TO COMPARE THE EFFICACY OF GENICULAR NERVE BLOCK AND INJECTION OF HYLAN G-F 20 VERSUS GENICULAR NERVE BLOCK ONLY FOR IMPROVING PAIN AND FUNCTION OF GRADE-II AND GRADE-III OSTEOARTHRITIS KNEE

2021 ◽  
pp. 57-62
Author(s):  
Nabarun Gupta ◽  
Saumen Kumar De ◽  
Rathindra Nath Haldar
Keyword(s):  
Nerve Block ◽  
Combined Therapy ◽  
Womac Score ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Vas Score ◽  
Osteoarthritis Knee ◽  
Grade Ii ◽  
Group 2 ◽  
Group 1

Introduction: Osteoarthritis (OA) of knee joint is a degenerative joint disease; heterogeneous and progressive in nature. Clinically presented with stiffness, swelling and pain which leads to a decrease in the quality of life. The presence of chronic knee pain has been found to be a strong predictor of future disability and dependency in older adults. Usually managed conservatively but if conservative treatment fails, Total Knee Replacement (TKR) is traditionally considered. This is associated with multiple perioperative morbidities. On the contrary, many patients are not suitable for surgical procedure and some do not want to go for surgical intervention. As many patients are not surgical candidates due to co-morbidities or unwillingness; other treatment options available are being sought for. The genicular nerve block (GNB) reduces pain and improves patient functions by blocking pain transmission of the sensory nerves. Combining this genicular nerve block with viscosupplementation (Injection Hylan G-F 20) appears to play a role and can be tried in patients suffering in grade II and grade III (radiological grading) osteo arthritis. There is paucity of information so as to compare the efcacy of genicular nerve block and injection of Hylan G-F 20 versus genicular nerve block only. Material And Methods: This Parallel group open label randomized controlled trial was done between July, 2018 to December, 2019 (Eighteen months). Patients with knee pain in grade II and III, OA knee attending the PMR OPD in IPGME&R, Kolkata in the specied tenure was considered for the study. The selected patients were allotted by random table. All the procedures were performed by single person. A total number of 60 patients with knee osteoarthritis of grade II and III, who did not respond with conservative management were included. Combined therapy of intra-articular injection of Hylan G-F 20 and genicular nerve block in Group 1 (Genicular Nerve Block and Injection Hylan G-F 20) and Genicular Nerve Block only in Group 2, performed to 30 patients in each arm. The three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves] were selected. Patients were evaluated initially (0 week) and at the 4th and 12th week followed up after intervention using VAS and WOMAC scale. Ultrasound guided genicular nerve block conducted under strict asepsis after proper dressing and draping with the visualization of genicular nerves (upper medial, upper lateral and lower medial quadrant) by musculoskeletal probe of Ultrasound machine (SAMSUNG/ Model PT60A/Musculoskeletal probe 12MHz). Injection Hylan G-F 20 (6 ml) intra-articular injection was given under strict asepsis. Results: 47% patients in group 1 and 67% patients in group 2 were in between 60-69 years. There is female preponderance in both the groups. WOMAC-pain score for dual intervention at 4th week was statistically signicantly lower compared to WOMAC-pain score obtained at any time of observation and any type of intervention. WOMAC- stiffness score for dual intervention at 4th week was statistically signicantly lower compared to WOMAC- stiffness score obtained at any time of observation. WOMAC SCORE: The changes in each intervention group at 0-week, 4th week and 12th week were statistically signicant. Statistically signicant difference of two groups were lost during 4th and 12th weeks observation. VAS: During 4th and 12th weeks observation, statistically signicantly different VAS score was observed among the two interventions; Genicular nerve block with injection consistently had a lower VAS score. This nding imply that Genicular nerve block alone did reduce the pain; however, reduction was greater in case of Genicular nerve block with Injection Hylan G-F 20 in both 4th and 12th week of observation. Conclusion: Genicular Nerve Block with injection HYLAN GF 20 (Combined Therapy Group) and Genicular Nerve Block alone are effective method of pain reduction in osteoarthritis knee. Combined Therapy doesn't have an added advantage as per WOMAC Score. But Combined therapy has a denite advantage over Genicular Nerve Block alone as per VAS Score.

