Autologous conditioned serum applications in the treatment of musculoskeletal diseases: a narrative review

Aim: Autologous conditioned serum has been studied as a treatment option in musculoskeletal disorders and resulted in varying outcomes. This study aims to pool the current data on this matter. Materials & methods: Major databases were searched for the topics, and after screening the results, the final 21 papers (level of evidence I or II) were included. Results & conclusion: This study showed a major focus of the literature on the effectiveness of autologous conditioned serum in osteoarthritis, in which there is much high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies which, despite positive results, recommend further evaluations on this topic.

Low frequency of disease flare in patients with rheumatic musculoskeletal diseases who received SARS-CoV-2 mRNA vaccine

Background Little is known about the safety of SARS-CoV-2 vaccination in patients with rheumatic musculoskeletal disease (RMD). We evaluated the occurrence of adverse events following immunization (AEFI) in RMD patients and heathy subjects who received anti-SARS-CoV-2 mRNA vaccine. Methods We performed a telephone interview collecting any adverse event (AE) following immunization (AEFI) that occurred in RMD patients and healthy controls after the two doses of mRNA vaccine including common local reactogenicity and systemic events (for example, fever, fatigue/malaise, joint and muscle pain). We also investigated the onset of new signs or symptoms of the RMD after the vaccination. Results We evaluated 126 patients with RMDs [105 females and 19 males, median age 51(IQR 17)] and 85 controls [62 females and 23 males, (median age 49 (20)]. Seventy patients (55.6%) were taking immunosuppressants, conventional synthetic (n=31, 43.3%) and/or biological [TNF inhibitors (n=49, 68.6%)], and 30 (23.8%) were taking hydroxychloroquine; treatment remained unchanged in 77% of patients. Eleven out of 126 patients and none of the 85 controls previously contracted COVID-19. The median follow-up from the completion of vaccination was 15 (3) weeks both in patients and controls. We reviewed 5 suspected cases confirming mild articular flares in 3 women (2.8) with inflammatory arthritis (2 psoriatic arthritis and 1 rheumatoid arthritis) while no disease reactivation was recorded in patients with connective tissue diseases; the incidence rate of RMD reactivation was 0.007 person/month. Multivariable logistic regression analysis showed similar frequencies of local and systemic AEFI in patients and controls with no effect of therapies or previous COVID-19. Local reaction—pain in the injection site—was the most frequently reported AEFI both in RMD and controls (71% and 75% of all the AEFI, respectively) after the first dose. Overall, up to 66% of patients experienced at least one AEFI at the second dose and up to 62% in the control group. Most of AEFI occurred within 2 days of vaccine administration. Two RMD patients developed pauci-symptomatic COVID-19 after the first dose of vaccine. Conclusion The low incidence rate of disease reactivation and the similar AEFI occurrence compared to controls should reassure on mRNA vaccine safety in RMD patients.

Effectiveness of a long-term Tecar Therapy treatment on Knee Pain: building T.T.E.S.S.K., an evaluating scale A systematic review and meta-analysis

Background T.E.C.a.R (Transfer of Energy Capacitive and Resistive) Therapy (TT) is a form of endogenous thermotherapy based on radio waves 1 . It is a non-invasive procedure, that makes use of a machine able to stimulate heat inside the body to repair the inflammatory processes. Although being well known in the physiotherapy and massage therapy ambient for its benefic effects, which are still not very explored especially physiological and biochemical ones; TT is commonly used by therapists for musculoskeletal diseases. Anyhow, TT is often used as a palliative remedy for musculoskeletal disease, or linked with an ibuprofen or antidolorific medical therapy, and not as a main cure. Current literature still lacks objective ways to evaluate TT treatment. This study aims to create an evaluating Scale for the knee joint lesions treated with TT, for athletes or sports enthusiasts. Methods PubMed, Embase, and Cochrane Library databases were screened to perform an extensive review. PRISMA guidelines were applied, and the risk of bias was assessed, as was the methodological quality of the included studies. 25 articles were reviewed. 178 patients (total amount of clinic cases in PubMed, Embase and Cochrane Library articles combined) have decreased their pain after a long-term TT treatment (> 3 or 5 sessions). Results Knee joint is often affected by non-sportive or sportive musculoskeletal lesions. ((At this point, not only the TT articles were reviewed, but also all the articles (122) that included these key aspects)). Six items were selected to evaluate the efficacy of TT on the impaired joint: Range of Motion (ROM), %MVIC of quadriceps, biceps femoris and gastrocnemius, Cincinnati Rating Scale System (CRSS), NRS Pain Scale, Muscle Fiber Orientation (MFO) and %Trigger Points. Conclusions Our study allows to build a new treatment methodology with TT. It guarantees the therapist to structure a long-lasting follow-up, which is not limited to the simple use of the machine. Applying this methodology, the patient receives a treatment that is not limited, but built on his own needs thanks to the distribution of the summing scores, strictly dependent on the type of clinical case that the therapist finds. Thanks to the six items we inserted in T.T.E.S.S.K. (“Tecar Therapy Evaluation Score System of the Knee”), every aspect of a musculotendinous pathology is recognized, and might be treated with TT by therapists.

