The Survey of Knee Osteoarthritis in the Population over Age 50 Visited in the Health Bus in Kermanshah, Iran

Along with an aging population worldwide, knee osteoarthritis (KOA), which is the main cause of musculoskeletal pain and disability in the elderly and decreases the quality of life, is prevalent, and their impact is widespread. This study aimed to evaluate the knee osteoarthritis status among the population over age 50 in Kermanshah, Iran. The research community consisted of the population who has been visited in the health bus in Kermanshah in 2016-2017, of which 589 were chosen by an available sampling method. A WOMAC questionnaire was used to determine the prevalence of knee osteoarthritis. The prevalence of knee stiffness rate after sitting, lying down, or resting during the day among women and men were 40.7% and 20.5%, respectively. According to the findings, the highest prevalence rate of knee pain was in subjects with a BMI higher than 30 (31.6%) and BMI 25–30 (24.5%). 39.2% of the subjects never experienced knee pain, 16.6% monthly, 13.4% once a week, 20.4% daily, and 10.4% of them had prolonged knee pain experience. The prevalence of gender-based knee pain was 60.5% among women and 38.6% among men. 30.5% of women and 61.4% of men never experienced knee pain.

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

Background Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up. Materials and methods We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery. Results Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up. Conclusions Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.

Assessment of the Response Profile to Hyaluronic Acid Plus Sorbitol Injection in Patients with Knee Osteoarthritis: Post-Hoc Analysis of a 6-Month Randomized Controlled Trial

In a previous randomized trial, the non-inferiority of two hyaluronic acid injections (Synolis VA versus Synvisc-One) was assessed in patients with knee OA, with a response rate of 79% for Synolis VA. To assess whether a responder profile could be established for this treatment modality, we used the Synolis VA arm of a published 6-month prospective, multicenter, comparative, randomized, double-blinded trial. At baseline and during the study, pain and function were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Ninety-six subjects from the intention-to-treat trial were included in the analysis. The 6-month change of WOMAC Pain with Synolis VA was not associated with any baseline clinical data. However, the change in WOMAC Function was significantly associated with its baseline level, even after adjustment for potential confounding variables (p = 0.028), i.e., a poorer physical function at baseline was associated with a better response. In conclusion, in addition to the high absolute response rate to Synolis VA, the probability of success is even increased if administered in patients with more limited physical function at baseline. Further research with other potential confounding clinical variables is warranted in order to better applicate the concept of personalized medicine.

Study protocol: effect of infection, Modic and inflammation on clinical outcomes in surgery for radiculopathy (EIMICOR)

Background Evidence indicates that inflammatory processes are involved in radicular pain as well as in resorption of herniated disc tissue. Furthermore there are indications that the presence of vertebral end plate pathology (Modic changes; MC) is associated with a negative effect on inflammation. It is hypothesized that in patients with MC, the (possibly bacterial induced) inflammation will be accompanied by pro inflammatory cytokines that worsen the outcome, and that in patients without MC, the inflammation is accompanied by cytokines that induce a resorption process to accelerate recovery. Methods This prospective cohort study will include 160 lumbar and 160 cervical patients (total of 320), which are scheduled for surgery for either a lumbar or cervical herniated disc with ages between 18 and 75. The main and interaction effects of local bacterial infection (culture), inflammatory cells in disc material (immunohistology), MC (MRI), and blood biomarkers indicating inflammation or infection (blood sample evaluation) will be evaluated. Clinical parameters to be evaluated are leg pain on the 11 point NRS pain scale, Oswestry (lumbar spine) or Neck (cervical spine) Disability Index, Global Perceived Recovery, Womac Questionnaire, and medication status, at baseline, and after 6, 16, 26 and 52 weeks. Discussion Gaining insight in the aetiology of pain and discomfort in radiculopathy caused by a herniated disc could lead to more effective management of patients. If the type of inflammatory cells shows to be of major influence on the rate of recovery, new immunomodulating treatment strategies can be developed to decrease the duration and intensity of symptoms. Moreover, identifying a beneficial inflammatory response in the disc through a biomarker in blood could lead to early identification of patients whose herniations will resorb spontaneously versus those that require surgery. Trial registration prospectively enrolled at trialregister.nl, ID:NL8464.

