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The Influence of Some Nonsteroidal Anti-inflammatory Drugs on Metabolic Enzymes of Aldose Reductase, Sorbitol Dehydrogenase, and α-Glycosidase: a Perspective for Metabolic Disorders. Appl Biochem Biotechnol 2019; 190:437-447. [DOI: 10.1007/s12010-019-03099-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
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Senol O, Gundogdu G, Gundogdu K, Miloglu FD. Investigation of the relationships between knee osteoarthritis and obesity via untargeted metabolomics analysis. Clin Rheumatol 2019; 38:1351-1360. [PMID: 30637603 DOI: 10.1007/s10067-019-04428-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/28/2018] [Accepted: 01/01/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Osteoarthritis (OA), the most encountered arthritis form, result from degeneration of articular cartilage. Obesity is accepted as a significant risk factor for knee OA (KOA). In this study, it is aimed to determine the variation of metabolites between control and patients with KOA and observe the effect of obesity on KOA via untargeted metabolomics method. METHODS Serum samples of following groups were collected: patient group including 14 obesity (OKOA) and 14 non-obesity (NOKOA) (n = 28) and control group (n = 15) from orthopedics and traumatology policlinic. Serum proteins were denatured by acetonitrile and chromatographic separation of metabolites was achieved by LC/Q-TOF/MS/MS method. Data acquisition, classification, and identification were achieved by METLIN database. Cluster analysis was performed with MATLAB2017a-PLS Toolbox 7.2. RESULTS Obtained results showed that 244 (patient vs control) and 274 (OKOA vs NOKOA) m/z ratios were determined in accordance with LC/Q-TOF/MS/MS analysis. Multivariate data analysis was applied 41 and 36 m/z signal (p ≤ 0.01; fold analysis > 1.5) were filtered for patient vs control group and OKOA vs NOKOA, respectively. Twenty-one different metabolites were identified for patient vs control group and 15 metabolites were determined for OKOA vs NOKOA group. CONCLUSION Acid concentration and oxidative stress agents were high in inflammation group and their levels were much higher in obesity. It is claimed that obesity cause oxidative stress and acidosis in arthritis patients. Valine was found to be the only BCAA molecule whose concentration has significantly different in KOA patients. The relation between KOA and obesity was firstly investigated with metabolomics method.
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Affiliation(s)
- Onur Senol
- Analytical Chemistry Department, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
| | - Gulsah Gundogdu
- Department of Physiology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey.
| | - Koksal Gundogdu
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Shori G, Kapoor G, Talukdar P. Effectiveness of home-based physiotherapy on pain and disability in participants with osteoarthritis of knee: an observational study. J Phys Ther Sci 2018; 30:1232-1236. [PMID: 30349155 PMCID: PMC6181665 DOI: 10.1589/jpts.30.1232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/20/2018] [Indexed: 12/14/2022] Open
Abstract
[Purpose] The objective of this observational study was to examine the effect of home
physiotherapy on pain and disability in participants with knee osteoarthritis.
[Participants and Methods] From January 2017 to December 2017, 139 participants who were
recipients of HealthCare atHome physiotherapy services across various locations were
included in the main analysis. The mean treatment cycle duration was 31.5 days (mean
number of sessions delivered, 19.7). Physiotherapy was performed for approximately
45–50 min in the form of electrotherapy, exercise therapy, and manual therapy. Visual
analog scale (VAS) scores were documented after each visit, whereas The Western Ontario
and Mcmaster Universities Osteoarthritis Index (WOMAC) as an outcome were recorded weekly.
[Results] Statistically significant improvement in the visual analog scale and Western
Ontario and Mcmaster Universities Osteoarthritis Index scores were observed, with overall
% improvement of 52% and 43%, respectively. [Conclusion] The average scores in pain and
disability were reduced after home based physiotherapy.
