Modern approaches to the treatment of joint pathology: the value of hyaluronic acid

Патология опорно-двигательного аппарата и остеоартрит в частности остаются частой причиной обращения за медицинской помощью в амбулаторном звене. Среди разных суставов самым страдающим считается коленный – на него приходится до 25% всех поражений опорно-двигательной системы, что связано с его опорной функцией и частым травматическим поражением. Рост популярности активного отдыха, развитие игровых и экстремальных видов спорта приводят к росту частоты травм коленного сустава, связочного аппарата, а также внутрисуставных повреждений. Именно травматизация признается одной из ведущих причин последующего остеоартрита. Статья предлагает краткие алгоритмы диагностики и терапии остеоартрита для применения на амбулаторно-поликлиническом этапе оказания медицинской помощи. Уделено внимание применению препаратов гиалуроновой кислоты, проведен анализ литературных данных, оценены перспективы применения подобной терапии в комплексе лечебных мероприятий. Гиалуроновая кислота является натуральным компонентом синовиальной жидкости, она служит в качестве смазки суставных поверхностей и обеспечивает ряд защитных и регуляторных эффектов. Вводимая извне гиалуроновая кислота берет на себя нагрузку, восполняя недостающие функции синовиальной жидкости, что и позволяет считать такое применение протезированием недостаточной функции сустава. Препараты гиалуроновой кислоты — быстродействующие локальные средства для улучшения функции пораженного сустава и купирования болевого синдрома, что важно для поддержания активности пациентов. Данные эффекты обусловлены реологическими особенностями гиалуроновой кислоты, которые позволяют не только улучшить смазывающие свойства и скольжение в пораженном суставе, но и обеспечивают защиту суставного хряща от ударных нагрузок. Полученная промышленным способом гиалуроновая кислота уже более 30 лет успешно применяется в лечении остеоартрита. Pathology of the musculoskeletal system and osteoarthritis, in particular, remain a frequent reason for seeking outpatient care. Among the various joints, the knee joint is considered the most affected - it accounts for up to 25% of all lesions of the musculoskeletal system, which is associated with its supporting function and frequent traumatic injury. The growing popularity of outdoor activities, the development of playing and extreme sports leads to an increase in the frequency of injuries of the knee joint, ligamentous apparatus, as well as intra-articular injuries. It is traumatization that is recognized as one of the leading causes of subsequent osteoarthritis. The article offers brief algorithms for the diagnosis and treatment of osteoarthritis for use at the outpatient stage of medical care. Attention is paid to the use of hyaluronic acid preparations, an analysis of the literature data is carried out, the prospects for the use of such therapy in a complex of therapeutic measures are assessed. Hyaluronic acid is a natural component of synovial fluid that serves as a lubricant for articular surfaces and provides a range of protective and regulatory effects. Hyaluronic acid introduced from the outside takes on the load, replenishing the missing functions of the synovial fluid, which allows us to consider such use as prosthetics of insufficient joint function. Hyaluronic acid preparations are a fast-acting local remedy to improve the function of the affected joint and relieve pain, which is important to keep patients active. These effects are due to the rheological features of hyaluronic acid, which not only improve lubricating properties and sliding in the affected joint, but also protect the articular cartilage from shock loads. The industrially obtained hyaluronic xylote has been successfully used in the treatment of osteoarthritis for more than 30 years.

Moderate Exercise Protects Against Joint Disease in a Murine Model of Osteoarthritis

Exercise is recommended as a non-pharmacological therapy for osteoarthritis (OA). Clinical studies investigating the impact of exercise on OA have primarily focussed on the assessment of joint pain and mobilisation, where positive outcomes have been demonstrated. Clinical imaging studies provide limited information on the impact of exercise (positive or negative) on the actual bone and soft tissue pathology. Various exercise regimes, with differing intensities and duration, have been used in a range of OA models, with disparate results. The present study provides definitive insight into the effect of moderate exercise on early joint pathology in the destabilisation of the medial meniscus (DMM) mouse model of OA. Exercise was induced by forced treadmill walking for 3 or 7 weeks. Joints were analysed by microcomputed tomography and histology. Exercise offered protection against cartilage damage and joint inflammation, and a temporary protection against osteosclerosis. Furthermore, exercise modified the metaphyseal trabecular microarchitecture of the osteoarthritic leg. Collectively, our findings provide scientific support for the clinical recommendation of moderate exercise as a physical therapy in OA. In addition to indirect benefit via positive physiological effects of weight loss, our data suggest direct short-term benefits in ameliorating pathology of cartilage, synovitis and bone.

