The effect of swan neck and boutonniere deformities on the outcome of silicone metacarpophalangeal joint arthroplasty in rheumatoid arthritis

Discovery and validation of anti-arthritic ingredients and mechanisms of Qingfu Juanbi Tang, a Chinese herbal formulation, on rheumatoid arthritis

ETHNOPHARMACOLOGICAL RELEVANCE

Qingfu Juanbi Tang (QFJBT), a novel and improved Chinese herbal formulation, has surged in recent years for its potential in the therapy of rheumatoid arthritis (RA). Anti-arthritic effects and underlying molecular mechanisms of QFJBT have increasingly become a focal point in research.

AIM OF THE STUDY

This study utilized network pharmacology, molecular docking, and experimental validation to elucidate effective ingredients and anti-arthritic mechanisms of QFJBT.

MATERIALS AND METHODS

Targets associated with QFJBT and RA were identified from relevant databases and standardized using the Uniprot for gene nomenclature. A "QFJBT-ingredient-target network" and a "Venn diagram of QFJBT and RA targets" were created from the data. The overlap in the Venn diagram highlighted potential targets of QFJBT in the treatment of RA. These targets were subjected to PPI network, GO, and KEGG pathway analysis. The findings were subsequently confirmed through molecular docking and pharmacological experiments to propose the mechanism of action of QFJBT.

RESULTS

The study identified 236 active ingredients in QFJBT, with 120 predicted to be effective against RA. Molecular docking showed high binding affinity of key targets (JUN, PTGS2, and TNF-α) with bioactive compounds (rhein, sinomenine, calycosin, and paeoniflorin) of QFJBT. Pharmacodynamic evaluation demonstrated the effects of QFJBT at the dose of 4.56 g/kg in ameliorating symptoms of AIA rats and in reducing levels of JUN, PTGS2, and TNF-α in synovial tissues. In vitro studies further exhibited that rhein, paeoniflorin, sinomenine, calycosin, and QFJBT-containing serum significantly inhibited abnormal proliferation of RA fibroblast-like synoviocytes. Interestingly, rhein and paeoniflorin specifically decreased p-JUN/JUN expression and TNF-α release, respectively, while sinomenine and calycosin selectively increased PTGS2 expression. Consistently, QFJBT-containing serum demonstrated similar effects as those active ingredients identified in QFJBT did.

CONCLUSIONS

QFJBT, QFJBT-containing serum, and its active ingredients (rhein, paeoniflorin, sinomenine, and calycosin) suppress inflammatory responses in RA. Anti-arthritic effects of QFJBT and its active ingredients are likely linked to their modulatory impact on identified hub targets.

Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand

Background

Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function.

Methods

Thirty-one patients with osteoarthritis of the CMC, MCP, or PIP joints underwent arthroplasty with meniscal allograft. Patient demographics and operative information were recorded. Preoperative Disability of the Shoulder, Arm, and Hand, Wong Baker pain, grip and pinch strength, and range of motion were compared to postoperative scores at 6 weeks, 6 months, and 1 year.

Results

Twenty-three women and 8 men, mean age 62.8 years, underwent 39 joint reconstructions, including CMC (n = 26), thumb MP (n = 2), thumb IP (n = 2), digit MP (n = 2), and digit PIP (n = 7). At 1 year, mean Disability of the Shoulder, Arm, and Hand scores decreased from 41.3 to 15.6 (P < 0.001) and pain scores from 6.9 to 1.0 (P < 0.001). Grip strength increased from 38.1 to 42.9 (P = 0.017) and radial and palmar abduction from 43.1 to 49.2 (P = 0.039) and 43.7 to 51.6 (P = 0.098), respectively. There were no complications related to the meniscus.

Conclusions

Meniscal allograft represents an alternative to arthrodesis which obviates the need for a donor site and avoids many of the complications inherent to synthetic alternatives. Our early results demonstrate its successful use to reduce subjective pain and disability scores, improve objective strength measures, and maintain range of motion.

Functional and patient-reported outcomes of the Swanson metacarpo-phalangeal arthroplasty in the rheumatoid hand

INTRODUCTION

Replacement of the metacarpo-phalangeal joints (MCPJ) with silastic Swanson's implants can help decrease pain, stiffness and allow for improved function in rheumatoid arthritis (RA). There is a lack of patient reported outcome measure (PROM) studies assessing the efficacy of this procedure in RA. The aim of this study was to report any change in function, pain, stiffness and satisfaction following the Swanson MCPJ replacement using patient reported outcomes in a rheumatoid population.

METHODS

The combined results of 64 RA patients (71 hands) with 284 Swanson MCPJ arthroplasties (mean follow-up: 75.85 months) were assessed using the validated M-SACRAH questionnaire and a separate satisfaction questionnaire. Radiographic evaluation was performed to insure correct alignment of the hinged prosthesis postoperatively. No attempt was made to identify other predictors, radiologically or clinically. Data analysed in the study was interpreted in the context of the number of hands and survivorship was defined as implant fracture, loosening or revision.

RESULTS

The mean total functional outcome score improved by 46.2% and the total pain outcome improved by 60.2%. The total stiffness outcome improved by 56.9% postoperatively and the results obtained from the satisfaction questions revealed that 73.2% of patients would retrospectively elect to have the procedure again. We report two postoperative complications in this group of superficial wound infections. Radiographically, all MCPJs showed improved alignment, however five patients reported worsening pain, four patients reported increased stiffness and four reported reduced function postoperatively. There was one re-operation of a 5th MCPJ Swanson's, which did not require implant exchange and one implant was revised. Implant survivorship was 98.6%.

CONCLUSIONS

Patient satisfaction and functional surrogate markers were overall favourable. Our results support the continued use of Swanson silastic arthoplasty in advanced RA.

Joint Arthroplasty With Osteochondral Grafting From the Knee for Posttraumatic or Degenerative Hand Joint Disorders

PURPOSE

To describe the operative procedure and report the clinical outcomes of articular surface reconstruction for various hand joint disorders using autologous osteochondral grafts from the knee.

METHODS

Ten patients underwent articular surface reconstruction for hand joint disorders with autologous osteochondral grafts from the patellofemoral joint. Mean patient age was 35 years (range, 15-52 y). The patients were followed for an average of 48 months (range, 16-89 mo). Arthroplasty was performed on the metacarpophalangeal joint in 4 cases, and on the proximal interphalangeal joint in 6 cases. The patients' clinical outcomes were evaluated with joint range of motion, visual analog scale (0-10 points), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Histological examination was performed in 3 cases after surgery.

RESULTS

Graft union was confirmed in all cases without radiographic evidence of resorption or necrosis. Follow-up radiographic examinations showed good graft incorporation without signs of osteoarthritis such as joint space narrowing. The finger flexion-extension arc improved significantly from an average of 21° to 61°. The mean visual analog scale also improved significantly from 7.0 to 1.5. The mean total active motion showed a significant improvement from 151° before surgery to 201° after surgery, and the mean DASH score improved significantly from 33 to 12. There were no significant differences for the arc of finger motion and DASH score between metacarpophalangeal and proximal interphalangeal joint disorders or between hemiarthroplasty and total joint arthroplasty. Histological examination revealed viable chondrocytes in the implanted cartilage.

CONCLUSIONS

Autologous osteochondral grafting from the patellofemoral joint provided satisfactory outcomes and may be a useful option for joint surface reconstruction of traumatic or degenerative hand joint disorders.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.