scholarly journals A COMPARISON BETWEEN FEMORAL NERVE BLOCK AND LOCAL INFILTRATION ANALGESIA WITH ROPIVACAINE: A PROSPECTIVE , COMPARATIVE AND OBSERVATIONAL STUDY

2020 ◽  
pp. 29-31
Author(s):  
Aamir Huda ◽  
Bimal Kumar Hajra ◽  
Payel Mitra ◽  
Preeti Banerjee ◽  
Debarshi Jana
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Postoperative Period ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Rescue Analgesia ◽  
Local Infiltration ◽  
Vas Score ◽  
Group 2 ◽  
Group 1

Background: postoperative pain is a type of acute pain in the immediate postoperative period which has both pathophysiological and therapeutic point of view. Different drugs through different routes are being used for relief of postoperative pain. we have analysed the efficacy of two different routes via femoral nerve block and local infiltration of ropivacaine for post-arthoscopic pain relief. Materials and methods: we have conducted the study from November 2017 to March 2018.60 patients undergoing arthoscopic anterior cruciate ligament reconstruction surgery wer randomly assigned into two groups;in a double blinded manner( group 1 and group 2). Group 1 received 0.2% of 20ml ropivacaine for blocking the femoral nerve of the affected limb whereas group 2 received the same drug through local infiltration of wound edges and subcutaneous plane. Pain was assessed using visual analogue scale(VAS) and rescue analgesia with 75mg injection diclofenac was given on demand when VAS score is >4 and number of times injection diclofenac was given in the 24 hours postoperative period. Analysis: demographic variables were quite comparable between the groups. The mean number of times of rescue analgesia was high in group 2 (2.9333+/-0.9444) than group 1 whose mean number of rescue analgesia was 1.4667+/- 0.7761 and difference of mean was statistically significant ( p<0.0001). Conclusion: compared with local infiltration of ropivacaine femoral nerve block with ropivacaine provides better analgesia after ACL reconstruction with lesser diclofenac consumption and lower VAS score.

Prediction of oligodendroglial tumor subtype and grade using perfusion weighted magnetic resonance imaging

2007 ◽  
Vol 107 (3) ◽  
pp. 600-609 ◽  
Author(s):  
Robert G. Whitmore ◽  
Jaroslaw Krejza ◽  
Gurpreet S. Kapoor ◽  
Jason Huse ◽  
John H. Woo ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Blood Volume ◽  
Tumor Grade ◽  
Grade Ii ◽  
Cytogenetic Profile ◽  
Group 2 ◽  
Oligodendroglial Neoplasms ◽  
Grade Iii ◽  
Group 1

Object Treatment of patients with oligodendrogliomas relies on histopathological grade and characteristic cytogenetic deletions of 1p and 19q, shown to predict radio- and chemosensitivity and prolonged survival. Perfusion weighted magnetic resonance (MR) imaging allows for noninvasive determination of relative tumor blood volume (rTBV) and has been used to predict the grade of astrocytic neoplasms. The aim of this study was to use perfusion weighted MR imaging to predict tumor grade and cytogenetic profile in oligodendroglial neoplasms. Methods Thirty patients with oligodendroglial neoplasms who underwent preoperative perfusion MR imaging were retrospectively identified. Tumors were classified by histopathological grade and stratified into two cytogenetic groups: 1p or 1p and 19q loss of heterozygosity (LOH) (Group 1), and 19q LOH only on intact alleles (Group 2). Tumor blood volume was calculated in relation to contralateral white matter. Multivariate logistic regression analysis was used to develop predictive models of cytogenetic profile and tumor grade. Results In World Health Organization Grade II neoplasms, the rTBV was significantly greater (p < 0.05) in Group 1 (mean 2.44, range 0.96–3.28; seven patients) compared with Group 2 (mean 1.69, range 1.27–2.08; seven patients). In Grade III neoplasms, the differences between Group 1 (mean 3.38, range 1.59–6.26; four patients) and Group 2 (mean 2.83, range 1.81–3.76; 12 patients) were not significant. The rTBV was significantly greater (p < 0.05) in Grade III neoplasms (mean 2.97, range 1.59–6.26; 16 patients) compared with Grade II neoplasms (mean 2.07, range 0.96–3.28; 14 patients). The models integrating rTBV with cytogenetic profile and grade showed prediction accuracies of 68 and 73%, respectively. Conclusions Oligodendroglial classification models derived from advanced imaging will improve the accuracy of tumor grading, provide prognostic information, and have potential to influence treatment decisions.