Risk factors of deforming osteoarthritis in the family doctor practice

Osteoarthritis (OA) is the most common bone and joint pathology, affecting, according to the American College of Rheumatology ACR (2019), about 302 million people worldwide and is the leading cause of disability in the elderly.Objective. To investigate the role of additional risk factors in patients with OA in the practice of family physicians for secondary prevention.Material and methods. A retrospective analysis of 50 outpatient records and electronic medical records (EMC) of patients with OA for 2019-2020 was performed: 30 women, 20 men; aged 35-75 years. Concomitant risk factors were studied by epidemiological analysis: obesity / overweight, burdensome family history, traumatic factor, occupational exposure.Results. The respiratory and circulatory systems diseases dominate in the structure of the primary morbidity of the Northern Bukovina inhabitants in 2020. The incidence of bone and joint is 4.04% in the general structure, which does not differ significantly from the European average. The structure of the primary morbidity of the bone and joint sphere is dominated by arthrosis and deforming OA (DOA). The injuries and occupational factors dominated in structure of DOA risk factors at the age under 50, but after 50 years – obesity and burdened heredity prevailed, with a significant impact of the occupational factor. Absence of injuries in the anamnesis and occupational factors reduce the risk of DOA 8 and 3.5 times, respectively (p<0.05). Age over 60 years increases the relative risk of DOA 2.5 times as much (p=0.013), especially in women to almost 4 times.Conclusions. Additional risk factors should be considered in patients with DOA for secondary prevention.

Passive Microwave Radiometry (MWR) as a Component of Imaging Diagnostics in Juvenile Idiopathic Arthritis (JIA)

Juvenile idiopathic arthritis (JIA) is a disease with unknown causes within all forms of arthritis in children under 16 years of age. The diagnosis is made when another joint pathology is excluded. Difficulties in early and differential diagnosis lead to the rapid disability of patients and an unfavourable life prognosis. Therefore, timely diagnosis is necessary to prevent irreversible damage to the joints and preserve their function. Due to the widespread use of new technologies, modern multimodal imaging has gained recognition, which includes X-ray, ultrasound, and MRI. The combination of methods plays a key role in confirming the diagnosis, monitoring disease activity, prognosis during the course, and outcome in children with JIA. Each method has its own advantages and disadvantages. The introduction of the method of passive microwave radiometry (MWR), in combination with other imaging methods, makes it possible to expand the possibilities of screening the disease in the preclinical and early clinical phases.

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.

Equine synovial fluid protein equalization via combinatorial peptide ligand libraries

To gain further knowledge of the equine synovial fluid (SF) proteome, we propose a protocol based on the equalization of the relative concentrations of its proteins, which leads to the modification of the standard electrophoretic pattern revealing low-abundance proteins that otherwise remain undetected. Fresh SF samples were collected from ten macroscopically normal metacarpophalangeal joints of crossbred horses. The samples were processed using standard procedures as the control and via combinatorial peptide ligand libraries (CPLL) using low ionic forces (NaH2PO4 10 mM) at different pHs (4.0, 7.0, and 9.3) with 10% sodium dodecyl sulfate (SDS) and 25 mM DTT for protein resolubilization. Proteins were then separated by conventional 8% SDS-PAGE and stained with coomassie blue. After separation of the equalized proteins, there was a significant reduction in the albumin (the most abundant protein in the SF) and, at the same time, other protein bands arise that were not visible without CPLL processing. In addition, there was variation in the protein profiles at different pHs. The results suggest that protein equalization of the equine SF by CPLL could be a useful tool to better understand the articular homeostasis and/or for the detection of new biomarkers of joint pathology.

