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Li J, Hu H, Xu X, Zhu D, Chen Y, Li L. Mechanisms of action of ethyl acetate fractions of Liparis nervosa (Thunb.) Lindl. as potential central anti-nociceptive agents. Inflammopharmacology 2025; 33:1455-1471. [PMID: 39688790 DOI: 10.1007/s10787-024-01620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 11/30/2024] [Indexed: 12/18/2024]
Abstract
Opioids/non-steroidal anti-inflammatory drugs are used to alleviate pain; however, they are expensive and can have adverse effects, especially when used over extended periods. Therefore, there is immense demand for innovative, non-addictive analgesics. Here, we report a novel plant-derived central anti-nociceptive agent, Liparis nervosa (Thunb.) Lindl. (LN), validated in animal pain models. Ethyl acetate fractions of L. nervosa (EALN) exhibited central anti-nociceptive activity in hot plate, tail immersion, formalin-induced paw oedema, and acetic acid-induced abdominal writhing tests. The chemical composition of the EALN was determined using ultra-high-performance liquid chromatography-mass spectrometry. Reserpine (monoamine transmitter-depleting agent) and naltrexone (opioid antagonist) partially suppressed the anti-nociceptive effect of EALN in both phases of the formalin test. Oral administration of EALN activated the endogenous opioid and central descending inhibitory systems by increasing β-endorphin, 5-hydroxytryptamine, and norepinephrine expression. EALN treatment increased the expression of γ-aminobutyric acid B; inhibited the expression of prostaglandin E2, substance P, calcitonin gene-related peptide, and c-Fos; and blocked the transmission of pain signals in the spinal cord. EALN treatment reduced the activity of nitric oxide and nitric oxide synthase in the central region and inhibited the nitric oxide-cyclic guanosine monophosphate signal transduction pathway, thereby attenuating the transmission of nociceptive information in the descending inhibitory pathways. The central anti-nociceptive effect of EALN was achieved by integrating these pathways. This study provides new insights into the pharmacologic action of LN and provide a therapeutic approach as a promising candidate for central anti-nociceptive agents.
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Affiliation(s)
- Jiachuan Li
- School of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Hu Hu
- School of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Xin Xu
- School of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Dan Zhu
- Department of Endocrinology and Nephrology, 363 Hospital, Chengdu, China
| | - Yisheng Chen
- School of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Laiming Li
- School of Pharmacy, Southwest Minzu University, Chengdu, China.
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Shtroblia V, Petakh P, Kamyshna I, Halabitska I, Kamyshnyi O. Recent advances in the management of knee osteoarthritis: a narrative review. Front Med (Lausanne) 2025; 12:1523027. [PMID: 39906596 PMCID: PMC11790583 DOI: 10.3389/fmed.2025.1523027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 01/02/2025] [Indexed: 02/06/2025] Open
Abstract
Knee osteoarthritis (OA) is a common condition that causes pain and reduces the quality of life for many people. It also leads to high health and financial costs. Managing knee OA pain requires using different methods together for the best results. This review overviews current therapeutic options for knee OA pain, focusing on their efficacy, safety, and potential roles in clinical practice. Topical treatments, such as NSAIDs and capsaicin, offer significant pain relief with minimal systemic side effects and are suitable for initial therapy, together with nonpharmacologic interventions like exercise and, when relevant, weight loss. Oral analgesics, including acetaminophen and opioids, have limited efficacy and serious side effects, making them appropriate only for short-term or rescue therapy. Intra-articular injections, such as corticosteroids, hyaluronic acid, and platelet rich plasma, demonstrate varying levels of efficacy and safety. Nutritional supplements, including curcumin, Boswellia serrata, and glucosaminechondroitin combinations, offer modest benefits and are best used as adjuncts to standart treatment. Nonpharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS), acupuncture, and local heat therapy, provide variable pain relief and should be customized based on individual patient responses. Targeted biologic agents, such as antibodies to TNF-α, IL-1, and NGF, hold promise for more precise pain relief; however, further research is required to establish their routine use. Treating knee OA pain should be personalized, combining several methods. Research must continue to improve treatments and make them safer.
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Affiliation(s)
- Viktor Shtroblia
- Department of General Surgery, Uzhhorod National University, Uzhhorod, Ukraine
| | - Pavlo Petakh
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Iryna Kamyshna
- Department of Medical Rehabilitation, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Iryna Halabitska
- Department of Therapy and Family Medicine, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleksandr Kamyshnyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Zhou J, Wu J, Fu F, Yao S, Zheng W, Du W, Luo H, Jin H, Tong P, Wu C, Ruan H. α-Solanine attenuates chondrocyte pyroptosis to improve osteoarthritis via suppressing NF-κB pathway. J Cell Mol Med 2024; 28:e18132. [PMID: 38345195 PMCID: PMC10863976 DOI: 10.1111/jcmm.18132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
α-Solanine has been shown to exhibit anti-inflammatory and anti-tumour properties; however, its efficacy in treating osteoarthritis (OA) remains ambiguous. The study aimed to evaluate the therapeutic effects of α-solanine on OA development in a mouse OA model. The OA mice were subjected to varying concentrations of α-solanine, and various assessments were implemented to assess OA progression. We found that α-solanine significantly reduced osteophyte formation, subchondral sclerosis and OARSI score. And it decreased proteoglycan loss and calcification in articular cartilage. Specifically, α-solanine inhibited extracellular matrix degradation by downregulating collagen 10, matrix metalloproteinase 3 and 13, and upregulating collagen 2. Importantly, α-solanine reversed chondrocyte pyroptosis phenotype in articular cartilage of OA mice by inhibiting the elevated expressions of Caspase-1, Gsdmd and IL-1β, while also mitigating aberrant angiogenesis and sensory innervation in subchondral bone. Mechanistically, α-solanine notably hindered the early stages of OA progression by reducing I-κB phosphorylation and nuclear translocation of p65, thereby inactivating NF-κB signalling. Our findings demonstrate the capability of α-solanine to disrupt chondrocyte pyroptosis and sensory innervation, thereby improving osteoarthritic pathological progress by inhibiting NF-κB signalling. These results suggest that α-solanine could serve as a promising therapeutic agent for OA treatment.
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Affiliation(s)
- Jinyi Zhou
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
- The First People's Hospital of WenlingTaizhouChina
| | - Jinting Wu
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
- Xinchang County Hospital of Traditional Chinese MedicineShaoxingChina
| | - Fangda Fu
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Sai Yao
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Wenbiao Zheng
- Department of OrthopedicsTaizhou Municipal HospitalTaizhouChina
| | - Weibin Du
- Research Institute of OrthopedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Huan Luo
- Department of Pharmacy, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Hongting Jin
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Peijian Tong
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Chengliang Wu
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Hongfeng Ruan
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
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Yu Y, Liu CZ, Wang XZ, Xi YW, Fu YM, Mi BH, Tu JF. Effect of 4 weeks vs 8 weeks of acupuncture for knee osteoarthritis in China: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079709. [PMID: 38267241 PMCID: PMC10824056 DOI: 10.1136/bmjopen-2023-079709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis represents the prevalent and incapacitating disease. Acupuncture, a widely used clinical treatment for knee osteoarthritis, has been shown to ameliorate pain and enhance joint function in affected individuals. However, there is a lack of evidence comparing different courses of acupuncture for knee osteoarthritis. In this trial, we will assess the effect of 4 weeks vs 8 weeks of acupuncture in patients with knee osteoarthritis. METHODS AND ANALYSIS The protocol is a pragmatic, parallel, two-arm randomised controlled trial, with the data analyst and assessor being blinded. 148 eligible patients with knee osteoarthritis will be randomly allocated in a 1:1 ratio to receive 4-week or 8-week acupuncture. Electroacupuncture will be administered three times per week for 4 or 8 weeks, respectively. Patients with knee osteoarthritis in both groups will be followed up to 26 weeks. The primary outcome is the response rate at week 26, and secondary outcomes include knee joint pain, knee joint function, knee joint stiffness, quality of life, patient global assessment, the Osteoarthritis Research Society International response rate and rescue medicine. A cost-effectiveness analysis will be carried out over 26 weeks. ETHICS AND DISSEMINATION The protocol has been approved by the Medical Ethical Committee of Beijing University of Chinese Medicine (2023BZYL0506). The study findings will be disseminated through presentation in a medical journal. Additionally, we plan to present them at selected conferences and scientific meetings. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR2300073383; https://www.chictr.org.cn/showproj.html?proj=199310).
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Affiliation(s)
- Ying Yu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Zhou Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ya-Wei Xi
- Acupuncture-Moxibustion Department, Beijing Liangxiang Hospital, Beijing, China
| | - Yi-Ming Fu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Bao-Hong Mi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Kim SM, Jo SY, Park HY, Lee YR, Yu JS, Yoo HH. Investigation of Drug-Interaction Potential for Arthritis Dietary Supplements: Chondroitin Sulfate, Glucosamine, and Methylsulfonylmethane. Molecules 2023; 28:8068. [PMID: 38138558 PMCID: PMC10745882 DOI: 10.3390/molecules28248068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoarthritis is one of the leading conditions that promote the consumption of these dietary supplements. Chondroitin sulfate, glucosamine, and methylsulfonylmethane are among the prominent alternative treatments for osteoarthritis. In this study, these dietary supplements were incubated with cytochrome P450 isozyme-specific substrates in human liver microsomes, and the formation of marker metabolites was measured to investigate their inhibitory potential on cytochrome P450 enzyme activities. The results revealed no significant inhibitory effects on seven CYPs, consistent with established related research data. Therefore, these substances are anticipated to have a low potential for cytochrome P450-mediated drug interactions with osteoarthritis medications that are likely to be co-administered. However, given the previous reports of interaction cases involving glucosamine, caution is advised regarding dietary supplement-drug interactions.
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Affiliation(s)
- Su Min Kim
- Institute of Pharmaceutical Science and Technology, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea; (S.M.K.); (S.Y.J.)
| | - So Young Jo
- Institute of Pharmaceutical Science and Technology, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea; (S.M.K.); (S.Y.J.)
| | - Ho-Young Park
- Food Functionality Research Division, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (H.-Y.P.); (Y.R.L.)
| | - Yu Ra Lee
- Food Functionality Research Division, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea; (H.-Y.P.); (Y.R.L.)
| | - Jun Sang Yu
- Institute of Pharmaceutical Science and Technology, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea; (S.M.K.); (S.Y.J.)
| | - Hye Hyun Yoo
- Institute of Pharmaceutical Science and Technology, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea; (S.M.K.); (S.Y.J.)
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Maleeva EE, Palikova YA, Palikov VA, Kazakov VA, Simonova MA, Logashina YA, Tarasova NV, Dyachenko IA, Andreev YA. Potentiating TRPA1 by Sea Anemone Peptide Ms 9a-1 Reduces Pain and Inflammation in a Model of Osteoarthritis. Mar Drugs 2023; 21:617. [PMID: 38132938 PMCID: PMC10744431 DOI: 10.3390/md21120617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Progressive articular surface degradation during arthritis causes ongoing pain and hyperalgesia that lead to the development of functional disability. TRPA1 channel significantly contributes to the activation of sensory neurons that initiate neurogenic inflammation and mediates pain signal transduction to the central nervous system. Peptide Ms 9a-1 from the sea anemone Metridium senile is a positive allosteric modulator of TRPA1 and shows significant anti-inflammatory and analgesic activity in different models of pain. We used a model of monosodium iodoacetate (MIA)-induced osteoarthritis to evaluate the anti-inflammatory properties of Ms 9a-1 in comparison with APHC3 (a polypeptide modulator of TRPV1 channel) and non-steroidal anti-inflammatory drugs (NSAIDs) such as meloxicam and ibuprofen. Administration of Ms 9a-1 (0.1 mg/kg, subcutaneously) significantly reversed joint swelling, disability, thermal and mechanical hypersensitivity, and grip strength impairment. The effect of Ms 9a-1 was equal to or better than that of reference drugs. Post-treatment histological analysis revealed that long-term administration of Ms9a-1 could reduce inflammatory changes in joints and prevent the progression of cartilage and bone destruction at the same level as meloxicam. Peptide Ms 9a-1 showed significant analgesic and anti-inflammatory effects in the model of MIA-induced OA, and therefore positive allosteric modulators could be considered for the alleviation of OA symptoms.