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Affiliation(s)
- Gaurav Shori
- HealthCare atHome, India Pvt. Ltd.: D-8, First Floor, Sector 3 Noida 201301, India
| | - Gagan Kapoor
- HealthCare atHome, India Pvt. Ltd.: D-8, First Floor, Sector 3 Noida 201301, India
| | - Prativa Talukdar
- HealthCare atHome, India Pvt. Ltd.: D-8, First Floor, Sector 3 Noida 201301, India
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Güner S, Gökalp MA, Gözen A, Ünsal SŞ, Güner Şİ. Effectiveness of etofenamate for treatment of knee osteoarthritis: a randomized controlled trial. Ther Clin Risk Manag 2016; 12:1693-1699. [PMID: 27881922 PMCID: PMC5115622 DOI: 10.2147/tcrm.s114707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The intramuscular application of etofenamate in the treatment of knee osteoarthritis was not observed in the existing English language literature. The objectives of this study were to compare the efficacy of etofenamate versus hyaluronic acid (HA) in reducing joint pain and functional improvement for mild to moderate knee osteoarthritis. The patients were randomly divided into etofenamate (n=29) and HA (n=30) groups. Intramuscular etofenamate injection was administered as a series of seven intramuscular injections at intervals of 1 day. Intra-articular HA injection was administered as a series of three intra-articular injections at intervals of 1 week. Clinical evaluation was made before the first injection and again both 6 and 12 months after the last injection. The evaluation consisted of patient-assessed pain on a visual analog scale (VAS) and on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical significance was found for the etofenamate group when comparing preinjection with 12 months postinjection VAS scores (P<0.05). Statistical significance was also found for the HA group when comparing preinjection with 12 months postinjection VAS and WOMAC scores (P<0.05). However, there was no significant difference between the etofenamate and HA groups in terms of VAS or WOMAC scores measured at 12 months after injection (P>0.05). Results from this study indicated that, etofenamate treatment was not significantly more effective than HA treatment. However, both methods were effective and successful in treating knee osteoarthritis.
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Affiliation(s)
- Savaş Güner
- Department of Trauma and Orthopedic Surgery, Medical School, Yuzuncu Yil University
| | - Mehmet Ata Gökalp
- Department of Trauma and Orthopedic Surgery, Medical School, Yuzuncu Yil University
| | - Abdurrahim Gözen
- Department of Trauma and Orthopedic Surgery, Medical School, Yuzuncu Yil University
| | - Seyyid Şerif Ünsal
- Department of Trauma and Orthopedic Surgery, Medical School, Yuzuncu Yil University
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Anwer S, Alghadir A, Brismée JM. Effect of Home Exercise Program in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Geriatr Phys Ther 2016; 39:38-48. [PMID: 25695471 DOI: 10.1519/jpt.0000000000000045] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Osteoarthritis Research Society International recommended that nonpharmacological methods include patient education programs, weight reduction, coping strategies, and exercise programs for the management of knee osteoarthritis (OA). However, neither a systematic review nor a meta-analysis has been published regarding the effectiveness of home exercise programs for the management of knee OA. PURPOSE The purpose of this systematic review was to examine the evidence regarding the effect of home exercise programs with and without supervised clinic-based exercises in the management of knee OA. METHODS We searched PubMed, CINAHL, Embase, Scopus, and PEDro for research articles published prior to September 2014 using key words such as pain, exercise, home exercise program, rehabilitation, supervised exercise program, and physiotherapy in combination with Medical Subject Headings "Osteoarthritis knee." We selected randomized and case-controlled trials published in English language. To verify the quality of the selected studies, we applied the PEDro Scale. Two evaluators individually selected the studies based on titles, excluding those articles that were not related to the objectives of this review. One evaluator extracted data from the included studies. A second evaluator independently verified extracted data for accuracy. RESULTS A total of 31 studies were found in the search. Of these, 19 studies met the inclusion criteria and were further analyzed. Seventeen of these 19 studies reached high methodological quality on the PEDro scale. Although the methods and home exercise program interventions varied widely in these studies, most found significant improvements in pain and function in individuals with knee OA. DISCUSSIONS The analysis indicated that both home exercise programs with and without supervised clinic-based exercises were beneficial in the management of knee OA. CONCLUSIONS The large evidence of high-quality trials supports the effectiveness of home exercise programs with and without supervised clinic-based exercises in the rehabilitation of knee OA. In addition, small but growing evidence supports the effectiveness of other types of exercise such as tai chi, balance, and proprioceptive training for individuals with knee OA.
