scholarly journals Biomarkers of bone remodeling in ankylosing spondylitis patients using nonsteroidal anti-inflammatory drugs: results of an ETHICS research program

2017 ◽  
Vol 89 (12-2) ◽  
pp. 185-189
Author(s):  
I Z Gaydukova ◽  
A V Aparkina ◽  
E V Khondkaryan ◽  
A P Rebrov
Keyword(s):  
Ankylosing Spondylitis ◽  
Bone Resorption ◽  
Comparison Group ◽  
Control Group ◽  
Type I ◽  
Healthy Individuals ◽  
On Demand ◽  
Ethics Research ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Aim. To evaluate changes in the concentration of biomarkers for osteoproliferation and bone resorption in ankylosing spondylitis (AS) patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in different regimens. Subjects and methods. Forty patients with AS (according to the modified New York criteria), who had BASDAI ≥ 4.0 at baseline and at 52 weeks of on-demand NSAID treatment were examined and randomized into 2 groups: 1) 30 patients who used continuously oral tenoxicam 20 mg daily (a study group); 2) 10 patients who continued previous therapy (a comparison group). BASDAI and ASDAS were calculated; the serum levels of C-reactive protein, C-terminal type I procollagen propeptide (PICP), and C-terminal telopeptide of type I collagen (CTX-I) were measured at baseline and at 52 and 56 weeks of treatment. A control group consisted of 19 healthy volunteers. Results. The continuous use of NSAIDs (tenoxicam) decreased higher baseline BASDAI and ASDAS scores. There were no changes in the indicators of AS activity in the patients who took on-demand NSAIDs. Baseline CTX-I levels did not differ between the patients with AS and the healthy individuals; those declined during continuous intake of tenoxicam and remained unchanged during on-demand administration. In the patients with AS, baseline PICP levels exceeded those in the healthy individuals. In the tenoxicam-treated patients, the concentrations of PICP at baseline and at 52 and 56 weeks were 17.1±9.0, 16.8±9.9, and 13.29±6.7 ng/ml, respectively (p=0.0001 for differences between the baseline and week 56 levels); in the comparison group, PICP levels did not change statistically significantly (p≥0.05 for all intergroup comparisons). Conclusion. Changing the inefficient long-term on-demand use of NSAIDs to their continuous intake is associated with a rapid decrease in clinical AS activity (within 4 weeks) with a reduction in the higher baseline concentration of the marker for osteoproliferation and in the normal level of the marker for bone resorption.

scholarly journals Repeated short cycles of nonsteroidal anti-inflammatory drugs and kidney injury in patients with spinal degenerative-dystrophic diseases

2018 ◽  
Vol 12 (3) ◽  
pp. 94-97
Author(s):  
D. M. Bichurina ◽  
I. Z. Gaydukova ◽  
D. А. Patrikeeva ◽  
A. P. Rebrov
Keyword(s):  
Back Pain ◽  
Kidney Injury ◽  
Control Group ◽  
Study Group ◽  
Creatinine Ratio ◽  
Healthy Individuals ◽  
Group A ◽  
Inflammatory Drugs ◽  
The Mean ◽  
Anti Inflammatory

Objective: to evaluate kidney function in patients with spinal degenerative-dystrophic diseases (SDDDs) who take nonsteroidal anti-inflammatory drugs (NSAIDs) as repeated short cycles of treatment for severe back pain.Patients and methods. The investigation enrolled 97 patients with SDDDs who took NSAIDs for back pain (a study group). A control group consisted of sexand age-matched healthy individuals who had not used NSAIDs within the past year (n=40). Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation and markers of kidney injury (albuminuria and globulinuria) were measured.Results. In the study group, GFR was decreased to <90 ml/min/1.73 m2 in 61 (62.9%) patients, to <60 ml/min/1.73 m2 in 11 (11.3%); the mean GFR was 77.5 [68.0; 89.0] ml/min/1.73 m2; in the control group, a decline in GFR to 89–60 ml/min/1.73 m2 was recorded in 35 (62.5%) cases; this indicator was >90 ml/min/1.73 m2 in the remaining 15 (37.5%) cases; the mean GFR was 82.5 [70.8; 90.0] ml/min/1.73 m2 (p≥0.05 for all pairwise comparisons). A decrease in GFR to <60 ml/min/1.73 m2 was found in 11 (11.3%) patients in the study group and in nobody in the control group (p=0.026). Elevated albuminuria was noted in 74 (76.3%) patients with SDDDs and in 9 (22.5%) healthy individuals (p<0.05). Albumin/creatinine ratio was 57.1 [33.8; 82.4] mg/g in the study group and 25.0 [17.5; 32.9] mg/g in the control group (p<0.0001). Increased globulinuria was established in all the patients with SDDDs and only in 3 (7.5%) healthy examinees. Globulin/creatinine ratio was 134.7 [77.5; 197.7] mg/g in the study group and 12.9 [0.5; 18.1] mg/g in the control group (p<0.0001).Conclusion. A decline in GFR to <60 ml/min/1.73 m2 was more often seen in the patients taking NSAIDs for spine pain caused by SDDDs than in the healthy individuals. In case of comparable GFR, the level of kidney injury markers was significantly higher in the study group than that in the control group, which suggests that patients with SDDDs who take NSAIDs have subclinical tubulointerstitial and glomerular changes.

