Mikrobiota Usus dan Osteoartritis

Osteoarthritis (OA) is one of the most commonly experienced musculoskeletal diseases. Various studies were conducted to find the relationship between the gut microbiota and the incidence of osteoarthritis. The gut microbiota encourages the production of proinflammatory cytokines and bacterial metabolites which are considered to be part of the pathophysiological mechanisms of osteoarthritis. Various risk factors that trigger osteoarthritis, such as age, gender, diet, and obesity have an influence on the gut microbiota. This suggests the possible involvement of the microbiota in the incidence of osteoarthritis. The increasing prevalence of osteoarthritis calls for an effective disease-modifying therapy strategy to relieve symptoms and slow the progression of the condition. The investigators hypothesized that modulation of the gut microbiota by external approaches might influence the progression of osteoarthritis. To date, some evidence suggests that gut microbiota intervention can be realized through probiotics, prebiotics, exercise, and fecal microbiota transplantation (FMT). Keywords: Osteoarthritis, Microbiota, Risk Factor

Osteoarthritis is not a disease, but rather an accumulation of predisposing factors. A systematic review

Introduction: Although they do not endanger the life of the individual, the major symptoms of osteoarthritis (OA), such as pain, inflammation and dysfunction, it will slowly decrease quality of life and performance, leading finally to disabilities. Due to the fact that this disease has no cure, strategies are still being sought to slow its evolution. The lack of understanding of the predisposing and triggering factors of OA, has led to different approaches to this pathology so discussed, but with modest results. This systematic review aims to debate the main phenomena underlying joint destruction in OA, and etiopathogenic theories. Materials and Methods: In this study were included 58 bibliographic sources, of which title 39 refers to OA, 6 with inflammation, 28 with cartilage, 3 with chondrocytes, and 5 with synovitis. In this study were discussed the etiopathogenic theories of OA which include: age, alteration of the cartilaginous matrix, alteration of chondrocyte metabolism, microtrauma and major trauma, inflammation of the joints - synovitis and obesity. Results: Increasing the level of understanding of predisposing factors, the occurrence of acute inflammatory phenomenon and the perpetuation of mechanisms that latently maintain chronic inflammation that over time develops a destructive effect on articular cartilage, would limit the negative effects of OA, delay the evolution and optimally combat that maintain the vicious circle: inflammation → production of enzymes → chondrolysis → inflammation. Conclusions: These studies contribute significantly to the understanding of destructive phenomena in OA. More studies are needed on the risk factors of OA and its production mechanisms, to find increasingly effective therapies that limiting its progression. Keywords: Osteoarthritis, etiopathogenic theories, chronic inflammation, age, obesity, cartilaginous matrixm, chondrocyte metabolism

To Compare the Effects of UST and TENS with PNF Stretching To Increase the Mobility and Reduce Pain in OA - A Randomised Control Trial

Osteoarthritis is a chronic disorder which is degenerative in nature having a multifactorial etiology characterized by subchondral sclerosis, loss of the articular cartilage, hypertrophy of the marginal bone along with morphological and biochemical changes in the joint capsules and synovium. Knee osteoarthritis is the most common form of osteoarthritis. Knee OA is characterized by quadriceps muscle weakness, hamstring weakness, possible joint stiffness, effusion, loss of proprioception loss of range of motion and knee pain. Transcutaneous electrical nerve stimulation is the most widely used physical modalities for the management osteoarthritis knee. The benefits of TENS for relive chronic pain are well documented. The UST for the treatment of OA will lead to improvement of life by decreasing the swelling and reducing the pain at the knee joint. PNF relieves pain improves the ROM, restores proprioception as confirmed by clinical research. The aim of study to find out the effect of UST and TENS with PNF stretching to increase the mobility and reduce pain in OA Patients. Study duration is 6-week, source of data is Goldi masala factory, Kanpur. Sample size is 60 and method of data collection is random. Subjects were divided into two equal group, for group A we give PNF with ultrasound and for group B we give PNF with TENS for six consecutive weeks. After analysis of collected data result was null hypothesis is rejected and alternate hypothesis is accepted. In this way both technique is statistically significant. So, we concluded that both the technique i.e., PNF with UST and PNF with TENS is effective in treating the osteoarthritis patient with relieving pain and increasing range of motion. But statistically PNF with TENS is more significant over PNF with UST. Keywords: Osteoarthritis, proprioceptive neuromuscular facilitation, ultrasound therapy, transcutaneous electrical nerve stimulator, pain, range of motion, VAS scale, goniometer.