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Affiliation(s)
- Ekaterina E. Maleeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, ul. Miklukho-Maklaya 16/10, 117997 Moscow, Russia (M.A.S.); (Y.A.L.)
| | - Yulia A. Palikova
- Branch of the Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Prospekt Nauki, 6, 142290 Pushchino, Russia; (Y.A.P.); (V.A.P.); (V.A.K.); (I.A.D.)
| | - Viktor A. Palikov
- Branch of the Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Prospekt Nauki, 6, 142290 Pushchino, Russia; (Y.A.P.); (V.A.P.); (V.A.K.); (I.A.D.)
| | - Vitaly A. Kazakov
- Branch of the Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Prospekt Nauki, 6, 142290 Pushchino, Russia; (Y.A.P.); (V.A.P.); (V.A.K.); (I.A.D.)
| | - Maria A. Simonova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, ul. Miklukho-Maklaya 16/10, 117997 Moscow, Russia (M.A.S.); (Y.A.L.)
| | - Yulia A. Logashina
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, ul. Miklukho-Maklaya 16/10, 117997 Moscow, Russia (M.A.S.); (Y.A.L.)
| | - Nadezhda V. Tarasova
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia;
| | - Igor A. Dyachenko
- Branch of the Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Prospekt Nauki, 6, 142290 Pushchino, Russia; (Y.A.P.); (V.A.P.); (V.A.K.); (I.A.D.)
| | - Yaroslav A. Andreev
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, ul. Miklukho-Maklaya 16/10, 117997 Moscow, Russia (M.A.S.); (Y.A.L.)
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia;
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Yue H, Li Y, Ma J, Xie C, Xie F, Cai J, Fang M, Yao F. Effect of Tai Chi on knee pain and muscle strength in middle-aged and older adults with knee osteoarthritis: a randomized controlled trial protocol. BMC Complement Med Ther 2023; 23:256. [PMID: 37474949 PMCID: PMC10360298 DOI: 10.1186/s12906-023-04070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common public health problem and a leading cause of long-term pain, decreased muscle strength, and even disability. Tai Chi has been proved effective and highly recommended for KOA management worldwide. However, little is known about its benefits on quadriceps strength which is closely associated with relieving knee pain. This trial is designed to evaluate the efficacy and safety of Tai Chi on knee pain and muscle strength in middle-aged and older adults with KOA. METHODS A total of 100 participants will be randomly divided into a Tai Chi group (TC group) (1x/week for 12 weeks) and a control group with a health education and stretching program (1x/week for 12 weeks) with a follow-up period of 6 weeks. The primary outcome is the change of Western Ontario and McMaster Universities (WOMAC) pain subscale at week 12 compared with baseline. Secondary outcomes include WOMAC stiffness and function subscales, data from isokinetic dynamometry, gait analysis with electromyography (EMG), and a 36-item short form health survey (SF-36). The daily dose of pain-relieving medication will also be recorded. All adverse effects will be assessed by the Treatment Emergent Symptom Scale (TESS). DISCUSSION We expect this randomized trial to evaluate the effectiveness of Tai Chi on relieving pain and increasing quadriceps strength in KOA patients. This protocol, if proven effective, will contribute to providing a promising alternative intervention for middle-aged and older adults with KOA. TRIALS REGISTRATION NUMBER This trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2300069339).
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Affiliation(s)
- Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianwen Ma
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chaoqun Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junhao Cai
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Ding G, He Y, Shi Y, Maimaitimin M, Zhang X, Huang H, Huang W, Yu R, Wang J. Sustained-Drug-Release, Strong, and Anti-Swelling Water-Lipid Biphasic Hydrogels Prepared via Digital Light Processing 3D Printing for Protection against Osteoarthritis: Demonstration in a Porcine Model. Adv Healthc Mater 2023; 12:e2203236. [PMID: 36943891 DOI: 10.1002/adhm.202203236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/28/2023] [Indexed: 03/23/2023]
Abstract
Osteoarthritis is a serious disease affecting joint cartilage. Owing to poor blood supply, the meniscus and acetabular labrum of joints heal poorly after injury. However, the development of artificial alternatives to these components that have similar mechanical properties and cartilage-protection ability is challenging. In this study, a strong hydrogel with a biomimetic microstructure is prepared with an emulsion-type photosensitive resin, where both hydrophilic and hydrophobic monomers, photo-initiator, and drugs can be adopted. In this system, the hydrophobic monomer forms uniformly dispersed aggregates after curing, improving the mechanical properties of the hydrogel significantly. Furthermore, the coordination bonds between nontoxic Zr4+ cations and sulfonic acid groups prevent hydrogel swelling. In addition, the water-oil biphasic hydrogel ink enables the loading of water- and lipid-soluble drugs, yielding hydrogel scaffolds with sustained dual-drug release ability. Crucially, hydrogel scaffolds having excellent mechanical properties, low swelling, and sustained biphasic drug release ability can be prepared using digital light processing 3D printing technology, owing to the high curing rate of the hydrophobic photo-initiator. These hydrogel scaffolds are applied as meniscal and labral replacements in a porcine model and show great promise for the prevention of secondary osteoarthritis, demonstrating the broad potential clinical applications of this material.
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Affiliation(s)
- Guocheng Ding
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - Yangyang He
- Key laboratory of Science and Technology on High-Tech Polymer Materials, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Yuanyuan Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - Wei Huang
- Key laboratory of Science and Technology on High-Tech Polymer Materials, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Ran Yu
- Key laboratory of Science and Technology on High-Tech Polymer Materials, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
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McDonald A. Primary Care-Based Interventional Procedures for Chronic Pain. Prim Care 2022; 49:425-437. [DOI: 10.1016/j.pop.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ding DF, Xue Y, Wu XC, Zhu ZH, Ding JY, Song YJ, Xu XL, Xu JG. Recent Advances in Reactive Oxygen Species (ROS)-Responsive Polyfunctional Nanosystems 3.0 for the Treatment of Osteoarthritis. J Inflamm Res 2022; 15:5009-5026. [PMID: 36072777 PMCID: PMC9443071 DOI: 10.2147/jir.s373898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/11/2022] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is an inflammatory and degenerative joint disease with severe effects on individuals, society, and the economy that affects millions of elderly people around the world. To date, there are no effective treatments for OA; however, there are some treatments that slow or prevent its progression. Polyfunctional nanosystems have many advantages, such as controlled release, targeted therapy and high loading rate, and have been widely used in OA treatment. Previous mechanistic studies have revealed that inflammation and ROS are interrelated, and a large number of studies have demonstrated that ROS play an important role in different types of OA development. In this review article, we summarize third-generation ROS-sensitive nanomaterials that scavenge excessive ROS from chondrocytes and osteoclasts in vivo. We only focus on polymer-based nanoparticles (NPs) and do not review the effects of drug-loaded or heavy metal NPs. Mounting evidence suggests that polyfunctional nanosystems will be a promising therapeutic strategy in OA therapy due to their unique characteristics of being sensitive to changes in the internal environment.
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Affiliation(s)
- Dao-Fang Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yan Xue
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), Tongji University, Shanghai, People’s Republic of China
| | - Xi-Chen Wu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Zhi-Heng Zhu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jia-Ying Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yong-Jia Song
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiao-Ling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, People’s Republic of China
- Correspondence: Xiao-Ling Xu, Shulan International Medical College, Zhejiang Shuren University, 8 Shuren Street, Hangzhou, 310015, People’s Republic of China, Email
| | - Jian-Guang Xu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Jian-Guang Xu, Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 200000, People’s Republic of China, Email
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11
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Lin X, Tsao CT, Kyomoto M, Zhang M. Injectable Natural Polymer Hydrogels for Treatment of Knee Osteoarthritis. Adv Healthc Mater 2022; 11:e2101479. [PMID: 34535978 DOI: 10.1002/adhm.202101479] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/29/2021] [Indexed: 12/11/2022]
Abstract
Osteoarthritis (OA) is a serious chronic and degenerative disease that increasingly occurs in the aged population. Its current clinical treatments are limited to symptom relief and cannot regenerate cartilage. Although a better understanding of OA pathophysiology has been facilitating the development of novel therapeutic regimen, delivery of therapeutics to target sites with minimal invasiveness, high retention, and minimal side effects remains a challenge. Biocompatible hydrogels have been recognized to be highly promising for controlled delivery and release of therapeutics and biologics for tissue repair. In this review, the current approaches and the challenges in OA treatment, and unique properties of injectable natural polymer hydrogels as delivery system to overcome the challenges are presented. The common methods for fabrication of injectable polysaccharide-based hydrogels and the effects of their composition and properties on the OA treatment are detailed. The strategies of the use of hydrogels for loading and release cargos are also covered. Finally, recent efforts on the development of injectable polysaccharide-based hydrogels for OA treatment are highlighted, and their current limitations are discussed.
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Affiliation(s)
- Xiaojie Lin
- Department of Materials Science and Engineering University of Washington Seattle WA 98195 USA
| | - Ching Ting Tsao
- Department of Materials Science and Engineering University of Washington Seattle WA 98195 USA
| | - Masayuki Kyomoto
- Medical R&D Center Corporate R&D Group KYOCERA Corporation 800 Ichimiyake, Yasu Shiga 520‐2362 Japan
| | - Miqin Zhang
- Department of Materials Science and Engineering University of Washington Seattle WA 98195 USA
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12
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Reichenbach S, Jüni P, Hincapié CA, Schneider C, Meli DN, Schürch R, Streit S, Lucas C, Mebes C, Rutjes AWS, da Costa BR. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis Cartilage 2022; 30:426-435. [PMID: 34826572 DOI: 10.1016/j.joca.2021.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effectiveness of TENS at relieving pain and improving physical function as compared to placebo TENS, and to determine its safety, in patients with knee osteoarthritis. METHODS Multi-centre, parallel, 1:1 randomized, double-blind, placebo-controlled clinical trial conducted in six outpatient clinics in Switzerland. We included 220 participants with knee osteoarthritis recruited between October 15, 2012, and October 15, 2014. Patients were randomized to 3 weeks of treatment with TENS (n = 108) or placebo TENS (n = 112). Our pre-specified primary endpoint was knee pain at the end of 3-weeks treatment assessed with the WOMAC pain subscale. Secondary outcome measures included WOMAC physical function subscale and safety outcomes. RESULTS There was no difference between TENS and placebo TENS in WOMAC pain at the end of treatment (mean difference -0.06; 95%CI -0.41 to 0.29; P = 0.74), nor throughout the trial duration (P = 0.98). Subgroup analyses did not indicate an interaction between patient/treatment characteristics and treatment effect on WOMAC pain at the end of treatment (P-interaction ≥0.22). The occurrence of adverse events was similar across groups, with 10.4% and 10.6% of patients reporting events in the TENS and placebo TENS groups, respectively (P = 0.95). No relevant differences were observed in secondary outcomes. CONCLUSIONS TENS does not improve knee osteoarthritis pain when compared to placebo TENS. Therapists should consider other potentially more effective treatment modalities to decrease knee osteoarthritis pain and facilitate strengthening and aerobic exercise. Our findings are conclusive and further trials comparing TENS and placebo TENS in this patient population are not necessary.