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Affiliation(s)
- Shahnawaz Anwer
- 1Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. 2Padmashree Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. 3Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock
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Alghadir A, Anwer S, Iqbal ZA, Alsanawi HA. Cross-cultural adaptation, reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis. Disabil Rehabil 2015; 38:689-94. [DOI: 10.3109/09638288.2015.1055380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskelet Disord 2014; 15:418. [PMID: 25492581 DOI: 10.1186/1471-2474-15-418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care pharmacological management of new musculoskeletal conditions is not consistent, despite guidelines which recommend prescribing basic analgesics before higher potency medications such as opioids or non-steroidal inflammatory drugs (NSAIDs).The objective was to describe pharmacological management of new musculoskeletal conditions and determine patient characteristics associated with type of medication prescribed. METHODS The study was set within a UK general practice database, the Consultations in Primary Care Archive (CiPCA). Patients aged 15 plus who had consulted for a musculoskeletal condition in 2006 but without a musculoskeletal consultation or analgesic prescription in the previous 12 months were identified from 12 general practices. Analgesic prescriptions within two weeks of first consultation were identified. The association of socio-demographic and clinical factors with receiving any analgesic prescription, and with strength of analgesic, were evaluated. RESULTS 3236 patients consulted for a new musculoskeletal problem. 42% received a prescribed pain medication at that time. Of these, 47% were prescribed an NSAID, 24% basic analgesics, 18% moderate strength analgesics, and 11% strong analgesics. Increasing age was associated with an analgesic prescription but reduced likelihood of a prescription of NSAIDs or strong analgesics. Those in less deprived areas were less likely than those in the most deprived areas to be prescribed analgesics (odds ratio 0.69; 95% CI 0.55, 0.86). Those without comorbidity were more likely to be prescribed NSAIDs (relative risk ratios (RRR) compared to basic analgesics 1.89; 95% CI 0.96, 3.73). Prescribing of stronger analgesics was related to prior history of analgesic medication (for example, moderate analgesics RRR 1.88; 95% CI 1.11, 3.10). CONCLUSION Over half of patients were not prescribed analgesia for a new episode of a musculoskeletal condition, but those that were often received NSAIDs. Analgesic choice appears multifactorial, but associations with age, comorbidity, and prior medication history suggest partial use of guidelines.
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Analgesic, anti-inflammatory, and chondroprotective activities of Cryptolepis buchanani extract: in vitro and in vivo studies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:978582. [PMID: 25247198 PMCID: PMC4160634 DOI: 10.1155/2014/978582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/07/2014] [Indexed: 01/10/2023]
Abstract
Cryptolepis buchanani Roem. & Schult. is widely used in folk medicine in Southeast Asia for treating muscle tension and arthritis. This study aimed to investigate an analgesic activity of the methanol extract of C. buchanani (CBE) in acetic acid-induced writhing response in mice, and to examine its anti-inflammatory activity in ethyl phenylpropiolate- (EPP-) induced ear edema and carrageenan-induced paw edema in rats. Its effects on cartilage degradation induced by interleukin-1β (IL-1β) in porcine cartilage explant culture were also determined. This study demonstrated that CBE significantly reduced acetic acid-induced writhing response. It also inhibited edema formation in both EPP-induced ear edema and carrageenan-induced paw edema models. In cartilage explant culture, CBE significantly reduced the sulfated glycosaminoglycan and hyaluronan released into culture media while it reserved the uronic acid and collagen within the cartilage tissues. It also suppressed the matrix metalloproteinase-2 activity with no effect on cell viability. In conclusion, CBE shows analgesic, anti-inflammatory, and chondroprotective effects in this preliminary study. Therefore, CBE may be useful as an alternative treatment for osteoarthritis.
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Affiliation(s)
- Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Training Self-Administered Acupressure Exercise among Postmenopausal Women with Osteoarthritic Knee Pain: A Feasibility Study and Lessons Learned. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012. [PMID: 23193423 PMCID: PMC3489108 DOI: 10.1155/2012/570431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background. Osteoarthritis (OA) is more prevalent in women, particularly after menopausal age. Women are more likely to seek complementary and alternative medicine (CAM) approaches. We examined the feasibility of training self-administered acupressure exercise and assessed its impact on OA symptoms among women with knee OA. Methods. Thirty-six eligible postmenopausal women were randomly assigned in the acupressure exercise group (n = 15) or the control group (n = 21) for 12 weeks. Feasibility outcomes (e.g., compliance and adverse effects) and clinical outcomes (e.g., pain, stiffness, and physical function) were assessed. Data were collected at baseline, 6 weeks and 12 weeks. Both per-protocol and intention-to-treat analysis were employed. Results. The training materials were well received. The feedback from participants suggests that self-administered acupressure exercise is easy to learn and safe to perform at home, although no statistically significant results of the clinical outcome were observed. Our findings didn't reveal superiority or inferiority of acupressure compared with usual care. Conclusion. Acupressure exercise is feasible to be trained among postmenopausal women with knee osteoarthritis. Due to the limitations of this study such as small sample size and high attrition rate, acupressure's efficacy needs to be further explored in larger scale studies with more rigorous design.