Quality Of Life and Associated Factors in Latin American Patients Undergoing Total Hip Arthroplasty

Background. The objective of this study was to determine whether individuals with hip osteoarthritis who undergo THA have higher HRQOL scores than those awaiting the procedure; An additional aim was to investigate associated factors exerting an impact on HRQOL. Materials and methods. A cross-sectional study was conducted. Participants were divided into two groups: pre-THA and post-THA. Functional capacity was assessed using the Harris Hip Score, and HRQOL was measured using a validated and adapted version of the WOMAC questionnaire. A multivariate analysis of the WOMAC results was used to identify the main variables associated with HRQOL in both groups. Results. The post-THA group had higher HRQOL scores (100.4 ± 88.5) than the pre-THA group (197.8 ± 54.1). The domains Pain (68.0 ± 19.0 versus 34.7 ± 30.8), Stiffness (61.2 ± 28.9 versus 29.9 ± 33.1), and Physical Activity (68.6 ± 16.1 versus 36.6 ± 30.2) also had higher scores in the post-THA group. Pain was the variable most frequently associated with the increase in post-THA HRQOL scores. Other variables such as occupation, time of diagnosis, joint function, and body weight also had an impact on the HRQOL of both groups. Conclusions. 1. Individuals who underwent THA had higher scores for HRQOL compared to those still awaiting the procedure. 2. Pain was the variable most strongly associated with quality of life.

Increasing Intrinsic Hyaluronic Acid and Down-regulation of Inflammation Markers in Synovial Fluid from Patients with Knee Osteoarthritis may be Associated with Symptom Relief after Intra-articular Injection of Hyaluronic Acid

Background: Hyaluronic acid (HA) is the most common intra-articular therapy used to treat mild to moderate osteoarthritis (OA). However, the mechanism involved in this treatment is still not fully understood. The aim of the present study was to examine the effect and the possible mechanism of intra-articular HA (IAHA) injection in patients with knee osteoarthritis (OA).Methods: Twenty-eight patients with Kellgren–Lawrence scale II to III were enrolled in this study. All patients underwent ultrasound-guided injection using three consecutive weekly IAHA. Functional ability and pain were determined by the Western Ontario and McMaster University Index (WOMAC) questionnaire and visual analog scale (VAS). Further, the levels of HA, metalloproteinase (MMP)-1, MMP-3, MMP-13, interleukin (IL)-1β and IL-6 in synovial fluid were determined weekly before HA injection. Results: Functional improvement and pain relief were observed 4 weeks after treatment. At week 4, a significant increase of HA concentration was found, and the concentration of inflammatory cytokines including IL-1β, and IL-6, as well as matrix MMP-3 and MMP-13 significantly decreased. However, no significant difference was observed in MMP-1 level. Conclusion: These results suggest that increasing HA accumulation in synovial fluid may be associated with disease relief after weekly IAHA injection in patients with knee OA.

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.

Association of Eccentric Quadriceps Torque With Knee Pain, Physical Function and Extension Lag in Women With Grade ≤ II Knee Osteoarthritis-A Cross-Sectional Study

Background Knee osteoarthritis (OA) is a prevalent disabling disease among women. Quadriceps weakness is attributed to one of the causes of knee pain (KP) and disability. The study aimed to test the correlation of eccentric quadriceps torque (EQT) with 2 subscales of reduced WOMAC questionnaire (KP and physical function) and extension lag range of motion (ROM) at the knee joint in osteoarthritic women. Methods A cross-sectional design was used. A total of 70 (age 41.1 ± 7.1) female patients having grade ≤ II knee OA participated in the study. Pearson’s correlation coefficient was used to test the correlation between the independent variable (EQT) and dependent variables (2 subscales of reduced WOMAC questionnaire and extension lag in the knee). Results EQT presented a significant moderate negative correlation with the reduced WOMAC subscales (pain r = -0.489, p < 0.01 and physical function r = -0.425, p < 0.01), and low positive correlation with available ROM (r = 0.349, p < 0.01). Conclusions The self-reported symptoms of KP, physical function, and extension lag in the early stages of knee OA in women are associated with EQT. Thus designing a rehabilitation program having eccentric quadriceps strengthening exercises may improve KP and physical activities but further randomized controlled trials are needed to verify this.