AB0582 KNEE OSTEOARTHRITIS PHENOTYPES STRATIFICATION

Background:Osteoarthritis (OA) relevance is determined by its record prevalence with progredient growth throughout the world [1]. Clinical and pathogenic heterogeneity of disease actualizes problem of its stratification [2]. Lack of unified understanding of OA and its phenotype determination results in incredible number of attempts to group OA, using of different classification criteria in last decade.Objectives:To analyze and systematize available OA classifications, proposals and phenotypes, to highlight the most promising of them.Methods:We studied publications from MEDLINE / PubMed and Google Scholar databases found by the keywords “osteoarthritis”, “phenotypes”, “subphenotypes”, “classification”, “subtypes”, “subsets”, “subgroups”, “subpopulations”, “profiles” and “endotypes” in various combinations in English and Russian. We did not set a time frame, but aimed to include as many different methods as possible in order to reflect evolution of scientists’ views on structuring of this disease.Results:A total of 55 OA grouping methods were covered so that OA was structured by different determinants into 6 big boxes.First OA classifications were characterized by complex etiopathogenetic approach, while subsequent studies differed in joint-mediated approach, and the knee joint was undisputed “champion” in this “race”. One of the first attempts to group OA was division into primary, or idiopathic, and secondary, due to known causes. It is now obvious that it is becoming obsolete, and criteria for OA primacy are difficult to determining. Genomic highly specialized studies based on isolation of “favorable” and “unfavorable” genes develops prerequisites to genetic OA classifying. Clinical variants occupy central place as they are the most fully consistent with modern phenotype conception [3], considerating as subtypes of disease shared by underlying pathobiological and pain mechanisms and their structural and functional consequences. Trajectories of OA progression are distinguished by longitudinal design, that is, the determinants for grouping here are disease characteristics in dynamics. The ancestor of structural OA trajectories can be considered Kellgren-Lawrence grades; subsequent studies identified complex of clinical, laboratory and morphological factors contributing to development of trajectories. Structural OA variants are diverse depending on visualization methods, and many of them can be naturally considered phenotypes, since they drive certain clinical OA manifestations. Morphological changes were described at macro- and microscopic levels; it is interesting to note the absence of histopathological norm in patients without OA. Laboratory profiles of patients are determined by content of systemic (serum, urinary) or local, “proximal” (in synovial fluid) biomarkers, which seem to be more precise. Metabolomic analysis is perspective new direction of laboratory studies based on joint metabolic products identification in the synovial fluid. New trend in OA research is molecular phenotyping. The specific molecular pathway explaining observed phenotype properties is called “endotype”. Endotype is related to certain pathobiological scenario, and laboratory markers are potentially effective for its diagnosis.Conclusion:Thus, a large amount of accumulated information and its diversity soon will probably lead to qualitatively new knowledge level with deep understanding of phenotype-associated strategy for managing OA patients.References:[1]Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA. 2017 Aug 29;114(35): 9332-9336. doi: 10.1073/pnas.1703856114 Epub 2017 Aug 14.[2]Deveza LA, Nelson AE, Loeser RF. Phenotypes of osteoarthritis: current state and future implications. Clin Exp Rheumatol 37 Suppl 2019;120(5):64-72.[3]Van Spil WE, Bierma-Zeinstra SMA, Deveza LA, et al. A consensus-based framework for conducting and reporting osteoarthritis phenotype research. Arthritis Res Ther. 2020;22(1):54. doi:10.1186/s13075-020-2143-0Disclosure of Interests:None declared.

AB0807 TOAST-STUDY: TREATMENT AND OSTEOARTHRITIS, WHAT ARE PEOPLE SAYING ON TWITTER?

Background:Osteoarthritis is a very common chronic disease. The information needs of patients vary depending on the health issue. Social media sites represent a novel source of health information and advice for patients with chronic diseases, such as osteoarthritis. Almost half of them use the internet to look for health related information [1]. No study has assessed the impact of social media on osteoarthritis and its treatment.Objectives:The purpose of this study was to evaluate frequently discussed osteoarthritis treatments on the social media Twitter.Methods:We retrospectively analyzed tweets, published between 1st and 31st January 2020, containing the keywords “osteoarthritis”. Only English language tweets were included. Tweets referred to veterinary medicine were excluded.Results:3587 tweets were analyzed. We identified 1737 tweets related to osteoarthritis treatment between 1st and 31st January 2020 (49.8%) (Figure 1). Dietary interventions were the most discussed treatment (18.3%, n=318/1737), including fruits, vegetables and plants (n=101), dietary supplements and vitamins (n=80), and spices (n=19). Physical medicine and rehabilitation (17.6%, n=305/1737) including sport (n=151), physiotherapy (n=70) and rehabilitation (n=57), were commonly discussed. Local therapies for osteoarthritis were also discussed by Twitter users (15.8%, n=274/1737). These included topical treatments such as anti-inflammatory gels and creams (n=23), and more invasive local treatments including intra-articular joint injections with corticosteroid (n=56), hyaluronans (n=29), stem cells (n=97), and Platelet-Rich Plasma (n=52). The frequently used systemic drugs were analgesia and non-steroidal anti-inflammatory drugs (n=113). Surgery and interventional radiology (genicular artery embolization) were also discussed (11.5%, n=199/1737). 5.6% tweets (n=97/1737) were related to alternative therapies. Predominant themes were related to marijuana (n=23), acupuncture treatment (n=17), homeopathy (n=10). Last but not least, 356 tweets (20.5%) referred to other websites including health programs.Conclusion:Our results demonstrate that osteoarthritis treatment is frequently discussed in published tweets. Thereby, social media could have an impact on behaviors and adherence on medication, and it seems interesting that learned societies, involved in osteoarthritis treatment, communicate more using social media.Figure 1.Osteoarthritis treatment discussed in published tweetsReferences:[1]Wagner TH, Baker LC, Bundorf MK, Singer S. Use of the Internet for health information by the chronically ill. Prev Chronic Dis 2004;1(4):A13.Disclosure of Interests:None declared

