzhong Zhu
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Hongyu Yan
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Junan Ma
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Hua Zhang
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Jidong Zhang
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Zhiheng Hu
- Department of Orthopaedic Surgery, Chengwu People's Hospital, Heze, China
| | - Yunliang Guo
- Department of Medical College, Qingdao University, Qingdao, China
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Lin YW, Fang CH, Meng FQ, Ke CJ, Lin FH. Hyaluronic Acid Loaded with Cerium Oxide Nanoparticles as Antioxidant in Hydrogen Peroxide Induced Chondrocytes Injury: An In Vitro Osteoarthritis Model. Molecules 2020; 25:molecules25194407. [PMID: 32992833 PMCID: PMC7582542 DOI: 10.3390/molecules25194407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis (OA) is the most common joint disease type and is accompanied by varying degrees of functional limitation. Both hyaluronic acid (HA) joint injections and pain relievers are efficient treatments for early-stage osteoarthritis. However, for the decomposition by hyaluronidase and free radicals in the knee joint, HA injection treatment has limited effect time. The cerium oxide nanoparticles (CeO2) is a long time free radical scavenger. CeO2 combined with HA expected, may extend the HA decomposition time and have a positive effect on osteoarthritis therapy. In this study, CeO2 was successfully synthesized using the hydrothermal method with a particle size of about 120 nm, which possessed excellent dispersibility in the culture medium. The in vitro OA model was established by cell treated with H2O2 for 30 min. Our study found that the inhibition of chondrocyte proliferation dose-dependently increased with H2O2 concentration but was significantly decreased by supplementation of cerium oxide nanoparticles. COL2a1 and ACAN gene expression in chondrocytes was significantly decreased after H2O2 treatment; however, the tendency was changed after cerium oxide nanoparticles treatment, which suggested that damaged chondrocytes were protected against oxidative stress. These findings suggest that cerium oxide nanoparticles are potential therapeutic applications in the early stage of OA.
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Affiliation(s)
- Yi-Wen Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei 10617, Taiwan; (Y.-W.L.); (C.-H.F.); (F.-Q.M.)
| | - Chih-Hsiang Fang
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei 10617, Taiwan; (Y.-W.L.); (C.-H.F.); (F.-Q.M.)
| | - Fan-Qi Meng
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei 10617, Taiwan; (Y.-W.L.); (C.-H.F.); (F.-Q.M.)
| | - Cherng-Jyh Ke
- Biomaterials Translational Research Center, China Medical University Hospital, No. 2, Yude Rd., North Dist., Taichung City 404332, Taiwan
- Correspondence: (C.-J.K.); (F.-H.L.); Tel.: +886-2-2732-7474 (F.-H.L.)
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei 10617, Taiwan; (Y.-W.L.); (C.-H.F.); (F.-Q.M.)
- Division of Biomedical Engineering and Nanomedicine Research, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Correspondence: (C.-J.K.); (F.-H.L.); Tel.: +886-2-2732-7474 (F.-H.L.)
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Park J, Sherman DG, Agogo G, Hoogendijk EO, Liu Z. Frailty modifies the intervention effect of chair yoga on pain among older adults with lower extremity osteoarthritis: Secondary analysis of a nonpharmacological intervention trial. Exp Gerontol 2020; 134:110886. [PMID: 32088398 PMCID: PMC7438234 DOI: 10.1016/j.exger.2020.110886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In an 8-week nonpharmacological pain intervention trial among older adults with lower extremity osteoarthritis (OA), we aimed to examine: a) the baseline frailty level of the participants; b) whether such intervention is more beneficial for baseline frailer older adults than for their counterparts with less frailty; and c) whether the intervention could also alter frailty. METHODS Participants were randomly assigned to either chair yoga (CY) or health education program (HEP) groups and attended twice-weekly 45-minute CY or HEP sessions for 8 weeks. Following a standard procedure, 82 variables were used to construct a frailty index (FI, 0-1). Primary outcomes were: Western Ontario and McMaster Universities (WOMAC) pain and pain interference. Linear mixed-effects models were used to evaluate the modifying effect of baseline frailty on the intervention effect of CY on primary outcomes. Similar models were used to evaluate the effect of CY on frailty. RESULTS A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3 [SD = 7.5] years) with 85 females (75.9%) were included. The mean values of baseline FI for the CY and HEP groups were similar (0.428 [0.05] and 0.433 [0.05], P = 0.355). Each 0.01 increment in baseline FI was associated with higher WOMAC pain (beta = 0.28, P < 0.001) and pain interference (beta = 0.51, P < 0.001). There was a significant interaction effect between intervention, time, and baseline FI (P = 0.020 for WOMAC pain; P = 0.010 for pain interference), indicating that participants with higher level of baseline FI had greater declines in WOMAC pain and pain interference. There was no significantly greater decline in FI for the CY group compared to the HEP group (between-group difference - 0.01; P = 0.509) and there were no significant trend changes in FI (P for interaction = 0.605). CONCLUSIONS Frailty modifies the intervention effect of CY on pain among older adults with lower extremity OA, underscoring the importance of assessing frailty to improve the management of pain in this population.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL, USA
| | - Diane G Sherman
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL, USA
| | - George Agogo
- Centers for Disease Control and Prevention (CDC), Village Market, Nairobi, Kenya; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-location VU University Medical Center, Amsterdam, Netherlands
| | - Zuyun Liu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Precision Health and Data Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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8
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Rivera NV, Parmelee PA, Smith DM. The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee. Aging Ment Health 2020; 24:8-14. [PMID: 30380912 DOI: 10.1080/13607863.2018.1506744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (β = 0.49, p < .001) and momentary, especially positive (β = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (β = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.