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Affiliation(s)
- S Reichenbach
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; Department of Rheumatology and Immunology, Bern University Hospital, Switzerland
| | - Peter Jüni
- Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - C A Hincapié
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - C Schneider
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - D N Meli
- General Practice, Huttwil, Switzerland
| | - R Schürch
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; CTU Bern, University of Bern, Switzerland; Department of Entomology, Virginia Tech Polytechnic Institute & State University, Blacksburg, USA
| | - S Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - C Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Faculty of Medicine (AMC), Amsterdam, the Netherlands
| | - C Mebes
- Physio Postmarkt AG, Grenchen, Switzerland
| | - A W S Rutjes
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - B R da Costa
- Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
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13
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Teng G, Zhang F, Li Z, Zhang C, Zhang L, Chen L, Zhou T, Yue L, Zhang J. Quantitative Electrophysiological Evaluation of the Analgesic Efficacy of Two Lappaconitine Derivatives: A Window into Antinociceptive Drug Mechanisms. Neurosci Bull 2021; 37:1555-1569. [PMID: 34550562 DOI: 10.1007/s12264-021-00774-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
Quantitative evaluation of analgesic efficacy improves understanding of the antinociceptive mechanisms of new analgesics and provides important guidance for their development. Lappaconitine (LA), a potent analgesic drug extracted from the root of natural Aconitum species, has been clinically used for years because of its effective analgesic and non-addictive properties. However, being limited to ethological experiments, previous studies have mainly investigated the analgesic effect of LA at the behavioral level, and the associated antinociceptive mechanisms are still unclear. In this study, electrocorticogram (ECoG) technology was used to investigate the analgesic effects of two homologous derivatives of LA, Lappaconitine hydrobromide (LAH) and Lappaconitine trifluoroacetate (LAF), on Sprague-Dawley rats subjected to nociceptive laser stimuli, and to further explore their antinociceptive mechanisms. We found that both LAH and LAF were effective in reducing pain, as manifested in the remarkable reduction of nocifensive behaviors and laser-evoked potentials (LEPs) amplitudes (N2 and P2 waves, and gamma-band oscillations), and significantly prolonged latencies of the LEP-N2/P2. These changes in LEPs reflect the similar antinociceptive mechanism of LAF and LAH, i.e., inhibition of the fast signaling pathways. In addition, there were no changes in the auditory-evoked potential (AEP-N1 component) before and after LAF or LAH treatment, suggesting that neither drug had a central anesthetic effect. Importantly, compared with LAH, LAF was superior in its effects on the magnitudes of gamma-band oscillations and the resting-state spectra, which may be associated with their differences in the octanol/water partition coefficient, degree of dissociation, toxicity, and glycine receptor regulation. Altogether, jointly applying nociceptive laser stimuli and ECoG recordings in rats, we provide solid neural evidence for the analgesic efficacy and antinociceptive mechanisms of derivatives of LA.
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Affiliation(s)
- Guixiang Teng
- College of Life Science, Northwest Normal University, Lanzhou, 730070, China.,The Rural Development Academy, Northwest Normal University, Lanzhou, 730070, China
| | - Fengrui Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of the Chinese Academy of Sciences, Beijing, 100049, China
| | - Zhenjiang Li
- School of Psychology, Jiangxi Normal University, Nanchang, 330022, China
| | - Chun Zhang
- School of Chemical and Biological Engineering, Lanzhou Jiaotong University, Lanzhou, 730070, China
| | - Libo Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of the Chinese Academy of Sciences, Beijing, 100049, China
| | - Lele Chen
- College of Life Science, Northwest Normal University, Lanzhou, 730070, China.,The Rural Development Academy, Northwest Normal University, Lanzhou, 730070, China
| | - Tao Zhou
- College of Life Science, Northwest Normal University, Lanzhou, 730070, China.,The Rural Development Academy, Northwest Normal University, Lanzhou, 730070, China
| | - Lupeng Yue
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China. .,Department of Psychology, University of the Chinese Academy of Sciences, Beijing, 100049, China.
| | - Ji Zhang
- College of Life Science, Northwest Normal University, Lanzhou, 730070, China. .,The Rural Development Academy, Northwest Normal University, Lanzhou, 730070, China.
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14
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Tsurko VV, Gromova MA. Evaluation of topical therapy of patients with osteoarthritis of small joints of the hands with Voltaren® Emulgel® 2% (diclofenac diethylamine 2%). TERAPEVT ARKH 2021; 93:71515. [DOI: 10.26442/00403660.2021.05.200846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 12/26/2022]
Abstract
Aim. To evaluate the efficacy and safety of using the drug Voltaren Emulgel 2% (diclofenac diethylaminе 2%) for 14 days in patients with osteoarthritis (OA) of small joints of the hands.
Materials and methods. 62 patients of both sexes with hands OA were included in the study, 31 of whom (main group) used Voltaren Emulgel 2% (diclofenac diethylaminе 2%) topically, and the remaining 31 (comparison group) Voltaren Emulgel 2% (diclofenac diethylamine 2%) + oral nonsteroidal anti-inflammatory drugs. The effectiveness of therapy was assessed by using a visual analogue scale (VAS) in dynamics: joint pain and stiffness at rest, pain on movement and during palpation, by functional indices AUSCAN, FIHOA, by assessment of the effect of therapy by the doctor and the patient on a weekly basis.
Results and discussion. Joint pain decreased after 2 weeks of therapy in all patients during treatment with Voltaren Emulgel 2% (diclofenac diethylamine 2%) in both groups. Significant reduction in stiffness and improvement in hand joint function was achieved after 7 days and lasted until the end of treatment. By the end of treatment, 100% of patients assessed their condition as improvement.
Conclusion. Voltaren Emulgel 2% (diclofenac diethylamine 2%) demonstrates comparable clinical efficacy in patients with OA of the hand joints (reduced pain, stiffness and improved joint function) in monotherapy as complex therapy in combination with oral NSAIDS, while being well tolerated.
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15
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Russu OM, Pop TS, Feier AM, Trâmbițaș C, Incze-Bartha Z, Borodi PG, Gergely I, Zuh SG. Treatment Efficacy with a Novel Hyaluronic Acid-Based Hydrogel for Osteoarthritis of the Knee. J Pers Med 2021; 11:jpm11040303. [PMID: 33920879 PMCID: PMC8071312 DOI: 10.3390/jpm11040303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Prior trials investigating the treatment of symptomatic osteoarthritis (OA) with hyaluronic-acid-derived products injections have provided optimistic results. The study was directed to assess the effectiveness of an innovative hyaluronic-acid-based hydrogel (Hymovis®) in the treatment of symptomatic knee OA. Methods: A prospective, single-center, clinical trial was performed. Thirty-five patients with degenerative knee OA were included. Inclusion criteria were: age between 45–80, radiographic Kellgren grade II or III osteoarthritis, minimum 35 mm score on the Visual Analogue Scale (VAS), pain for at least 6 months and agreement to participate in the study. Patients received two injections at a one-week interval. The evaluator assessed the patients using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and VAS. Evaluation was performed before, at 2 and 6 months after the injections. Results: A significant improvement on the WOMAC Index pain subscale was observed at 6 months after the injection. At two months, pain subscale score decreased from 10.34 to 9.34. At six months, a significant decrement in pain parameters compared to baseline was observed (from 10.34 to 7.72; p = 0.0004). Median points on VAS significantly ameliorated after 6 months (from 74.2 to 57.3 cm; p < 0.0001). Regarding physical function, a statistically significant difference compared to baseline was observed at the end of the study (from 29.74 to 25.18; p = 0.0025). WOMAC Index stiffness component did not differ from baseline at any time during follow-up. Conclusions: Pain relief installed with a delayed on-set but had a prolonged duration. The novel hyaluronic acid-based hydrogel (Hymovis®) had effective results, particularly after six months post-injections and offers a therapeutic advancement in the treatment of moderate to severe osteoarthritis.
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Affiliation(s)
- Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Tudor Sorin Pop
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
- Correspondence: ; Tel.: +40-2652-13720
| | - Cristian Trâmbițaș
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Department of Anatomy and Embriology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Zsuzsanna Incze-Bartha
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Department of Anatomy and Embriology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Paul Gabriel Borodi
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - István Gergely
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Sándor-György Zuh
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
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16
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Pinheiro YT, Barbosa GM, Fialho HRF, Silva CAM, Anunciação JDO, Silva HJDA, Souza MCD, Lins CADA. Does tension applied in kinesio taping affect pain or function in older women with knee osteoarthritis? A randomised controlled trial. BMJ Open 2020; 10:e041121. [PMID: 33328259 PMCID: PMC7745684 DOI: 10.1136/bmjopen-2020-041121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To analyse the short-term effects of kinesio taping (KT) with tension (KTT) or without tension (KTNT) in older women with knee osteoarthritis (KOA), and compare them to controls who did not receive KT. DESIGN Randomised controlled trial. SETTING University physiotherapy school clinic. PARTICIPANTS Forty-five older women (fifteen participants per group) with 66.8 (±5.6) years and clinical diagnosis of KOA were assessed pre, post and 3 days after intervention. INTERVENTIONS Participants were randomly allocated to KTT, who received two simultaneous applications of KT with tension on the knee and rectus femoris; KTNT, who received the same application as the KTT group, but without tension and a control group that attended a class on KOA. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was pain intensity and secondary outcomes were knee-related health status, functional capacity, muscle strength and global rating of change. RESULTS No between-group differences were observed in pain after the first intervention (KTT vs KTNT: mean difference (MD), -1.8 points; 95% CI -4.2 to 0.5; KTT vs control: MD, -1.2 points; 95% CI -3.6 to 1.2; KTNT vs control: MD, 0.66 points; 95% CI -1.7 to 3.0) or 3 days later (KTT vs KTNT: MD, -1.3 points; 95% CI -3.7 to 1.0; KTT vs control: MD, 0.13 points; 95% CI -2.2 to 2.5; KTNT vs control: MD, 1.4 points; 95% CI -0.9 to 3.8). The lack of between-group differences was also found for secondary outcomes. CONCLUSION The short-term use of KT with or without tension in older woman with KOA had no beneficial effects on pain and function. These findings call into question the clinical use of KT as a non-pharmacological therapy for this population. TRIAL REGISTRATION NUMBER NCT03624075.
