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Stevenson RDM, Chowdhury EA, Inza VB, Western MJ, Walsh NE, Jones SL, Bilzon JLJ. Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach. BMC Musculoskelet Disord 2024; 25:189. [PMID: 38431553 PMCID: PMC10908108 DOI: 10.1186/s12891-024-07313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support. METHODS The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention. RESULTS Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application. CONCLUSIONS Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.
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Affiliation(s)
- Richard D M Stevenson
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Enhad A Chowdhury
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Victor B Inza
- Visual Computing Centre, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Max J Western
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
| | - Nicola E Walsh
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Simon L Jones
- Department of Computer Science, The University of Bath, Bath, BA2 7AY, UK
| | - James L J Bilzon
- Department for Health, The University of Bath, Bath, BA2 7AY, UK.
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK.
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Buchanan WW, Kean CA, Kean WF, Rainsford KD. Osteoarthritis. Inflammopharmacology 2024; 32:13-22. [PMID: 37195499 DOI: 10.1007/s10787-023-01223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 05/18/2023]
Abstract
The clinical appearance and radiological pattern of osteoarthritis have been identified in the skeletons of dinosaurs some 50-70 million years old, and in Egyptian mummies, and in ancient skeletons in England. Osteoarthritis patterns of joint involvement, often referred to as primary osteoarthritis, can be seen in the hands, spinal facet joints, hips, knees and feet, but can also be termed secondary osteoarthritis when seen in any joint that has had trauma, sepsis, surgery or metabolic insult. The prevalence of osteoarthritis increases with age. The histology and pathophysiology both demonstrate an inflammatory process. While there have been studies of genetic predisposition, the basic cause of primary osteoarthritis has not been determined.
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Affiliation(s)
- W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | - Walter F Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Wang Z, Xu H, Wang Z, Zhou H, Diao J, Zhang L, Wang Y, Li M, Zhou Y. Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis. Front Immunol 2023; 14:1309751. [PMID: 38155966 PMCID: PMC10752972 DOI: 10.3389/fimmu.2023.1309751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Background With the continuous development of clinical medicine, an increasing number of non-pharmacological interventions have been applied for the treatment of knee osteoarthritis (KOA), with the results of several recent randomized controlled trials (RCTs) showing that a variety of externally-applied, non-pharmacological interventions (EANPI) can improve symptoms and inflammation in patients with KOA. However, the relative benefits and disadvantages of non-drug therapies remain uncertain, and an optimal treatment strategy has not yet been determined. Objective This study applied network meta-analysis (NMA) to compare and rank the effectiveness of EANPI on the short- and long-term clinical symptoms and inflammatory cytokine levels in patients with KOA. Methods Two independent researchers searched online databases and performed manual retrieval of related citations to identify RCTs that met the selection criteria for the network meta-analysis. These researchers retrieved studies indexed from database inception to August 2023 and performed data extraction and assessment of the risk of bias. Results The analysis included 80 RCTs involving 8440 participants and nine externally-applied, non-pharmacological therapies, namely extracorporeal shock wave, radiofrequency, acupotomy, laser therapy, Tuina therapy, kinesio taping, electroacupuncture, platelet-rich plasma injection, and ozone therapy. The treatment courses ranged from 1 to 12 weeks, with follow-up periods ranging from 4 to 24 weeks. The results of the NMA indicated that each non-drug therapy was superior to sham intervention in improving all outcome indicators. Except for the visual analog scale (VAS) and Western Ontario MacMaster (WOMAC) pain outcomes, all non-drug therapies had better efficacy than pharmacological treatments. For short-term VAS and tumor necrosis factor-alpha (TNF-α), extracorporeal shock wave performed better than other therapies (90.2% and 85.2% respectively). Radiofrequency therapy may be the most promising method to reduce long-term VAS, short- and long-term WOMAC pain, and interleukin (IL)-1β level (84.8%, 97.8%, 90.1%, 94.8% respectively). Tuina therapy may be a significant choice for short- and long-term outcomes of WOMAC function and range of motion (ROM). Conclusions The results of the comprehensive comparison of the outcome indicators in 9 different EANPI indicated that radiofrequency and Tuina therapy were more effective and consistently ranked high in improving clinical symptoms in the short and long term. Radiofrequency is effective at relieving pain, and Tuina therapy can be given priority for treatment when hypofunction is the main symptom. EANPI to improve pain symptoms may be related to the regulation of inflammatory cytokine levels, which may be a potential mechanism of action. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42023464177.
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Affiliation(s)
- Zhen Wang
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hui Xu
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
- Tuina Department, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zheng Wang
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hang Zhou
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jieyao Diao
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lijuan Zhang
- Rehabilitation Department, Jiaozuo Coal Industry (Group) Co. Ltd., Central Hospital, Jiaozuo, China
| | - Yu Wang
- College of Computer Science, Xidian University, Xian, China
| | - Miaoxiu Li
- College of Acupuncture and Massage, Shanghai University of Chinese Medicine, Shanghai, China
| | - Yunfeng Zhou
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
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Almahasneh F, Abu-El-Rub E, Khasawneh RR. Mechanisms of analgesic effect of mesenchymal stem cells in osteoarthritis pain. World J Stem Cells 2023; 15:196-208. [PMID: 37181003 PMCID: PMC10173815 DOI: 10.4252/wjsc.v15.i4.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Osteoarthritis (OA) is the most common musculoskeletal disease, and it is a major cause of pain, disability and health burden. Pain is the most common and bothersome presentation of OA, but its treatment is still suboptimal, due to the short-term action of employed analgesics and their poor adverse effect profile. Due to their regenerative and anti-inflammatory properties, mesenchymal stem cells (MSCs) have been extensively investigated as a potential therapy for OA, and numerous preclinical and clinical studies found a significant improvement in joint pathology and function, pain scores and/or quality of life after administration of MSCs. Only a limited number of studies, however, addressed pain control as the primary end-point or investigated the potential mechanisms of analgesia induced by MSCs. In this paper, we review the evidence reported in literature that support the analgesic action of MSCs in OA, and we summarize the potential mechanisms of these antinociceptive effects.
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Affiliation(s)
- Fatimah Almahasneh
- Basic Medical Sciences, Faculty of Medicine -Yarmouk University, Irbid 21163, Jordan
| | - Ejlal Abu-El-Rub
- Basic Medical Sciences, Faculty of Medicine -Yarmouk University, Irbid 21163, Jordan
| | - Ramada R Khasawneh
- Basic Medical Sciences, Faculty of Medicine -Yarmouk University, Irbid 21163, Jordan
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Su G, Lei X, Wang Z, Xie W, Wen D, Wu Y. Mesenchymal Stem Cell-derived Exosomes Affect Macrophage Phenotype: A Cell-free Strategy for the Treatment of Skeletal Muscle Disorders. Curr Mol Med 2023; 23:350-357. [PMID: 35546766 DOI: 10.2174/1566524022666220511123625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
Abstract
The process of tissue damage, repair, and regeneration in the skeletal muscle system involves complex inflammatory processes. Factors released in the inflammatory microenvironment can affect the phenotypic changes of macrophages, thereby changing the inflammatory process, making macrophages an important target for tissue repair treatment. Mesenchymal stem cells exert anti-inflammatory effects by regulating immune cells. In particular, exosomes secreted by mesenchymal stem cells have become a new cell-free treatment strategy due to their low tumorigenicity and immunogenicity. This article focuses on the mechanism of the effect of exosomes derived from mesenchymal stem cells on the phenotype of macrophages after skeletal muscle system injury and explores the possible mechanism of macrophages as potential therapeutic targets after tissue injury.