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Cheng DS, Visco CJ. Pharmaceutical therapy for osteoarthritis. PM R 2012; 4:S82-8. [PMID: 22632707 DOI: 10.1016/j.pmrj.2012.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 11/26/2022]
Abstract
There are a variety of oral and topical pharmaceutical agents for the treatment of osteoarthritis. To date there is no pharmacologic agent proved to prevent disease progression. This article focuses primarily on the medications used for symptomatic relief and palliation of pain. The article reviews the medications' mechanisms of action and the available efficacy literature, as well as indications, contraindications, and common adverse effects.
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Affiliation(s)
- David S Cheng
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
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Segal NA, Glass NA, Shakoor N, Wallace R. Vibration platform training in women at risk for symptomatic knee osteoarthritis. PM R 2012; 5:201-9; quiz 209. [PMID: 22981005 DOI: 10.1016/j.pmrj.2012.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/19/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether a platform exercise program with vibration is more effective than platform exercise alone for improving lower limb muscle strength and power in women ages 45 to 60 with risk factors for knee osteoarthritis (OA). DESIGN Randomized, controlled study. SETTING Academic center. PARTICIPANTS A total of 48 women ages 45-60 years with risk factors for knee OA (a history of knee injury or surgery or body mass index ≥25 kg/m(2)). INTERVENTIONS Subjects were randomly assigned to a twice-weekly lower limb exercise program (quarter squat, posterolateral leg lifts, calf raises, step-ups, and lunges) on either a vertically vibrating platform (35 Hz, 2 mm) or a nonvibrating platform. MAIN OUTCOME MEASUREMENTS Change in isokinetic quadriceps strength, leg press power, and stair climb power by 12 weeks. RESULTS A total of 39 of 48 enrolled participants completed the study (26 vibration and 13 control exercise). Nine participants discontinued the study after randomization mainly because of a lack of time. No intergroup differences in age, body mass index, or activity level existed. Isokinetic knee extensor strength did not significantly improve in either group. Leg press power improved by 92.0 ± 69.7 W in the vibration group (P < .0001) and 58.2 ± 96.2 W in the control group (P = .0499) but did not differ between groups (P = .2262). Stair climb power improved by 53.4 ± 64.7 W in the vibration group (P = .0004) and 55.7 ± 83.3 W in the control group (P = .0329) but did not differ between groups (P = .9272). CONCLUSIONS Whole body vibration platforms have been marketed for increasing strength and power. In this group of asymptomatic middle-aged women with risk factors for knee OA, the addition of vibration to a 12-week exercise program did not result in significantly greater improvement in lower limb strength or power than did participation in the exercise program without vibration.
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Affiliation(s)
- Neil A Segal
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, IA 52242-1088, USA.
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Anwer S, Quddus N, Miraj M, Equebal A. Effectiveness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee. Hong Kong Physiother J 2011. [DOI: 10.1016/j.hkpj.2011.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The Influence of Radiographic Severity on the Relationship between Muscle Strength and Joint Loading in Obese Knee Osteoarthritis Patients. ARTHRITIS 2011; 2011:571519. [PMID: 22046519 PMCID: PMC3200076 DOI: 10.1155/2011/571519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 01/08/2023]
Abstract
Objective. To investigate the relationship between knee muscle strength and the external knee adduction moment during walking in obese knee osteoarthritis patients and whether disease severity influences this relationship. Methods. This cross-sectional study included 136 elderly obese (BMI > 30) adults with predominant medial knee osteoarthritis. Muscle strength, standing radiographic severity as measured by the Kellgren and Lawrence scale, and the peak external knee adduction moment were measured at self-selected walking speed. Results. According to radiographic severity, patients were classified as “less severe” (KL 1-2, N = 73) or “severe” (KL 3-4, N = 63). A significant positive association was demonstrated between the peak knee adduction moment and hamstring muscle strength in the whole cohort (P = .047). However, disease severity did not influence the relationship between muscle strength and dynamic medial knee joint loading. Severe patients had higher peak knee adduction moment and more varus malalignment (P < .001). Conclusion. Higher hamstring muscle strength relates to higher estimates of dynamic knee joint loading in the medial compartment. No such relationship existed for quadriceps muscle strength. Although cross sectional, the results suggest that hamstrings function should receive increased attention in future studies and treatments that aim at halting disease progression.