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Affiliation(s)
- Yago Tavares Pinheiro
- Postgraduate Program in Rehabilitation Sciences - Federal University of Rio Grandedo Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
| | - Germanna Medeiros Barbosa
- Federal University of Rio Grande do Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
| | | | - César Augusto Medeiros Silva
- Federal University of Rio Grande do Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
| | | | - Hugo Jário de Almeida Silva
- Postgraduate Program in Rehabilitation Sciences - Federal University of Rio Grandedo Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
| | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences - Federal University of Rio Grandedo Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
| | - Caio Alano de Almeida Lins
- Postgraduate Program in Rehabilitation Sciences - Federal University of Rio Grandedo Norte, Faculty of Health Sciences of Trairi - (FACISA/UFRN), Santa Cruz, RN, Brazil
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17
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Ren Y, Hu J, Tan J, Tang X, Li Q, Yang H, Liu C, He Q, Zou K, Sun X, Tan B. Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study. BMC Public Health 2020; 20:1491. [PMID: 33004017 PMCID: PMC7528331 DOI: 10.1186/s12889-020-09611-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a common disease condition associated with aging and a frequent cause of primary care consultations. Few longitudinal studies have been conducted to investigate the incidence of symptomatic knee osteoarthritis (OA) and to identify its risk factors among the Chinese population. Methods The China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal survey of persons aged ≥45 years. Symptomatic knee OA was diagnosed when both self-reported knee pain and self-reported physician-diagnosis arthritis existed. Using the national survey data collected from the CHARLS, we estimated the incidence of symptomatic knee OA, taking into account the complex survey design and response rate. We applied weighted logistic regression analysis to identify its risk factors. Results In the 4-year follow-up, the cumulative incidence of symptomatic knee OA among middle-aged and older Chinese adults was 8.5%; the incidence was higher among females (11.2%) than males (5.6%). Female (odds ratio (OR) 1.98 [95% confidence interval (CI) 1.65–2.37]), rural area (OR 1.32 [95% CI 1.08–1.60]), and West region (OR 2.33 [95% CI 1.89–2.87]) were associated with a higher risk of incident symptomatic knee OA. Physical activities (OR 0.47 [95% CI 0.29–0.76]) and high education level (OR 0.60 [95% CI 0.41–0.88]) was associated with a lower risk of incident symptomatic knee OA, while histories of heart disease (OR 1.40 [95% CI 1.07–1.82]), kidney disease (OR 1.80 [95% CI 1.35–2.39]), and digestive disease (OR 1.54 [95% CI 1.30–1.82]) were associated with a higher risk of incident symptomatic knee OA. Conclusion The cumulative incidence of symptomatic knee OA over 4 years was relatively high, and varied by province and region. Lack of physical activities was confirmed to be risk factors of incident symptomatic knee OA. The presence of heart disease, kidney disease, and digestive disease may be associated with a higher risk of incident symptomatic knee OA, further research need to confirm these findings.
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Affiliation(s)
- Yan Ren
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Jiang Hu
- Department of Orthopedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Jing Tan
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Xiaoming Tang
- Department of Orthopedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Qianrui Li
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China.,Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huazhen Yang
- West China School of Public Health, Sichuan University, Chengdu, 610041, China
| | - Chunrong Liu
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Qiao He
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Kang Zou
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China.
| | - Bo Tan
- Department of Orthopedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.
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18
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Zhang Z, Huang C, Jiang Q, Zheng Y, Liu Y, Liu S, Chen Y, Mei Y, Ding C, Chen M, Gu X, Xing D, Gao M, He L, Ye Z, Wu L, Xu J, Yang P, Zhang X, Zhang Y, Chen J, Lin J, Zhao L, Li M, Yang W, Zhou Y, Jiang Q, Chu CQ, Chen Y, Zhang W, Tsai WC, Lei G, He D, Liu W, Fang Y, Wu D, Lin J, Wei CC, Lin HY, Zeng X. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1213. [PMID: 33178745 PMCID: PMC7607097 DOI: 10.21037/atm-20-4665] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Osteoarthritis (OA) is a degenerative disease of middle-aged and elderly people, contributed a higher burden of disease in China and the world. In 2017, under the support of the Rheumatology and Immunology Expert Committee of the Cross-Strait Medical and Health Exchange Association. The objective was to develop an evidence-based diagnosis and treatment guideline for OA in China based on emerging new evidence. The guideline was registered at International Practice Guidelines Registry Platform (IPGRP-2018CN028). The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations, and the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was followed to report the guideline. The guideline provides recommendations for the OA diagnosis, disease risks monitoring and evaluate, treatment purpose and physical, medical and surgical interventions. This guideline is intended to serve as a tool for Chinese clinicians for the best decisions-making on diagnosis and treatment of OA.
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Affiliation(s)
- Zhiyi Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Jiang
- Department of Rheumatism, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Zheng
- Department of Rheumatology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences, Beijing, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengyun Liu
- Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjuan Chen
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifang Mei
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xin Gu
- Department of Rehabilitaion Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Dan Xing
- Department of Orthopaedics, Peking University People's Hospital, Beijing, China
| | - Min Gao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan He
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhizhong Ye
- Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, the People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jianhua Xu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pinting Yang
- Department of Rheumatic Immunology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuewu Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yue Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Chen
- Department of Rheumatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Like Zhao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR, USA
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
| | - Wei-Chung Tsai
- Department of Internal Medicine, Kaohsiung Medical College, Kaohsiung
| | - Guanghua Lei
- Department of Orthopedic, Xiangya Hospital, Central South University, Changsha, China
| | - Dongyi He
- Department of Arthrology, Guanghua Integrative Medicine Hospital, Shanghai, China
| | - Wei Liu
- Department of Rheumatology and Immunology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongfei Fang
- Department of Rheumatology and Immunology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Darong Wu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianhao Lin
- Department of Orthopedics, Peking University People's Hospital, Beijing, China
| | - Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung
| | - Hsiao-Yi Lin
- Veterans General Hospital, Taipei and National Yang-Ming Medical University, Taipei
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Dehghan M, Saffari M, Rafieian-kopaei M, Ahmadi A, Lorigooini Z. Comparison of the effect of topical Hedera helix L. extract gel to diclofenac gel in the treatment of knee osteoarthritis. J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Shah DD, Sorathia ZH. Tramadol/Diclofenac Fixed-Dose Combination: A Review of Its Use in Severe Acute Pain. Pain Ther 2020; 9:113-128. [PMID: 32062853 PMCID: PMC7203365 DOI: 10.1007/s40122-020-00155-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Pain is a health issue affecting all populations, regardless of age, gender, economic status, race, or geography. Acute pain is the most common type of pain, with a complex aetiology. Inadequately managed acute pain adversely affects quality of life and imposes significant economic burden. The majority of the available pain-relieving drugs have monomodal mechanisms of analgesia, which necessitates combining drugs with non-redundant mechanisms of action in order to provide adequate pain relief and reduce the side effects from higher doses of individual drugs. In this regard, combining an oral opioid (such as codeine or tramadol) and a non-opioid (such as paracetamol or non-steroidal anti-inflammatory drug) offers a plausible option. Tramadol/diclofenac fixed-dose combination (FDC) is one such analgesic combination which has demonstrated promising clinical activity via its multimodal mechanisms of action. This review seeks to provide an up-to-date narrative on the current scientific literature regarding the pharmacological properties, clinical efficacy, and tolerability of tramadol/diclofenac FDC in the treatment of acute severe pain. A comprehensive, qualitative review of the literature was conducted using a structured search strategy in Medline/PubMed and additional Internet-based sources to identify relevant studies. Based on the available scientific literature, evidence of the efficacy and safety of tramadol/diclofenac FDC for treatment of patients with acute severe pain, including musculoskeletal pain, postoperative pain, and acute flare-up of osteoarthritis or rheumatoid arthritis, appears to be substantial. Although additional comparative studies would be required to definitively position tramadol/diclofenac FDC with respect to other analgesic combinations, the available data suggest that tramadol/diclofenac FDC is a valuable treatment option for patients with acute severe pain.
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Affiliation(s)
- Dilip D Shah
- Jewel Nursing Home, Plot No 89, Ns Road No 1, Andheri West, Mumbai, 400058, India.
| | - Zubair H Sorathia
- Medicare Hospital, Marol Naka Metro Station, Andheri East, Mumbai, 400059, India
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21
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González-Lama Y, Sanz J, Bastida G, Campos J, Ferreiro R, Joven B, Gutiérrez A, Juanola X, Sicilia B, Veroz R, P Gisbert J, Chaparro M, Domènech E, Esteve M, Gomollón F. Recommendations by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the treatment of patients with inflammatory bowel disease associated with spondyloarthritis. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:273-283. [PMID: 32247533 DOI: 10.1016/j.gastrohep.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
Abstract
Extraintestinal manifestations, in general, and in particular arthropathies, are a common problem in patients with inflammatory bowel disease. In fact, the relationship between those 2entities is close and there are increasingly more data which suggest that the bowel plays a significant role in the aetiopathogenesis of spondyloarthritis. The association of inflammatory bowel disease with any kind of spondyloarthritis represents a challenging clinical scenario. It is therefore necessary that both gastroenterologists and rheumatologists work together and establish a fluent communication that enables the patient to receive the most appropriate treatment for each specific situation. The aim of this review is to make some recommendations about the treatment of patients with inflammatory bowel disease and associated spondyloarthritis, in each different clinical scenario.
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Affiliation(s)
- Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Guillermo Bastida
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Fe, Valencia, España
| | - José Campos
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Rocío Ferreiro
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Complejo Hospital Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario Doce de Octubre, Madrid, España
| | - Ana Gutiérrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Alicante, España
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, España
| | - Beatriz Sicilia
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España
| | - Raúl Veroz
- Servicio de Reumatología, Hospital de Mérida, Mérida, Badajoz, España
| | - Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y CIBEREHD, Madrid, España
| | - María Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y CIBEREHD, Madrid, España
| | - Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, CIBEREHD, Badalona, Barcelona, España
| | - María Esteve
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBEREHD, Terrassa, Barcelona, España
| | - Fernando Gomollón
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, IIS Aragón. CIBEREHD, Zaragoza, España
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22
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Yu SP, Hunter DJ. What is the selection process for osteoarthritis pharmacotherapy? Expert Opin Pharmacother 2020; 21:1393-1397. [PMID: 32352847 DOI: 10.1080/14656566.2020.1761325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Osteoarthritis is the most prevalent joint condition that continues to increase with an ever-aging population and the rising tide of obesity. There are multiple recommendations/guidelines for the management of osteoarthritis. The basis of management should focus on self-management and education, lifestyle modifications, exercise and when appropriate, weight loss. Pharmacotherapy is targeted toward pain palliation with no agents available presently to target prevention and disease modification. The selection of pharmacotherapy should be tailored to the individual, taking into account of personal preferences and interactions with underlying co-morbidities. This editorial provides a guide to the selection process of presently available pharmacotherapy in osteoarthritis.
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Affiliation(s)
- Shirley P Yu
- Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia.,Institute of Bone and Joint Research, University of Sydney , Sydney, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia.,Institute of Bone and Joint Research, University of Sydney , Sydney, Australia
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23
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Xu X, Yang K, Zhang F, Liu W, Wang Y, Yu C, Wang J, Zhang K, Zhang C, Nenadic G, Tao D, Zhou X, Shang H, Chen J. Identification of herbal categories active in pain disorder subtypes by machine learning help reveal novel molecular mechanisms of algesia. Pharmacol Res 2020; 156:104797. [PMID: 32278044 DOI: 10.1016/j.phrs.2020.104797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Abstract
Chronic pain is highly prevalent and poorly controlled, of which the accurate underlying mechanisms need be further elucidated. Herbal drugs have been widely used for controlling various pain disorders. The systematic integration of pain herbal data resources might be promising to help investigate the molecular mechanisms of pain phenotypes. Here, we integrated large-scale bibliographic literatures and well-established data sources to obtain high-quality pain relevant herbal data (i.e. 426 pain related herbs with their targets). We used machine learning method to identify three distinct herb categories with their specific indications of symptoms, targets and enriched pathways, which were characterized by the efficacy of treatment to the chronic cough related neuropathic pain, the reproduction and autoimmune related pain, and the cancer pain, respectively. We further detected the novel pathophysiological mechanisms of the pain subtypes by network medicine approach to evaluate the interactions between herb targets and the pain disease modules. This work increased the understanding of the underlying molecular mechanisms of pain subtypes that herbal drugs are participating and with the ultimate aim of developing novel personalized drugs for pain disorders.
