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Remily EA, Bains SS, Dubin J, Chen Z, Hameed D, Livesey MG, Weir TB, Gilotra MN, Ingari JV, Hasan SA. Open versus arthroscopic treatment of the rheumatoid elbow arthritis: a comparison of complications at two years utilizing a nationally representative database. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1811-1815. [PMID: 38421494 DOI: 10.1007/s00590-024-03842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Symptomatic rheumatoid arthritis (RA) can be addressed surgically with open procedures or elbow arthroscopy. Previous studies comparing outcomes of open to arthroscopic arthrolysis for the management of RA did not utilize a large database study. The aim was to compare demographics and two-year complications, in RA patients undergoing open or arthroscopic elbow arthrolysis. METHODS A retrospective, cohort study was performed utilizing a private, nationwide, all-payer database. We queried the database to identify patients undergoing open (n = 578) or arthroscopic (n = 379) arthrolysis for elbow RA. The primary goal of the study was to compare complications at two-years. Categorical variables were assessed utilizing the chi-squared test; while, continuous variables were analyzed using the Student's t-test. Multivariable logistic regression was performed to assess risk factors for infection following open or arthroscopic arthrolysis. RESULTS RA patients undergoing open elbow arthrolysis were older (55 vs. 49 years, p < 0.001), predominately female (61.6% vs 60.9%, p = 0.895), and likely to have chronic kidney disease (20.4 vs. 12.9%), and DM (45.2 vs. 32.2%) (both p < 0.005). Open elbow arthrolysis was also associated with higher rates of infection (31.7 vs. 4.7%) and wound complications (26.8 vs. 3.4%) (both p = 0.001). Nerve injury rates were found to be similar (8.3 vs. 9.0%, p = 0.81). On multivariable logistic regression, open elbow procedures were associated with the highest risk for infection (OR: 8.43). CONCLUSIONS Patients undergoing open arthrolysis for RA were at a higher risk of infection and wound complications compared to arthroscopic arthrolysis utilizing a nationally representative database. While there appears to be a difference in outcomes following these two procedures, higher level evidence is needed to draw more definitive conclusions. LEVEL OF EVIDENCE Retrospective, Level III.
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Affiliation(s)
- Ethan A Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael G Livesey
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Tristan B Weir
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - John V Ingari
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - S Ashfaq Hasan
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
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Colasanti CA, Boin M, Hacquebord J, Virk M. Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report. Clin Shoulder Elb 2023; 26:462-466. [PMID: 37088884 DOI: 10.5397/cise.2022.00899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication.
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Affiliation(s)
| | - Michael Boin
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Jacques Hacquebord
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Mandeep Virk
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Elbow Arthritis. J Hand Surg Am 2023:S0363-5023(23)00003-5. [PMID: 36759236 DOI: 10.1016/j.jhsa.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/27/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023]
Abstract
Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis, posttraumatic arthritis, and primary osteoarthritis. Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids. Operative intervention may be considered once nonsurgical management has failed. Surgical treatment depends on the underlying etiology, chief complaint, patient age, and functional demand. Advances in technology, especially arthroscopic techniques, have expanded the treatment options available to surgeons. The goals of treatment include pain relief and restoration of functional range of motion. The purpose of this article is to review the pertinent soft tissue and osseous anatomy, discuss the etiologies, review the principles of diagnosis and evaluation, and finally, study the treatment options for elbow arthritis.
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Wang Y, Liu L, Le Z, Tay A. Analysis of Nanomedicine Efficacy for Osteoarthritis. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yuwen Wang
- Department of Biomedical Engineering National University of Singapore Singapore 117583 Singapore
| | - Ling Liu
- Institute of Health Innovation and Technology National University of Singapore Singapore 117599 Singapore
| | - Zhicheng Le
- Department of Biomedical Engineering National University of Singapore Singapore 117583 Singapore
| | - Andy Tay
- Department of Biomedical Engineering National University of Singapore Singapore 117583 Singapore
- Institute of Health Innovation and Technology National University of Singapore Singapore 117599 Singapore
- Tissue Engineering Programme National University of Singapore Singapore 117510 Singapore
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Ek ET, Wang KK, Bohan CM, Goulding NJ, Jamieson RP. Role of Tranexamic Acid in Arthroscopic Osteocapsular Release of the Elbow for Degenerative Arthritis. Orthop J Sports Med 2022; 10:23259671221089608. [PMID: 35464902 PMCID: PMC9019345 DOI: 10.1177/23259671221089608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Minimizing intra-articular bleeding and swelling is crucial in preventing the development of stiffness around the elbow. Tranexamic acid (TXA) has been shown to be an effective adjunct in reducing perioperative bleeding after surgery. Purpose: To determine the effect of intravenous (IV) TXA on postoperative drain tube output in arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective cohort study of 83 consecutive patients with primary degenerative elbow arthritis who underwent an arthroscopic osteocapsular release between 2015 and 2018. They organized patients into a no-TXA group (control) and a group that was given 1.0 g of IV TXA before tourniquet release. The primary