Association between cervical disc disease and lesions of multiple sclerosis

2021 ◽  
pp. 197140092098356
Author(s):  
Marwan Alkrenawi ◽  
Michael Osherov ◽  
Azaria Simonovich ◽  
Jonathan Droujin ◽  
Ron Milo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Group 4 ◽  
Demyelinating Lesions ◽  
Grade Ii ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. Methods Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1–C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher’s exact test was used to test the association between demyelinating lesions and disc pathology. Results Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease ( p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). Conclusion Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.

scholarly journals Pudendal Nerve Block in Male Goats: Comparison of Ischiorectal Fossa and Ischial Arch Approaches Using Low Volume 1% Lignocaine Hydrochloride

2016 ◽  
Vol 39 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Mujeebur Rehman Fazili ◽  
Nida Handoo ◽  
Mohd Younus Mir ◽  
Beenish Qureshi
Keyword(s):  
Nerve Block ◽  
Local Anaesthetic ◽  
Pudendal Nerve ◽  
Rectal Wall ◽  
Ischiorectal Fossa ◽  
Pudendal Nerve Block ◽  
Short Term Exposure ◽  
Group 2 ◽  
Manual Manipulation ◽  
Group 1

AbstractThirty (30) adult male goats were injected xylazine (0.05 mg/kg, IM) and randomly divided into three equal groups. Internal pudendal nerve block was tried using 3.5 ml (on each side) of 1% lignocaine hydrochloride byischiorectal fossa or ischial arch approaches in goats from Group 1 and Group 2 respectively, 15 minutes after giving xylazine. Inadvertent puncture of the rectal wall and prick to the finger placed in the rectum was experienced once in Group 1 animal. None of the animals showed protrusion of the penis without manual manipulation. Prolapse of the prepucial ring was noticed in three animals from Group 1 and two each from Group 2 and 3. The application of mild manual push percutaneously resulted in the exposure of the penis in eight and six animals belonging to Group 1 and Group 2 respectively, 15 minutes after injection of the local anaesthetic. Statistically significant (P>0.05) difference between Group 1 and 2 values was detected only once at 90 minutes following injection of the local anaesthetic. The block lasted longer in animals of Group 1. The exposed organ was flaccid and insensitive. The organ retracted into the prepucial cover within five minutes of its release in all the animals. The penile exposure could not be achieved by similar manipulation in any of the Group 3 animals. From this study it was concluded that the ischiorectal fossa approach is cumbersome and may lead to inadvertent punctures, but the block develops in more number of animals for a longer period than with the ischial arch approach. The outcome of the two techniques did not show statistically significant (P>0.05) difference for most of the assessment period. Reducing the concentration of lignocaine hydrochloride may reduce the chances of continued relaxation of the penis beyond the required period and also the drug toxicity. However, studies using larger volume of 1% lignocaine hydrochloride may be undertaken for short term exposure of the penis without manual manipulation.

Molecular markers relating to malignant progression in Grade II astrocytoma

2009 ◽  
Vol 110 (4) ◽  
pp. 709-714 ◽  
Author(s):  
Wei-Ying Yue ◽  
Su-Huan Yu ◽  
Shi-Guang Zhao ◽  
Zhong-Ping Chen
Keyword(s):  
Molecular Markers ◽  
Histological Analysis ◽  
Malignant Progression ◽  
Labeling Index ◽  
Ki 67 ◽  
Recurrent Tumors ◽  
Grade Ii ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Object Astrocytoma may progress rapidly or remain stable for many years. To clarify whether molecular characteristics could be prognostic factors, several cell cycling–associated molecular alterations in the diffuse astrocytoma have been investigated. Methods Thirty-three patients in whom WHO Grade II astrocytoma had been initially diagnosed were assigned to 1 of 3 groups. Group 1 consisted of 10 patients with malignant progression; the tumor had recurred within 5 years and histological analysis had confirmed that the tumor progressed to Grade III or IV. Group 2 consisted of 10 patients in whom there was no malignant progression; the tumor recurred within 5 years, but histological analysis confirmed that the tumor remained at Grade II. Group 3 consisted of 13 patients who did not experience recurrence within 5 years. Expression of Ki 67, TP53, p27, and p21 was examined using immunohistochemical analysis for the tumor samples obtained during the first and second (in recurrent cases) surgeries. Exons 5, 7, and 8 of TP53 were scanned by DNA sequencing. Results The Ki 67 labeling index expression was significantly higher in Group 1 (even though it was similar between initial and recurrent tumors) than that of Group 3 (p < 0.05). However, there was no difference between Group 2 (both initial and recurrent tumors) and Group 3. The TP53 protein accumulation was also higher in Group 1 than in Group 2 or 3 (p < 0.05); a difference in TP53 expression was not found between Groups 2 and 3. The p27 and p21 was expressed in all cases, but no predictive values were found. The p53 mutation was found only in 6 cases in Group 1. Conclusions Overexpression of TP53, TP53 mutation, and Ki 67 labeling index could be molecular markers in astrocytomas predicting malignant progression.