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Affiliation(s)
- Nicole V Rivera
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Dylan M Smith
- Program in Public Health and Department of Family, Preventive, and Population Medicine, Stony Brook University, Stony Brook, NY, USA
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Efficacy of intra-articular hyaluronic acid injections in hip osteoarthritis: a meta-analysis of randomized controlled trials. Oncotarget 2017; 8:86865-86876. [PMID: 29156841 PMCID: PMC5689731 DOI: 10.18632/oncotarget.20995] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/29/2017] [Indexed: 12/16/2022] Open
Abstract
There is less credible evidence of using of intra-articular injections of hyaluronic acid (HA) to treat hip osteoarthritis (OA). This study is to determine the therapeutic effects and risk of adverse events of HA administration for hip OA. The MEDLINE, Cochrane of Systematic Reviews, Cochrane Clinical Trial Register and EMBASE, were searched for articles published. Eligible studies were limited to trials of HA with a randomized design. A total of six studies were included in this the meta-analysis. The pooled effect size of improved pain scores from pretreatment was –0.72 (95%CI; –1.06 to –0.39; P < 0.05). The standardized mean difference (SMD) of improved Lequesne's index and McMaster Universities Osteoarthritis Index (WOMAC) was –0.74 (95%CI, –1.42 to –0.51; P < 0.05) and –7.75 (95%CI, –14.28 to –1.21; P < 0.05), respectively. The pooled effect size of improved pain scores compared HA with different controls was 0.03 (95%CI; –0.20 to 0.26; P < 0.05). The SMD of improved Lequesne's index and WOMAC was –0.24 (95%CI, –0.50 to 0.02; P > 0.05) and –0.13 (95%CI, 0.64 to 0.37; P > 0.05). There were no significant differences between HA and control group in adverse events (RR: 0.94; 95%CI, 0.41 to 2.20; P > 0.05). Intra-articular HA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there seems no significant difference between HA and saline or other treatments. Currently, available evidence indicated that intra-articular HA in hip OA would not be increased risk of adverse events.
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10
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Jacobs BY, Dunnigan K, Pires-Fernandes M, Allen KD. Unique spatiotemporal and dynamic gait compensations in the rat monoiodoacetate injection and medial meniscus transection models of knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:750-758. [PMID: 27986622 PMCID: PMC5403559 DOI: 10.1016/j.joca.2016.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In rodent osteoarthritis (OA) models, behavioral changes are often subtle and require highly sensitive methods to detect these changes. Gait analysis is one assay that may provide sensitive, quantitative measurement of these behavioral changes. To increase detection sensitivity of gait assessments relative to spatiotemporal gait collection alone, we combined our spatiotemporal and dynamic gait collection systems. Using this combined system, gait was assessed in the rat medial meniscus transection (MMT) model and monoiodoacetate (MIA) injection model of knee OA. DESIGN 36 male Lewis rats were separated into MMT (n = 8), medial collateral ligament transection (MCLT) (n = 8), skin incision (n = 4), MIA injection (n = 8), and saline injection (n = 8) groups. After initiation of OA, gait data were collected weekly in each group out to 4 weeks. RESULTS The MMT and MIA injection models produced unique pathologic gait profiles, with MMT animals developing a shuffling gait and MIA injection animals exhibiting antalgic gait. Spatiotemporal changes were also observed in the MMT model at week 1 (P < 0.01), but were not observed in the MIA injection model until week 3 (P < 0.01). Dynamic gait changes were observed in both models as early as 1 week post-surgery (P < 0.01). CONCLUSION Combined analysis of spatiotemporal and dynamic gait data increased detection sensitivity for gait modification in two rat OA models. Analyzing the combined gait data provided a robust characterization of the pathologic gait produced by each model. Furthermore, this characterization revealed different patterns of gait compensations in two common rat models of knee OA.
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MESH Headings
- Adaptation, Physiological
- Animals
- Behavior, Animal
- Biopsy, Needle
- Disease Models, Animal
- Gait/physiology
- Immunohistochemistry
- Injections, Intra-Articular
- Iodoacetic Acid/pharmacology
- Male
- Menisci, Tibial/drug effects
- Menisci, Tibial/pathology
- Menisci, Tibial/surgery
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/pathology
- Physical Conditioning, Animal
- Random Allocation
- Rats
- Rats, Inbred Lew
- Spatio-Temporal Analysis
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Affiliation(s)
- B Y Jacobs
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
| | - K Dunnigan
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
| | - M Pires-Fernandes
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
| | - K D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
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Marklein KE, Leahy RE, Crews DE. In sickness and in death: Assessing frailty in human skeletal remains. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:208-25. [DOI: 10.1002/ajpa.23019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - Rachael E. Leahy
- Department of Anthropology; The Ohio State University; Columbus Ohio 43210
| | - Douglas E. Crews
- Department of Anthropology; The Ohio State University; Columbus Ohio 43210
- College of Public Health, The Ohio State University; Columbus Ohio 43210
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12
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Muttigi MS, Han I, Park HK, Park H, Lee SH. Matrilin-3 Role in Cartilage Development and Osteoarthritis. Int J Mol Sci 2016; 17:ijms17040590. [PMID: 27104523 PMCID: PMC4849044 DOI: 10.3390/ijms17040590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/10/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022] Open
Abstract
The extracellular matrix (ECM) of cartilage performs essential functions in differentiation and chondroprogenitor cell maintenance during development and regeneration. Here, we discuss the vital role of matrilin-3, an ECM protein involved in cartilage development and potential osteoarthritis pathomechanisms. As an adaptor protein, matrilin-3 binds to collagen IX to form a filamentous network around cells. Matrilin-3 is an essential component during cartilage development and ossification. In addition, it interacts directly or indirectly with transforming growth factor β (TGF-β), and bone morphogenetic protein 2 (BMP2) eventually regulates chondrocyte proliferation and hypertrophic differentiation. Interestingly, matrilin-3 increases interleukin receptor antagonists (IL-Ra) in chondrocytes, suggesting its role in the suppression of IL-1β-mediated inflammatory action. Matrilin-3 downregulates the expression of matrix-degrading enzymes, such as a disintegrin metalloproteinase with thrombospondin motifs 4 (ADAMTS4) and ADAMTS5, matrix metalloproteinase 13 (MMP13), and collagen X, a hypertrophy marker during development and inflammatory conditions. Matrilin-3 essentially enhances collagen II and aggrecan expression, which are required to maintain the tensile strength and elasticity of cartilage, respectively. Interestingly, despite these attributes, matrilin-3 induces osteoarthritis-associated markers in chondrocytes in a concentration-dependent manner. Existing data provide insights into the critical role of matrilin-3 in inflammation, matrix degradation, and matrix formation in cartilage development and osteoarthritis.