A Randomized, Placebo Controlled Clinical Trial to Evaluate the Efficacy and Safety of HFPM-01 in Improving Pain, Stiffness, and Inflammation in Patients Suffering from Knee Osteoarthritis

Objective: Osteoarthritis is a common chronic joint condition which causes stiffness and difficulty in moving, loss of muscle tone, strength and stamina. All these difficulties affect daily activities and quality of life and may also have an impact of mental health. Globally over 9.6% men and 18.0% women aged over 60 years has symptomatic osteoarthritis worldwide. It is the second most common rheumatologic problem and it is the most frequent joint disease with a prevalence of 22% to 39% in India. Considering the increasing prevalence and limitations of the conventional treatment for the management of Osteoarthritis, the current research aims at systematic clinical validation of the HFPM-01 in subjects primarily suffering from knee osteoarthritis. Materials and Methods: 90 subjects were enrolled in the study and were randomized to one of the three treatment groups. Subjects were undergoing clinical examination. Vitals were recorded. Blood samples were collected for readings of CRP. Subjective questionnaire scores evaluation was performed like SF-36 health survey score, VAS scale, WOMAC questionnaire. Changes in symptoms severity were noted like morning stiffness, tiredness, tenderness, and muscle spasms along with assessment of GI symptoms. Results: The change in WOMAC score, the increase in SF-36 score, the decrease in VAS score, the decrease in CRP levels, and the reduction in GI symptoms were found to be 33%, 308%, 60.44%, 52%, 40% respectively. Swelling, inflammation and pain was reduced from moderated to mild and eventually to no symptoms. Conclusion: This explains that HFPM-01 tablet is significantly effective in improving SF36 score WOMAC and VAS scale score. It is effective in reducing pain, swelling, and stiffness of knee joints, also improves the mobility of knee joints, and provides gastro protection being effective in managing pain and stiffness. HFPM-01tablet is safe and effective in the management of Osteoarthritis. Keywords: Osteoarthritis, WOMAC, VAS, CRP, Gastro protective.

Intra-articular hyaluronic acid: dependence of the effect on molecular weight

The article discusses the patient management with knee osteoarthritis according to the ESCEO 2019 algorithm. The focus is on the second stage in the persistence of osteoarthritis signs. The article pays attention to the means based on hyaluronic acid for intra-articular injection. It also provides the study analysis that proved the anti-inflammatory mechanism of action of hyaluronic acid-based drugs during intraarticular administration, as well as the study results in which histology data indicated that hyaluronic acid prevents cartilage degradation and can promote its regeneration. These researches show that repeated injections of hyaluronic acid are not only effective, but also safe. In the literature, there is evidence that during treatment, the time to endoprosthesis increases, as well as the need for taking NSAIDs and opioids decreases. The article discusses the molecular weight of hyaluronic acid, providing research data confirming the greatest efficacy of hyaluronic acid with medium and high molecular weight. KEYWORDS: osteoarthritis, knee joints, hyaluronic acid, intraarticular injection. FOR CITATION: Filatova Yu.S., Gawert V.R. Intra-articular hyaluronic acid: dependence of the effect on molecular weight. Russian Medical Inquiry. 2021;5(3):156–161. DOI: 10.32364/2587-6821-2021-5-3-156-161.