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Abstract
AIM This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis. BACKGROUND Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non-pharmacological strategies, including complementary therapies and pain-relieving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms. METHOD Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and follow-up interviews and telephone conversations were conducted. FINDINGS Seven themes were identified in the data: (1) Meditative-like stillness and relaxation of thoughts; (2) Constant penetrating warmth throughout the body; (3) Positive change in outlook; (4) Increased energy and interest in the world; (5) Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others; (6) Increased suppleness within the body and (7) More comfortable, flexible joint mobility. The essential experience of ginger compresses exposed the unique qualities of heat, stimulation, anti-inflammation and analgesia. CONCLUSION Nurses could consider this therapy as part of a holistic treatment for people with osteoarthritis symptoms. Controlled research is needed with larger numbers of older people to explore further the effects of the ginger compress therapy.
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Sivan S, Schroeder A, Verberne G, Merkher Y, Diminsky D, Priev A, Maroudas A, Halperin G, Nitzan D, Etsion I, Barenholz Y. Liposomes act as effective biolubricants for friction reduction in human synovial joints. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2010; 26:1107-16. [PMID: 20014818 DOI: 10.1021/la9024712] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Phospholipids (PL) form the matrix of biological membranes and of the lipoprotein envelope monolayer, and are responsible for many of the unique physicochemical, biochemical, and biological properties of these supermolecular bioassemblies. It was suggested that phospholipids present in the synovial fluid (SF) and on the surface of articular cartilage have major involvement in the low friction of cartilage, which is essential for proper mobility of synovial joints. In pathologies, such as impaired biolubrication (leading to common joint disorders such as osteoarthritis), the level of phospholipids in the SF is reduced. Using a human-sourced cartilage-on-cartilage setup, we studied to what extent and how phospholipids act as highly effective cartilage biolubricants. We found that large multilamellar vesicles (MLV), >800 nm in diameter, composed of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) or of a mixture of DMPC and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) are superior lubricants in comparison to MLV composed of other phosphatidylcholines. Introducing cholesterol into liposomes resulted in less effective lubricants. DMPC-MLV was also superior to small unilamellar vesicles (SUV), <100 nm in diameter, composed of DMPC. MLV are superior to SUV due to MLV retention at and near (<200 microm below) the cartilage surface, while SUV penetrate deeper into the cartilage (450-730 microm). Superiority of specific PL compositions is explained by the thermotropic behavior (including compressibility) of the lipid bilayer. Correlating physicochemical properties of the MLV with the friction results suggests that MLV having lipid bilayers in the liquid-disordered phase and having a solid-ordered to liquid-disordered phase transition temperature slightly below physiological temperature are optimal for lubrication. High phospholipid headgroup hydration, high compressibility, and softness are the common denominators of all efficient PL compositions. The high efficiency of DMPC-MLV and DMPC/DPPC-MLV as cartilage lubricants combined with their resistance to degradation at 37 degrees C supports further evaluation of these MLV for treatment of joint impairments related to poor lubrication. This work also demonstrates the relevance of basic physicochemical properties of phospholipids to their activities in biological systems.