In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications

2017 ◽  
Vol 45 (14) ◽  
pp. 3345-3350 ◽  
Author(s):  
Geoffrey D. Abrams ◽  
Wenteh Chang ◽  
Jason L. Dragoo
Keyword(s):  
Cell Death ◽  
Single Dose ◽  
Joint Surface ◽  
Saline Control ◽  
Type I ◽  
Dose Equivalent ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Opioid Medications

Background: A variety of medications are administered to the intra-articular space for the relief of joint pain. While amide-type local anesthetics have been extensively studied, there is minimal information regarding the potential chondrotoxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid medications. Purpose: To investigate the in vitro chondrotoxicity of single-dose equivalent concentrations of ketorolac, morphine, meperidine, and fentanyl on human chondrocytes. Study Design: Controlled laboratory study. Methods: Human cartilage was arthroscopically harvested from the intercondylar notch and expanded in vitro. Gene expression of cultured chondrocytes before treatment was performed with quantitative polymerase chain reaction for type I collagen, type II collagen, aggrecan, and SOX9. Chondrocytes were then exposed to 0.01%, 0.02%, and 0.04% morphine sulfate; 0.3% and 0.6% ketorolac tromethamine; 0.5%, 1.0%, and 1.5% meperidine hydrochloride; 0.0005% and 0.001% fentanyl citrate; and saline. A custom bioreactor was used to constantly deliver medications, with the dosage of each medication and the duration of exposure based on standard dose equivalents, medication half-lives, and differences in the surface area between the 6-well plates and the native joint surface. After treatment, a live/dead assay was used to assess chondrocyte viability and if minimal cell death was detected. A subset of samples after treatment was maintained to analyze for possible delayed cell death. Results: All tested concentrations of ketorolac and meperidine caused significantly increased cell death versus the saline control, demonstrating a dose-response relationship. The morphine and fentanyl groups did not show increased chondrotoxicity compared with the saline group, even after 2 weeks of additional culture. Conclusion: In vitro exposure of chondrocytes to single-dose equivalent concentrations of either ketorolac or meperidine demonstrated significant chondrotoxicity, while exposure to morphine or fentanyl did not lead to increased cell death.

scholarly journals NUTRITION FOR CORRECTING METABOLISM DISORDERS OF THE JOINT-LIGAMENT SYSTEM IN PHYSICALLY ACTIVE PEOPLE

2019 ◽  
Vol 19 (1) ◽  
pp. 108-116
Author(s):  
O Tolmachyov ◽  
A Vekovtsev ◽  
V Vovchenko ◽  
A Bykov ◽  
V Poznyakovsky
Keyword(s):  
Nutritional Support ◽  
Pain Syndrome ◽  
Disease Recurrence ◽  
Biologically Active ◽  
Control Group ◽  
Movement Activity ◽  
Physically Active ◽  
Daily Movement ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Aim. The article deals with developing and assessing the efficiency of a complex nutritional support program for the joint-ligament system in athletes and physically active people. Materials and methods. The clinical evidence of biologically active substance (BAS) efficiency and functional orientation was obtained from the representative group of people with knee-joint osteoarthrosis. The main group of participants received a BAS complex with synergistic properties in terms of metabolism correction during osteoarthrosis: BAS 1 – 2 pills, BAS 2 – 1 capsule (2 times per day, 12 weeks), and BAS 3 – 1 capsule (2 times per day, 8 weeks). Nonsteroidal anti-inflammatory drugs were also prescribed to participants from the main and control groups. We used the general and special methods for assessing the quality and functional properties of specialized products. Knee joints were studied by using the Lequesne index (scores) characterizing pain syndrome, maximal distance, and daily movement activity. The intensity of pain syndrome was assessed with the visual analog scale (VAS, in mm). Results. We provided a scientific justification for the qualitative and quantitative content of BAS recipes for complex nutritional support of the joint-ligament system: BAS 1 – chondroprotective orientation; BAS 2 – an optimal source of minerals and vitamins; BAS 3 – polyunsaturated fatty acids. The results obtained revealed that specialized products improve the movement activity of participants with osteoarthrosis and significantly decrease pain syndrome (36 %). Apart from a chondroprotective effect such nutrition provides an anti-inflammatory effect and allows decreasing the intake of Nonsteroidal anti-inflammatory drugs in the absence of side effects. We revealed an insignificant number of disease recurrence – 6.7% (in the control group – 36.5 %) and established the mechanisms of such an influence. Conclusion. The application of biologically active complexes could serve as a reliable means of preventing and treating the diseases of the joint-ligament system, providing physical performance, and preserving health in athletes and physically active people.