Chondroitin sulfate: treatment tactics in osteoarthritis

Osteoarthritis (OA) is the most common among all musculoskeletal disorders, becoming the main cause of chronic pain, impaired static and dynamic function and disability among the elderly, and represents the main burden for public health worldwide. Modern pharmacological treatment methods of OA are focused on reducing the disease symptoms and the pain syndrome intensity. One method in this direction is the use of symptom-modifying slow-acting drugs, which have shown promising positive effects on pain and other OA symptoms. The article presents an overview of the main experimental and clinical studies, and meta-analyses devoted to the evaluation of chondroitin sulfate (CS) efficacy and safety as one of the most commonly prescribed drugs for the treatment of OA. Some studies are devoted to the assessment of structural changes in articular cartilage during CS and placebo therapy, while others focus on the dynamics of pain syndrome and the degree of functional insufficiency, and on the assessment of the incidence and time of delayed knee replacement. The place of CS in the structure of EULAR and ESCEO recommendations is considered. KEYWORDS: osteoarthritis, chondroitin sulfate, symptom-modifying slow-acting drugs, medial condyle, articular cartilage thickness, articular replacement. FOR CITATION: Alabut A.V. Chondroitin sulfate: treatment tactics in osteoarthritis. Russian Medical Inquiry. 2021;5(2):102–106. DOI: 10.32364/2587-6821-2021-5-2-102-106.

Chondroitin sulfate injection efficacy in the treatment of knee osteoarthritis

Aim: to evaluate the efficacy of two-month therapy with chondroitin sulfate (CS) (Mucosat®) injections in patients with osteoarthritis and the drug potential in terms of structure-modifying action. Patients and Methods: an open prospective study with participation of 30 patients (mean age 52.5±11.7 years) with osteoarthritis, grade 2 gonarthrosis according to the Kellgren-Lawrence classification, and severe pain syndrome (more than 50 points according to VAS) was conducted. 76.7% of subjects had concomitant pathology. The drug was prescribed according to the standard regimen with a course of up to 25–30 injections. The examination included a clinical assessment of indicators of joint syndrome, life quality, joint function using WOMAC, Lekken, KOOS, EQ-5D scales, cartilage oligomeric matrix protein (COMP) and C-reactive protein (CRP), ultrasound of the knee joints. Results: after a two-month treatment course with Mucosat®, there was a significant (p<0.05) decrease in pain intensity by 1.8 times, the number of tender and swollen joints by 2 or more times, an improvement in indicators of functional activity and life quality of patients. Reactive synovitis of the knee joints, which was present at the beginning of the study in 53.3% of cases, was preserved clinically and according to ultrasound data only in 17% of subjects by the end of treatment. There was a tendency to decrease the levels of CRP and COMP. Ultrasound of the knee joints showed a significant (p=0.000) increase in the average thickness of articular cartilage from 1.55±0.26 mm initially to 1.67±0.27 mm after 2 months of treatment. More significant positive dynamics during therapy was observed in patients without arterial hypertension. In general, no adverse events were registered during treatment. Conclusion: in clinical practice, the use of the CS injections in patients with gonarthrosis is safe and effective. The tendency to decrease the cartilage degradation and increase its thickness suggests a positive effect of CS in the form of slowing the disease progression in the long-term period. KEYWORDS: osteoarthritis, cartilage degradation, synovitis, chondroitin sulfate, bioavailability, structure-modifying effect, Mucosat. FOR CITATION: Lapshina S.A., Mingaleeva G.F. Chondroitin sulfate injection efficacy in the treatment of knee osteoarthritis. Russian Medical Inquiry. 2021;5(5):301–306 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-301-306.

Methods for the diagnosis and treatment of primary osteoporosis (in aid of a practicing physician)

Back pain is a common medical and social problem that requires a doctor of any speciality to conduct a careful differential diagnosis and appropriate therapy. Commonly, both the doctor and the patient underestimate the importance of metabolic bone diseases in the development of acute and chronic pain. The article presents a clinical case of primary (postmenopausal) osteoporosis in a 66-year-old patient, female, with a clinically manifest form of generalized osteoarthritis. A detailed analysis of the algorithm of standard and additional diagnostic manipulations was conducted, indications for the prescription and treatment tactics concerning a drug for pathogenetic therapy were considered. The presence of the metabolic bone disease was suspected by back pain in an elderly female patient who had an onset at a late age (older than 50 years), and a decrease in height by more than 4 cm compared to the height at 25 years. The diagnosis was made clinically on the basis of X-ray data (vertebral compression fracture) and confirmed by the laboratory tests results. The risk of fracture was taken into account during treatment tactics determination. In particular, it was regarded as high in the presented case. KEYWORDS: osteoarthritis, back pain, osteoporosis, low-energy fracture, antiresorptive therapy, bisphosphonate. FOR CITATION: Kadyrova L.R., Bashkova I.B., Akarachkova E.S. Methods for the diagnosis and treatment of primary osteoporosis (in aid of a practicing physician). Russian Medical Inquiry. 2021;5(5):288–293 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-288-293.