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Affiliation(s)
- Sarit Sivan
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel
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Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial. BMC Musculoskelet Disord 2009; 10:130. [PMID: 19852841 PMCID: PMC2775018 DOI: 10.1186/1471-2474-10-130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 10/24/2009] [Indexed: 11/29/2022] Open
Abstract
Background There is some evidence that acupuncture for pain and osteoarthritis (OA) of the knee is more than a placebo, and short term clinical benefits have been observed when acupuncture is compared to usual care. However there is insufficient evidence on whether clinical benefits of acupuncture are sustained over the longer term. In this study our key objectives are to inform the design parameters for a fully powered pragmatic randomised controlled trial. These objectives include establishing potential recruitment rates, appropriate validated outcome measures, attendance levels for acupuncture treatment, loss to follow up and the sample size for a full scale trial. Methods Potential participants aged over 50 with pain and osteoarthritis of the knee were identified from a GP database. Eligible patients were randomised to either 'acupuncture plus usual care' and 'usual care' alone, with allocation appropriately concealed. Acupuncture consisted of up to 10 sessions usually weekly. Outcome measures included Western Ontario and McMaster Universities (WOMAC) index with the sample size for a full scale trial determined from the variance. Results From the GP database of 15,927 patients, 335 potential trial participants were identified and invited to participate. After screening responses, 78 (23%) were identified as eligible and 30 patients who responded most promptly were randomised to 'acupuncture plus usual care' (15 patients) and 'usual care' alone (15 patients). Attendance for acupuncture appointments was high at 90% of the maximum. Although the trial was not powered to detect significant changes in outcome, the WOMAC pain index showed a statistically significant reduction at 3 months in the acupuncture group compared to usual care. This was not sustained at 12 months. The sample size for a fully powered two-arm trial was estimated to be 350. Conclusion This pilot study provided the evidence that a fully powered study to explore the longer term impact of acupuncture would be worthwhile, and relevant design features for such a trial were determined. Trial registration number ISRCTN25134802.
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The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. Knee 2009; 16:303-9. [PMID: 19321348 DOI: 10.1016/j.knee.2008.12.007] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 12/09/2008] [Accepted: 12/13/2008] [Indexed: 02/07/2023]
Abstract
CONTEXT Osteoarthritis (OA) is a musculoskeletal disorder primarily affecting the older population and resulting in chronic pain and disability. Biomechanical variables, associated with OA severity such as external knee adduction moment (KAM) and joint malalignment, may affect the disease process by altering the bone-on-bone forces during gait. OBJECTIVE To investigate the association between biomechanical variables and KAM in knee OA. METHOD A systematic search for published studies' titles and abstracts was performed on Ovid Medline, Cumulative index to Nursing and Allied Health, PREMEDLINE, EBM reviews and SPORTDiscus. Fourteen studies met the inclusion criteria and were considered for the review. RESULTS The magnitude and time course of KAM during gait appeared to be consistent across laboratories and computational methods. Only two of the included studies that compared patients with OA to a control group reported a higher peak KAM for the OA group. Knee adduction moment increased with OA severity and was directly proportional to varus malalignment. Classifying the patients on the basis of disease severity decreased the group variability, permitting the differences to be more detectable. CONCLUSIONS Biomechanical variables such as varus malalignment are associated with KAM and therefore may affect the disease process. These variables should be taken into considerations when developing therapeutic interventions for individuals suffering from knee OA.
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Lange AK, Vanwanseele B, Foroughi N, Baker MK, Shnier R, Smith RM, Singh MAF. Resistive Exercise for Arthritic Cartilage Health (REACH): a randomized double-blind, sham-exercise controlled trial. BMC Geriatr 2009; 9:1. [PMID: 19144148 PMCID: PMC2649134 DOI: 10.1186/1471-2318-9-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 01/13/2009] [Indexed: 12/25/2022] Open
Abstract