Bone-Regulating MicroRNAs and Resistance Exercise: A Mini-Review

MicroRNAs (miRNA) are a class of short noncoding RNA that play important roles in controlling gene expression. Many miRNAs have been identified as being important regulators of bone cell function, thus affecting the bone remodeling processes. In addition to being expressed in specific tissues and exerting intracellular effects, miRNAs can enter the blood where they can be taken up by other tissues. These circulating miRNAs (c-miRNA) also have clinical significance as biomarkers of musculoskeletal diseases as they are tissue-specific, are stable and easily detectable, and require minimally invasive procedures. This mini-review discusses miRNAs with regulatory roles in bone metabolism and c-miRNA responses to acute bouts of resistance exercise. MiRNA responses (e.g., upregulation/downregulation of expression) vary depending on the resistance exercise protocol characteristics and the age of the participants. There are gaps in the literature that need to be addressed as most of the resistance exercise studies focused on miRNAs that regulate skeletal muscle in male participants.

Lack of workplace risk assessment as a predictor of adverse health effects for teleworkers - results from the survey on Life with COVID-19 in Latvia

Workplace risk assessment is one of the key tools for improving occupational safety and health conditions. However, providing risk assessment for teleworkplaces in the COVID-19 pandemic-related restrictions has been a challenge for employers. The objective of this study was to identify the frequency of implementation of workplace risk assessment for teleworkplaces and the association between it and self-reported health complaints among teleworkers during the 1st emergency state of the COVID-19 pandemic in Latvia. Teleworkers were recruited using a non-probability sampling (snowball sampling) method and social media advertisements. To obtain data that is representative of the demographic profile of the working population in Latvia, the sample was weighed based on gender and age. Out of 447 teleworking respondents included in our analysis, only 20.3% have mentioned that their employer had assessed the teleworking conditions (additional 8.1% reported partial assessment). Workers who have reported lack of risk assessment more often have health related complaints – e.g., pain longer than three days (26.9% with risk assessment versus 73.1% with no risk assessment), sore eyes (24.4% versus 75.6%) and anxiety (21.8% versus 78.2%) (p < 0.001 in all cases, except for pain). Increased incidence of occupational musculoskeletal diseases and burnout can be predicted in coming years in Latvia. Good practise examples should be gathered and promoted; guidelines for labour inspection should be developed in order to cover supervision of teleworking workplaces.

Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry

ObjectivesTo describe the safety of vaccines against SARS-CoV-2 in people with inflammatory/autoimmune rheumatic and musculoskeletal disease (I-RMD).MethodsPhysician-reported registry of I-RMD and non-inflammatory RMD (NI-RMDs) patients vaccinated against SARS-CoV-2. From 5 February 2021 to 27 July 2021, we collected data on demographics, vaccination, RMD diagnosis, disease activity, immunomodulatory/immunosuppressive treatments, flares, adverse events (AEs) and SARS-CoV-2 breakthrough infections. Data were analysed descriptively.ResultsThe study included 5121 participants from 30 countries, 90% with I-RMDs (n=4604, 68% female, mean age 60.5 years) and 10% with NI-RMDs (n=517, 77% female, mean age 71.4). Inflammatory joint diseases (58%), connective tissue diseases (18%) and vasculitis (12%) were the most frequent diagnostic groups; 54% received conventional synthetic disease-modifying antirheumatic drugs (DMARDs), 42% biological DMARDs and 35% immunosuppressants. Most patients received the Pfizer/BioNTech vaccine (70%), 17% AstraZeneca/Oxford and 8% Moderna. In fully vaccinated cases, breakthrough infections were reported in 0.7% of I-RMD patients and 1.1% of NI-RMD patients. I-RMD flares were reported in 4.4% of cases (0.6% severe), 1.5% resulting in medication changes. AEs were reported in 37% of cases (37% I-RMD, 40% NI-RMD), serious AEs in 0.5% (0.4% I-RMD, 1.9% NI-RMD).ConclusionThe safety profiles of SARS-CoV-2 vaccines in patients with I-RMD was reassuring and comparable with patients with NI-RMDs. The majority of patients tolerated their vaccination well with rare reports of I-RMD flare and very rare reports of serious AEs. These findings should provide reassurance to rheumatologists and vaccine recipients and promote confidence in SARS-CoV-2 vaccine safety in I-RMD patients.