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Affiliation(s)
- Manjunatha S Muttigi
- School of Integrative Engineering, Chung-Ang University, Seoul 06911, Korea.
- Department of Biomedical Science, CHA University, Seongnam-Si 13488, Korea.
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea.
| | - Hun-Kuk Park
- Department of Biomedical Engineering, Collage of Medicine, Kyung Hee University, Seoul 02447, Korea.
| | - Hansoo Park
- School of Integrative Engineering, Chung-Ang University, Seoul 06911, Korea.
| | - Soo-Hong Lee
- Department of Biomedical Science, CHA University, Seongnam-Si 13488, Korea.
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Harris ML, Byles JE, Sibbritt D, Loxton D. "Just get on with it": qualitative insights of coming to terms with a deteriorating body for older women with osteoarthritis. PLoS One 2015; 10:e0120507. [PMID: 25781471 PMCID: PMC4364122 DOI: 10.1371/journal.pone.0120507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/24/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To qualify the psychosocial burden of osteoarthritis for older women and identify factors perceived to assist with psychological adjustment to the disease. Methods Women who indicated being diagnosed/treated for osteoarthritis in the previous three years in the fifth survey of the Australian Longitudinal Study on Women’s Health provided the sampling frame. Participants were randomly sampled until saturation was reached using a systematic process. Thematic content analysis was applied to the 19 semi-structured telephone interviews using a realist framework. Results The findings indicate that the emotional burden of osteoarthritis is considerable, and the process of psychological adjustment complex. Older women with osteoarthritis have psychological difficulties associated with increasing pain and functional impairment. Psychological adjustment over time was attributed primarily to cognitive and attitudinal factors (e.g. stoicism, making downward comparisons and possessing specific notions about the cause of arthritis). This was a dynamic ‘day to day’ process involving a constant struggle between grieving physical losses and increasing dependence amidst symptom management. Conclusion The findings of this study add to the current understanding of the complex processes involved in psychological adjustment over time. Targeted interventions focused on assisting women with arthritis redefine self-concepts outside the confines of caring responsibilities, coupled with public health education programs around understanding the destructive nature of arthritis are required. Understanding the destructive and (potentially) preventable nature of arthritis may facilitate early detection and increased uptake of appropriate treatment options for osteoarthritis that have the ability to modify disease trajectories.
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Affiliation(s)
- Melissa L. Harris
- Priority Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
| | - Julie E. Byles
- Priority Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - David Sibbritt
- Priority Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Deborah Loxton
- Priority Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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The effect of healing touch on the pain and mobility of persons with osteoarthritis: a feasibility study. Geriatr Nurs 2013; 34:314-22. [PMID: 23835011 DOI: 10.1016/j.gerinurse.2013.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/05/2013] [Accepted: 05/11/2013] [Indexed: 12/16/2022]
Abstract
The aims of this pilot study were to investigate the effects of Healing Touch (HT) on the pain level, joint function, mobility, and depression in persons with osteoarthritis (OA) of the knee joint(s). A randomized controlled trial using a repeated measures design was used. Cognitively intact persons (institutionalized and community) with a diagnosis of OA of the knee joint(s) received either HT sessions three times per week for 6 weeks (n = 12) or weekly friendly visits (FV) (n = 7). The HT sessions were delivered by a team of two nurses certified as HT practitioners and the FV was conducted by a nurse. All subjects continued to receive their standard care including the methods they had been using to relieve their joint pain. The two groups were similar regarding demographic variables, number of knees affected, co-morbidities, pain medications used and outcome variables at baseline. Two pain outcome measures (intensity and life interference) produced significant interaction effects. Two joint outcome measures (extension and extensor lag) also produced significant interaction effects. Furthermore, the HT group demonstrated significant improvements in 9 of the 12 outcome variables (75%) while no significant improvements occurred in the FV group. The HT group exhibited sustained effects (3 weeks post treatments) in three outcome variables. The reduction in joint pain and improvement in joint function suggest that biofield therapies could be effective non-pharmacological adjuncts to treatment of OA.