Background This article provides the rationale and methodology, of the first randomised controlled trial to our knowledge designed to assess the efficacy of progressive resistance training on cartilage morphology in women with knee osteoarthritis. Development and progression of osteoarthritis is multifactorial, with obesity, quadriceps weakness, joint malalignment, and abnormal mechanical joint forces particularly relevant to this study. Progressive resistance training has been reported to improve pain and disability in osteoarthritic cohorts. However, the disease-modifying potential of progressive resistance training for the articular cartilage degeneration characteristic of osteoarthritis is unknown. Our aim was to investigate the effect of high intensity progressive resistance training on articular cartilage degeneration in women with knee osteoarthritis. Methods Our cohort consisted of women over 40 years of age with primary knee osteoarthritis, according to the American College of Rheumatology clinical criteria. Primary outcome was blinded measurement of cartilage morphology via magnetic resonance imaging scan of the tibiofemoral joint. Secondary outcomes included walking endurance, balance, muscle strength, endurance, power, and velocity, body composition, pain, disability, depressive symptoms, and quality of life. Participants were randomized into a supervised progressive resistance training or sham-exercise group. The progressive resistance training group trained muscles around the hip and knee at 80% of their peak strength and progressed 3% per session, 3 days per week for 6 months. The sham-exercise group completed all exercises except hip adduction, but without added resistance or progression. Outcomes were repeated at 3 and 6 months, except for the magnetic resonance imaging scan, which was only repeated at 6 months. Discussion Our results will provide an evaluation of the disease-modifying potential of progressive resistance training for osteoarthritis. Trial Registration ANZCTR Reference No. 12605000116628
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Affiliation(s)
- Angela K Lange
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
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Sato E, Sato T, Yoshikawa A, Yamaji T, Usuda S, Watanabe H. Effect of WISH-Type Hip Brace on Dynamic Balances in Patients with Hip Osteoarthritis. ACTA ACUST UNITED AC 2008. [DOI: 10.2974/kmj.58.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]. Altern Ther Health Med 2007; 7:34. [PMID: 17974032 PMCID: PMC2131759 DOI: 10.1186/1472-6882-7-34] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 10/31/2007] [Indexed: 11/20/2022]
Abstract
Background The efficacy and safety of a dietary supplement derived from South American botanicals was compared to glucosamine sulfate in osteoarthritis subjects in a Mumbai-based multi-center, randomized, double-blind study. Methods Subjects (n = 95) were screened and randomized to receive glucosamine sulfate (n = 47, 1500 mg/day) or reparagen (n = 48, 1800 mg/day), a polyherbal consisting of 300 mg of vincaria (Uncaria guianensis) and 1500 mg of RNI 249 (Lepidium meyenii) administered orally, twice daily. Primary efficacy variable was response rate based on a 20% improvement in WOMAC pain scores. Additional outcomes were WOMAC scores for pain, stiffness and function, visual analog score (VAS) for pain, with assessments at 1, 2, 4, 6 and 8 weeks. Tolerability, investigator and subject global assessments and rescue medication consumption (paracetamol) were measured together with safety assessments including vital signs and laboratory based assays. Results Subject randomization was effective: age, gender and disease status distribution was similar in both groups. The response rates (20% reduction in WOMAC pain) were substantial for both glucosamine (89%) and reparagen (94%) and supported by investigator and subject assessments. Using related criteria response rates to reparagen were favorable when compared to glucosamine. Compared to baseline both treatments showed significant benefits in WOMAC and VAS outcomes within one week (P < 0.05), with a similar, progressive improvement over the course of the 8 week treatment protocol (45–62% reduction in WOMAC or VAS scores). Tolerability was excellent, no serious adverse events were noted and safety parameters were unchanged. Rescue medication use was significantly lower in the reparagen group (p < 0.01) at each assessment period. Serum IGF-1 levels were unaltered by treatments. Conclusion Both reparagen and glucosamine sulfate produced substantial improvements in pain, stiffness and function in subjects with osteoarthritis. Response rates were high and the safety profile was excellent, with significantly less rescue medication use with reparagen. Reparagen represents a new natural productive alternative in the management of joint health. Trial registration Current Controlled Trials ISRCTN25438351.
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Sato T, Yamaji T, Inose H, Sekino Y, Uchida S, Usuda S, Takagishi K, Shirakura K, Watanabe H. Effect of a modified S-form hip brace, WISH type, for patients with painful osteoarthritis of the hip: a role in daily walking as a hip muscle exercise. Rheumatol Int 2007; 28:419-28. [PMID: 17899093 DOI: 10.1007/s00296-007-0455-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 09/02/2007] [Indexed: 01/26/2023]
Abstract
A hip brace designated as WISH-type of S-form hip brace was applied for 14 patients with painful hip osteoarthritis (OA), who were required to walk as an exercise at least a half hour every day. Patients were independently evaluated and serially scored using the Harris and Japanese Orthopaedic Surgery (JOA) scores. Pain relief on gait was obtained immediately and dramatically in all patients, providing high compliance. Approximately three fourths of patients acquired independence from analgesics. Both Harris and JOA scoring systems indicated significant improvement of hip function. Only two cases showed poor responses, and common factors in these cases included bilateral involvement and unsuccessfulness of daily walking exercise. The present WISH-type hip brace may be one of the most valuable treatments in the management of the hip OA. Requirements of muscle exercise around the hip girdle involving daily walking should be emphasized for maintenance of the brace effects.
