Median time to pain improvement and the impact of baseline pain severity on pain response in patients with psoriatic arthritis treated with tofacitinib

BackgroundPain is a core domain of psoriatic arthritis (PsA). This post hoc analysis evaluated time to pain improvement and the impact of baseline pain severity on pain response in patients with PsA receiving tofacitinib.MethodsData from two trials (NCT01877668; NCT01882439) in patients receiving tofacitinib 5 mg twice daily, placebo switching to tofacitinib 5 mg twice daily at month 3 (placebo-to-tofacitinib) or adalimumab (NCT01877668 only) were included. Improvement in pain (≥30%/≥50% decrease from baseline in Visual Analogue Scale pain score) was assessed; median time to initial (first post-baseline visit)/continued (first two consecutive post-baseline visits) pain improvement was estimated (Kaplan-Meier) for all treatment arms. A parametric model was used to determine the relationship between baseline pain severity and time to pain response in patients receiving tofacitinib.ResultsAt month 3, more patients experienced pain improvements with tofacitinib/adalimumab versus placebo. Median days (95% CI) to initial/continued pain improvements of ≥30% and ≥50%, respectively, were 55 (29–57)/60 (57–85) and 85 (57–92)/171 (90–not estimable (NE)) for tofacitinib, versus 106 (64–115)/126 (113–173) and 169 (120–189)/NE (247–NE) for placebo-to-tofacitinib. Pain improvements were also experienced more quickly for adalimumab versus placebo. Predicted time to ≥30%/≥50% pain improvement was shorter in patients with higher baseline pain versus lower baseline pain (tofacitinib arm only).ConclusionsIn patients with PsA, pain improvements were experienced by more patients, and more rapidly, with tofacitinib and adalimumab versus placebo. In those receiving tofacitinib, higher baseline pain was associated with faster pain improvements.

Mouthwash with Active Oxygen (blue®m) Reduces Postoperative Inflammation and Pain

The aim of this case series was to evaluate the effects of blue®m mouthwash on oral surgical wounds. Eleven patients underwent bilateral preprosthetic surgery and were instructed to apply the product only to the right side of the surgery. In this way, the right side corresponds to the test side and the left side (place without applying any type of solution) to the control side. After seven days of using the product (3 times a day), the following parameters were evaluated by means of a visual analogue scale: pain, changes in taste, and acceptance by the patient. Then, the level of tissue inflammation was assessed, by the number of pixels, using ImageJ® software. The main results show that the blue®m mouthwash was widely accepted by patients, reducing their pain. The number of inflammation pixels was lower on the test side ( p < 0.05 ), indicating improved healing. It is suggested that blue®m mouthwash positively influences tissue healing reducing pain and the postsurgical inflammatory process; however, randomized clinical trials should be done to prove this clinical observation.

Hallux Varus Correction With Extensor Hallucis Longus Tendon Transfer and Reverse Scarf Osteotomy

Introduction Hallux varus is the medial deviation of the hallux. Although rare, it can cause discomfort, functional weakness, difficulty with shoe wear, and dissatisfactory cosmesis. This study reports 3 cases of hallux varus treated using extensor hallucis longus (EHL) tendon transfer with or without the use of reverse scarf osteotomy (RSO). Methods This cases series studies the technique of using EHL tendon transfer and the role for RSO in the surgical correction of hallux varus. Indication for RSO included osseous overcorrection in the index hallux valgus surgery or as an adjunct when EHL tendon transfer alone was unable to restore alignment. Patients were followed-up for 24 months and their postoperative outcomes were recorded. Results All patients were female between the ages 55 to 67 years. Radiological parameters after surgery improved in all patients. The mean hallux-valgus angle was corrected from −23.7 ± 3.5° to −3.2 ± 2.0° postoperatively ( P < .05). Intermetatarsal angle was increased from 5.0 ± 1.9° to 6.7 ± 1.0° ( P = .065). Distal metatarsal articular angle improved from −28.9 ± 7.6° to −7.8 ± 3.7° ( P < .05). Mean American Orthopaedic Foot and Ankle Society scores improved from 37 ± 24 to 75 ± 9 ( P = .064) at 24 months. In addition, visual analogue scale pain scores reduced from 5 ± 1.5 to 1 ± 1 ( P < .05). All patients reported being satisfied with the procedure, and no complications were reported at 24 months after surgery. Conclusion Hallux varus correction using EHL tendon transfer with or without RSO appears to provide satisfactory results at 24 months. Levels of Evidence Level V: Expert opinion, Techniques

Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series

Aim of the study: To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Methods: Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. Results: In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks postinjection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. Conclusion: In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament.