Personalized pharmacotherapy of arterial hypertension patients with musculoskeletal system diseases based on pharmacogenetic aspects

Pharmacotherapy in patients with comorbidity is a current issue for clinical practice. Combination of hypertension and musculoskeletal diseases can be found in 40% of outpatients, which requires simultaneous administration of different drugs. The main mechanisms of drug interactions are associated with pharmacokinetics or pharmacodynamics alterations. It has been proven that changes in drugs pharmacokinetics can be due to cytochromes P450 activity. The main symptom of musculoskeletal diseases is chronic pain, which requires long-term therapy with non-steroidal anti-inflammatory drugs (NSAIDs). The 2C19 isoenzyme takes part in metabolism of some NSAIDs. Losartan, the inhibitor of renin-angiotensinaldosterone system (RAAS), is also metabolized by the 2C9 isoenzyme and is quite often prescribed to outpatients to treat hypertension. Hence, an influence of genetic factors on efficacy and safety of antihypertensive drugs and NSAIDs combinations requires further studies.

Repetitive transspinal magnetic stimulation in the treatment of chronic low back pain. A meta-analysis (Part II)

Цель обзора - анализ результатов исследований эффективности ритмической транскраниальной и трансспинальной магнитной стимуляции (рТМС и рТсМС) в лечении боли в пояснице. Хроническая боль в нижней части спины (ХБНЧС) преобладает над другими видами боли и, выходя за нозологические рамки болезней опорно-двигательного аппарата, поражает около 80-84% населения в течение жизни. Нейропластичность, лежащая в основе патогенеза ХБНЧС, управляется стимулами, которые могут быть опосредованы процессами, происходящими как «сверху вниз», от вышележащих к нижерасположенным иерархическим структурам нервной системы, так и «снизу вверх», - от периферических к центральным. Это находит отражение в повышенном интересе профессионального сообщества регенеративной медицины к применению высокотехнологических методов нейромодуляции ритмическими электромагнитными импульсами при ХБНЧС. Во второй части обзора представлен метаанализ накопленных к моменту его публикации литературных данных. Он дополняет опубликованную ранее информацию о том, что и рТМС, и рТсМС относятся к перспективным патогенетическим терапевтическим методам для пациентов с ХБНЧС, основываясь на экспериментальных и клинических эффектах положительного влияния на искаженную сенсорную передачу, изменение проприоцепции, управление движением и психологическую модуляцию. Обе методики зарекомендовали себя в кратковременном облегчении хронической дорсалгии, в то время как долгосрочные последствия рТсМС (>1 месяца) должны быть исследованы далее. Различные факторы, связанные с унификацией пока еще разнородных протоколов стимуляции, включая форму подачи импульсов, частоту, место приложения, регулярность и продолжительность лечения, могут улучшить дальнейшую надлежащую трактовку ее результатов. Очевидная по мнению авторов настоящего обзора, но до настоящего времени не описанная в литературе комбинация рТМС и рТсМС при ХБНЧС, могла бы повлиять на процессы управления болью при изучаемой патологии в большей степени, чем каждая из них по отдельности. The aim of this review was to analyze results of studies on the effectiveness of repetitive transcranial and transspinal magnetic stimulation (rTMS and rTsMS) in the treatment of low back pain. Chronic low back pain (CLBP) is prevalent over other types of pain and, beyond the nosological scope of musculoskeletal diseases, affects about 80-84% of the population in a lifetime. Neuroplasticity underlying the pathogenesis of CLBP is driven by stimuli, and stimuli can be mediated by processes from «top to bottom», i.e. from the overlying to the underlying hierarchical structures of the nervous system, and vice versa, i.e. from peripheral to the central. This is reflected in the increased interest of the professional community of regenerative medicine in implementing high-tech methods of neuromodulation by repetitive electromagnetic pulses in CLBP. In this second part of the review, we present a meta-analysis of the literature data accumulated by the time of its publication. It completes our previously published information stating that both rTMS and rTsMS are viable pathogenetic therapeutic modalities for patients with CLBP, based on experimental and clinical positive effects on impaired sensory transmission, changes in proprioception, motor control, and psychological modulation. Both methods have proven successful in providing short-term relief for chronic dorsalgia, while the long-term effects of rTsMS (>1 month) require further investigation. Various factors associated with the unification of the still heterogeneous stimulation protocols, including pulse delivery form, frequency, application location, periodicity and treatment duration, may further improve proper result interpretation. The combination of rTMS and rTsMS in CLBP, which is evident to the authors of this review but has not been described in the literature yet, could have more impact on the pain management processes of the investigated pathology than each of them separately.