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Arthritis Care & Research Sep 2023To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG...
OBJECTIVE
To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG recommendations.
METHODS
Five databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions.
RESULTS
Of 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA.
CONCLUSION
This synthesis of high-quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.
Topics: Humans; Adolescent; Osteoarthritis; Physical Therapy Modalities; Hand; Knee Joint; Lower Extremity
PubMed: 36762545
DOI: 10.1002/acr.25101 -
The American Journal of Sports Medicine Jul 2023Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint...
BACKGROUND
Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint loading is scarce for a majority of common weightbearing rehabilitation exercises.
PURPOSE
To define a loading index to quantify, compare, rank, and categorize overall loading levels in the patellofemoral joint across 35 types of weightbearing rehabilitation exercises and activities of daily living.
STUDY DESIGN
Descriptive laboratory study.
METHODS
Model-estimated knee flexion angles and extension moments based on motion capture and ground-reaction force data were used to quantify patellofemoral joint loading in 20 healthy participants who performed each exercise. A loading index was computed via a weighted sum of loading peak and cumulative loading impulse for each exercise. The 35 rehabilitation exercises and daily living activities were then ranked and categorized into low, moderate, and high "loading tiers" according to the loading index.
RESULTS
Overall patellofemoral loading levels varied substantially across the exercises and activities, with loading peak ranging from 0.6 times body weight during walking to 8.2 times body weight during single-leg decline squat. Most rehabilitation exercises generated a moderate level of patellofemoral joint loading. Few weightbearing exercises provided low-level loading that resembled walking or high-level loading with both high magnitude and duration. Exercises with high knee flexion tended to generate higher patellofemoral joint loading compared with high-intensity exercises.
CONCLUSION
This study quantified patellofemoral joint loading across a large collection of weightbearing exercises in the same cohort.
CLINICAL RELEVANCE
The visualized loading index ranks and modifiable worksheet may assist clinicians in planning patient-specific exercise programs for patellofemoral pain rehabilitation.
Topics: Humans; Patellofemoral Joint; Activities of Daily Living; Patellofemoral Pain Syndrome; Biomechanical Phenomena; Exercise Therapy; Weight-Bearing; Body Weight; Knee Joint
PubMed: 37272685
DOI: 10.1177/03635465231175160 -
BMC Neurology Jul 2023People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity... (Randomized Controlled Trial)
Randomized Controlled Trial
The hip joint mobilization with movement technique improves muscle activity, postural stability, functional and dynamic balance in hemiplegia secondary to chronic stroke: a blinded randomized controlled trial.
BACKGROUND
People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity in balance maintenance, hip joint mobilization with movement technique can be applied to enhance normal joint arthrokinematics. Therefore, the present study aimed to investigate the effectiveness of hip joint mobilization with movement technique on stroke patients' muscle activity and balance.
METHODS
Twenty patients aged between 35 and 65 years old with chronic stroke were randomly assigned either to an experimental group (n = 10) or to a control group (n = 10). Both groups participated in a 30-minute conventional physiotherapy session 3 times per week for 4 weeks. The experimental group received an additional 30-minute's session of hip joint mobilization with movement technique on the affected limb. The muscle activity, berg balance scale, time up and go, and postural stability were measured at baseline, 1-day and 2-week follow-up by a blinded assessor.
RESULTS
The experimental group showed a significant improvement in berg balance scale, time up and go, and postural stability (p ≤ 0.05). The rectus femoris, tibialis anterior, biceps femoris, and medial gastrocnemius muscles' activations of the affected limb during static balance test markedly changed along with the biceps femoris, erector spine, rectus femoris, and tibialis anterior muscles during dynamic balance test after hip joint mobilization with movement technique. The mean onset time of rectus abdominus, erector Spine, rectus femoris, and tibialis anterior muscles activity significantly decreased in the affected limb after hip joint mobilization with movement technique compared to the control group (p ≤ 0.05).
CONCLUSIONS
The results of the present study suggest that a combination of hip joint mobilization with movement technique and conventional physiotherapy could improve muscle activity and balance among chronic stroke patients.
TRIAL REGISTRATION NUMBER
The study was registered in the Iranian Registry of Clinical Trials (No; IRCT20200613047759N1). Registration date: 2/08/2020.
Topics: Humans; Adult; Middle Aged; Aged; Hemiplegia; Iran; Stroke; Quadriceps Muscle; Brain Damage, Chronic; Hip Joint; Physical Therapy Modalities
PubMed: 37434123
DOI: 10.1186/s12883-023-03315-2 -
Cells Jun 2023Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by autoimmunity, synovial inflammation and joint destruction. Pannus formation in the... (Review)
Review
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by autoimmunity, synovial inflammation and joint destruction. Pannus formation in the synovial cavity can cause irreversible damage to the joint and cartilage and eventually permanent disability. Current conventional treatments for RA have limitations regarding efficacy, safety and cost. microRNA (miRNA) is a type of non-coding RNA (ncRNA) that regulates gene expression at the post-transcriptional level. The dysregulation of miRNA has been observed in RA patients and implicated in the pathogenesis of RA. miRNAs have emerged as potential biomarkers or therapeutic agents. In this review, we explore the role of miRNAs in various aspects of RA pathophysiology, including immune cell imbalance, the proliferation and invasion of fibroblast-like synovial (FLS) cell, the dysregulation of inflammatory signaling and disturbance in angiogenesis. We delve into the regulatory effects of miRNAs on Treg/Th17 and M1/M2 polarization, the activation of the NF-κB/NLRP3 signaling pathway, neovascular formation, energy metabolism induced by FLS-cell-induced energy metabolism, apoptosis, osteogenesis and mobility. These findings shed light on the potential applications of miRNAs as diagnostic or therapeutic biomarkers for RA management. Furthermore, there are some strategies to regulate miRNA expression levels by utilizing miRNA mimics or exosomes and to hinder miRNA activity via competitive endogenous RNA (ceRNA) network-based antagonists. We conclude that miRNAs offer a promising avenue for RA therapy with unlimited potential.