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Affiliation(s)
- Gang Su
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaoting Lei
- Department of Orthopedics, The First People's Hospital of Tianshui City, Tianshui, China
| | - Zhenyu Wang
- Department of Orthopedics, The First People's Hospital of Tianshui City, Tianshui, China
| | - Weiqiang Xie
- Department of Orthopedics, The First People's Hospital of Tianshui City, Tianshui, China
| | - Donghong Wen
- Department of Orthopedics, The First People's Hospital of Tianshui City, Tianshui, China
| | - Yucheng Wu
- Department of Orthopedics, The First People's Hospital of Tianshui City, Tianshui, China
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Korkmaz MD, Menekşeoğlu AK, Yakşi E. Are inflammatory parameters an independent predictor of hip osteoarthritis severity? A prospective cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:1423-1427. [PMID: 36417647 PMCID: PMC9683907 DOI: 10.1590/1806-9282.20220445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between the presence of hip osteoarthritis and the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and neutrophil-monocyte ratio. METHODS Participants with hip osteoarthritis and healthy controls aged 45-75 years were recruited in the study. The participants with hip osteoarthritis were divided into two groups: mild/moderate hip osteoarthritis and severe hip osteoarthritis. Complete blood parameters of the participants were recorded, and neutrophil-lymphocyte ratio, neutrophil-monocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. Pain severity was evaluated using a visual analog scale. RESULTS A total of 76 participants with hip osteoarthritis and 59 healthy controls were included in the study. The mean age of the participants was 57.6±6.11 years. Mean neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were statistically significantly different between the hip osteoarthritis group and healthy control group (p<0.05). Platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values were not significantly different between the groups. Also, there was no difference between all inflammatory parameters and hip osteoarthritis severity (p>0.05). CONCLUSIONS Neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were higher in patients with hip osteoarthritis than in healthy controls. Mean platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values did not change according to the presence of hip osteoarthritis. Not all hematological indices give valuable information regarding the severity of hip osteoarthritis.
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Affiliation(s)
- Merve Damla Korkmaz
- Kanuni Sultan Suleyman Training and Research Hospital, Department of Physical Therapy and Rehabilitation – Istanbul, Turkey
| | - Ahmet Kıvanç Menekşeoğlu
- Kanuni Sultan Suleyman Training and Research Hospital, Department of Physical Therapy and Rehabilitation – Istanbul, Turkey
| | - Elif Yakşi
- Abant Izzet Baysal University, Medical Faculty, Department of Physical Therapy and Rehabilitation – Bolu, Turkey.,Corresponding author:
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Wang S, Ma J, Zhao X, Xue Y, Liu W, Huang H, Zhang L, Tian A, Ma X. The Osteoarthritis Natural Progress and Changes in Intraosseous Pressure of the Guinea Pig Model in Different Degeneration Stages. Orthop Surg 2022; 14:3036-3046. [PMID: 36168980 DOI: 10.1111/os.13496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Articular cartilage and subchondral bone changes during the pathological progress of knee osteoarthritis (KOA) is a key event marking the development of the disease. The age varying alteration patterns within entire osteochondral unit remains poorly understood. The purpose of this study was to find a reasonable age range of the Dunkin-Hartley guinea pig model for the studying of KOA pathological process, and to investigate Intraosseous pressure (IOP) in the process during different degeneration stages of KOA. METHODS Male Dunkin-Hartley guinea pigs were selected and divided into groups of 3, 6, 9, 12, 18 months old by age, 10 in each group. All knees underwent imaging examination including X-ray, Micro-CT and MRI. Observed the imaging findings with the use of Kellgren-Lawrence (K-L) classification and knee osteoarthritis MRI scores. Measured the IOP of distal femur (DF) and proximal tibia (PT) in each group, and observed the differences of bilateral tibiofemoral articular cartilage in histological and immunohistochemistry, staining results were evaluated by using Mankin's score. Analysis of variance (ANOVA) and t-tests were used to compare the differences indicators between groups. RESULTS With the increase of age, changes in X-ray, Micro-CT and MRI imaging findings and pathological staining results of articular cartilage in all stages were consistent with the changing of degenerative KOA process. The IOP of DF and PT increased gradually with age, and reached its peak in 12-month age group, and then gradually decreased, there was a statistically significant difference of IOP between each group. The IOP of DF was slightly higher than that of PT, but the difference was not statistically significant. CONCLUSION Dunkin-Hartley guinea pigs can be used as an animal model to study different pathological stages of KOA. There might be a correlation between the changes of IOP and the pathological progress of articular cartilage and subchondral bone in DF and PT.
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Affiliation(s)
- Shuo Wang
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China.,Department of Orthopaedics, Chinese People's Liberation Army Joint Logistics Support Force Tianjin Rehabilitation Center (Former No. 464 Hospital of People's Liberation Army), Tianjin, China
| | - Jianxiong Ma
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xingwen Zhao
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Liu
- Department of Orthopaedics, Tianjin Baodi Hospital, Tianjin, China
| | - Hongchao Huang
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lei Zhang
- Department of Orthopaedics, Tianjin Medical University Hospital for Metabolic Diseases, Tianjin, China
| | - Aixian Tian
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xinlong Ma
- Orthopaedics Institute of Tianjin, Tianjin Hospital, Tianjin University, Tianjin, China
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Berteau JP. Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions. J Clin Med 2022; 11:3252. [PMID: 35743322 DOI: 10.3390/jcm11123252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
For patients presenting knee pain coming from osteoarthritis (OA), non-pharmacological conservative treatments (e.g., physical therapy interventions) are among the first methods in orthopedics and rehabilitation to prevent OA progression and avoid knee surgery. However, the best strategy for each patient is difficult to establish, because knee OA's exact causes of progression are not entirely understood. This narrative review presents (i) the most recent update on the pathogenesis of knee OA with the risk factors for developing OA and (ii) the most recent evidence for reducing knee pain with physical therapy intervention such as Diathermy, Exercise therapy, Ultrasounds, Knee Brace, and Electrical stimulation. In addition, we calculated the relative risk reduction in pain perception for each intervention. Our results show that only Brace interventions always reached the minimum for clinical efficiency, making the intervention significant and valuable for the patients regarding their Quality of Life. In addition, more than half of the Exercise and Diathermy interventions reached the minimum for clinical efficiency regarding pain level. This literature review helps clinicians to make evidence-based decisions for reducing knee pain and treating people living with knee OA to prevent knee replacement.
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ABSTRACTS (BY NUMBER): These are the abstracts as submitted through the website. Last minute changes, title and presenting changes are not always reflected in this file.. Tissue Eng Part A 2022; 28:S-1-S-654. [DOI: 10.1089/ten.tea.2022.29025.abstracts] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Abstract
Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.
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Affiliation(s)
- Chu-Yang Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen-Rong Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Zhi-Ming Tang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Fu-Zhou Hua
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Fantoni I, Biz C, Fan C, Pirri C, Fede C, Petrelli L, Ruggieri P, De Caro R, Stecco C. Fascia Lata Alterations in Hip Osteoarthritis: An Observational Cross-Sectional Study. Life (Basel) 2021; 11:life11111136. [PMID: 34833012 PMCID: PMC8625990 DOI: 10.3390/life11111136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022] Open
Abstract
The present study compares the structure and composition of fascia lata in healthy subjects and in patients with hip osteoarthritis (OA), to evaluate any differences in the amount of Collagen type I, Collagen type III, and Hyaluronan. Fascia lata samples from voluntary healthy subjects and patients with OA were harvested during surgery. Collagen type I (COL I), III (COL III) antibody, and biotinylated hyaluronan binding protein (HABP) immunohistochemistry stainings were used to evaluate fascial morphology and COL I, COL III, and Hyaluronan (HA) content in both groups. Ten samples from healthy subjects and 11 samples from OA patients were collected. COL I was significantly more abundant in the OA group (p = 0.0015), with a median percentage positivity of 75.2 (IQR 13.11)%, while representing only 67 (IQR: 8.71)% in control cases. COL III, with median values of 9.5 (IQR 3.63)% (OA group) and 17.10 (IQR 11)% (control cases), respectively, showed significant reduction in OA patients (p = 0.002). HA showed a median value of 10.01 (IQR 8.11)% in OA patients, denoting significant decrease (p < 0.0001) with respect to the control group median 39.31 (IQR 5.62)%. The observed differences suggest a relationship between fascial pathology and hip OA. The observed increase in COL I in OA patients, along with the reduction of COL III and HA, could lead to fascial stiffening, which could alter fascial mechanics and be linked to the development and symptoms of OA.