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Affiliation(s)
- Xue Xu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA, 02131, USA
| | - Kuo Yang
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China; MOE Key Laboratory of Bioinformatics, TCM-X Centre/Bioinformatics Division, BNRIST/Department of Automation, Tsinghua University, Beijing, 10084, China
| | - Feilong Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Wenwen Liu
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Yinyan Wang
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Changying Yu
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Junyao Wang
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Keke Zhang
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chao Zhang
- School of Mathematical Sciences, Dalian University of Technology, DaLian, Liaoning, 116024, China
| | - Goran Nenadic
- Computer Science, Faculty of Engineering and Physical Sciences, University of Manchester, Manchester, UK
| | - Dacheng Tao
- School of Information Technologies, The University of Sydney, Darlington, NSW, 2008, Australia
| | - Xuezhong Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China.
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Jianxin Chen
- Beijing University of Chinese Medicine, Beijing, 100029, China.
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24
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Westin CB, Nagahara MH, Decarli MC, Kelly DJ, Moraes ÂM. Development and characterization of carbohydrate-based thermosensitive hydrogels for cartilage tissue engineering. Eur Polym J 2020. [DOI: 10.1016/j.eurpolymj.2020.109637] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Gu M, Jin J, Ren C, Chen X, Gao W, Wang X, Wu Y, Tian N, Pan Z, Wu A, Zhou Y, Zhang X. Akebia Saponin D suppresses inflammation in chondrocytes via the NRF2/HO-1/NF-κB axis and ameliorates osteoarthritis in mice. Food Funct 2020; 11:10852-10863. [PMID: 33241814 DOI: 10.1039/d0fo01909g] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Akebia Saponin D promotes the translocation of NRF2 into nucleus, activates NRF2/HO-1 pathway and inhibits NF-κB pathway in chondrocytes, and ultimately alleviates osteoarthritis development.
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26
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Kurup H, Vasukutty N. Midfoot arthritis- current concepts review. J Clin Orthop Trauma 2020; 11:399-405. [PMID: 32405198 PMCID: PMC7211829 DOI: 10.1016/j.jcot.2020.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 12/11/2022] Open
Abstract
Midfoot arthritis causes chronic foot pain and significant impairment of daily activities. Although post traumatic arthritis and primary osteoarthritis are the most common pathologies encountered, surgeons need to rule out inflammatory causes and neuropathic aetiology before starting treatment. Steroid Injections are invaluable in conservative management and have diagnostic value in guiding surgical treatment. For the definitive surgical option of fusion there are a variety of fixation devices available. A successful union is linked to a satisfactory outcome which most authors report to be in the range of 90% following the key principles of careful patient selection, pre-operative planning, adequate joint preparation and a stable fixation.
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27
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Vicentini M, Mancuso P, Giorgi Rossi P, Di Pede S, Pellati M, Gandolfi A, Zoboli D, Riccò D, Busani C, Ferretti A. A cluster randomized trial to measure the impact on nonsteroidal anti-inflammatory drug and proton pump inhibitor prescribing in Italy of distributing cost-free paracetamol to osteoarthritic patients. BMC FAMILY PRACTICE 2019; 20:169. [PMID: 31810456 PMCID: PMC6896368 DOI: 10.1186/s12875-019-1050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/13/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Paracetamol is recommended as first-line treatment for pain control in osteoarthritis because it has fewer side effects than do other therapeutic options, including nonsteroidal anti-inflammatory drugs (NSAIDs). Prescribing proton pump inhibitors (PPIs) as gastric bleeding prophylaxis in chronic NSAID users is also common, although not recommended. In Italy, paracetamol is not reimbursed by the National Health System. The aim of this trial was to test whether the availability to osteoarthritis patients of free paracetamol would decrease their use of NSAIDs and, as a secondary objective, whether opioid and PPI consumption would also decrease. METHODS Eight general practitioners (GPs) (59 patients) were randomized to usual care and 8 (58 patients) to the experimental arm, where prescribed paracetamol was directly distributed for free by the local hospital. After 6 months, paracetamol was also available for free in the control arm. The main outcome was the pre/post difference in average NSAID and PPI consumption. Differences between experimental and control arms in pre/post differences are reported, as registered by the drug prescription information system. RESULTS Average NSAID consumption decreased non-significantly, from 6.79 to 2.16 defined daily dose (DDD) in the experimental arm and from 3.19 to 2.97 DDD in the control group (p = 0.067). No changes were observed for PPIs (from 11.27 to 14.65 DDD and from 9.74 to 12.58 DDD in experimental and control arms, respectively, p = 0.788) or opioids (from 1.61 to 1.14 DDD and from 1.41 to 1.56 DDD in experimental and control arms, respectively, p = 0.419). When the intervention was extended to the control arm, no decrease in NSAID consumption was observed (from 2.46 to 2.43 DDD, p = 0.521). CONCLUSIONS Removing small economic barriers had small or no effect on the appropriateness of opioid or PPI prescribing to patients with osteoarthritis; a reduction in NSAID consumption cannot be ruled out. TRIAL REGISTRATION NUMBER NCT02691754 (Approved February 24, 2016).
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Affiliation(s)
- Massimo Vicentini
- Epidemiology Unit, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy , Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy , Reggio Emilia, Italy.
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy , Reggio Emilia, Italy
| | - Sara Di Pede
- Pharmaceutical Department, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy
| | - Morena Pellati
- Primary Health Care, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy
| | - Alberto Gandolfi
- General Practitioner, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Daniela Zoboli
- Pharmaceutical Department, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy
| | - Daniela Riccò
- Medical Directorate, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Corrado Busani
- Pharmaceutical Department, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy
| | - Alessandra Ferretti
- Pharmaceutical Department, Local Health Authority AUSL-IRCCS, Reggio Emilia, Italy
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28
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Pyrikova NV, Antropova ON, Osipova IV. Adverse Reactions of the Cardiovascular System when Taking Nonsteroidal Anti-inflammatory Drugs and Ways to Reduce Them. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-750-758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The most important issue of modern pharmacotherapy is not only efficacy, but also the safety of medicines. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the main methods of treating acute and chronic pain in a wide range of diseases and pathological conditions. However, the prescription of this group of drugs requires consideration of the potential risks of complications, including from the side of the cardiovascular system. The purpose of the review was to assess the adverse reactions of the cardiovascular system when taking NSAIDs and approaches to their reduction. The article presents data on the mutual potential impact of cardiovascular diseases and musculoskeletal system, presents the results of large-scale studies of Russian and foreign authors and meta-analyzes of the NSAIDs effect on blood pressure profile, development of myocardial infarction, stroke and heart failure. The possible pathogenetic mechanisms of the side effects of NSAIDs are reviewed; the complexity of managing comorbid patients is demonstrated; it is shown that symptomatic treatment of pain and inflammatory syndrome should be carried out considering a personalized approach to the patient and rational choice of drugs.Before the NSAIDs prescription, it is necessary to consider all cardiovascular risk factors with the determination of the total risk of cardiovascular complications. In patients with a very high cardiovascular risk, the use of any NSAIDs should be avoided; with high and moderate risk, the use of NSAIDs with the most favorable cardiovascular safety profile is possible. If the patient belongs to the category of low total coronary risk, the doctor can choose any NSAIDs.
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Shan W, Cheng C, Huang W, Ding Z, Luo S, Cui G, Lu W, Liu F, Xu J, He W, Yin Z. Angiopoietin-like 2 upregulation promotes human chondrocyte injury via NF-κB and p38/MAPK signaling pathway. J Bone Miner Metab 2019; 37:976-986. [PMID: 31214838 DOI: 10.1007/s00774-019-01016-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/03/2019] [Indexed: 01/15/2023]
Abstract
Several cellular and molecular processes participate in the pathologic changes of osteoarthritis (OA). However, the core molecular regulators of these processes are unclear, and no effective treatment for OA disease has been developed so far. ANGPTL2 is well known for its tissue remolding and pro-inflammation properties. However, the role of ANGPTL2 in osteoarthritis (OA) still remains unclear. To explore the expression level of ANGPTL2 in human OA cartilage and investigate the function of ANGPTL2 in human chondrocytes injury, qRT-PCR, western blot and immunohistochemistry were employed to investigate the expression of ANGPTL2 between human OA and normal cartilage samples. Next, human primary chondrocytes were treated with IL-1β to mimic OA progress in vitro, and the expression of ANGPTL2 were tested by qRT-PCR and western blot. Furthermore, the effect of ANGPTL2 in the expression of pro-inflammation cytokines (IL-1β, IL-6), proteolytic enzymes (MMP-1, MMP-13) and component of the cartilage matrix (COL2A1 and aggrecan) in human primary chondrocyte were explored by gain-of-function and loss-of-function methods. Finally, the nuclear factor kappa B (NF-κB) and p38/MAPK signaling pathways were also tested by western blot analysis. In this study, firstly, the expression level of ANGPTL2 was elevated both in human OA cartilage samples and IL-1β stimulated human chondrocytes. Secondly, ANGPTL2 upregulation promotes extracellular matrix (ECM) degradation and inflammation mediator production in human chondrocytes. Finally, ANGPTL2 activated the NF-κB and p38/MAPK signaling pathways via integrin α5β1. This study, for the first time, highlights that ANGPTL2 secreted by human chondrocytes plays a negative role in the pathogenesis of osteoarthritis, and it may be a potential therapeutic target in OA.
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Affiliation(s)
- Wenshan Shan
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
| | - Chao Cheng
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, 372#Tun Xi Road, Hefei, 230032, Anhui, China
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17#Lu Jiang Road, Hefei, 230001, Anhui, China
| | - Zhenfei Ding
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
| | - Sha Luo
- School of Basic Medical Science, and the First Clinical Medical College, Anhui Medical University, 81# Mei Shan Road, Hefei, 230032, Anhui, China
| | - Guanjun Cui
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
| | - Wei Lu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
| | - Fuen Liu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China
| | - JieGou Xu
- School of Basic Medical Science, and the First Clinical Medical College, Anhui Medical University, 81# Mei Shan Road, Hefei, 230032, Anhui, China.
| | - Wei He
- School of Basic Medical Science, and the First Clinical Medical College, Anhui Medical University, 81# Mei Shan Road, Hefei, 230032, Anhui, China.
| | - Zongsheng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, 230032, Anhui, China.
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30
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Aweid O, Haider Z, Saed A, Kalairajah Y. Treatment modalities for hip and knee osteoarthritis: A systematic review of safety. J Orthop Surg (Hong Kong) 2019; 26:2309499018808669. [PMID: 30415598 DOI: 10.1177/2309499018808669] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Current guidelines on the management of hip and knee osteoarthritis (OA) do not compare safety of treatment modalities. We therefore systematically reviewed 20 studies investigating mortality and serious complications of both medical and surgical treatments for hip and knee OA using PubMed, Scopus, Web of Knowledge and Google Scholar. Mortality was the highest for naproxen (hazard ratio (HR) = 3 (1.9, 4.6)) and lowest for total hip replacement (relative risk (RR) = 0.7 (0.7, 0.7)). Highest gastrointestinal complications were reported for diclofenac (odds ratio (OR) = 4.77 (3.94, 5.76)) and lowest for total knee replacement (HR = 0.6 (0.49, 0.75)). Ibuprofen had the highest renal complications (OR = 2.32 (1.45, 3.71)), whereas celecoxib had the highest cardiovascular risk (OR = 2.26 (1, 5.1)) and lowest was for tramadol (RR = 1.1 (0.87, 1.4)). Results show that medical management of hip and knee OA, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery. Careful consideration should be given to medical management taking into account known co-morbidities.