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Affiliation(s)
- Takahisa Sato
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Zhang DW, Yang QS, Zhu JY, Cao XR, Li LW, Zhu QS. Amelioration of osteoarthritis by intra-articular hyaluronan synthase 2 gene therapy. Med Hypotheses 2007; 69:1111-3. [PMID: 17433560 DOI: 10.1016/j.mehy.2007.01.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 01/04/2007] [Indexed: 12/19/2022]
Abstract
Osteoarthritis (OA) is a chronic, degenerative disorder of multifactorial aetiology, characterized by loss of articular cartilage and periarticular bone remodelling. Goals of managing OA include controlling pain, maintaining and improving function and health-related quality of life, and limiting functional impairment. Although several managements had been proved to ameliorate the symptoms of osteoarthritis, no methods could cure it thoroughly. High-molecular-weight hyaluronan (HMW-HA) is a major component of synovial joint fluids which physically acts as a viscous lubricant for slow joint movements and as an elastic shock absorber during rapid movements. It also has a variety of biologic effects in vivo, such as inhibiting the release of inflammatory factors and suppressing the degradation of cartilage matrix. Intra-articular injection of synthetic HMW-HA has been used as viscosupplement for knee OA and its therapeutic efficacy has been verified. However, repeated injections of HMW-HA which is needed to control symptoms increase the probability of infection and sometimes there will have acute joint pain with effusion, which requires aspiration to exclude sepsis. In order to overcome the disadvantages of repeated injections of HMW-HA, novel strategies should be developed. As HMW-HA is synthesized by hyaluronan synthase-2 (HAS2), we postulate that HAS2 gene could be delivered into intra-articular cells by methods of gene therapy to achieve long-lasting synthesis of HMW-HA. In our opinion, this strategy seems to hold interesting future prospects for the treatment of OA.
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Affiliation(s)
- Da-Wei Zhang
- Institute of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, #17 Changle Western Road, Xi'an 710032, China
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Chrubasik C, Duke RK, Chrubasik S. The evidence for clinical efficacy of rose hip and seed: a systematic review. Phytother Res 2006; 20:1-3. [PMID: 16395741 DOI: 10.1002/ptr.1729] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of this review is to evaluate whether clinical research has gained any evidence of effectiveness of Rosa canina preparations. METHODS Several databases and other sources were searched to identify randomized controlled trials of Rosa canina preparations. RESULTS Trials were described in a narrative way, taking into consideration methodological quality scores. Four trials were included in this review and two were identified as subgroup analyses. CONCLUSIONS Moderate evidence exists for the use of a powder of the seeds and husks of a Rosa canina subspecies in patients suffering from osteoarthritis.
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Affiliation(s)
- C Chrubasik
- Institute of Forensic Medicine, University of Freiburg i.Br., Albertstr. 9, 79104 Freiburg i.Br., Germany
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Abstract
Osteoarthritis (OA) treatment is complex and multifactorial, with pharmacological regimens requiring sufficient flexibility to be adapted to individual disease progression, flare ups, and response to treatment. Coexisting conditions are common and can lead to problems regarding polypharmacy. Several guidelines have been published for the management of OA pain. While differences exist, most recommend paracetamol as the initial oral drug for OA, based on its efficacy, tolerability, and cost; in patients who respond inadequately to paracetamol, supplementary or replacement analgesics should be recommended. This article considers the reality of analgesic use for OA in clinical practice and the extent to which guidelines are followed both in primary and secondary care. An international survey of rheumatologists (n = 610) found that paracetamol was recommended as first-choice analgesic for OA by 82% of those surveyed. Similarly, in a survey of French GPs, 90% of those surveyed recommended paracetamol first line; NSAIDs were recommended more frequently for stronger pain relief but were also recommended alongside paracetamol as a first-line treatment of mild to moderate pain by 43% of GPs. Finally, a UK patient survey, conducted at a London hospital (n = 200), found that 64% of patients were taking more than 1 drug for treatment of painful OA of the knee or hip; 76% were taking paracetamol and 40% were taking an NSAID. A further 39% had used an NSAID in the past but switched treatment, primarily due to side effects. These findings reinforce the case for the simple analgesic paracetamol to be seen as the cornerstone of pharmacological OA treatment, both as a first-line analgesic and as a foundation to which additional treatment modalities, including NSAIDs, can be added if and when necessary.
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Affiliation(s)
- Ali S M Jawad
- The Royal London Hospital, Bancroft Road, London El 4DG, United Kingdom.
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Kotsirilos V, Hassed CS. Ethical and legal issues at the interface of complementary and conventional medicine. Med J Aust 2004. [DOI: 10.5694/j.1326-5377.2004.tb06464.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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