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Affiliation(s)
- Ilaria Fantoni
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy; (I.F.); (C.B.); (P.R.)
| | - Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy; (I.F.); (C.B.); (P.R.)
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
- Correspondence:
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy; (I.F.); (C.B.); (P.R.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (L.P.); (R.D.C.); (C.S.)
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Baer K, Kieser S, Schon B, Rajendran K, Ten Harkel T, Ramyar M, Löbker C, Bateman C, Butler A, Raja A, Hooper G, Anderson N, Woodfield T. Spectral CT imaging of human osteoarthritic cartilage via quantitative assessment of glycosaminoglycan content using multiple contrast agents. APL Bioeng 2021; 5:026101. [PMID: 33834156 PMCID: PMC8018795 DOI: 10.1063/5.0035312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Detection of early osteoarthritis to stabilize or reverse the damage to articular cartilage would improve patient function, reduce disability, and limit the need for joint replacement. In this study, we investigated nondestructive photon-processing spectral computed tomography (CT) for the quantitative measurement of the glycosaminoglycan (GAG) content compared to destructive histological and biochemical assay techniques in normal and osteoarthritic tissues. Cartilage-bone cores from healthy bovine stifles were incubated in 50% ioxaglate (Hexabrix®) or 100% gadobenate dimeglumine (MultiHance®). A photon-processing spectral CT (MARS) scanner with a CdTe-Medipix3RX detector imaged samples. Calibration phantoms of ioxaglate and gadobenate dimeglumine were used to determine iodine and gadolinium concentrations from photon-processing spectral CT images to correlate with the GAG content measured using a dimethylmethylene blue assay. The zonal distribution of GAG was compared between photon-processing spectral CT images and histological sections. Furthermore, discrimination and quantification of GAG in osteoarthritic human tibial plateau tissue using the same contrast agents were demonstrated. Contrast agent concentrations were inversely related to the GAG content. The GAG concentration increased from 25 μg/ml (85 mg/ml iodine or 43 mg/ml gadolinium) in the superficial layer to 75 μg/ml (65 mg/ml iodine or 37 mg/ml gadolinium) in the deep layer of healthy bovine cartilage. Deep zone articular cartilage could be distinguished from subchondral bone by utilizing the material decomposition technique. Photon-processing spectral CT images correlated with histological sections in healthy and osteoarthritic tissues. Post-imaging material decomposition was able to quantify the GAG content and distribution throughout healthy and osteoarthritic cartilage using Hexabrix® and MultiHance® while differentiating the underlying subchondral bone.
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Affiliation(s)
| | - Sandra Kieser
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE), Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | | | | | - Mohsen Ramyar
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | - Christopher Bateman
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | | | | | - Nigel Anderson
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
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Aiyer R, Noori S, Schirripa F, Schirripa M, Aboud T, Jain S, Gulati A, Puttanniah V, Gungor S, Hunter C. Treatment of knee osteoarthritic pain with platelet-rich plasma: a systematic review of clinical studies. Pain Manag 2021; 11:419-431. [PMID: 33764185 DOI: 10.2217/pmt-2020-0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: Knee osteoarthritis is a degenerative joint disease that is secondary to degradation of articular cartilage, reformation of subchondral bone through degradation and proliferation as well as presence of synovitis. Materials & methods: This systematic review was conducted and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: A total of 30 of the 48 comparators showed statistically significant superiority with platelet-rich plasma (PRP) compared with a control, while the other 16 comparators showed no significant difference between PRP and the comparator. Conclusion: We can only recommend PRP for patients with early-stage osteoarthritis (I or II) and who are aged below 65, based on our findings. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommendations, while studies reviewed were randomized controlled studies, and therefore, high grade, due to variance in imprecision, risk of bias and inconsistency among the 37 studies, it would be reasonable to rate this paper as subjectively moderate.
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Affiliation(s)
- Rohit Aiyer
- Department of Anesthesiology, Pain Management & Perioperative Medicine- Henry Ford Health System, Detroit, MI, USA
| | | | - Frank Schirripa
- Department of Rehabilitation & Regenerative Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine & Columbia Campuses, NY, USA
| | - Michael Schirripa
- Department of Anesthesiology, NewYork-Presbyterian, Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Talal Aboud
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sameer Jain
- Pain Centers of America, White Hall, AK, USA
| | - Amitabh Gulati
- Department of Anesthesia & Critical Care, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, NY, USA
| | - Vinay Puttanniah
- Department of Anesthesia & Critical Care, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, NY, USA
| | - Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, NY, USA
| | - Corey Hunter
- Ainsworth Institute of Pain Management & Department of Rehabilitation & Human Performance, Mount Sinai Health System, NY, USA
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Zheng L, Zhang Z, Sheng P, Mobasheri A. The role of metabolism in chondrocyte dysfunction and the progression of osteoarthritis. Ageing Res Rev 2021; 66:101249. [PMID: 33383189 DOI: 10.1016/j.arr.2020.101249] [Citation(s) in RCA: 237] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) is a degenerative joint disease characterized by low-grade inflammation and high levels of clinical heterogeneity. Aberrant chondrocyte metabolism is a response to changes in the inflammatory microenvironment and may play a key role in cartilage degeneration and OA progression. Under conditions of environmental stress, chondrocytes tend to adapt their metabolism to microenvironmental changes by shifting from one metabolic pathway to another, for example from oxidative phosphorylation to glycolysis. Similar changes occur in other joint cells, including synoviocytes. Switching between these pathways is implicated in metabolic alterations that involve mitochondrial dysfunction, enhanced anaerobic glycolysis, and altered lipid and amino acid metabolism. The shift between oxidative phosphorylation and glycolysis is mainly regulated by the AMP-activated protein kinase (AMPK) and mechanistic target of rapamycin (mTOR) pathways. Chondrocyte metabolic changes are likely to be a feature of different OA phenotypes. Determining the role of chondrocyte metabolism in OA has revealed key features of disease pathogenesis. Future research should place greater emphasis on immunometabolism and altered metabolic pathways as a means to understand the pathophysiology of age-related OA. This knowledge will advance the development of new drugs against therapeutic targets of metabolic significance.
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Affiliation(s)
- Linli Zheng
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080 China
| | - Ziji Zhang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080 China
| | - Puyi Sheng
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080 China.
| | - Ali Mobasheri
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080 China; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, FI-90014 Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, LT-08406, Vilnius, Lithuania; Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, 508 GA, Utrecht, The Netherlands.