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Affiliation(s)
- Osama Aweid
- 1 Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, Bedfordshire, UK
| | - Zakir Haider
- 2 Department of Trauma and Orthopaedics, University College Hospital (London), Fitzrovia, London, UK
| | - Abdel Saed
- 1 Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, Bedfordshire, UK
| | - Yegappan Kalairajah
- 1 Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, Bedfordshire, UK
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31
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The effectiveness of treatments for Kashin–Beck disease: a systematic review and network meta-analysis. Clin Rheumatol 2019; 38:3595-3607. [DOI: 10.1007/s10067-019-04704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
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Henrotin Y, Malaise M, Wittoek R, de Vlam K, Brasseur JP, Luyten FP, Jiangang Q, Van den Berghe M, Uhoda R, Bentin J, De Vroey T, Erpicum L, Donneau AF, Dierckxsens Y. Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study. Arthritis Res Ther 2019; 21:179. [PMID: 31351488 PMCID: PMC6661105 DOI: 10.1186/s13075-019-1960-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/17/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives Comparison of two doses of bio-optimized Curcuma longa extract (BCL) in the management of symptomatic knee osteoarthritis (OA). Methods A prospective, randomized, 3-month, double-blind, multicenter, three-group, placebo-controlled trial assessing Patient Global Assessment of Disease Activity (PGADA) and serum sColl2-1, a biomarker of cartilage degradation, as co-primary endpoints. Pain on visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and paracetamol/non-steroidal anti-inflammatory drug (NSAID) consumption were used as secondary endpoints. Results One hundred fifty patients with knee OA were followed for 90 days. Low and high doses of BCL showed a greater decrease of PGADA than placebo. Analysis of sColl2-1 showed in the placebo and BCL low-dose groups, but not in the BCL high-dose group, a transient but non-significant increase of sColl2-1 between T0 and T1. Thereafter, in all groups, sColl2-1 decreased between T1 and T3 (all p < 0.01), but no difference between the groups was found. Pain reduction at day 90 in the low- and high-dose BCL groups (− 29.5 mm and − 36.5 mm) was higher than that in the placebo (− 8 mm; p = 0.018). The global KOOS significantly decreased overtime, but changes were comparable across treatment arms. The ratio of patients with adverse events (AE) related to the product was similar in the placebo and treatment groups, but the number of AE linked to the product was higher in the high-dose BCL group compared to the placebo (p = 0.012). Conclusions BCL appeared safe and well-tolerated with no evidence of severe adverse effects. Efficacy analysis suggested positive trends for measurements of PGADA and serum levels of an OA biomarker and showed a rapid and significant decrease of pain in knee OA (Trial registration: ISRCTN, ISRCTN12345678. Registered 21 September 2016—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02909621?term=osteoarthritis+curcumin&rank=5—Evaluation of FLEXOFYTOL® Versus PLACEBO (COPRA) NCT02909621). Electronic supplementary material The online version of this article (10.1186/s13075-019-1960-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, Institute of Pathology, Level 5, CHU Sart-Tilman, University of Liège, 4000, Liège, Belgium. .,Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium. .,Artialis SA, GIGA Tower, CHU-Sart-Tilman, 4000, Liège, Belgium.
| | - M Malaise
- Rheumatology Department, CHU Sart-Tilman, Liège, Belgium
| | - R Wittoek
- Rheumatology Department, UZ Gent, Ghent, Belgium
| | - K de Vlam
- Rheumatology Department, ZNA Jan Palfijn, Merksem, Belgium
| | - J-P Brasseur
- Rheumatology Department, CHU UCL Namur, Yvoir, Belgium
| | - F P Luyten
- Rheumatology Department, University Hospitals Leuven, Leuven, Belgium
| | - Q Jiangang
- Rheumatology and Physical Medicine Department, Hôpitaux Iris Sud, Bruxelles, Belgium
| | - M Van den Berghe
- Rheumatology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - R Uhoda
- Physical Medicine and Rehabilitation Department, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgium
| | - J Bentin
- Rheumatology Department, CHU Brugmann, Bruxelles, Belgium
| | - T De Vroey
- Physical Medicine, UZA, Antwerpen, Belgium
| | | | - A F Donneau
- Public health Science Department, University of Liège, Liège, Belgium
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Spitaels D, Vankrunkelsven P, Grypdonck L, Dusar FR, Aertgeerts B, Luyten FP, Hermens RPMG. Quality of Care for Knee Osteoarthritis in Primary Care: A Patient's Perspective. Arthritis Care Res (Hoboken) 2019; 72:1358-1366. [PMID: 31325228 DOI: 10.1002/acr.24034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/16/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the quality of osteoarthritis care in general practice from a patient's perspective and to identify novel associations between process quality indicators and patient-reported outcome and experience measures. METHODS For this study, 235 individuals with knee osteoarthritis completed a survey based on both process and outcome indicators. Process indicators were extracted from international guidelines and included the domains: diagnosis, self-management, treatment, and follow-up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and RAND 36-item Short Form health survey (SF-36) were used to assess patient-reported outcomes. Patient-reported experience with care was evaluated with the European Task Force on Patient Evaluations of General Practice Care (EUROPEP) instrument. A series of multilevel regression analyses were then performed to analyze determinants at the patient level (i.e., age, sex, body mass index, and education) and associations between process and outcome indicators. RESULTS Overall, low adherence to the process indicators was observed (38%), particularly on informing patients about the importance of weight loss (24% [95% confidence interval (95% CI) 19-31]) or referring them for physical therapy (41% [95% CI 33-49]). Patients described their quality of life as moderate, with an overall score of 63% and 35% on the SF-36 and WOMAC surveys, respectively. Regarding the determinants, patients with a higher education level were better informed (odds ratio [OR] 3.4; P = 0.0003). Associations between process and outcome indicators were scarce, with the exception of patient satisfaction with care and use of nonsteroidal antiinflammatory drugs (NSAIDs) (OR 2.9; P = 0.0014). CONCLUSION Patients with knee osteoarthritis receive suboptimal conservative management. They report a moderate quality of life. This study confirms the evidence suggesting that NSAIDs are the backbone of osteoarthritis pain management but also adds evidence from a patient's perspective.
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Affiliation(s)
- David Spitaels
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Lies Grypdonck
- Former Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Bert Aertgeerts
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Rosella P M G Hermens
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium, and Radboud Institute for Health Sciences, IQ Healthcare, and Radboud University Medical Center, Nijmegen, The Netherlands
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Hayati M, Yazdi Z, Abbasi M. Comparison of non-steroidal anti-inflammatory drugs and knee kinesio taping in early osteoarthritis pain: A randomized controlled trial. J Bodyw Mov Ther 2019; 23:666-670. [DOI: 10.1016/j.jbmt.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/01/2018] [Accepted: 05/12/2018] [Indexed: 10/28/2022]
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Delgado-Enciso I, Valtierra-Alvarez J, Paz-Garcia J, Preciado-Ramirez J, Soriano-Hernandez AD, Mendoza-Hernandez MA, Guzman-Esquivel J, Cabrera-Licona A, Delgado-Enciso J, Cortes-Bazan JL, Rodriguez-Sanchez IP, Martinez-Fierro ML, Cabrera-Medina AO, Barajas-Saucedo CE, Paz-Michel B. Patient-reported health outcomes for severe knee osteoarthritis after conservative treatment with an intra-articular cell-free formulation for articular cartilage regeneration combined with usual medical care vs. usual medical care alone: A randomized controlled trial. Exp Ther Med 2019; 17:3351-3360. [PMID: 30988711 PMCID: PMC6447772 DOI: 10.3892/etm.2019.7384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a major public health problem characterized by joint pain, fatigue, functional limitation and decreased quality of life of the patient, which results in increased use of healthcare services and high economical costs. A promising novel bioactive cell-free formulation (BIOF2) for cartilage regeneration has recently been tested in pre-clinical and clinical trials, and has demonstrated a success rate similar to that of total joint arthroplasty for the treatment of severe knee OA. The present study evaluated the efficacy of treatment with BIOF2, by including it within a conservative regimen of 'usual medical care' of knee OA, and whether its efficacy was affected in subgroups of patients presenting with comorbidities that exacerbate OA. A prospective, randomized, 2-arm parallel group phase III clinical trial was conducted, which included 105 patients in the 'usual medical care' group (paracetamol/NSAIDs and general care provided by the family physician) and 107 patients in the BIOF2 group (usual medical care + intra-articular BIOF2 application at 0, 1 and 2 months). Two aspects were evaluated at 0, 6 and 12 months: i) Minimal clinically important improvement (MCII), based on 30% improvement of pain from the baseline; and ii) the Patient Acceptable Symptom State (PASS), a questionnaire that determines patient well-being thresholds for articular pain and function. Adverse effects and regular NSAID use were registered. At 12 months, BIOF-2 treatment produced MCII in 70% of the patients and >50% achieved PASS. Excluding the patients with class 2 obesity or malalignment conditions (genu varum or genu valgum >20 degrees), the experimental treatment produced MCII and PASS in 100 and 92% of patients, respectively, compared with 25 and 8% in the group of usual medical care (P<0.001). No patient with malalignment and treatment with BIOF2 achieved PASS. Notably, there were no serious adverse effects. To conclude, BIOF2 is a safe therapeutic alternative that is easy to implement together with usual medical care for knee OA. Trial registration: Cuban Public Registry of Clinical Trials (RPCEC) Database RPCEC00000277. Retrospectively registered June, 2018.
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Affiliation(s)
- Ivan Delgado-Enciso
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Jose Valtierra-Alvarez
- Department of Traumatology, University Regional Hospital, Colima State Health Services, Colima 28019, Mexico
| | - Juan Paz-Garcia
- Department of Traumatology, Union Hospital Center, Villa de Alvarez, Colima 28970, Mexico
| | - Jorge Preciado-Ramirez
- Department of Traumatology, University Regional Hospital, Colima State Health Services, Colima 28019, Mexico
| | - Alejandro D. Soriano-Hernandez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | | | - Jose Guzman-Esquivel
- Department of Research, General Hospital of Zone No. 1 IMSS, Villa de Alvarez, Colima 28983, Mexico
| | - Ariana Cabrera-Licona
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
| | - Josuel Delgado-Enciso
- Department of Research, Foundation for Cancer Ethics, Education and Research of The Cancerology State Institute, Colima 28085, Mexico
| | - Jose L. Cortes-Bazan
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
| | - Iram P. Rodriguez-Sanchez
- Department of Cellular Biology, School of Biological Sciences, Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon 64460, Mexico
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico
| | - Ana O. Cabrera-Medina
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Carlos E. Barajas-Saucedo
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Brenda Paz-Michel
- Department of Research, Esteripharma Mexico, Mexico City 03100, Mexico
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Pickering G, Creveaux I, Macian N, Pereira B. Paracetamol and Pain Modulation by TRPV1, UGT2B15, SULT1A1 Genotypes: A Randomized Clinical Trial in Healthy Volunteers. PAIN MEDICINE 2019; 21:661-669. [DOI: 10.1093/pm/pnz037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Background
The influence of the genetic polymorphism of enzymes and receptors involved in paracetamol metabolism and mechanism of action has not been investigated. This trial in healthy volunteers investigated the link between paracetamol pain relief and the genetic polymorphism of 23 enzymes and receptors.