scholarly journals Feeding and Bone Turnover in Gastric Bypass

2014 ◽  
Vol 99 (2) ◽  
pp. 491-497 ◽  
Author(s):  
Juan P. Valderas ◽  
Oslando Padilla ◽  
Sandra Solari ◽  
Manuel Escalona ◽  
Gilberto González
Keyword(s):  
Gastric Bypass ◽  
Bone Resorption ◽  
Bone Turnover ◽  
Area Under The Curve ◽  
Significant Negative Correlation ◽  
University Hospital ◽  
Control Group ◽  
Type I ◽  
Cross Sectional ◽  
Calcium Phosphorus

Context: Roux-en-Y gastric bypass (RYGB) is associated with high bone turnover. In healthy subjects, feeding causes acute reduction of bone resorption, which is regulated by several intestinal and pancreatic peptides. Objective: Our objective was to assess bone turnover after feeding in patients with RYGB. Design and Setting: This was a cross-sectional case-control study at a university hospital. Participants: Fifteen postmenopausal women who underwent RYGB 7.4 ± 4.1 years previously were matched by age and body mass index with 15 nonoperated women (controls). Main Outcomes: Serum PTH, calcium, phosphorus, insulin, carboxy telopeptide (CTX), procollagen type I N-terminal propeptide (P1NP), and glucagon-like peptide 2 (GLP-2) were measured while fasting and after a standard meal (SM). Results: The fasting calcium, phosphorus, and PTH were similar in both groups and exhibited similar decreases after an SM. The fasting CTX level was higher in the RYGB than in the control group (0.589 ± 0.18 vs 0.382 ± 0.11 ng/mL; P &lt; .05) and fell to a nadir of 42.2% of the basal value in the RYGB and 53.9% in controls (P &lt; .05). The fasting and postprandial P1NP levels were similar in both groups and fell to a nadir of 85.8% in the RYGB and 89.3% in controls. Insulin and GLP-2 levels were similar during fasting in both groups. RYGB patients had exaggerated postprandial insulin and GLP-2 response compared with the controls with the insulin and GLP-2 area under the curve being significantly higher in the RYGB group. There was a significant negative correlation between the peak of insulin levels and the CTX changes. Conclusion: The acute reduction in bone resorption after feeding is preserved in RYGB and is even higher than in nonoperated subjects. This phenomenon is related to the increase of postprandial levels of insulin. These findings suggest a bone-protecting mechanism in RYGB that may counteract the elevated bone resorption that occurs during fasting.

scholarly journals Lipoprotein-Associated Phospholipase A2 Is Increased in Patients with Impaired Bone Density

2014 ◽  
Vol 33 (4) ◽  
pp. 317-322
Author(s):  
Karel Kotaška ◽  
Jitka Kolárová ◽  
Blanka Jedličková ◽  
Jana Čepová ◽  
Jan Kotaška ◽  
...  
Keyword(s):  
Bone Density ◽  
Bone Resorption ◽  
Bone Metabolism ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Serum Levels ◽  
Phospholipase A ◽  
Control Group ◽  
Low Density ◽  
Healthy Individuals