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Dhaneshwar S, Patel V, Patil D, Meena G. Studies on synthesis, stability, release and pharmacodynamic profile of a novel diacerein-thymol prodrug. Bioorg Med Chem Lett 2013; 23:55-61. [DOI: 10.1016/j.bmcl.2012.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 11/03/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
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Maneesh M, Jayalekshmi H, Suma T, Chatterjee S, Chakrabarti A, Singh TA. Evidence for oxidative stress in osteoarthritis. Indian J Clin Biochem 2012; 20:129-30. [PMID: 23105509 DOI: 10.1007/bf02893057] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Evidence of increased oxidative stress in patients of osteoarthritis in comparison with healthy control subjects was investigated by measuring the thiobarbituric acid reactive substances (TBARS), vitamin C, reduced glutathione (GSH) and the activities of superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) in erythrocytes. It was observed that osteoarthritis patients were more susceptible to oxidative damage than controls as evident from increased TBARS and decreased ascorbic acid, GSH, catalase and GPx in erythrocytes. Significant increase in SOD activity found in patients might be an adaptive response. With the understanding of the role of antioxidants in arthritis, it is becoming increasingly clear that these agents seem to be beneficial in osteoarthritis.
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Affiliation(s)
- M Maneesh
- Department of Biochemistry, Sikkim Manipal Institute of Medical Sciences, 737102 Gangtok, Sikkim
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Kitisomprayoonkul W, Promsopa K, Chaiwanichsiri D. Do Heberden and Bouchard nodes affect finger dexterity in elderly? Rheumatol Int 2009; 30:543-5. [PMID: 19802610 DOI: 10.1007/s00296-009-1196-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 09/13/2009] [Indexed: 10/20/2022]
Abstract
Elderly often have Heberden nodes (HN) and Bouchard nodes (BN) that may affect finger dexterity. The aim of this cross-sectional study was to assess an effect of HN and BN on finger dexterity of the elderly. The nine-hole peg test was used for dexterity measurement in 200 elderly with HN and/or BN. Mean age was 68.6 +/- 5.39 years. Average performance of each hand was compared between elderly with or without nodes. HN and BN were found in 75 right hands (37.5%) and 73 left hands (36.5%). Nodes were found in females more often than males (p < 0.001). Average right hand dexterity in elderly with and without nodes was 21.6 +/- 3.16 and 21.4 +/- 3.16 s. Average left hand dexterity in elderly with and without nodes was 23.3 +/- 3.13 and 23.3 +/- 3.67 s. There was no significant difference between elderly with or without nodes (p >/= 0.05). In conclusion, HN and BN in elderly hands do not affect finger dexterity. Therapist may use the same training program to prevent deterioration of finger dexterity in elderly with or without nodes.
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Affiliation(s)
- Wasuwat Kitisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Prathumwan, Bangkok, Thailand.
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Ayis S, Dieppe P. The natural history of disability and its determinants in adults with lower limb musculoskeletal pain. J Rheumatol 2009; 36:583-91. [PMID: 19208591 DOI: 10.3899/jrheum.080455] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate determinants of deterioration or improvement in disability in people with chronic hip and knee pain. METHODS We analyzed data from the Somerset and Avon Survey of Health, a longitudinal, community-based cohort study containing data collected in 1994-95 and again in 2002-03. The Medical Outcomes Study Short-Form 36 was completed by subjects at both timepoints, and used to categorize people as disabled or not. Baseline data were used to explore possible determinants of change in functional status over the 8-year time period. Adjusted odds ratios (OR) were derived from a multivariate, multinomial logistic model. RESULTS Data were available on 1072 subjects, all of whom reported chronic hip and/or knee pain at baseline. At baseline, 56.8% of women and 42.0% of men were disabled. Of 545 people with disabilities at baseline, 107 (19.6%) reported no disability at followup; of 527 with no disability at baseline, 177 (33.6%) became disabled. The development of disability was significantly associated with older age (OR 2.1), living in the most deprived areas (2.4), the presence of 3 or more comorbidities (3.6), more problems with physical function at baseline (2.0), and more severe pain (2.4). The determinants of improvement mirrored those of deterioration. The data suggest a "threshold effect" at which recovery becomes unlikely. CONCLUSION Of people presenting with hip or knee pain, healthcare professionals should be most concerned about those who are older, of lower socioeconomic status, with comorbidities, and who have more severe pain. Much longstanding disability might be preventable.
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Affiliation(s)
- Salma Ayis
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Menz HB, Zammit GV, Landorf KB, Munteanu SE. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res 2008; 1:7. [PMID: 18822162 PMCID: PMC2553779 DOI: 10.1186/1757-1146-1-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 08/11/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. METHODS Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, SD 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. RESULTS Of the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. CONCLUSION Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.
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Affiliation(s)
- Hylton B Menz
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, 3086, Australia.
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van den Bekerom MPJ, Lamme B, Sermon A, Mulier M. What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature. Arch Orthop Trauma Surg 2008; 128:815-23. [PMID: 17874246 DOI: 10.1007/s00402-007-0447-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Osteoarthritis (OA) is a disease of the synovial joints and is the most common cause of chronic pain in the elderly. One of the treatment modalities for OA of the hip is viscosupplementation (VS). Today there are several different formulations of viscosupplements produced by different manufactures of different molecular weights. The objective of this review is to asses the efficacy of VS treatment of hip OA osteoarthritis in the current literature. MATERIAL AND METHODS The following databases were searched: Medline (period 1966 to November 2006), Cochrane Database of Systematic Reviews (1988 to November 2006), Cochrane Clinical Trial Register (1988 to November 2006), Database of Abstracts on Reviews and Effectiveness, Current Controlled Trials, National Research Register and Embase (January 1988 to November 2006). The search terms [osteoarthritis, hip (joint), viscosupplementation, hyaluronic acid, hyaluronan, sodium hyaluronate and trade names] were applied to identify all studies relating to the use of VS therapy for OA of the hip joint. RESULTS Sixteen articles concerning the efficacy of a total of 509 patients undergoing VS treatment for hip OA were included. Twelve European studies, three Turkish studies and one American study with Levels of Evidence ranging from I to IV evaluated the following products: Hylan G-F 20, Hyalgan, Ostenil, Durolane, Fermatron and Orthovisc. Heterogeneity of included studies did not allow pooled analysis of data. DISCUSSION Despite the relatively low Level of Evidence of the included studies, VS performed under fluoroscopic or ultrasound guidance seems an effective treatment and may be an alternative treatment of hip OA. Intra-articular injection of (derivatives of) HA into the hip joint appears to be safe and well tolerated. However, VS cannot be recommended as standard therapy in hip OA for wider populations, and therefore the indications remain a highly individualised matter.