Eponymous terms and rarities

This chapter provides a list of eponymous terms and rare diseases. These include acanthosis nigricans, which is pigmentation of the axillary skin associated with breast or gastric cancer; Baker’s cyst, which is almost always associated with knee joint pathology such as arthritis or torn meniscus; and Cloquet’s (Callisen’s) hernia, which is a deep femoral hernia that cannot protrude from the saphenous opening as it lies deep to the femoral vessels. The chapter then deals with DeQuervain’s disease, encephalocele, and familial adenomatous polyposis (FAP). It also describes gamekeeper’s thumb, hereditary osteodystrophy, inspissated bile syndrome, Jansen’s disease, Kaposi’s sarcoma, and livedo reticularis. Finally, the chapter defines McMurray’s test, which is used to identify medial meniscal tears; nutcracker oesophagus, which is an alternative name for diffuse oesophageal spasm; and osteogenesis imperfecta, which is an inherited collagen disorder, resulting in fragile bones that fracture easily, blue sclera, deafness, and soft teeth.

Collecting linked patient reported and technology reported outcome measures for informing clinical decision making: a scoping review

Review question / Objective: We aim to map out the existing research where concomitant use of patient reported and technology reported outcome measures is used for patients with musculoskeletal conditions. Condition being studied: Musculoskeletal disorders (MSD) covering injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Musculoskeletal manifestations of joint pathology. Eligibility criteria: 1) Peer-reviewed primary studies and literature reviews. Grey literature not included. 2) Studies which include co-administration of Patient-Reported Outcomes (PROMs) AND wearable electronic devices (e.g. fitness trackers, accelerometers, gyroscopes, pedometers smartphones, smartwatches) in musculoskeletal manifestations of joint pathology. Studies are EXCLUDED which feature wearable electronic devices but not concomitant/real time capturing of PROMs (e.g. they are recorded retrospectively/ at different timepoints). 3) Studies in languages other than English will be excluded unless a translation is available.

Inflammatory arthritis complicating galactosialidosis: a case report

Background Galactosialidosis (GS) is a rare inherited lysosomal storage disorder (LSD) which is characterized by a defect in the lysosomal glycoprotein catabolism. We report, for the first time, the case of a child affected by GS presenting with recurrent episodes of extensive joint inflammation in both knee joints. The aim of this case-report is to describe the clinical presentation as well as the laboratory, radiologic and microscopic features of this unique presentation of GS. Furthermore, we explore inflammatory mechanisms potentially responsible for the origination of the arthritic joint pathology observed in our patient. Case presentation We describe the rare case of a 12-year-old boy diagnosed with GS (late infantile form) who presented with multiple episodes of inflammatory arthritis involving both knees; no other joints were suspected for joint inflammation. Laboratory results did not indicate an autoimmune disorder. Synovial fluid tested negative for any bacterial infection and ruled out a malignancy and crystal-induced arthritis. Microscopic examination of the synovial tissue revealed numerous foamy macrophages with extensive vacuolization, consistent with the previous diagnosis of GS. Treatment consisted of aspiration of excessive joint fluid and subsequent intra-articular injection of triamcinolonhexacetonide with excellent but transient result. Given the evidence of storage products within macrophages of the inflamed synovial tissue and the absence of other etiological clues, GS itself was considered as the primary cause for the relapsing inflammatory joint pathology. According to the restricted data on articular manifestations in GS, to date, GS cannot be linked directly to joint inflammation. Nevertheless, in several other LSDs, the accumulation of storage material has been associated with numerous osteoimmunological changes that might play a role in the pathophysiology of arthritic processes. Conclusions We hypothesize that the articular build-up of GS storage products triggered systemic as well as local inflammatory processes, resulting in the extensive inflammatory joint pathology as observed in our patient. Future identification of other patients with GS is required to corroborate the existence of an arthritic clinical phenotype of GS and to assess the underlying pathophysiology.