Summary Background: Increased levels of lipoprotein-associated phospholipase A2 are associated with atherosclerosis, and may contribute to cardiac disease. The aim of this study was to analyze serum levels of lipoprotein phospholipase A2 (Lp-PLA2) in patients with impaired bone resorption and correlate the findings with markers of bone metabolism (osteocalcin) and other biochemical markers (cholesterol, low density lipoprotein, triacylglycerols). Methods: Serum Lp-PLA2 was measured by a turbidimetric method in a group of currently treated 85 patients with impaired bone resorption and in a control group of 46 healthy individuals. Serum triacylglycerols was measured by the electrochemiluminescence immunoassay. Cholesterol, low density lipoprotein and triacylglycerols were measured by commercially available enzymatic assays. Bone density was investigated by dual energy X-ray densitometry performed on the lower spine and hips. Results: Concentrations of LP-PLA2 were significantly elevated in the patients with bone resorption compared to the control group of healthy individuals (225 ng/mL vs. 192 ng/mL, p>0.001) with the highest difference in patients with a T score below –2.5 SD (227 vs. 192 ng/mL). Serum levels of Lp-PLA2 also negatively correlated with decreased levels of serum osteocalcin in patients, and a significant difference in Lp-PLA2 (p=0.02) levels was observed between the control group and group with low levels of osteocalcin. Elevated Lp-PLA2 levels were significantly associated with the therapeutic procedures used, but not with age, gender and concentration of lipids. Conclusions: Lipoprotein-associated phospholipase A2 seems to play an important role also in bone metabolism.

scholarly journals Exploring Physicians' Comfort Level with Opioids for Chronic Noncancer Pain

2004 ◽  
Vol 9 (4) ◽  
pp. 195-201 ◽  
Author(s):  
Martin N Scanlon ◽  
Urmil Chugh
Keyword(s):  
Rank Correlation ◽  
Response Rates ◽  
Comfort Level ◽  
Ordinal Scale ◽  
Control Group ◽  
Short Version ◽  
Chronic Noncancer Pain ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Noncancer Pain

OBJECTIVE:To explore the attitudes of family physicians (FPs) toward the use of opioids in the management of chronic noncancer pain (CNCP) in the Calgary Health Region (CHR), Calgary, Alberta.METHODS:From January to February 2003, random samples of 147 FPs (32 were used to pretest the instrument and were therefore excluded from the findings) and 142 specialists practicing in the CHR were invited to participate in a 20 min survey to explore aspects of CNCP management in the CHR. Physicians' comfort in prescribing opioids and nonsteroidal anti-inflammatory drugs for CNCP was measured on a four-point ordinal scale. The specialists' subgroup served as a quasi-control group. In addition, a short version of the survey was provided for those physicians who declined to fully partake in the study. This allowed the researchers to compare important characteristics between respondents and nonrespondents.RESULTS:A total of 125 physicians (63 FPs and 62 specialists) participated in the study. The overall response rate was 48.6% and response rates for FPs and specialists were 54.8% and 43.7%, respectively. Response rates for the long version of the survey were 42.6% for FPs (n=49), 31.6% for other specialists (n=45) and 36.6% for both combined. The majority of FPs and specialists (98% and 71.1%, respectively) reported that 'they can handle' nonsteroidal anti-inflammatory drugs, Tylenol No 3 with Codeine (Janssen-Ortho/McNeil Consumer Healthcare, Canada) (95.9% and 64.4%, respectively), morphine/MS Contin (Purdue Pharma, Canada) (61.2% and 24.4%, respectively) and Percocet (Bristol-Myers Squibb, Canada)/OxyContin (Purdue Pharma, Canada) (61.2% and 33.3%, respectively). Fewer FPs and specialists report that 'they can handle' Dilaudid (Abbott Laboratories, Canada)/Hydromorph Contin (Purdue Pharma, Canada) (36.7% and 13.3%, respectively), fentanyl patch (30.6% and 11.1%, respectively) and methadone (0% and 6.7%, respectively). Male FPs reported a greater degree of comfort than female FPs regarding morphine/MS Contin, Percocet/OxyContin and Dilaudid/Hydromorph Contin (Mann-Whitney U tested at a£0.05). No sex differences were detected among specialists. No relationship was detected between comfort and years of practice or number of chronic pain patients in practice. Among specialists, a weak positive relationship was detected between the degree of comfort with methadone (Spearman's rank correlation coefficient=0.35, a=0.03) and the significance of pain management in the practice. Except for methodone, the FPs reported a higher confidence with the drugs in question compared with specialists (a£0.05).CONCLUSIONS:FPs in the CHR need to increase their comfort level toward opioids in general to adequately manage CNCP. Their lack of comfort may reflect a lack of education or fear of regulatory scrutiny.

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