outcome measure was drain tube output, and secondary outcome measures included postoperative day 1 pain levels on a visual analog scale and early range of motion at 8 weeks. Differences between groups were analyzed using 1-way analysis of variance, the Mann-Whitney U test, or the Fisher exact test. Results: There were 43 patients in the no-TXA group and 40 patients in the TXA group. Administration of IV TXA resulted in a 51% decrease in mean intra-articular bleeding for the TXA group, as measured via drain tube output (88.8 ± 80.5 mL [no-TXA] vs 43.4 ± 52.4 mL [TXA]; P = .0016). In both groups, there were significant increases in elbow arc of motion when compared with preoperative measurements. There were no between-group differences in early range of motion (129.7° ± 12.4° [no-TXA] vs 131.7° ± 9.2° [TXA]; P = .549) or postoperative pain (1.9 ± 2.2 [no-TXA] vs 1.5 ± 1.7 [TXA]; P = .89). Conclusion: In this study, IV TXA significantly reduced postoperative intra-articular bleeding in patients who underwent arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. However, there were no differences in postoperative range of motion or pain between patients who received TXA and controls.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Kemble K. Wang
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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Kim H, Kwak JM, Kholinne E, Kim DM, Park JH, Koh KH, Jeon IH. Determination of the patient acceptable symptomatic state after osteocapsular arthroplasty for primary elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:2127-2133. [PMID: 33529774 DOI: 10.1016/j.jse.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The study aimed (1) to determine patient acceptable symptomatic state (PASS) values for the pain visual analog scale (PVAS), range-of-motion (ROM) scale difference, Mayo Elbow Performance Score (MEPS), and Self-evaluation Elbow (SEE) following osteocapsular arthroplasty for primary elbow osteoarthritis and (2) to determine factors for achieving the PASS. METHODS The study analyzed retrospectively collected osteocapsular arthroplasty registry data from January 2010 to April 2019. Fifty patients were evaluated, and anchor questions for deriving PASS values were administered at a 1-year follow-up. PASS values for the PVAS score, ROM difference, MEPS, and SEE score were derived using a sensitivity- and specificity-based approach. Univariate and multivariate logistic regression analyses were performed to determine factors for achieving the PASS. A subgroup comparison analysis based on age was also conducted. RESULTS The PASS value was 1.0 for the PVAS score, 15° for ROM difference, 75 for the MEPS, and 60 for the SEE score. Older age (≥65 years) showed significantly lower odds ratios for achieving the PASS for the PVAS score (0.888; 95% confidence interval, 0.804-0.981; P = .032) and ROM (0.861; 95% confidence interval, 0.760-0.976; P = .020). CONCLUSION Reliable PASS values were derived for the PVAS score, ROM difference, MEPS, and SEE score after osteocapsular arthroplasty. The PASS values defined in this study can be implemented as clinically relevant targets in patients undergoing osteocapsular arthroplasty. An analysis of factors that affect clinical symptom improvement showed that older age (≥65 years) was significantly correlated with lower PASS values for the PVAS score and ROM.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Dong Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:S8-S13. [PMID: 33892121 DOI: 10.1016/j.jse.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies. METHODS A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score. RESULTS The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies. CONCLUSION CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.
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Otoshi K, Kikuchi S, Kato K, Sato R, Igari T, Kaga T, Konno S. Arthroscopic Elbow Debridement Using Anterocentral Transbrachialis Portal. Arthrosc Tech 2021; 10:e1425-e1430. [PMID: 34258186 PMCID: PMC8252852 DOI: 10.1016/j.eats.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/07/2021] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic debridement for elbow osteoarthritis has been widely used as a minimally invasive treatment; however, in some cases, it can be a technically demanding procedure, such as in patients with severe osteoarthritis with large spur formation and severe synovitis. The anterocentral transbrachialis portal is a recently developed portal for elbow arthroscopy, which allows easy and convenient access to the anterior compartment for sufficient debridement. This report describes in detail the anterocentral transbrachialis portal and its usefulness for debridement of the elbow joint in osteoarthritis.
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Affiliation(s)
- Kenichi Otoshi
- Department of Sports Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
- Address correspondence to Kenichi Otoshi, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Shinichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Ryohei Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Takahiro Igari
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Takahiro Kaga
- Department of Sports Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Martinez-Catalan N, Sanchez-Sotelo J. Primary Elbow Osteoarthritis: Evaluation and Management. J Clin Orthop Trauma 2021; 19:67-74. [PMID: 34099969 PMCID: PMC8165431 DOI: 10.1016/j.jcot.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity . Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages . When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures . The ulnar nerve needs to be carefully assessed and addressed at the time of surgery . Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice . Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.
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Affiliation(s)
- N. Martinez-Catalan
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - J. Sanchez-Sotelo
- Department of Orthopedic Surgery Mayo Clinic, Rochester, MN, USA,Corresponding author. Consultant and Professor of Orthopedic Surgery Chair, Division of Shoulder and Elbow Surgery Mayo Clinic, 55905, Rochester, MN, USA.