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Saari P, Heikkinen E, Sakari-Rantala R, Rantanen T. Fall-related injuries among initially 75- and 80-year old people during a 10-year follow-up. Arch Gerontol Geriatr 2007; 45:207-15. [PMID: 17184857 DOI: 10.1016/j.archger.2006.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 10/24/2006] [Accepted: 10/27/2006] [Indexed: 11/21/2022]
Abstract
The aim of this study was to investigate the occurrence, type, scene and seasonal variation of fall related injuries, and the impact of socio-economic factors, mobility limitation, and the most common diseases on the risk of injurious falls over a 10-year follow-up. Elderly residents of Jyväskylä, Finland, aged initially 75 and 80 years, took part in the study in 1989-1990. The health and functional capacity assessments were carried out at the baseline. Injurious falls were monitored over a 10-year period. The rate of injurious falls per thousand person-years was 188 among women and 78 among men. Of all fall-related diagnoses, head injuries comprised 32%, upper limb injuries 27% and hip injuries 19%. Majority of injurious falls took place indoors and no seasonal variation in fall occurrence was observed. Recurring falls were more likely to take place in institutions. Osteoarthritis increased the risk of injurious falls but no effect was observed for coronary heart diseases or mobility limitation. All in all, intrinsic factors, such as chronic diseases and mobility limitation had only minor effect on risk of injurious falls among older people. The current results suggest that preventive interventions for injurious falls among older people should pay attention to the risk factors present indoors.
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Affiliation(s)
- Päivi Saari
- Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland.
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Sherman AM, Shumaker SA, Jack Rejeski W, Morgan T, Applegate WB, Ettinger W. Social support, social integration, and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST). Psychol Health 2006. [DOI: 10.1080/14768320500380881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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St Clair SF, Higuera C, Krebs V, Tadross NA, Dumpe J, Barsoum WK. Hip and Knee Arthroplasty in the Geriatric Population. Clin Geriatr Med 2006; 22:515-33. [PMID: 16860243 DOI: 10.1016/j.cger.2006.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Osteoarthritis is the leading cause of hip and knee pathology in the geriatric population. Hip and knee arthroplasty are the definitive interventions to alleviate pain and restore physical functioning. Complications related to these procedures do occur: the most com-mon of these are infection, thromboembolism, dislocations, and periprosthetic fractures. New improvements related to minimally invasive and computer-assisted navigation surgery techniques are promising and already have shown excellent outcomes in patients exposed to joint arthroplasty.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- History, 19th Century
- History, 20th Century
- Humans
- Joint Diseases/history
- Joint Diseases/surgery
- Osteoarthritis, Hip/pathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/pathology
- Osteoarthritis, Knee/surgery
- Postoperative Complications
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Affiliation(s)
- Selvon F St Clair
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue Cleveland, OH 44195, USA
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Tikiz C, Unlü Z, Sener A, Efe M, Tüzün C. Comparison of the efficacy of lower and higher molecular weight viscosupplementation in the treatment of hip osteoarthritis. Clin Rheumatol 2005; 24:244-50. [PMID: 15647968 DOI: 10.1007/s10067-004-1013-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 08/23/2004] [Indexed: 11/25/2022]
Abstract
We aimed to compare the efficacy of intra-articular injections of a lower molecular weight hyaluronan (LMW HA) (Ostenil) with a higher molecular weight viscosupplement (hylan G-F 20, Synvisc) in hip osteoarthritis. For this purpose, 43 patients (56 hips) with hip osteoarthritis with a visual analogue scale (VAS) pain score higher than 50/100, a Lequesne index greater than 6, and persistence of the pain for longer than 3 months despite all conservative methods were enrolled in the study and randomly assigned to two groups: 25 (32 hips) received LMW HA and the remaining 18 patients (24 hips) received hylan G-F 20. Three injections were administered once weekly to each patient under fluoroscopic guidance. During the 6-month follow-up period, the primary outcomes were assessed at the 1st, 3rd, and 6th month by VAS, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and Lequesne index. The intra-articular injections produced a significant reduction in VAS, WOMAC, and Lequesne index scores in both groups. After three injections, improvement was prominent at the 1st month and maintained for 6 months in both groups. The percentage reduction was 38 and 40% (p<0.001) in VAS pain score, 43 and 40% in WOMAC (p<0.001), and 47 and 49% in Lequesne index (p<0.001) in the LMW HA and hylan G-F groups at the 6th month, respectively. However, there were no significant differences in outcomes between any of the measurements at the 1st, 3rd, and 6th month between the two groups (p>0.05). No systemic adverse effect was recorded. Local adverse effects consisting of pain and/or swelling were noted in 3 of 32 hips (9%) injected with LMW HA and in 3 of 24 hips (12.5%) injected with hylan G-F 20. In conclusion, both types of viscosupplementation produced a significant clinical improvement during the 6-month follow-up period. However, no significant difference was found in outcomes between higher and lower molecular weight hyaluronan.