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Novak S, Guerron G, Zou Z, Cheung G, Berteau JP. New Guidelines for Electrical Stimulation Parameters in Adult Patients With Knee Osteoarthritis Based on a Systematic Review of the Current Literature. Am J Phys Med Rehabil 2020; 99:682-8. [PMID: 32167955 DOI: 10.1097/PHM.0000000000001409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The goal of this systematic review was to provide guidelines for treatment parameters regarding electrical stimulation by investigating its efficacy in improving muscle strength and decreasing pain in patients with knee osteoarthritis. DESIGN Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard, three electronic databases (CINAHL, PubMed, and PEDro) and gray literature were used. Randomized control trials comparing electrical stimulation and conservative physical therapy were critically appraised using the 2005 University of Oxford standard. RESULTS Nine randomized control trials were included in our review. First, our review confirmed that neuromuscular electrical stimulation is the most effective electrical stimulation treatment in the management of knee OA, and its efficiency is higher when combined with a strengthening program. Second, frequency of at least 50 Hz and no more than 75 Hz with a pulse duration between 200 and 400 μs and a treatment duration of 20 mins is necessary for successful treatment. CONCLUSIONS For the first time, our review provides standardized clinical treatment parameters for neuromuscular electrical stimulation to be included in a strengthening program for the adult patient with knee OA. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Recall the impact of quadriceps femoris weakness on joint stability; (2) Summarize the mechanism of action of neuromuscular electrical stimulation (NMES) on reducing pain and increasing muscle strength; and (3) Plan the clinical treatment parameters of NMES to be included in a strengthening program for an adult patient with knee osteoarthritis. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Doyle EC, Wragg NM, Wilson SL. Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2020; 28:3827-3842. [PMID: 32006075 PMCID: PMC7669782 DOI: 10.1007/s00167-020-05859-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/16/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE This review aimed to evaluate the efficacy of intra-articular injections of bone marrow derived mesenchymal stem cells (BM-MSCs) for the treatment of knee osteoarthritis (KOA). METHODS This narrative review evaluates recent English language clinical data and published research articles between 2014 and 2019. Key word search strings of ((("bone marrow-derived mesenchymal stem cell" OR "bone marrow mesenchymal stromal cell" OR "bone marrow stromal cell")) AND ("osteoarthritis" OR "knee osteoarthritis")) AND ("human" OR "clinical"))) AND "intra-articular injection" were used to identify relevant articles using PMC, Cochrane Library, Web Of Science and Scopus databases. RESULTS Pre-clinical studies have demonstrated successful, safe and encouraging results for articular cartilage repair and regeneration. This is concluded to be due to the multilineage differential potential, immunosuppressive and self-renewal capabilities of BM-MSCs, which have shown to augment pain and improve functional outcomes. Subsequently, clinical applications of intra-articular injections of BM-MSCs are steadily increasing, with most studies demonstrating a decrease in poor cartilage index, improvements in pain, function and Quality of Life (QoL); with moderate-to-high level evidence regarding safety for therapeutic administration. However, low confidence in clinical efficacy remains due to a plethora of heterogenous methodologies utilised, resulting in challenging study comparisons. A moderate number of cells (40 × 106) were identified as most likely to achieve optimal responses in individuals with grade ≥ 2 KOA. Likewise, significant improvements were reported when using lower (24 × 106) and higher (100 × 106) cell numbers, although adverse effects including persistent pain and swelling were a consequence. CONCLUSION Overall, the benefits of intra-articular injections of BM-MSCs were deemed to outweigh the adverse effects; thus, this treatment be considered as a future therapy strategy. To realise this, long-term large-scale randomised clinical trials are required to enable improved interpretations, to determine the validity of efficacy in future studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Emily Claire Doyle
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU Leicestershire UK
| | - Nicholas Martin Wragg
- Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU Leicestershire UK
| | - Samantha Louise Wilson
- Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK.
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17
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Abstract
Osteoarthritis (OA) is the most common motor system disease in the elderly, with a high incidence and a huge social and economic burden. Therefore, it is urgent to study its potential pathogenesis to improve the therapeutic effect of the disease. In this study, we constructed a number of regulator-mediated OA dysfunction modules, and carried out in-depth analysis in order to examine the disease development process. Differential expression analysis, co-expression analysis and enrichment analysis were combined to screen genes related to disease progression. Subsequently, key regulatory factors in the process of OA were identified based on the pivotal regulators that may manipulate important parts of the module subnetwork. A total of 16 OA dysfunction modules were obtained, involving the aggregation of 3,239 module genes. Then, enrichment analysis showed that module genes were significantly involved in apoptosis, inflammation-related functions and signaling pathways. Finally, we revealed a series of regulators, including 842 ncRNA (miR-132-3p, miR-130a-3p and miR-590-3p), 59 transcription factors (NFKB1, RELA and STAT3). We consider that STAT3 is the core transcription factor and promotes the development of OA through the signal of NF-κB. Overall, our results provide biologists and pharmacists with a new way of thinking to reveal the disease process of OA, and provide a wider range of candidate targets for follow-up research.
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Affiliation(s)
- Feida Wang
- Department of Osteopathy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Zhenye Guo
- Department of Osteopathy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yinpeng Yuan
- Department of Osteopathy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
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Chin KY, Wong SK, Japar Sidik FZ, Abdul Hamid J, Abas NH, Mohd Ramli ES, Afian Mokhtar S, Rajalingham S, Ima Nirwana S. The Effects of Annatto Tocotrienol Supplementation on Cartilage and Subchondral Bone in an Animal Model of Osteoarthritis Induced by Monosodium Iodoacetate. Int J Environ Res Public Health 2019; 16:ijerph16162897. [PMID: 31412648 PMCID: PMC6720523 DOI: 10.3390/ijerph16162897] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/18/2022]
Abstract
Osteoarthritis is a degenerative joint disease which primarily affects the articular cartilage and subchondral bones. Since there is an underlying localized inflammatory component in the pathogenesis of osteoarthritis, compounds like tocotrienol with anti-inflammatory properties may be able to retard its progression. This study aimed to determine the effects of oral tocotrienol supplementation on the articular cartilage and subchondral bone in a rat model of osteoarthritis induced by monosodium iodoacetate (MIA). Thirty male Sprague-Dawley rats (three-month-old) were randomized into five groups. Four groups were induced with osteoarthritis (single injection of MIA at week 0) and another served as the sham group. Three of the four groups with osteoarthritis were supplemented with annatto tocotrienol at 50, 100 and 150 mg/kg/day orally for five weeks. At week 5, all rats were sacrificed, and their tibial-femoral joints were harvested for analysis. The results indicated that the groups which received annatto tocotrienol at 100 and 150 mg/kg/day had lower histological scores and cartilage remodeling markers. Annatto tocotrienol at 150 mg/kg/day significantly lowered the osteocalcin levels and osteoclast surface of subchondral bone. In conclusion, annatto tocotrienol may potentially retard the progression of osteoarthritis. Future studies to confirm its mechanism of joint protection should be performed.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia.