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Szabo SJ. Editorial Commentary: Arthroscopic Elbow Arthritis Treatment With Osteocapsular Debridement Yields Favorable Results: On Second Thought, the Elbow Isn't That Unforgiving. Arthroscopy 2021; 37:759-760. [PMID: 33546806 DOI: 10.1016/j.arthro.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
The elbow has been referred to as the unforgiving joint. Arthroscopy for treating elbow arthritis is both challenging and rewarding. Most joints require arthroplasty for treatment of arthritis, but the elbow is amenable to osteocapsular debridement. This is especially beneficial when elbow arthroplasty options have high complication rates and the need for permanent physical limitations. Thus, when treating arthritis, the elbow is more forgiving than once thought.
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Clinical outcomes of a combined arthroscopic and mini-open Outerbridge-Kashiwagi procedure for elbow osteoarthritis. J Shoulder Elbow Surg 2020; 29:2646-2653. [PMID: 33190762 DOI: 10.1016/j.jse.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND To evaluate the short-term clinical outcomes of a modified Outerbridge-Kashiwagi (O-K) procedure in the treatment of elbow osteoarthritis. METHODS Between January 2012 and December 2016, 27 patients with elbow osteoarthritis were treated with a modified O-K procedure combining mini-open and arthroscopic technique in our institution. All patients with primary osteoarthritis and post-traumatic degenerative osteoarthritis of the elbow were included in the study if they had undergone the modified O-K procedure. Clinical outcomes were assessed using the visual analog scale (VAS), degree of flexion, extension loss, arc of motion, Mayo Elbow Performance Score (MEPS), and radiographs. RESULTS Twenty-five patients with a mean age of 47.2 years (range, 21-69 years) at surgery were followed up for a mean of 54.5 months (range, 27-86 months). The VAS improved from 8.0 ± 1.4 (range, 6-10) preoperatively to 1.3 ± 1.1 (range, 0-3) at the final follow-up (P < .001), degree of flexion from 115.2° ± 12.0° (range, 90°-135°) to 130.6° ± 6.3° (range, 120°-140°) (P < .001), extension loss from 31.2° ± 15.0° (range, 10°-60°) to 10.2° ± 7.7° (range, 0°-30°) (P < .001), arc of motion from 84.0° ± 18.8° (range, 55°-120°) to 120.4° ± 9.3° (range, 105°-135°) (P < .001), and MEPS from 55.8 ± 8.1 (range, 40-70) to 88.4 ± 7.2 (range, 70-100) (P < .001). Radiographs at the final follow-up showed that 9 patients (36%) had significant recurrence of bone formation within the fenestration of the olecranon fossa. One patient developed delayed-onset ulnar neuropathy, with only slight numbness in the ulnar nerve distribution 6 months after surgery. CONCLUSIONS The modified O-K procedure is safe and effective in pain relief and function restoration in patients with elbow osteoarthritis.
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Roflumilast prevents lymphotoxin α (TNF-β)-induced inflammation activation and degradation of type 2 collagen in chondrocytes. Inflamm Res 2020; 69:1191-1199. [PMID: 32990777 DOI: 10.1007/s00011-020-01404-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Osteoarthritis (OA) is a chronic disease accompanied by severe inflammation. The inflammation activation in the chondrocytes and the degradation of the extracellular matrix were reported to be involved in the progress of OA. Roflumilast is a selective PDE4 inhibitor used for treating chronic obstructive pulmonary disease (COPD) and exerts significant anti-inflammation effects. The present study aims to investigate the effects of Roflumilast on tumor necrosis factor-β (TNF-β)-induced inflammation activation and degradation of type 2 collagen in chondrocytes. METHODS TNF-β was used to establish the in-vitro inflammation model on ATDC5 chondrocytes. Quantitative real-time polymerase chain reaction (QRT-PCR) and western blot were used to determine the expression level of tumor necrosis factor receptor 2 (TNFR2), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), matrix metalloproteinase 3 (MMP-3), matrix metalloproteinase 13 (MMP-13), type 2 collagen and nuclear factor kappa B (NF-κB) p65. The release of prostaglandin E2 (PGE2), MMP-3, and MMP-13 were evaluated by ELISA. The production of NO was determined by DAF-FM DA staining and the function of the NF-κB promoter was evaluated by Luciferase activity assay. RESULTS TNFR2 and COX-2 were upregulated and the release of PGE2 was promoted by TNF-β stimulation, which were all inhibited by Roflumilast. Roflumilast suppressed the promoted iNOS expression and NO production induced by TNF-β. MMP-3 and MMP-13 were up-regulated, and type 2 collagen was down-regulated by TNF-β stimulation, which were all reversed by Roflumilast. Roflumilast inhibited the promoted releasing of Interleukin-8 (IL-8) and Interleukin-12 (IL-12), expression of up-regulated NF-κB, and activation of NF-κB transcriptional activity induced by TNF-β. CONCLUSION Roflumilast may prevent TNF-β-induced inflammation activation and degradation of type 2 collagen in chondrocytes.
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