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Affiliation(s)
- Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Celal Bayar, Manisa, Turkey
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Brenner SS, Klotz U, Alscher DM, Mais A, Lauer G, Schweer H, Seyberth HW, Fritz P, Bierbach U. Osteoarthritis of the knee--clinical assessments and inflammatory markers. Osteoarthritis Cartilage 2004; 12:469-75. [PMID: 15135143 DOI: 10.1016/j.joca.2004.02.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Accepted: 02/24/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The present cross sectional study was performed to test the hypothesis that in osteoarthritis (OA) of the knee severity of this disease is related to local levels of inflammatory metabolites and their corresponding enzymes. METHODS From 41 patients with OA of the knee (age range 45-79 years) undergoing arthroscopy blood, synovial fluid (SF) and synovial membrane (SM) were collected. Clinical conditions were primarily assessed by the WOMAC-index and radiographic grading (K&L-grade). Concentrations of PGE(2), TxB(2)and NO(2/3)and that of IL-6, IL-1 alpha, IL-1 beta, TNF alpha, COX-2 and iNOS were determined in SF and SM, respectively. RESULTS With advancing age K&L-grade and COX-2 in SM increased significantly (P=0.005 and P=0.01, respectively). TNF alpha and IL-1 alpha were not detectable in SM samples. Apart from a correlation between PGE(2)and WOMAC-index (r=0.36, P=0.035) no significant relationships could be found between the various inflammatory parameters and any of the assessed clinical signs. CONCLUSIONS Apparently no direct relationships exist between the measured markers of inflammation (e.g. PGE(2), NO(2/3)) or the involved enzymes (e.g. COX-2, iNOS) and the severity of OA of the knee. The degenerative condition of this disease might be due to the more local, mainly mechanical injury with little systemic upset. However, further longitudinal studies are needed to clarify whether the assessed biochemical markers could serve as predictors for the progression of OA.
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Affiliation(s)
- Stefanie S Brenner
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
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Noh SS, Lee JJ, Hwang SM, Lim SY, Chung IY, Choi YR. Efficacy of Intra-articular Sodium Hyaluronate in Patients with Osteoarthritis of the Knee. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.2.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seung Sook Noh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Il Young Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Young Ryong Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
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Abstract
The purpose of this study was to identify how sociodemographic characteristics such as age, race, and socioeconomic status; psychosocial factors of hardiness, health promotion practices, and social support; health status; and pain are related to the ability of older, community-residing individuals with osteoarthritis (OA) to maintain psychological equilibrium and physical function. A total of 81 older adults with OA completed a survey that included a sociodemographic data form, a hardiness scale, a measure of health promoting practices, and five subscales from the Arthritis Impact Measure Scale 2 on social support, general health status, pain, and psychological status and physical function. Analyses using multiple regression showed that hardiness, pain, and social support were significant contributors to psychological status and physical function and, respectively, accounted for 53% and 54% of the variance. By knowing about OA and being aware of factors that contribute to maintaining independence in individuals with OA, nurses can provide expert help to aging individuals.
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Affiliation(s)
- Carolyn C Kee
- Byrdine F. Lewis School of Nursing, Atlanta, Georgia, USA
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Smith HS, Baird W. Meloxicam and selective COX-2 inhibitors in the management of pain in the palliative care population. Am J Hosp Palliat Care 2003; 20:297-306. [PMID: 12911075 DOI: 10.1177/104990910302000413] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper discusses the treatment of pain in the palliative care patient, specifically the use of meloxicam and recent advances in agents with cyclooxygenase-2 (COX-2) selectivity. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that preferentially inhibits COX-2 more than cyclooxygenase-1 (COX-1), especially at low doses, thereby offering advantages over traditional nonselective NSAIDs. New COX-2 selective agents are discussed, including valdecoxib, parecoxib, etoricoxib, and COX-189.
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Affiliation(s)
- Howard S Smith
- UPMC Presbyterian Pain Medicine, Department of Anesthesiology, Pittsburgh, Pennsylvania, USA
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Abstract
Depressive symptoms often occur as a comorbid condition in the context of chronic illnesses such as arthritis. However, the role of both social support and social strain in relation to depressive symptoms has not been adequately explored. This study investigates the association of support and strain with depressive symptoms among a sample of older men and women in the USA (N = 298, mean age 71 years) who have knee osteoarthritis (OA). Data were collected from a survey mailed to residents who had previously participated in the Osteoarthritis Study in Seniors (OASIS), a longitudinal observational study of OA progression (survey response rate was 77%). Hierarchical regression analyses revealed significant associations of both support and strain with depressive symptoms, while statistically controlling for a variety of demographic, psychosocial and disease-related variables. In addition, social support significantly buffered the relation between social strain and depressive symptoms. The interaction effect was not significantly different for women and men, nor were the individual associations of support and strain with depressive symptoms conditioned by participant gender. The results add to the ongoing discussion regarding gender and social relations as well as highlight the role of both positive (social support) and negative (social strain) aspects of social interactions in relation to the psychological functioning of older adults coping with a chronic illness.
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Affiliation(s)
- Aurora M Sherman
- Psychology Department, Brandeis University, Mailstop 062, Waltham, MA 02454-9110, USA.