Platelet-rich plasma as an effective biological therapy in early-stage knee osteoarthritis: One year follow up

Objective: PRP is produced by centrifugation of whole blood containing highly concentrated platelets, associated growth factors, and other bioactive agents which has been shown to provide some symptomatic relief in early knee osteoarthritis (OA). The principal objective of our study was to evaluate the effectiveness and safety of standardized intra-articular injection of autologous PRP in early osteoarthritis knee. Methods: A total of 98 eligible symptomatic patients received two injections of standardized PRP 3 weeks apart. Clinical outcomes were evaluated using the VAS and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before treatment and at 6 weeks, 3 months, 6 months, and 1 year after treatment. Secondary objectives were safety (side effects), and the effect of PRP on the different grades of knee degeneration. Results: There was a statistically significant improvement in mean VAS and WOMAC scores at 6 weeks, 3 months, 6 months, and slight loss of improvement at 1 year follow-up. There was also a correlation between the degree of degeneration and improvement in the mean scores. The decrease in mean pain score is more in grades 1 and 2 (early OA) than in grade 3. The intraarticular injection is safe, with no major complications. Conclusion: PRP is a safe and effective biological regenerative therapy for early OA Knees. It provides a significant clinical improvement in patients with some loss of improvement with time. More studies will be needed to confirm our findings.

PROBLEM OF PAIN IN THE INTERNIST'S PRACTICE

Introduction. Pain is an important problem in current medical practice and a fundamental issue of medical research. More than 75% of population suffers from chronic pain syndrome. One on seven patients who visit out-of-patient departments complains on painful feelings in joints or muscles. Moreover, in 30% of cases the symptoms of rheumatic diseases or the back pain syndrome are present that considerably impacts the quality of life. The aim of the study was to evaluate the effectiveness of the combined therapeutic strategy in the treatment of patients with osteoarthritis and comorbidities. The therapy included: glucosamine sulfatis in forms of solution for IV administration and powder for oral administration; patented form of undenaturated cartilaginous collagen (natural) type II (UC-ІІtm); non-steroidal anti-inflammatory drugs (meloxycam), angiotensin receptor type 2 blockers (valsartan), statins (rosuvastatin). Materials and methods. This prospective study was performed at the Department of Family Medicine and Therapy, Ukrainian Medical Stomatological Academy, and at Regional Rheumatology Centre of Poltava M. Sklifosovsliy Regional Clinical Hospital. 30 in- and out-patients aged 52-67 years having previously diagnosed primary gonarthrosis of X-ray stages ІІ–ІІІ by the Kellgren and Lawrence classification and any of the comorbid conditions (arterial hypertension, coronary arteries disease, chronic back pain syndrome, NSAIDS-induced gastropathy) were enrolled to the study, which lasted for 12 months. Results. Analyzing the effectiveness of the combined therapy for the patients with diagnosed osteoarthritis and concomitant conditions during the 12-month period of the study, we have found better results in the patients, who received chondroprotectors parenterally and orally. Significant clinical effect presumably caused by chondroprotectors in mixed forms among the patients with osteoarthritis and comorbid pathology was proved by the improvement in the following clinical parameters as the Leken index and WOMAC. In 6 months of the therapy, we achieved a significant decrease in the total functional Leken index (10.88 ± 2.07), p<0.0001 in the patients of the main group who received chondroprotectors in a mixed form compared to the control group (12.68 ± 2.08, p<0.0001). A significant decrease in the Leken index in the main group was also observed in 12 months since the theraoy started (p<0.0001), indicating the presence of long-term effects. We also observed the reducing in pain severity at rest and on movement, decline in the level of daily activities restrictions according to WOMAC questionnaire filled in 6 months since the therapy began. The findings supporting positive therapeutic effects fwere found in both groups, but in the main group they were more significant. The total WOMAC questionnaire score in 6 month treatment period was 676.08 ± 215.63 in the main group that was significantly lower compared to the control group (858.46 ± 167.64, p <0.0001). This clinical indicator was also significantly lower in the main group (564.82 ± 187.34) compared to the control group (797.12 ± 218.10, p <0.0001) in 12 month period.