| | - Sok Kuan Wong
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | | | - Juliana Abdul Hamid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Nurul Hafizah Abas
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Elvy Suhana Mohd Ramli
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Sakthiswary Rajalingham
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Soelaiman Ima Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
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Arias-Vázquez PI, Tovilla-Zárate CA, Hernández-Díaz Y, González-Castro TB, Juárez-Rojop IE, López-Narváez ML, Bermudez-Ocaña DY, Barjau-Madrígal HA, Legorreta-Ramírez G. Short-Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta-Analysis. PM R 2019; 11:879-887. [PMID: 30689297 DOI: 10.1002/pmrj.12088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ozone therapy has been used widely to decrease pain related to osteoarthritis, but the effectiveness of this treatment has not been evaluated. OBJECTIVE To evaluate the effectiveness of ozone therapy in the reduction of pain in patients with knee osteoarthritis, according to the type of intervention and duration of the effect. TYPE: Meta-analysis. LITERATURE SURVEY We performed an online search using PUBMED, DIALNET, SCIELO, MEDIGRAPHIC, and ISCO3 databases. We searched for articles published up to January 2018. PARTICIPANTS We selected eight studies including a total of 355 patients and 363 controls. METHODOLOGY Only randomized-controlled trials that assessed the efficacy of intraarticular or periarticular infiltrations with ozone to treat knee osteoarthritis in humans were included in the analysis. The results are expressed as standardized mean difference and 95% confidence intervals. The meta-analysis was performed in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. SYNTHESIS We observed that ozone treatment had a therapeutic effect when compared with placebo (d = -0.81, 95% CI -1.06 to -0.55, I2 = 34.79, P(Q) = .47) or other noninvasive treatments. No significant effects were found in favor of the ozone treatment when compared with the use of hyaluronic acid or platelet-rich plasma. However, the use of ozone had a significant short-term benefit reducing knee pain (d = -2.26, 95% CI -2.26 to -3.72, I2 = 97, P(Q) < .001). Pain relief benefits lasted between 3 and 6 months. CONCLUSION Our results indicate that intraarticular infiltrations of ozone can be used as an optional effective treatment for the management of pain related to knee osteoarthritis. There are short-term effect benefits that peak at around 1 month of treatment, with a gradual decline in efficacy after 3 to 6 months of treatment. More studies are needed to improve our understanding of the efficacy of this interventional treatment. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Pedro Iván Arias-Vázquez
- Multidisciplinary Academic Division of Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- Multidisciplinary Academic Division of Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Yazmín Hernández-Díaz
- Multidisciplinary Academic Division of Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, Mexico
| | - Thelma Beatriz González-Castro
- Multidisciplinary Academic Division of Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, Mexico
| | - Isela Esther Juárez-Rojop
- Academic Division of Health Sciences, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | | | - Deysi Yadira Bermudez-Ocaña
- Multidisciplinary Academic Division of Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Hugo Adrián Barjau-Madrígal
- Multidisciplinary Academic Division of Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Gabriela Legorreta-Ramírez
- Subdirección Medical Clinic, Rehabilitation Center Children Telethon, Tlanepantla, Estado de México, MéxicoDisclosures: none
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20
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O'Connell B, Wragg NM, Wilson SL. The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res 2019; 376:143-52. [PMID: 30758709 DOI: 10.1007/s00441-019-02996-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/11/2019] [Indexed: 01/11/2023]
Abstract
Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented.
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21
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Zhang Y, Zeng Y. Curcumin reduces inflammation in knee osteoarthritis rats through blocking TLR4 /MyD88/NF-κB signal pathway. Drug Dev Res 2019; 80:353-359. [PMID: 30663793 DOI: 10.1002/ddr.21509] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023]
Abstract
Preclinical Research & Development Curcumin has been shown to possess a series of beneficial effects, such as antiinflammatory, antioxidant, analgesic, and promoting healing. However, the effect and relative mechanism of curcumin on knee osteoarthritis (OA) have not been elucidated. The aim of this study is to explore the protective effect of curcumin on monosodium iodoacetate (MIA)-induced OA. Forty-eight rats were randomized into four experimental groups: control group, OA group, OA + PBS group, and OA + curcumin group, respectively. A single intraarticular injection of MIA was applied to establish the rat model of knee OA. Hematoxylin-eosin staining was used to evaluate histological changes of knee joint. The paw withdrawal threshold was collected and the expression of synovial fluid cytokine levels was measured by ELISA. The protein expression of TRL-4, MyD88, p-IκBα, NF-κB, TNF-α, IL-1β, and IL6 was measured by western blot. Treating with curcumin can significantly reduce joint diameter and Mankin's score, and increase the paw withdrawal threshold. The expression of synovial fluid inflammatory biomarkers, IL-6, IL-1β, and TNF-α in the OA + curcumin group were lower than that in OA and OA + PBS group. The protein expression of the TLR4 receptor was increased in the OA, OA + PBS, and OA + curcumin group compared to the control group. However, curcumin treatment can significantly decrease the expression of MyD88, p-IκBα, NF-κB, TNF-α, IL-1β, and IL6 in OA + curcumin group. These findings may indicate that curcumin could block TLR4/NF-κB signal pathway, and reduce inflammation level to prevent knee wound in OA rats. Curcumin may be a feasible kind of medicament in the treatment of knee OA.
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Affiliation(s)
- Yun Zhang
- Department of Orthopedics of Traditional Chinese Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Yu Zeng
- Department of Hyperbaric Oxygen, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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22
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Edd SN, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Modeling knee osteoarthritis pathophysiology using an integrated joint system (IJS): a systematic review of relationships among cartilage thickness, gait mechanics, and subchondral bone mineral density. Osteoarthritis Cartilage 2018; 26:1425-1437. [PMID: 30056214 DOI: 10.1016/j.joca.2018.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce an integrated joint system (IJS) model of joint health and osteoarthritis (OA) pathophysiology through a systematic review of the cross-sectional relationships among three knee properties (cartilage thickness, gait mechanics, and subchondral bone mineral density). METHODS Searches using keywords associated with the three knee properties of interest were performed in PubMed, Scopus, and Ovid databases. English-language articles reporting cross-sectional correlations between at least two knee properties in healthy or tibiofemoral OA human knees were included. A narrative synthesis of the data was conducted. RESULTS Of the 5600 retrieved articles, 13 were included, eight of which reported relationships between cartilage thickness and gait mechanics. The 744 tested knees were separated into three categories based on knee health: 199 healthy, 340 at-risk/early OA, and 205 late OA knees. Correlations between knee adduction moment and medial-to-lateral cartilage thickness ratios were generally positive in healthy, inconclusive in at-risk/early OA, and negative in late OA knees. Knee adduction moment was positively correlated with medial-to-lateral tibial subchondral bone mineral density ratios in knees of all health categories. One study reported a positive correlation between lateral tibial subchondral bone mineral density and femoral cartilage thickness in at-risk/early OA knees. CONCLUSIONS The correlations identified between knee properties in this review agreed with the proposed relationship-based IJS model of OA pathophysiology. Accordingly, the IJS model could provide insights into overcoming current barriers to developing disease-modifying treatments by considering multiple aspects of OA disease, aspects that could be assessed simultaneously at an in vivo system level.
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Affiliation(s)
- S N Edd
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
| | - P Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland.
| | - T P Andriacchi
- Department of Mechanical Engineering, Stanford, CA, USA; Palo Alto Veterans Affairs, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - B M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland.
| | - J Favre
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
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Zhou J, Liao Y, Xie H, Liao Y, Liu H, Zeng Y, Li N. Pulsed electromagnetic field ameliorates cartilage degeneration by inhibiting mitogen-activated protein kinases in a rat model of osteoarthritis. Phys Ther Sport 2017; 24:32-38. [DOI: 10.1016/j.ptsp.2016.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
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Li Y, Zhang Y, Chen C, Zhang H, Ma C, Xia Y. Establishment of a rabbit model to study the influence of advanced glycation end products accumulation on osteoarthritis and the protective effect of pioglitazone. Osteoarthritis Cartilage 2016; 24:307-14. [PMID: 26321377 DOI: 10.1016/j.joca.2015.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/24/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the role of advanced glycation end products (AGEs) in cartilage degeneration in vivo and determine the influence of the peroxisome proliferator-activated receptor-γ (PPARγ) agonist pioglitazone on AGEs-induced osteoarthritis (OA) in a rabbit model. DESIGN Thirty-two rabbits were separated into four groups (n = 8 each) and received 500 μL of 123, 350, or 1000 mmol/L D-ribose or Phosphate buffered saline (PBS) solution administered to the right stifle joint via intra-articular injection twice a week. All the rabbits ran 500 m on treadmills every day. Another 16 rabbits were administered 1000 mmol/L D-ribose and divided into 2 groups (n = 8) that received either placebo or pioglitazone administered orally at 20 mg/kg/day. Eight weeks later, cartilage damage was evaluated macroscopically, histologically, and biochemically. RESULTS Artificially increasing the AGEs level and exercise load resulted in cartilage damage and dose-dependent downregulation of PPARγ expression. The efficacy of pioglitazone treatment was tested in a rabbit OA model, and a clear chondroprotective effect was revealed by macro- and microscopic assessments. CONCLUSION Elevating AGEs in rabbits can accelerate the articular cartilage degradation that occurs with physical exercise, and pioglitazone can reduce the severity of the AGEs-induced OA in a rabbit model.