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30
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Toh EM, Prasad PS, Teanby D. Correlating the efficacy of knee viscosupplementation with osteoarthritic changes on roentgenological examination. Knee 2002; 9:321-30. [PMID: 12424042 DOI: 10.1016/s0968-0160(02)00040-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study was designed to identify the roentgenological changes of the knee that correlated with an unfavourable outcome when treated with an intra-articular knee viscoelastic supplementation. A prospective cohort of 60 patients receiving a standard course of intra-articular knee viscoelastic supplementation with a commercial uncross-linked hyaluronic acid derivative of an intermediate molecular weight were studied. Follow up was for 12 weeks post-treatment with clinical improvement measured using the Western Ontario and McMasters Universities Osteoarthritis Index. X-Rays of the relevant knee were viewed and graded for the severity of joint space, osteophyte, tibial spine, sclerosis, cyst formation, alignment and general severity by an observer blinded to the outcome of the treatment. There were no appreciable differences noted in the age, sex, length of follow up, pre-treatment, the severity of symptoms before treatment and number of intra-articular injections given per course in each X-ray category identified. There was a significant amount of improvement in patients with a minor loss of medial and lateral joint space in all outcome measures. Minimal changes in tibial spine and global appearance also indicated a positive outcome in stiffness, pain and overall improvement. Thus, patients with moderate to severe osteoarthritic changes in joint space on roentgenological examination would not significantly benefit from intra-articular knee viscoelastic supplementation. In addition, we feel that changes in the tibial spine and global appearance are not reviewed consistently enough to be included as part of our recommendation. As such, we conclude that only patients with a minimal to mild loss in joint space on roentgenological examination should form part of the target group who are likely to benefit from intra-articular knee viscoelastic supplementation.
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Affiliation(s)
- E M Toh
- Department of Orthopaedic and Trauma Surgery, Whiston Hospital, St Helens and Knowsley NHS Trust, Merseyside L35 5DR, UK.
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31
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Katz WA. Use of nonopioid analgesics and adjunctive agents in the management of pain in rheumatic diseases. Curr Opin Rheumatol 2002; 14:63-71. [PMID: 11790999 DOI: 10.1097/00002281-200201000-00012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antirheumatic analgesic medications generally fall into one of the following categories: acetaminophen, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, traditional opioids, or adjunctive analgesics. This article does not discuss corticosteroids, opioids, or topical analgesics. Acetaminophen, usually indicated early for mild pain, is often used in combination with other drugs. It has established safety. Traditional NSAIDs are effective in relieving moderate pain in certain inflammatory and noninflammatory conditions. There are many effective choices, but as a class it is fraught with the risk of serious peptic ulcer disease and its complications. Cyclooxygenase-2 specific inhibitors are NSAIDS that reduce the gastrointestinal risk and platelet-mediated bleeding. All NSAIDs may produce peripheral edema, hypertension, and potentiate warfarin. The evidence that coxibs cause thrombotic heart disease is weak. Tramadol is an alternative to musculoskeletal pain management, particularly in patients with moderate to moderately severe pain who do not respond to or who cannot tolerate acetaminophen, NSAIDs, or opioids. The role of analgesic adjuvants is discussed.
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Affiliation(s)
- Warren A Katz
- Division of Rheumatology, University of Pennsylvania Health System/Presbyterian Medical Center, Philadelphia, Pennsylvania, USA.
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32
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Brandt KD, Block JA, Michalski JP, Moreland LW, Caldwell JR, Lavin PT. Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. ORTHOVISC Study Group. Clin Orthop Relat Res 2001:130-43. [PMID: 11302304 DOI: 10.1097/00003086-200104000-00021] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A prospective, multicenter, randomized, double-blind, controlled trial was conducted in 226 patients with knee osteoarthritis to evaluate the safety and efficacy of intraarticular injections of sodium hyaluronate. Patients were randomized to three weekly injections of 30 mg sodium hyaluronate or physiologic saline (control) and were observed for an additional 25 weeks. In comparison with the control group, among patients who completed at least 15 weeks of the study and whose Western Ontario and McMaster Universities Osteoarthritis Index pain score for the contralateral knee was less than 12 at baseline, sodium hyaluronate injection resulted in improvement in Western Ontario and McMaster Universities Osteoarthritis Index pain score, patient and investigator global assessments, and pain on standing from Weeks 7 to 27. Fifty-eight percent of patients treated with sodium hyaluronate achieved a 5-unit or greater improvement in mean pain score from Weeks 7 through 27, compared with 40% of control patients. In addition, nearly twice as many patients treated with sodium hyaluronate as with saline (30% versus 17%, respectively) achieved a net improvement of at least 7 units. In contrast to treatment with saline, Western Ontario and McMaster Universities Osteoarthritis Index pain score for the contralateral knee was inversely related to the magnitude of improvement after treatment with sodium hyaluronate. Few side effects were attributed to treatment, and no differences between treatment groups were seen in this respect (sodium hyaluronate, nine [8%]; saline, 11 [10%]). The incidence of injection site reactions was low (sodium hyaluronate, 1.2 %; saline, 1.5%). The results indicate that sodium hyaluronate treatment is well tolerated and produces statistically and clinically significant improvement of symptoms in patients with mild to moderate knee osteoarthritis in whom pain in the contralateral knee is relatively modest.