Is there a role for music in reducing anxiety in plastic surgery minor operations?

2012 ◽  
Vol 94 (3) ◽  
pp. 152-154 ◽  
Author(s):  
H Sadideen ◽  
A Parikh ◽  
T Dobbs ◽  
A Pay ◽  
PS Critchley
Keyword(s):  
Local Anaesthetic ◽  
Clinical Care ◽  
Statistical Significance ◽  
Patient Anxiety ◽  
Vas Score ◽  
The Mean ◽  
Anxiety Levels ◽  
Group 2 ◽  
Surgical Setting ◽  
Group 1

Introduction It is well documented that music plays a role in reducing anxiety levels. Its role in reducing intra-operative anxiety levels in surgical patients while awake is less well known. We report the effects of music on intra-operative patient anxiety in both the elective and trauma plastic surgical setting. Methods Two groups of patients undergoing local anaesthetic surgical procedures were identified: those where music was played in the operating theatre (Group 1) and those where it was not (Group 2). Ninety-six patients were included. Subjectively anxiety was evaluated by the patient with a visual analogue scale (VAS) and objectively by the respiratory rate (RR), both pre and post-operatively. The unpaired t-test was used to evaluate the statistical significance of differences between the groups. Results The mean pre-operative VAS score was similar in both groups (5.7 in Group 1 and 5.8 in Group 2). The mean preoperative RR was 15 breaths per minute in both groups. Post-operatively, the VAS score and RR were both lower in Group 1 (VAS: 3.5 vs 4.9; p<0.01 and RR: 11 vs 13 breaths per minute; p<0.05). Conclusions In the era of the patient centred approach to clinical care, it is crucial to minimise patient anxiety. Music appears to reduce intra-operative anxiety in awake patients in both the elective and trauma plastic surgical setting. Easy listening music and chart classics appear to be suitable genres according to patients. We believe there is a role for a large, multicentre, randomised control study to examine the benefits of music in all local anaesthetic procedures across different specialties.

scholarly journals Supracostal Approach for PCNL: Is 10th and 11th Intercostal Space Safe According to Clavien Classification System?

2014 ◽  
Vol 99 (6) ◽  
pp. 857-862 ◽  
Author(s):  
Cengiz Kara ◽  
Tansu Değirmenci ◽  
Zafer Kozacioglu ◽  
Bulent Gunlusoy ◽  
Omer Koras ◽  
...  
Keyword(s):  
Shock Wave Lithotripsy ◽  
Operative Time ◽  
Intercostal Space ◽  
Clavien Classification ◽  
Stone Free Rate ◽  
Grade Ii ◽  
Clavien Classification System ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Abstract The purpose of this study was to evaluate the success and morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11th and 10th intercostal space. Between March 2005 and February 2012, 612 patients underwent PCNL, 243 of whom had a supracostal access. The interspace between the 11th and 12th rib was used in 204 cases (group 1) and between the 10th and 11th interspaces in 39 cases (group 2). PCNL was performed using standard supracostal technique in all patients. The operative time, success rate, hospital stay, and complications according to the modified Clavien classification were compared between group 1 and group 2. The stone-free rate was 86.8% in group 1 and 84.6% in group 2 after one session of PCNL. Auxiliary procedures consisting of ureterorenoscopy (URS) and shock wave lithotripsy (SWL) were required in 5 and 7 patients, respectively, in group 1; and in 1 patient each in group 2 . After the auxiliary procedures, stone-free rates increased to 92.6% in group 1 and 89.7% in group 2. A total of 74 (30.4%) complications were documented in the 2 groups according to modified Clavien classification. Grade-I complications were recorded in 20 (8.2%), grade-II in 38 (15.6%), grade-IIIa in 13 (5.3%), and grade-IIIb in 2 (0.8%) patients; grade-IVa was recorded in 1 (0.4%) patient. There were no grade-IVb or grade-V complications. Overall complication rate was 30.9% in group 1 and 28.2% in group 2. Supracostal PCNL in selected cases is effective and safe with acceptable complications. The modified Clavien system provides a standardized grading system for complications of PCNL.