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Affiliation(s)
- Y Li
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
| | - Y Zhang
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
| | - C Chen
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
| | - H Zhang
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
| | - C Ma
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
| | - Y Xia
- The 163rd Central Hospital of the People's Liberation Army, The Second Affiliated Hospital of Hunan Normal University, PR China.
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Liao Y, Li X, Li N, Zhou J. Electroacupuncture protects against articular cartilage erosion by inhibiting mitogen-activated protein kinases in a rat model of osteoarthritis. Acupunct Med 2016; 34:290-5. [PMID: 26810784 DOI: 10.1136/acupmed-2015-010949] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The therapeutic effects of electroacupuncture (EA) on osteoarthritis (OA) are well documented; however, the precise mechanisms of action have not yet been fully elucidated. The present study aimed to investigate the effect of EA on cartilage in an experimental animal model of OA induced by anterior cruciate ligament transection (ACLT) and to examine for concomitant changes in the expression of mitogen-activated protein kinases (MAPKs) in the articular cartilage. METHODS Thirty-three-month-old male Sprague Dawley rats were randomly divided into the following three groups (n=10 each): sham operated group (Control group), ACLT without treatment (ACLT group), and ACLT with EA treatment (ACLT+EA group). One week after ACLT, rats in the ACLT+EA group received 12 weeks of EA treatment. Histological analysis and quantitative real-time PCR were used to investigate the effects of EA on cartilage morphology (quantified using modified Mankin scores) and expression of MAPKs (p38, c-Jun N-terminal kinase (c-Jun), and extracellular signal-regulated kinase (ERK)1), respectively. RESULTS ACLT produced coarse cartilage surfaces, fibrous degeneration, and fissuring, all of which were suppressed by EA treatment. Although Mankin scores in the ACLT+EA group were significantly higher compared to the Control group (p<0.01), they were significantly lower than the (untreated) ACLT group (p<0.01). The increase in mRNA expression of p38, c-Jun, ERK1, and matrix metalloproteinase (MMP)-13 observed in cartilage after ACLT was significantly inhibited by EA. CONCLUSIONS EA appears to prevent the degeneration of articular cartilage, at least partly through regulation of MMP-13 and inhibition of MAPKs in the cartilage of rats with ACLT-induced OA.
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Affiliation(s)
- Ying Liao
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Xinhong Li
- Hunan Polytechnic of Environment and Biology, Hengyang, Hunan, People's Republic of China
| | - Neng Li
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Jun Zhou
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
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Abstract
OBJECTIVES Potential gene therapy application of single and co-expression of interleukin 1 (IL-1) receptor antagonist (IL-1Ra) and transforming growth factor-β1 (TGF-β1) to alter disease progression was investigated in an in-vivo rabbit model of osteoarthritis (OA). METHOD Sixteen young adult rabbits were randomly and equally divided into four groups: blank control group, IL-1Ra transfection group, TGF-β1 transfection group, and IL-1Ra/TGF-β1 double transfection group. Histological examinations were performed to monitor disease progression after haematoxylin and eosin (H&E) staining of articular cartilage. Immunohistochemistry was used to detect IL-1Ra and TGF-β1 in synovial membrane tissues. Exogenous IL-1Ra and TGF-β1 content was assessed in joint lavage fluid using an enzyme-linked immunosorbent assay (ELISA). RESULTS ELISA measurements from the joint lavage fluid showed high expressions of IL-1Ra and TGF-β1 in the single and double transfection groups. Remarkably, concomitant reductions in IL-1β and tumour necrosis factor alpha (TNF-α) levels were observed in these single and double transfection groups. Radioimmunoassay (RIA)-based detection showed that IL-1β and TNF-α levels in the gene transfection groups were significantly lower compared to the blank control group, in parallel experiments. Importantly, injection of IL-1Ra and TGF-β1 expressing cartilage cells into joints led to a significant inhibition of cartilage matrix degradation. Finally, IL-1Ra and TGF-β1 expression in tissues correlated with disease reversal in the experimental group, with improved tissue architecture and collagen deposition. CONCLUSIONS Our results reveal that both single- and double-gene transfection of IL-1Ra and TGF-β1 promote extensive repair of damaged cartilage, and double transfections showed better recovery than single transfections, suggesting that co-expression of IL-1Ra and TGF-β1 inhibits degeneration and improves repair of articular cartilage in OA.
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Affiliation(s)
- P Zhang
- a Department of Orthopaedics, the Third Affiliated Hospital , Guangzhou Medical University , Guangzhou , P. R. China
| | - Z-H Zhong
- a Department of Orthopaedics, the Third Affiliated Hospital , Guangzhou Medical University , Guangzhou , P. R. China
| | - H-T Yu
- a Department of Orthopaedics, the Third Affiliated Hospital , Guangzhou Medical University , Guangzhou , P. R. China
| | - B Liu
- b Department of Orthopaedics, the Third Affiliated Hospital , Sun Yat-Sen University , Guangzhou , P. R. China
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Wen Y, Li J, Tan Y, Qin J, Xie X, Wang L, Mei Q, Wang H, Magdalou J, Chen L. Angelica Sinensis polysaccharides stimulated UDP-sugar synthase genes through promoting gene expression of IGF-1 and IGF1R in chondrocytes: promoting anti-osteoarthritic activity. PLoS One 2014; 9:e107024. [PMID: 25202993 PMCID: PMC4159308 DOI: 10.1371/journal.pone.0107024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic joints disease characterized by progressive degeneration of articular cartilage due to the loss of cartilage matrix. Previously, we found, for the first time, that an acidic glycan from Angelica Sinensis Polysaccharides (APSs), namely the APS-3c, could protect rat cartilage from OA due to promoting glycosaminoglycan (GAG) synthesis in chondrocytes. In the present work, we tried to further the understanding of ASP-3c's anti-OA activity. METHODOLOGY/PRINCIPAL FINDINGS Human primary chondrocytes were treated with APS-3c or/and recombinant human interleukin 1β (IL-1β). It turned out that APS-3c promoted synthesis of UDP-xylose and GAG, as well as the gene expression of UDP-sugar synthases (USSs), insulin like growth factor 1 (IGF1) and IGF1 receptor (IGF1R), and attenuated the degenerative phenotypes, suppressed biosynthesis of UDP-sugars and GAG, and inhibited the gene expression of USSs, IGF1 and IGF1R induced by IL-1β. Then, we induced a rat OA model with papain, and found that APS-3c also stimulated GAG synthesis and gene expression of USSs, IGF1 and IGF1R in vivo. Additionally, recombinant human IGF1 and IGF1R inhibitor NP-AEW541 were applied to figure out the correlation between stimulated gene expression of USSs, IGF1 and IGF1R induced by APS-3c. It tuned out that the promoted GAG synthesis and USSs gene expression induced by APS-3c was mediated by the stimulated IGF1 and IGF1R gene expression, but not through directly activation of IGF1R signaling pathway. CONCLUSIONS/SIGNIFICANCES We demonstrated for the first time that APS-3c presented anti-OA activity through stimulating IGF-1 and IGF1R gene expression, but not directly activating the IGF1R signaling pathway, which consequently promoted UDP-sugars and GAG synthesis due to up-regulating gene expression of USSs. Our findings presented a better understanding of APS-3c's anti-OA activity and suggested that APS-3c could potentially be a novel therapeutic agent for OA.