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Affiliation(s)
- K D Brandt
- Indiana University School of Medicine, Indianapolis 46202-5103, USA
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33
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Wilcox S, Brenes GA, Levine D, Sevick MA, Shumaker SA, Craven T. Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis. J Am Geriatr Soc 2000; 48:1241-51. [PMID: 11037011 DOI: 10.1111/j.1532-5415.2000.tb02597.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA). DESIGN Baseline analyses of an observational prospective study. SETTING AND PARTICIPANTS Participants were 429 men and women aged 65 years and older experiencing knee pain or knee pain with radiographic evidence of OA enrolled in the Observational Arthritis Study in Seniors (OASIS). MEASUREMENTS Demographic variables (age, gender, ethnicity, education), health (X-rays of knee rated for OA severity, medical conditions, medication use, smoking status, body mass index, self-rated health), physical functioning (self-rated physical functioning, physical performance), knee pain, and psychosocial functioning (social support, depression) were measured. RESULTS Problems with sleep onset, sleep maintenance, and early morning awakenings occurred at least weekly among 31%, 81%, and 51% of participants, respectively. Bivariate correlates of greater sleep disturbance in those with OA were less education, cardiovascular disease, more arthritic joints, poorer self-rated health, poorer physical functioning, poorer physical performance, knee pain, depression, and less social support. In regression analyses, each set of variables representing the domains of health, physical functioning, pain, and psychosocial functioning contributed to the prediction of sleep disturbance beyond the demographic set. Finally, in a simultaneous model, white race (trend, P = .06), poorer self-rated health, poorer physical functioning, and depressive symptoms were predictive of sleep disturbance. CONCLUSIONS Sleep disturbance is common in older adults experiencing knee pain or knee pain with radiographic evidence of OA and is best understood through the consideration of demographic, physical health, physical functioning, pain, and psychosocial variables. Interventions that take into account the multidetermined nature of sleep disturbance in knee pain or knee OA are most likely to be successful.
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Affiliation(s)
- S Wilcox
- Department of Exercise Science, School of Public Health, University of South Carolina, Columbia 29208, USA
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34
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Abstract
Geriatric pain will be a significant health care problem in the next millennium. Pain can be acute due to trauma or surgery, and chronic due to medical illnesses and their sequels. In this article, management of geriatric chronic pain is discussed.
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35
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36
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Freedman GM, Peruvemba R. Geriatric pain management. The anesthesiologist's perspective. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2000; 18:123-41, vii. [PMID: 10935004 DOI: 10.1016/s0889-8537(05)70153-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Geriatric patients have a unique physiology that makes their pain management problematic. This article reviews the issue of geriatric pain management from the perspective of the anesthesiologist. It looks at the main causes of geriatric chronic pain and emphasizes the different analgesic modalities available that can provide maximum relief and minimal potential side effects.
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Affiliation(s)
- G M Freedman
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York, USA
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37
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Wynne CF, Ling SM, Remsburg R. Comparison of pain assessment instruments in cognitively intact and cognitively impaired nursing home residents. Geriatr Nurs 2000; 21:20-3. [PMID: 10679604 DOI: 10.1067/mgn.2000.105793] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study was conducted to determine which pain severity and location instruments were most useful in the nursing home setting. Pain severity and location were assessed monthly for 1 year in 37 participants enrolled in a restorative rehabilitation program. Pain location was determined by the residents' indications on a diagram, a doll, and their body. Pain severity was determined by resident response to verbal, visual analog, faces, and word scales. Cognitively impaired residents had greater difficulty using all instruments. The McGill Word Scale was used most to determine pain severity. Pointing to themselves most frequently determined pain location among residents. New strategies are needed for pain assessment in the elderly, especially the cognitively impaired elderly, and a combination of instruments to assess pain in the latter group may be necessary.
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Affiliation(s)
- C F Wynne
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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38
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Andersen RE, Crespo CJ, Ling SM, Bathon JM, Bartlett SJ. Prevalence of significant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 1999; 47:1435-8. [PMID: 10591238 DOI: 10.1111/j.1532-5415.1999.tb01563.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the prevalence of persistent knee pain among older adults in the US. DESIGN A nationally representative cross-sectional survey with an in-person interview and medical examination SETTING AND PARTICIPANTS Between 1988 and 1994, 6596 adults aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were over-sampled to produce reliable estimates for these groups. MAIN OUTCOME MEASUREMENTS Participants were asked to report whether they had experienced knee pain on most days for the 6 weeks preceding their medical exam. RESULTS Overall, 18.1% of US men and 23.5% of US women aged 60 years and older reported knee pain. Sixty- to ninety-year-old men reported knee pain less frequently than their age-matched female counterparts. There was a trend for reports of knee pain to increase steadily as these adults aged from 60 to 85 years. The highest prevalence of knee pain was reported among 85- to 90-year-old men (23.7%) and women (30.0%). Among non-Hispanic white adults older than age 60, 18.4% of men and 22.0% of women reported knee pain. Reports of knee pain among non-Hispanic black men and Mexican American men were similar to those of their non-Hispanic white counterparts. In contrast, 26.4% of Mexican American women and 32.8% of non-Hispanic black women reported knee pain. We also found that difficulty in performing physical functioning activities was associated with a higher prevalence of knee pain. CONCLUSIONS Many US adults older than age 60 years report knee pain, and the prevalence is higher in older adults. Reports of knee pain are highest among non-Hispanic black women and the oldest Americans. Intervention strategies are needed to prevent and better manage knee pain among older US adults to stem the adverse health consequences and diminished quality of life associated with this common problem.
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Affiliation(s)
- R E Andersen
- Johns Hopkins School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, Maryland 21224, USA
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39
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Moreland LW, St Clair EW. The use of analgesics in the management of pain in rheumatic diseases. Rheum Dis Clin North Am 1999; 25:153-91, vii. [PMID: 10083963 DOI: 10.1016/s0889-857x(05)70059-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pain is the most common complaint of patients who see rheumatologists. In this article, the current treatment options for pain are reviewed; these include acetaminophen, nonsteroidal anti-inflammatory drugs, new specific cyclooxygenase-2 inhibitors, opioid analgesics, centrally acting muscle relaxants, antidepressants, and topical analgesics and counterirritants. The doses of medication and known adverse effects of these medications are highlighted.
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Affiliation(s)
- L W Moreland
- Department of Medicine, University of Alabama at Birmingham, USA
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