AB0861 СURRENT PHARMACOTHERAPY FOR KNEE OSTEOARTHRITIS: SPECIFIC FEATURES OF SYMPTOMATIC AND DISEASE MODIFYING EFFECTS

Objectives:to study the specific features of the symptomatic effect and tolerability of paracetamol (P), glucosamine sulfate (GS), chondroitin sulfate (CS), and meloxicam (M) in patients with knee osteoarthritis (OA).Methods:An 18-month open-label randomized prospective parallel-group trial enrolled 80 patients with knee OA who fulfilled the American College of Rheumatology criteria and signed the informed consent. They had Kellgren and Lawrence grades I-III OA with visual analogue scale pain intensity of > 40mm in the target knee, a body mass index of < 35 rg/m2, and no clinical dysfunctions of vital organs and systems. The patients were randomized into 4 groups: 1) P 2g daily; 2) a standard GS regimen; 3) a standard CS regimen; 4) M 15mg daily. The patients were followed up for 18 months, The effectiveness was evaluated by the WOMAC questionnaire, Lequesne index, and OMERACT-OARSI (D scenario) during 8 visits. Laboratory and clinical examination as well as electrocardiography were performed. Adverse events were recorded during each visit.Results:After 4 weeks of treatment, symptomatic improvement was noted in all groups; however, the best effect was achieved by the use of M and continued to the end of the study. The percentage of patients reacting to the therapy by the OMERACT-OARSI criteria was highest in M group (100%), reached 90% in GS, 85% in CS groups and 75% in P group. In the groups of P, GS and CS failed to respond to treatment 25, 10, and 15% correspondingly. However, medium narrowing of articular space (NAS) was measured at the end of the study and was significantly lower in GS group (-0.07; p=0,0002), CS (-0.1; p=0.004) and M (-0.06; p=0.006). Besides, the quota of patients without heavy NAS (> 0.5 mm in medial KJ) was the lowest in GS group as compared with three other groups.Conclusion:The results of this trial suggest that it is expedient to use GS, CS and M long, support the recent guidelines of the European Society for Clinical and Economic aspects of Osteoporosis and OA (ESCEO), and can give proofs of the efficiency and safety of GS, CS, and M used in the treatment of knee OA.Disclosure of Interests:None declared

Outcomes of Partial Meniscectomy in Obese Patients: A Systematic Review and Meta-Analysis

Objective Arthroscopic partial meniscectomy (APM) is one of the most commonly performed surgical procedures. However, the indications for APM are controversial and obese patients may have worse outcomes. This study’s primary purpose was to investigate differences in outcome after APM associated with elevated body mass index (BMI). Secondary objectives included differences in pathophysiology, surgical complications/failures, or osteoarthritis development. Design MEDLINE, EMBASE, and OVID databases were systematically searched for eligible studies reporting on APM outcomes at a minimum of 1 year postoperatively. Studies that did not include BMI categorization were excluded. Meta-analysis was conducted with random-effects modeling where data from at least 2 studies was available. Results A total of 16 articles were included. Overweight/obese BMI was associated with worse preoperative Lysholm (mean difference, −6.06 [95% CI, −11.70 to −0.42]) and visual analogue scale pain scores (0.43 [0.07 to 0.79]). Worse postoperative normalized knee-specific patient-reported outcome scores were also associated with obese BMI (−4.57 [−5.33 to −3.81]). There were no significant differences in clinical improvement or osteoarthritis progression among BMI groups. Two studies found higher complication/failure rates, 3 articles associated medial meniscus posterior root tears, and 1 article found differences in gene transcript expression with increased BMI. Conclusions Obesity is associated with worse knee function after APM, and patients with elevated BMI have worse preoperative knee pain and function. However, there is no difference in amount of improvement between elevated and normal BMI patients. Further prospective research is necessary to determine the comparative effectiveness of APM in patients with elevated BMI.

Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia

ObjectiveNon-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition.MethodsA cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development.ResultsTenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, p<0.001), although synovitis and enthesitis were numerically more frequent in PsOAr. Five patients in PsOAr and one in PsO group developed PsA, with an incidence rate of 109.2/1000 person-years in PsOAr vs 13.4/1000 person-years in PsO (p=0.03). Visual Analogue Scale pain, Health Assessment Questionnaire, joint tenderness and US active enthesitis were baseline variables associated with PsA development.ConclusionTenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.

Two-Year Follow Up after Autologous Matrix-induced Chondrogenesis (AMIC) in Patients with an Osteochondral Lesion of the Talus

Category: Sports Introduction/Purpose: The treatment of osteochondral lesions in the talus remains challenging. In recent years a promising technique, the autologous matrix-induced chondrogenesis (AMIC) has been described, a technique combining micro fracturing with application of a collagen matrix. The aim was to analyze the clinical follow up two years after surgery and define risk factors for inferior outcome. Methods: This prospective study included 16 consecutive patients, who underwent AMIC for an osteochondral lesion of the talus at our institution. We compared preoperative and at two years follow up the following clinical scores: AOFAS (American Orthopeadic foot and ankle score), FFI (foot functional index) and VAS (visual analogue scale) pain and satisfaction. Further, clinical scores at two years were correlated with BMI, age, gender and size and stage osteochondral lesion according to Hepple. Additionally outcome after primary AMIC and revision surgery was compared. Results: FFI increased from 50 ± 16 preoperative to 30 ± 24 at follow-up (p-value: 0.017). VAS pain increased from 5.6 ± 2.0 to 2.8 ± 2.7 (p-value: <0.001). AOFAS (67 ± 12 to 78 ± 21) and VAS satisfaction (7.2 ± 2.6 to 7.6 ± 2.8) change was not significant. AOFAS and FFI did not correlate with BMI, age, gender or size and grade of the osteochondral lesion. Patients with primary AMIC or revision surgery had a similar preoperative AOFAS (69 ± 11 versus 64 ± 14) and FFI (54 ± 14 versus 42 ± 17). At follow-up, patients with primary AMIC showed superior AOFAS (86 ± 11 versus 65 ± 27, p-value: 0.049) and FFI (17 ± 16 versus 52 ± 20; p- value: 0.001). Conclusion: Increased clinical outcome was found two years after AMIC in patients with talus cartilage lesion without previous surgery.

Outcomes of ulnotriquetral split tear repair: a report of 96 patients

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6–112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores. Level of evidence: IV