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Affiliation(s)
- Yinxian Wen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jing Li
- Department of pharmacology, Basic Medical School of Wuhan University, Wuhan, China
| | - Yang Tan
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Qin
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xianfei Xie
- Department of pharmacology, Basic Medical School of Wuhan University, Wuhan, China
| | - Linlong Wang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qibing Mei
- Department of Pharmacology, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Hui Wang
- Department of pharmacology, Basic Medical School of Wuhan University, Wuhan, China; Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, China
| | - Jacques Magdalou
- UMR 7365 CNRS-Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, China
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Abstract
BACKGROUND Foot osteoarthritis (OA) is linked with chronic foot pain and functional impairment. OBJECTIVE To review the current knowledge on midfoot and forefoot OA. METHODS PubMed, CINAHL, PEDro, and the ISI Web of Science databases (1950-2013) were searched for keywords: foot OA, midfoot OA, forefoot OA and metatarsal OA. The search was limited to reports in human subjects and English language. Published cohort, cross-sectional studies and clinical trials relating to epidemiology, clinical features, functional impairment, risk factors and treatment were included. RESULTS We found heterogeneity in the design, radiographic views and grading systems used among studies. Most of the literature focused on radiographic OA, being the prevalence between 0.1% and 61%, depending on gender, age and joint evaluated. The age and female gender were the main associated factors, whereas structural (bone length) and mechanical factors (hypermobility, altered tarso-metatarsal stress, etc.) seemed to be related. Various treatments are widely used, i.e. physical therapy, orthotics, steroid injection, analgesics and arthrodesis. However, scarce research supports their efficacy. CONCLUSION Most of the current knowledge comes from observational and small case-control studies. Future population-based studies as well as controlled studies are essential to understand the risk factors and to evaluate the effectiveness of treatment options.
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Scherer J, Rainsford KD, Kean CA, Kean WF. Pharmacology of intra-articular triamcinolone. Inflammopharmacology 2014; 22:201-17. [DOI: 10.1007/s10787-014-0205-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/15/2014] [Indexed: 12/16/2022]
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Guney A, Karaman I, Oner M, Ibrahim Kafadar H, Deniz K. Is There an Association Between Synovial CD30+ T Lymphocyte Count and Chondral Lesion Depth? Curr Ther Res Clin Exp 2014; 75:44-7. [PMID: 24465042 PMCID: PMC3898187 DOI: 10.1016/j.curtheres.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 11/13/2022] Open
Abstract
Background Exact role of the inflammation in osteoarthritis is still unclear, but it is thought to originate from synovitis due to micro-crystals or breakdown products of the cartilage. Objective To determine the effect of CD30+ T lymphocytes on the development of osteoarthritis by comparing the lesion depth and synovial CD30+ count in patients with chondral lesions undergoing knee joint arthroscopy. Design A total of 79 patients with chondral lesions detected during arthroscopy were categorized in 4 different groups based on chondral lesion classification. CD30+ lymphocyte counts were calculated using flow cytometry on synovial fluid samples obtained at the time of initial entrance into the joint and compared between the groups. In addition, biopsy samples obtained from the suprapatellar bursa were stained for histologic examination to identify existence of CD30+ lymphocytes in the synovium. Results Although there were no significant differences between the first 3 groups in terms of synovial fluid CD30+ lymphocyte counts, patients in Group IV had significantly higher counts (6.2 8 [2.48] vs 2.51 [1.84], 2.97 [2.40], and 3.80 [2.07], respectively; P < 0.05). Except for a single patient with a Grade III chondral lesion, there were no cases of CD30 positivity in synovial tissue. Also there was a correlation between CD30 levels and chondral lesion depth when controlled for age. Conclusions Our results indicate higher CD30+ lymphocyte counts in patients with modified Outerbridge Grade IV chondral lesions than in other groups. The origin of the CD30+ lymphocytes may not be the synovial tissue per se. Thus, it was hypothesized that the injured chondral tissues and the associated subchondral structures might have been the source of CD30+ lymphocytes with a possible influence on the development of osteoarthritis.
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Affiliation(s)
- Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ibrahim Karaman
- Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Mithat Oner
- Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - H Ibrahim Kafadar
- Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Kemal Deniz
- Department of Pathology, Erciyes University Medical Faculty, Kayseri, Turkey
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Jutila AA, Zignego DL, Hwang BK, Hilmer JK, Hamerly T, Minor CA, Walk ST, June RK. Candidate mediators of chondrocyte mechanotransduction via targeted and untargeted metabolomic measurements. Arch Biochem Biophys 2014; 545:116-23. [PMID: 24440608 DOI: 10.1016/j.abb.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 11/30/2022]
Abstract
Chondrocyte mechanotransduction is the process by which cartilage cells transduce mechanical loads into biochemical and biological signals. Previous studies have identified several pathways by which chondrocytes transduce mechanical loads, yet a general understanding of which signals are activated and in what order remains elusive. This study was performed to identify candidate mediators of chondrocyte mechanotransduction using SW1353 chondrocytes embedded in physiologically stiff agarose. Dynamic compression was applied to cell-seeded constructs for 0-30min, followed immediately by whole-cell metabolite extraction. Metabolites were detected via LC-MS, and compounds of interest were identified via database searches. We found several metabolites which were statistically different between the experimental groups, and we report the detection of 5 molecules which are not found in metabolite databases of known compounds indicating potential novel molecules. Targeted studies to quantify the response of central energy metabolites to compression found a transient increase in the ratio of NADP+ to NADPH and a continual decrease in the ratio of GDP to GTP, suggesting a flux of energy into the TCA cycle. These data are consistent with the remodeling of cytoskeletal components by mechanically induced signaling, and add substantial new data to a complex picture of how chondrocytes transduce mechanical loads.
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Affiliation(s)
- Aaron A Jutila
- Department of Mechanical and Industrial Engineering, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Donald L Zignego
- Department of Mechanical and Industrial Engineering, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Bradley K Hwang
- Department of Mechanical and Industrial Engineering, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Jonathan K Hilmer
- Department of Chemistry and Biochemistry, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Timothy Hamerly
- Department of Chemistry and Biochemistry, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Cody A Minor
- Department of Mechanical and Industrial Engineering, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Seth T Walk
- Department of Immunology and Microbiology, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States
| | - Ronald K June
- Department of Cell Biology and Neuroscience, Montana State University, PO Box 173800, Bozeman, MT 59717-3800, United States.
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Sudoł-Szopińska I, Hrycaj P, Prohorec-Sobieszek M. Role of inflammatory factors and adipose tissue in pathogenesis of rheumatoid arthritis and osteoarthritis. Part II: Inflammatory background of osteoarthritis. J Ultrason 2013; 13:319-28. [PMID: 26674301 PMCID: PMC4603222 DOI: 10.15557/jou.2013.0032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/13/2013] [Accepted: 03/21/2013] [Indexed: 12/21/2022] Open
Abstract
Osteoarthritis is the most common rheumatoid disease. It may develop as a primary disease of the motor organ or as a secondary one in the course of other inflammatory joint diseases. Similarly to the majority of rheumatoid conditions, the pathogenesis of osteoarthritis has not been fully explained. The fact that its development is determined by adipocytokines, which are inflammatory mediators produced in the adipose tissue, has been known for several years. Additionally, inflammatory processes taking place in the adipose tissue that lead to degenerative changes are the main subject of studies conducted by various immunological laboratories. Degenerative changes in patients with osteoarthritis are frequently accompanied by secondary inflammation with cellular infiltrations in the synovial membrane. In numerous cases, the intensification of inflammatory lesions resembles changes seen in arthritis, particularly in rheumatoid arthritis, which inhibits the differential diagnosis by means of imaging examinations. This may have significant clinical implications, e.g. with respect to sonography, which is the basic imaging examination in diagnosing rheumatoid arthritis, monitoring the efficacy of implemented treatment or confirming remission. This article discusses the pathogenesis of three elements of osteoarthritis, i.e. synovitis (due to the difficulties in differentiation of synovitis in the course of osteoarthritis and in rheumatoid arthritis) as well as osteophytes and subchondral sclerosis (due to the significance of the inflammatory factor in their development).