Design
This randomized double-blind crossover controlled pilot study took place in the Clinical Pharmacology Department, University Hospital, Clermont-Ferrand, France. Forty-seven Caucasian volunteers were recruited. The trial consisted of two randomized sessions one week apart with oral paracetamol or placebo, and pain changes were evaluated with mechanical pain stimuli. The genetic polymorphism of 23 enzymes and receptors was studied, and correlations were made with pain relief. All tests are two-sided with a type I error at 0.05.
Results
Paracetamol was antinociceptive compared with placebo (222 ± 482 kPaxmin vs 23 ± 431 kPaxmin; P = 0.0047), and the study showed 30 paracetamol responders and 17 paracetamol nonresponders. Responders were characterized by TRPV1rs224534 A allele, UGT2B15rs1902023 TT genotype, and SULT1A1rs9282861 GG genotype (P < 0.05 for all). These findings confirm for the first time the involvement of a specific TRPV1 rs224534 variant in paracetamol antinociception. They also reveal a new antinociceptive role for specific variants of hepatic phase II enzymes associated with paracetamol metabolism.
Conclusions
The study warrants larger clinical trials on these potential genomic markers of paracetamol analgesia in patients. Confirmation of the present findings would open the way to effective individualized pain treatment with paracetamol, the most commonly used analgesic worldwide.
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Affiliation(s)
- Gisèle Pickering
- Faculty of Medicine Inserm 1107, Clinical Pharmacology Centre, CPC/CIC Inserm 1405 University Hospital, Clermont-Ferrand, France
| | - Isabelle Creveaux
- Molecular Biology Department, Faculty of Medicine, University Hospital, Clermont-Ferrand, France
| | - Nicolas Macian
- Faculty of Medicine Inserm 1107, Clinical Pharmacology Centre, CPC/CIC Inserm 1405 University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction Recherche Clinique, Biostatistics Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Steinmeyer J, Bock F, Stöve J, Jerosch J, Flechtenmacher J. Pharmacological treatment of knee osteoarthritis: Special considerations of the new German guideline. Orthop Rev (Pavia) 2018; 10:7782. [PMID: 30662685 PMCID: PMC6315310 DOI: 10.4081/or.2018.7782] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022] Open
Abstract
The pharmacological treatment of knee osteoarthritis (OA) is a purely symptomatic therapy, which often ensures that the mobility of the patient is successfully retained. This article refers to the recommendations and opinions regarding the pharmacotherapy of knee OA contained in the new guideline of the Association of the Scientific Medical Societies in Germany (AWMF), highlighting several important aspects and describing the considerations underlying the decision-making process. With this article it is hoped that therapeutic effectiveness can be realistically estimated, that any risks of medication errors and avoidable side effects can be reduced, and that further helpful measures can be taken into consideration.
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Affiliation(s)
- Juergen Steinmeyer
- Laboratory for Experimental Orthopedics, Department of Orthopedics, Justus Liebig University, Giessen
| | - Fritjof Bock
- Orthopaedics at the Green Tower, Ravensburg.,Interdisciplinary Society for Orthopedic/Trauma and General Pain Therapy, Ravensburg
| | - Johannes Stöve
- Orthopaedic and Trauma Surgery Clinic, St. Marienkrankenhaus, Ludwigshafen
| | - Jörg Jerosch
- Clinic for Orthopedics, Traumatology and Sports Medicine, Johanna Etienne Hospital, Neuss
| | - Johannes Flechtenmacher
- Ortho Centre - Orthopedic Community Practice at the Ludwigsplatz, Karlsruhe.,Professional Association for Orthopedics and Trauma Surgery, Berlin, Germany
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Rustenburg CM, Emanuel KS, Peeters M, Lems WF, Vergroesen PA, Smit TH. Osteoarthritis and intervertebral disc degeneration: Quite different, quite similar. JOR Spine 2018; 1:e1033. [PMID: 31463450 PMCID: PMC6686805 DOI: 10.1002/jsp2.1033] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023] Open
Abstract
Intervertebral disc degeneration describes the vicious cycle of the deterioration of intervertebral discs and can eventually result in degenerative disc disease (DDD), which is accompanied by low-back pain, the musculoskeletal disorder with the largest socioeconomic impact world-wide. In more severe stages, intervertebral disc degeneration is accompanied by loss of joint space, subchondral sclerosis, and osteophytes, similar to osteoarthritis (OA) in the articular joint. Inspired by this resemblance, we investigated the analogy between human intervertebral discs and articular joints. Although embryonic origin and anatomy suggest substantial differences between the two types of joint, some features of cell physiology and extracellular matrix in the nucleus pulposus and articular cartilage share numerous parallels. Moreover, there are great similarities in the response to mechanical loading and the matrix-degrading factors involved in the cascade of degeneration in both tissues. This suggests that the local environment of the cell is more important to its behavior than embryonic origin. Nevertheless, OA is widely regarded as a true disease, while intervertebral disc degeneration is often regarded as a radiological finding and DDD is undervalued as a cause of chronic low-back pain by clinicians, patients and society. Emphasizing the similarities rather than the differences between the two diseases may create more awareness in the clinic, improve diagnostics in DDD, and provide cross-fertilization of clinicians and scientists involved in both intervertebral disc degeneration and OA.
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Affiliation(s)
- Christine M.E. Rustenburg
- Department or Orthopaedic SurgeryAmsterdam Movement Sciences, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Kaj S. Emanuel
- Department or Orthopaedic SurgeryAmsterdam Movement Sciences, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Mirte Peeters
- Department or Orthopaedic SurgeryAmsterdam Movement Sciences, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Willem F. Lems
- Department of RheumatologyAmsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Theodoor H. Smit
- Department or Orthopaedic SurgeryAmsterdam Movement Sciences, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Department of Medical BiologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Atzeni F, Masala IF, Sarzi-Puttini P. A Review of Chronic Musculoskeletal Pain: Central and Peripheral Effects of Diclofenac. Pain Ther 2018; 7:163-177. [PMID: 29873010 PMCID: PMC6251833 DOI: 10.1007/s40122-018-0100-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 12/22/2022] Open
Abstract
Diclofenac is widely used to manage chronic inflammatory and degenerative joint diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, and extra-articular rheumatism. Its various mechanisms of action make it particularly effective in treating nociceptive pain, but it is also an alternative for treating spinal and chronic central pain. Osteoarthritis and rheumatoid arthritis are the most frequently encountered arthritic conditions in adults. The management of nociceptive pain requires a sequential hierarchical approach, with the initial NSAID treatment being characterized by the replacement of one drug with another, or complete discontinuation usually because of insufficient pain control. OA- and RA-related pain is complex and multifactorial, and due to physiological interactions between the signaling of the central and peripheral nervous systems. The mechanisms of action of diclofenac make it particularly effective in treating both nociceptive pain and chronic central pain. This review underlines the mechanisms of diclofenac involved in chronic and acute joint pain, the most relevant adverse events.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy.
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40
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Jung SY, Jang EJ, Nam SW, Kwon HH, Im SG, Kim D, Cho SK, Kim D, Sung YK. Comparative effectiveness of oral pharmacologic interventions for knee osteoarthritis: A network meta-analysis. Mod Rheumatol 2018; 28:1021-1028. [PMID: 29429391 DOI: 10.1080/14397595.2018.1439694] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/26/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To explore the relative efficacy of oral pharmacologic interventions in the treatment of knee OA. METHODS A systematic literature review was conducted using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify trials conducted in patients with knee OA with a minimum 6 weeks of follow-up. The standardized mean differences of the change from baseline to week 6 in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain between the treatment groups were estimated using Bayesian random-effects network meta-analyses. Subgroup analyses of baseline pain status (high, pain score ≥60 mm; low, pain score <60 mm) were performed. RESULTS Of 4067 manuscripts, 44 were included in the evidence synthesis. Etoricoxib had the highest ranking for improving WOMAC pain (probability of being top ranked, p (best) = .43) followed by naproxen (p (best) = .12), acetaminophen (AAP) (p (best) = .04), and celecoxib (p (best) = .02). The top three ranked interventions were etoricoxib, celecoxib and aceclofenac in the higher pain group, and tramadol, celecoxib, and diclofenac in the lower pain group. CONCLUSION In the overall analysis, etoricoxib, celecoxib, and aceclofenac had the highest rankings for improving WOMAC pain. The ability to improve knee OA symptoms may differ depending on baseline pain and radiologic features.
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Affiliation(s)
- Sun-Young Jung
- a College of Pharmacy , Chung-Ang University , Seoul , South Korea
| | - Eun Jin Jang
- b Department of Information Statistics , Andong National University , Andong-si , South Korea
| | - Seoung Wan Nam
- c Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Hyuk Hee Kwon
- c Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Seul Gi Im
- d Department of Statistics , Kyungpook National University , Daegu , South Korea
| | - Dam Kim
- c Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Soo-Kyung Cho
- c Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Dalho Kim
- d Department of Statistics , Kyungpook National University , Daegu , South Korea
| | - Yoon-Kyoung Sung
- c Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
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41
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Recent advances in intra-articular drug delivery systems for osteoarthritis therapy. Drug Discov Today 2018; 23:1761-1775. [DOI: 10.1016/j.drudis.2018.05.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/17/2018] [Accepted: 05/16/2018] [Indexed: 02/07/2023]
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Huang K, Wu LD. Dehydroepiandrosterone: Molecular mechanisms and therapeutic implications in osteoarthritis. J Steroid Biochem Mol Biol 2018; 183:27-38. [PMID: 29787833 DOI: 10.1016/j.jsbmb.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
Dehydroepiandrosterone (DHEA), a 19-carbon steroid hormone primarily synthesized in the adrenal gland, exerts a chondroprotective effect against osteoarthritis (OA) and has been considered an effective candidate of disease-modifying OA drugs (DMOADs) that slow disease progression. We and others previously demonstrated that DHEA exerted a beneficial effect on osteoarthritic cartilage by positively modulating the balance between anabolic and catabolic factors (e.g., MMPs/TIMP-1, ADAMTS/TIMP-3 and cysteine proteinases/cystatin C), inhibiting catabolic signaling pathways (e.g., Wnt/β-catenin), and suppressing proinflammatory cytokines-mediated low-grade synovial inflammation (e.g., IL-1β). However, the full picture of the pharmacological molecular mechanism(s) underlying the activity of DHEA against OA is still incomplete, and a comprehensive and up-to-date review article in this field is unavailable. In this review, recent findings (apart from the well documented pathogenesis of OA) regarding disease-related mechanisms involving low grade synovial inflammation, cartilage matrix stiffness, chondrocyte autophagy and the roles of a variety of catabolic cellular signaling pathways are discussed. Moreover, the possible relationship between these disease-related mechanisms and DHEA action is discussed. Emerging evidence from in vivo and in vitro studies were scrutinized and are concisely presented to demonstrate the investigational and putative mechanisms underlying the anti-OA potential of DHEA.