scholarly journals Evaluation of the efficiency and safety of combined therapy with a symptomatic sustained-release drug and hyaluronic acid versus monotherapy with hyaluronic acid in patients with knee osteoarthritis

2020 ◽  
Vol 14 (3) ◽  
pp. 63-70
Author(s):  
K. A. Berdyugin ◽  
I. V. Kadyntsev ◽  
O. V. Berdyugina ◽  
E. A. Taskina ◽  
N. G. Kashevarova
Keyword(s):  
Hyaluronic Acid ◽  
Combination Therapy ◽  
Sustained Release ◽  
Combined Therapy ◽  
Randomized Study ◽  
Vital Signs ◽  
Joint Disease ◽  
Release Drug ◽  
Group 2 ◽  
Group 1

Osteoarthritis (OA) is the most common joint disease. Searching for new treatment methods and regimens for OA is relevant.Objective: to evaluate the efficiency and safety of therapy with a symptomatic sustained-release drug (Alflutop) in combination with intra-articular hyaluronic acid (HA) injection versus monotherapy with HA in patients with knee OA in routine clinical practice.Patients and methods. A post-registration open-labeled prospective comparative randomized study was conducted to assess the results of treatment in 76 patients (31 men and 45 women; mean age, 49.3±8.5 years; body mass index, 28.4±0.8 kg/m2 ) in two clinical centers in Yekaterinburg and Perm. The patients were randomized into two equal groups, were homogeneous in terms of gender, the frequency of comorbidities, and vital signs (blood pressure, heart rate, and respiratory rate).Group 1 patients received Alflutop as 1-ml daily intramuscular injections (a total of 20 injections) + 2 ml of 1% intraarticular (IA) HA solution injections three times at 1-week intervals; Group 2 patients were given 2 ml of 1% intraarticular HA solution injections three times at 1-week intervals. As an additional therapy, the use of meloxicam 7.5–15 mg/day was permitted, and, if non-steroidal anti-inflammatory drugs were contraindicated, paracetamol 1–3 g/day might be used.Results and discussion. During treatment, both groups of patients showed improvement (compared to the baseline levels). At the same time, evaluating the intergroup values revealed clear differences: a more pronounced decrease in all WOMAC indicators in Group 1 patients: pain scores, 2 [1; 3] vs. 4 [2; 5] in Group 2 (p<0.001); stiffness, 1 [0; 2] vs. 2 [1; 4] (p<0.001); functional insufficiency, 8 [3; 12] vs. 15.5 [12; 20] (p<0.001); and total WOMAC scores, 12 [7; 13] vs. 21.5 [15; 28] (p<0.001). Pain-intensity assessment using the visual analogue scale also showed the more pronounced positive effect of the combination therapy in Group 1 (p<0.001).Alflutop used in combination with HA was shown to be more preferable than HA monotherapy, which was confirmed by the results achieved for all WOMAC indicators. At 6 months, by the last visit, there were pronounced positive changes in all the analyzed parameters in both groups. At the same time, the most significant changes were recorded in the Alflutop + HA group than in the HA group (p<0.001). Perhaps, the mechanism in exhibiting the found synergistic effect of these drugs lies in their different effect on the pathogenesis of the disease. However, further study of this issue is required in multicenter randomized controlled trials.The good safety of the drugs was confirmed: not a single adverse event was revealed.Conclusion. The patients receiving the combination therapy with Alflutop + HA had the best treatment results in all the parameters assessed.