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Zakład Radiologii, Instytut Reumatologii, Warszawa, Polska ; Zakład Diagnostyki Obrazowej, Warszawski Uniwersytet Medyczny, Warszawa, Polska
| | - Paweł Hrycaj
- Zakład Reumatologii i Immunologii Klinicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Poznań, Polska
| | - Monika Prohorec-Sobieszek
- Zakład Patofizjologii, Immunologii i Anatomii Patologicznej, Instytut Reumatologii, Warszawa, Polska ; Zakład Diagnostyki Hematologicznej, Instytut Hematologii i Transfuzjologii, Warszawa, Polska
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Abstract
Pain is the defining symptom of osteoarthritis (OA), yet available treatment options, of which NSAIDs are the most common, provide inadequate pain relief and are associated with serious health risks when used long term. Chronic pain pathways are subject to complex levels of control and modulation, both in the periphery and in the central nervous system. Ongoing clinical and basic research is uncovering how these pathways operate in OA. Indeed, clinical investigation into the types of pain associated with progressive OA, the presence of central sensitization, the correlation with structural changes in the joint, and the efficacy of novel analgesics affords new insights into the pathophysiology of OA pain. Moreover, studies in disease-specific animal models enable the unravelling of the cellular and molecular pathways involved. We expect that increased understanding of the mechanisms by which chronic OA-associated pain is generated and maintained will offer opportunities for targeting and improving the safety of analgesia. In addition, using clinical and genetic approaches, it might become possible to identify subsets of patients with pain of different pathophysiology, thus enabling a tailored approach to pain management.
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Røe C. Amplification of osteoarthritis pain by peripheral and central nervous systems pain mechanisms. Scand J Pain 2013; 4:109-110. [PMID: 29913897 DOI: 10.1016/j.sjpain.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway
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Teeple E, Jay GD, Elsaid KA, Fleming BC. Animal models of osteoarthritis: challenges of model selection and analysis. AAPS J 2013; 15:438-46. [PMID: 23329424 PMCID: PMC3675748 DOI: 10.1208/s12248-013-9454-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 01/04/2013] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) is the most common musculoskeletal disease, affecting millions of individuals worldwide. New treatment approaches require an understanding of the pathophysiology of OA and its biomechanical, inflammatory, genetic, and environmental risk factors. The purpose of animal models of OA is to reproduce the pattern and progression of degenerative damage in a controlled fashion, so that opportunities to monitor and modulate symptoms and disease progression can be identified and new therapies developed. This review discusses the features, strengths, and weaknesses of the common animal models of OA; considerations to be taken when choosing a method for experimental induction of joint degeneration; and the challenges of measuring of OA progression and symptoms in these models.
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Affiliation(s)
- Erin Teeple
- Department of Emergency Medicine, Brown Medical School/Rhode Island Hospital, 1 Hoppin Street Coro West, Suite 106, Providence, RI 02903, USA.
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Kean WF, Tocchio S, Kean M, Rainsford KD. The musculoskeletal abnormalities of the Similaun Iceman ("ÖTZI"): clues to chronic pain and possible treatments. Inflammopharmacology 2013; 21:11-20. [PMID: 23096483 PMCID: PMC3560943 DOI: 10.1007/s10787-012-0153-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND INTRODUCTION In 1991, a deceased human male was found frozen in a glacier pool in the Italian Alps in north west Italy, and is now carefully preserved in the South Tyrol Museum of Archaeology, in Bolzano, Italy. The bodily tissues of the 5,300 year old male (colloquially referred to as the Iceman or Ötzi) were well preserved despite damage related to freezing, and glacial movement. Associated articles of well-preserved clothing, tools, weapons and other devices were also present and have been studied in detail. Clinical examination and imaging investigations have also shown that the Icemen had experienced possible illnesses in his lifetime and had identifiable areas of arthritis and musculoskeletal injury. This report includes some key observations on the musculoskeletal state of Ötzi and reference to the involvement of tattoo markings. Some aspects about the aetiology of his abnormalities and inflammatory arthritis are considered along with possible treatments that he might have employed. METHODS AND RESULTS We (WFK and MK) undertook a clinical musculoskeletal examination of the Iceman, details of which with available photographs and radiographic imaging pertaining to the musculoskeletal findings of the Iceman are reported here. The skin of the Iceman has numerous linear carbon tattoos, which are not of a decorative type. These have been presumed to possibly be "medicinal" tattoos administered for therapeutic reasons and may have been used in acupuncture-like treatment of pain. Spinal imaging identified areas of spinal damage and our observations have provided clues as to possible sites of spinal initiated pain and hence sites for administration of the "medicinal" tattoos. We observed body areas of the Iceman, in which imaging demonstrated arthritis and other forms of long-term musculoskeletal damage, but which do not have adjacent or corresponding "medicinal" tattoos. We contend that the back and leg "medicinal" tattoos correspond directly to sites of chronic right knee and right ankle pain, and left thoracolumbar pain. They also correspond to lower lumbar and sciatic referred radicular pain which may have a contributory cause related to the presence of a transitional lumbar 5 vertebra. Using recent published data (Keller et al. in Nature Commun 3:698, 2012. doi: 10.1038/ncomms1701 ) of the genome structure of the Iceman, we suggest some potential causes of the osteoarthritis or inflammatory joint injury may relate to presence of coronary heart disease (CHD) and Lyme disease (Borrelia burgdorferi) infection. We speculate on possible medical applications of natural products for self-medication. CONCLUSIONS These observations highlight several diagnostic features of musculoskeletal conditions in the Iceman with the possibility that tattoos may have been used for diagnosis or location of his painful states. The origins of his musculoskeletal conditions are unclear but there are indications that Lyme disease and CHD may have been factors. The associations or use of natural products may give insights into their applications at the time of the life of the Iceman.
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Affiliation(s)
- Walter F Kean
- Division of Rheumatology, McMaster University, 401-1 Young Street, Hamilton, ON, L8N1T8, Canada.
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Abstract
Osteoarthritis is the most common joint disease, affecting over 60 % of the elderly population, leading to incapacity of movement. The primary form is usually oligoarticular. In case of an underlying systemic disease or local injury, the cartilage destruction is considered as secondary osteoarthritis. The pathogenesis of primary osteoarthritis suggests an intrinsic disease of cartilage in which biochemical and metabolic alterations result in its breakdown. Within the last decades, different models were established concentrating on joint structures such as bones or ligaments. Changes of the subchondral bone were found to precede cartilage damage, suggesting a primary alteration of the subchondral region. Other studies concentrated on the metabolic activity of chondrocytes in healthy cartilage of patients with osteoarthritis. The precise event that leads to these changes is still not clear. This review concentrates on the histological features in the course of the disease and provides a summary on different pathogenetic risk factors.
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Affiliation(s)
- Irene Sulzbacher
- Clinical Institute of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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