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Affiliation(s)
- Kai Huang
- Department of Orthopedic Surgery, Tongde Hospital of Zhejiang Province, China.
| | - Li-Dong Wu
- Department of Orthopedic Surgery, The Second Hospital of Medical College, Zhejiang University, China
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Buendía-López D, Medina-Quirós M, Fernández-Villacañas Marín MÁ. Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol 2018; 19:3. [PMID: 30128934 PMCID: PMC6102156 DOI: 10.1186/s10195-018-0501-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/26/2018] [Indexed: 01/23/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a disease with a high prevalence in the adult population. Nonsteroidal anti-inflammatory drugs (NSAID) or intra-articular injections [hyaluronic acid (HA) or platelet-rich plasma (PRP)] can provide clinical benefit. Magnetic resonance imaging (MRI) has proven to be useful for the evaluation of cartilage volume and thickness in knee osteoarthritis. The purpose of this study was to evaluate the benefit provided by PRP injection in comparison with hyaluronic acid and NSAID in knee OA patients and to compare the radiographic evolution at the 52-week follow-up. Methods One hundred and six patients were enrolled and randomized according to the Spanish Rheumatology Society knee osteoarthritis diagnosis criteria. Ninety-eight patients completed the study (33 received NSAID treatment, 32 a single hyaluronic acid injection and 33 a single PRP injection). Patients were prospectively evaluated at baseline, 26 and 52 weeks using the Western Ontario McMaster Universities osteoarthritis index (WOMAC) and the visual analogue scale (VAS), and at baseline and 52 weeks with X-ray and MRI. Results A 20% decrease in WOMAC pain and increase in physical function was found in 30 and 24%, respectively, of those patients who received PRP treatment, at the 52-week follow-up. WOMAC pain and VAS improved in the hyaluronic acid and NSAID groups. However, better results were obtained in the PRP group compared to hyaluronic acid and NSAIDs (P < 0.05). No differences in Kellgren–Lawrence or cartilage thickness progression were found. Conclusions Leukocyte-poor platelet-rich plasma (LP-PRP) injections are better in terms of clinical improvement with respect to HA injections or oral NSAID treatment in knee osteoarthritis patients at the 52-week follow-up. Moreover, a single LP-PRP injection is effective. However, LP-PRP has no influence on cartilage progression. Level of evidence Level II.
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Affiliation(s)
- David Buendía-López
- Hospital Caravaca de la Cruz, Avenida Miguel Espinosa, 1, Caravaca de la Cruz, 30400, Murcia, Spain.
| | - Manuel Medina-Quirós
- Hospital Virgen de la Arrixaca, Carretera Madrid-Cartagena, El Palmar, 30120, Murcia, Spain
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Liu X, Eyles J, McLachlan AJ, Mobasheri A. Which supplements can I recommend to my osteoarthritis patients? Rheumatology (Oxford) 2018; 57:iv75-iv87. [PMID: 29506080 DOI: 10.1093/rheumatology/key005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
OA is a chronic and disabling joint disease with limited evidence-based pharmacological treatment options available that improve outcomes for patients safely. Faced with few effective pharmacological treatments, the use has grown of dietary supplements and complementary medicines for symptomatic relief among people living with OA. The aim of this review is to provide a summary of existing evidence and recommendations supporting the use of supplements for OA. Systematic reviews and randomized controlled trials investigating oral supplements for treating OA were identified. Limited research evidence supports recommendations for the oral use of Boswellia serrata extract and Pycnogenol, curcumin and methylsulfonylmethane in people with OA despite the poor quality of the available studies. Few studies adequately reported possible adverse effects related to supplementation, although the products were generally recognized as safe. Further high quality trials are needed to improve the strength of evidence to support this recommendation and better guide optimal treatment of people living with OA.
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Affiliation(s)
- Xiaoqian Liu
- Rheumatology Department, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.,Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jillian Eyles
- Rheumatology Department, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.,Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, Sydney, NSW, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy and Centre for Education and Research in Ageing, The University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - Ali Mobasheri
- Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
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45
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Zeng C, Wei J, Persson MSM, Sarmanova A, Doherty M, Xie D, Wang Y, Li X, Li J, Long H, Lei G, Zhang W. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med 2018; 52:642-650. [PMID: 29436380 PMCID: PMC5931249 DOI: 10.1136/bjsports-2017-098043] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of topical non-steroidal anti-inflammatory drugs (NSAIDs), including salicylate, for the treatment of osteoarthritis (OA). METHODS PubMed, Embase, Cochrane Library and Web of Science were searched from 1966 to January 2017. Randomised controlled trials (RCTs) comparing topical NSAIDs with placebo or each other in patients with OA and observational studies comparing topical NSAIDs with no treatment or each other irrespective of disease were included. Two investigators identified studies and independently extracted data. Bayesian network and conventional meta-analyses were conducted. The primary outcomes were pain relief for RCTs and risk of adverse effects (AEs) for observational studies. RESULTS 43 studies, comprising 36 RCTs (7 900 patients with OA) and seven observational studies (218 074 participants), were included. Overall, topical NSAIDs were superior to placebo for relieving pain (standardised mean difference (SMD)=-0.30, 95% CI -0.40 to -0.20) and improving function (SMD=-0.35, 95% CI -0.45 to -0.24) in OA. Of all topical NSAIDs, diclofenac patches were most effective for OA pain (SMD=-0.81, 95% CI -1.12 to -0.52) and piroxicam was most effective for functional improvement (SMD=-1.04, 95% CI -1.60 to -0.48) compared with placebo. Although salicylate gel was associated with higher withdrawal rates due to AEs, the remaining topical NSAIDs were not associated with any increased local or systemic AEs. CONCLUSIONS Topical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population. However, confirmation of the cardiovascular safety of topical NSAIDs still warrants further observational study.
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Affiliation(s)
- Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jie Wei
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Monica S M Persson
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Aliya Sarmanova
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - YiLun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huizhong Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center for Clinical Technology and Research of Joint Surgery, Hunan, China
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
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Wastesson JW, Martikainen JE, Zoëga H, Schmidt M, Karlstad Ø, Pottegård A. Trends in Use of Paracetamol in the Nordic Countries. Basic Clin Pharmacol Toxicol 2018. [DOI: 10.1111/bcpt.13003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jonas W. Wastesson
- Aging Research Center; Karolinska Institutet & Stockholm University; Stockholm Sweden
| | | | - Helga Zoëga
- Centre of Public Health Sciences; Faculty of Medicine; University of Iceland; Reykjavík Iceland
- Medicines Policy Research Unit; Centre for Big Data Research in Health; University of New South Wales; Sydney NSW Australia
| | - Morten Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Øystein Karlstad
- Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
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Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage 2018; 26:319-325. [PMID: 29229563 PMCID: PMC5835411 DOI: 10.1016/j.joca.2017.11.014] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
This review is based on a systematic review of the literature relevant to clinical topics in osteoarthritis (OA) performed for the time period February 22, 2016 to April 1, 2017. A PubMed search using the terms "osteoarthritis" and "treatment or epidemiology" returned over 800 papers, of which 57 are reviewed here, with inclusion primarily based on relevance to clinical OA. Epidemiologic studies in this time frame focused on the incidence and prevalence of OA, comorbidities and mortality in relation to OA (particularly obesity and cardiovascular disease), and multiple joint involvement. Papers on therapeutic approaches to OA considered: non-pharmacologic options, a number of topical, oral, and intra-articular therapies, as well as the cost-effectiveness of some OA treatments. There an enormous need to identify novel strategies to reduce the impact of this highly prevalent and debilitating condition.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7280, USA
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48
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Recent advances in hyaluronic acid based therapy for osteoarthritis. Clin Transl Med 2018; 7:6. [PMID: 29450666 PMCID: PMC5814393 DOI: 10.1186/s40169-017-0180-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/22/2017] [Indexed: 12/15/2022] Open
Abstract
Osteoarthritis is a debilitating disease that has increased in prevalence across the world due to the aging population. Currently, physicians use a plethora of treatment strategies to try and slow down the progression of the disease, but none have been shown to ubiquitously treat and cure the disease. One of the strategies uses the high molecular weight molecule hyaluronic acid as either an injectable or oral supplement for treatment. Hyaluronic acid (HA) is a relatively new treatment that has shown varied results through several clinical trials. It can be used as a scaffold for engineering new treatments and several new preparations have just been added to the market. A comprehensive search was conducted through several search databases according our inclusion and exclusion criteria. This review included 44 prospective clinical trial investigating the feasibility and efficacy of HA injection for knee, hip, and ankle osteoarthritis. This review will take a closer look at hyaluronic acid and its properties, as well clinical effectiveness and future options.
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Reist L, Erlenwein J, Meissner W, Stammschulte T, Stüber F, Stamer UM. Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German-speaking countries. Eur J Pain 2018; 22:1103-1112. [PMID: 29377479 DOI: 10.1002/ejp.1194] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Nonopioid analgesics are frequently used for the treatment of acute and chronic pain. Dipyrone is an alternative to NSAIDs and paracetamol, however, data on the frequency of its usage by anaesthesiologists in the perioperative and chronic pain setting are lacking and its adverse reactions are a matter of debate. METHODS The link to a questionnaire on the use of nonopioid analgesics (NSAIDs, COX-2 inhibitors, paracetamol, dipyrone) and the safety of dipyrone in the perioperative and chronic pain setting was mailed to anaesthesiologists and pain physicians. RESULTS A total of 2237 responses were analysed. About 97.4% of the respondents used nonopioid analgesics for the treatment of acute pain, with 93.8% administering dipyrone, 54.0% NSAIDs, 41.8% COX-2 inhibitors and 49.2% paracetamol. Nonopioid analgesics were administered preoperatively by 22.3%, intraoperatively by 86.1% and postoperatively by 73.0% of the respondents. For chronic pain management, 76.7% of the respondents prescribed oral dipyrone in combination with other nonopioid analgesics; 19.9% used dipyrone as sole nonopioid, whereas 2.9% denied its use. Cases of dipyrone-associated agranulocytosis were observed by 3.5% of the respondents of the acute and 1.5% of the chronic pain questionnaire, respectively. The majority of respondents (acute pain: 73.0%, chronic pain 59.3%) performed no blood cell counts to monitor dipyrone therapy. Patients were rarely informed about possible adverse drug reactions. CONCLUSIONS Dipyrone is the preferred nonopioid analgesic in the perioperative and chronic pain setting. Although cases of agranulocytosis occur, benefits apparently outweigh the risks according to anaesthesiologists. Measures like patient information may improve safety. SIGNIFICANCE A survey of anaesthesiologist in German-speaking countries revealed dipyrone as preferred nonopioid analgesic for the treatment of acute and chronic pain. Benefits seem to outweigh the risks, specifically the risk of agranulocytosis. Information of medical staff and patients on adverse drug reactions and symptoms of agranulocytosis should be implemented.
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Affiliation(s)
- L Reist
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - J Erlenwein
- Pain Clinic, Department of Anaesthesiology, University Medical Center Goettingen, Georg-August-University of Goettingen, Goettingen, Germany
| | - W Meissner
- Department of Anaesthesiology, University Hospital, Jena, Germany
| | - T Stammschulte
- Drug Commission of the German Medical Association, Berlin, Germany
| | - F Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - U M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
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50
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Moore N, Scheiman JM. Gastrointestinal safety and tolerability of oral non-aspirin over-the-counter analgesics. Postgrad Med 2018; 130:188-199. [DOI: 10.1080/00325481.2018.1429793] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas Moore
- Department of Pharmacology, University of Bordeaux, Bordeaux, France
| | - James M Scheiman
- Division of Gastroenterology and Hepatology, University of Virginia Medical School, Charlottesville, VA, U.S.A
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