scholarly journals T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

2020 ◽  
Author(s):  
Matjaz Vogrin ◽  
Jakob Naranda ◽  
Mario Gorenjak ◽  
Tomaz Bajec ◽  
Domen Mongus ◽  
...  
Keyword(s):  
Placebo Group ◽  
Knee Osteoarthritis ◽  
Pain Score ◽  
T2 Mapping ◽  
Womac Score ◽  
Controlled Study ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Knee Oa

Abstract BackgroundIn this study we focused on evaluating the effect of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) on the qualitative and quantitative properties of the articular cartilage in patients with knee osteoarthritis (OA).MethodsWe evaluated 264 patients undergoing treatment of moderate knee OA. Patients aged between 40 and 70 years were included with articular K-L stage ≤ 2. Patients were randomized into three groups and treated with three doses of intra-articular PRP, HA, or placebo injection. Patients were evaluated clinically and by using T2 mapping.ResultsBoth PRP (619.05 ± 243 ms; p = 2.7 × 10− 5) and HA (637.12 ± 273 ms; p = 1.×10− 4) group showed statistically significant lower post-application T2 relaxation times in comparison to the placebo group (859.80 ± 406 ms).Cartilage thickness increased significantly after PRP (2.41±0.87 vs. 2.58±0.97 mm, p=0.033) and HA (2.28±0.81 vs. 2.80±1.00 mm, p=1.8×10) applications. There was a significant decrease in WOMAC pain score by 30% (p=0,001) and the overall WOMAC score by 27 p=1.9×10-4%) in PRP group. The decrease in WOMAC pain score and the overall WOMAC score in the placebo group was similar to the results observed in the PRP group. In the HA group a significant decrease in WOMAC pain score by 14% (p=0,005) was observed only at the first follow-up, whereas no difference was observed at the second follow-up. ConclusionsT2 mapping of cartilage tissue may aid to monitor its properties after the intra-articular therapies in knee OA. However, there is a discrepancy between clinical findings and the results of T2 mapping, suggesting questionable grounds for applying intra-articular therapy.

scholarly journals Profiling of inflammatory mediators in the synovial fluid related to pain in knee osteoarthritis

2019 ◽  
Author(s):  
Li Li ◽  
Zhenxing Li ◽  
Yuyan Li ◽  
Xi Hu ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Synovial Fluid ◽  
Knee Osteoarthritis ◽  
Inflammatory Mediators ◽  
Early Stage ◽  
Womac Score ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Pain Scores ◽  
Tnf Α

Abstract Background: Inflammatory mediators in the synovial fluid (SF) play critical roles in the initiation and development of pain in knee osteoarthritis (KOA). However, the expression of inflammatory mediators is controversial and the role of SF inflammatory mediators in neuropathic pain is not clear. Therefore, the aim of this study is to identify the SF inflammatory mediators associated with nociceptive and neuropathic pain in KOA. Methods: The levels of IL-1β, IL-6, TNF-α, macrophage colony-stimulating factor, MMP-3, MMP-13, metalloproteinase with thrombospondin motifs 5, calcitonin gene-related peptide, neuropeptide Y, substance P and bradykinin were measured in 86 patients using enzyme-linked immunosorbent assays. Nociceptive pain was measured using the numeric rating scale (NRS), visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Neuropathic pain was measured using the PainDETECT questionnaire. Moreover, knee function was evaluated by the WOMAC score and range of motion (ROM) assessments. Radiological grade was defined using the Kellgren-Lawrence (K-L) grading scale. Results: Pain scores measured using different methods were highly correlated to each other. The worse the pain, the worse the K-L grade and knee function were. The expression of IL-1β and IL-6 was increased in the early stage compared with the late stage. The NRS was positively correlated to age, K-L grade, and the WOMAC score and negatively correlated to ROM and TNF-α expression. The VAS was positively correlated to age, K-L grade, and the WOMAC score but negatively correlated to ROM and the levels of IL-1β, IL-6 and TNF-α. The WOMAC pain score was not correlated to any of the measured inflammatory mediators; it correlated to only ROM. The PainDETECT score correlated to only the WOMAC score. The expression of other inflammatory mediators was not correlated to any of the pain scores. Conclusions: IL-1β, IL-6 and TNF-α play critical roles in pain in the early stage of KOA and correlated to pain. The measured catabolic enzymes and neuropeptides are not correlated to nociceptive and neuropathic pain. New biomarkers related to pain in the late stage need to be further investigated.

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