Topics: Humans; MicroRNAs; Arthritis, Rheumatoid; Joints; Synoviocytes; Biomarkers
PubMed: 37443783
DOI: 10.3390/cells12131749 -
Organogenesis Dec 2023Articular cartilage is a common cartilage type found in a multitude of joints throughout the human body. However, cartilage is limited in its regenerative capacity. A... (Review)
Review
Articular cartilage is a common cartilage type found in a multitude of joints throughout the human body. However, cartilage is limited in its regenerative capacity. A range of methods have been employed to aid adults under the age of 45 with cartilage defects, but other cartilage pathologies such as osteoarthritis are limited to non-steroidal anti-inflammatory drugs and total joint arthroplasty. Cell therapies and synthetic biology can be utilized to assist not only cartilage defects but have the potential as a therapeutic approach for osteoarthritis as well. In this review, we will cover current cell therapy approaches for cartilage defect regeneration with a focus on autologous chondrocyte implantation and matrix autologous chondrocyte implantation. We will then discuss the potential of stem cells for cartilage repair in osteoarthritis and the use of synthetic biology to genetically engineer cells to promote cartilage regeneration and potentially reverse osteoarthritis.
Topics: Adult; Humans; Cartilage, Articular; Cartilage Diseases; Stem Cells; Cell- and Tissue-Based Therapy; Osteoarthritis
PubMed: 37963189
DOI: 10.1080/15476278.2023.2278235 -
Medical Sciences (Basel, Switzerland) Aug 2023Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include... (Review)
Review
Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include liver disease, cardiomyopathy, skin pigmentation, diabetes mellitus, erectile dysfunction, hypothyroidism, and arthropathy. Arthropathy with joint pain is frequently reported at diagnosis and mainly involves the metacarpophalangeal and ankle joints, and more rarely, the hip and knee. Symptoms in ankle joints are in most cases non-specific, and they can range from pain and swelling of the ankle to deformities and joint destruction. Furthermore, the main radiological signs do not differ from those of primary osteoarthritis (OA). Limited data are available in the literature regarding treatment; surgery seems to be the gold standard for ankle arthropathy in HH. Pharmacological treatments used to maintain iron homeostasis can also be undertaken to prevent the arthropathy, but conclusive data are not yet available. This review aimed to assess the ankle arthropathy in the context of HH, including all its aspects: epidemiology, physiopathology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
Topics: Male; Humans; Ankle; Ankle Joint; Hemochromatosis; Joint Diseases; Iron
PubMed: 37606430
DOI: 10.3390/medsci11030051 -
Acta Biomaterialia Sep 2023Osteoarthritis (OA) is a widespread clinical disease characterized by cartilage degeneration in middle-aged and elderly people. Currently, there is no effective... (Review)
Review
Osteoarthritis (OA) is a widespread clinical disease characterized by cartilage degeneration in middle-aged and elderly people. Currently, there is no effective treatment for OA apart from total joint replacement in advanced stages. Mesenchymal stem cells (MSCs) are a type of adult stem cell with diverse differentiation capabilities and immunomodulatory potentials. MSCs are known to effectively regulate the cartilage microenvironment, promote cartilage regeneration, and alleviate OA symptoms. As a result, they are promising sources of cells for OA therapy. Recent studies have revealed the presence of resident MSCs in synovial fluid, synovial membrane, and articular cartilage, which can be collected as knee joint-derived MSCs (KJD-MSC). Several preclinical and clinical studies have demonstrated that KJD-MSCs have great potential for OA treatment, whether applied alone, in combination with biomaterials, or as exocrine MSCs. In this article, we will review the characteristics of MSCs in the joints, including their cytological characteristics, such as proliferation, cartilage differentiation, and immunomodulatory abilities, as well as the biological function of MSC exosomes. We will also discuss the use of tissue engineering in OA treatment and introduce the concept of a new generation of stem cell-based tissue engineering therapy, including the use of engineering, gene therapy, and gene editing techniques to create KJD-MSCs or KJD-MSC derivative exosomes with improved functionality and targeted delivery. These advances aim to maximize the efficiency of cartilage tissue engineering and provide new strategies to overcome the bottleneck of OA therapy. STATEMENT OF SIGNIFICANCE: This research will provide new insights into the medicinal benefit of Joint resident Mesenchymal Stem Cells (MSCs), specifically on its cartilage tissue engineering ability. Through this review, the community will further realize promoting joint resident mesenchymal stem cells, especially cartilage progenitor/MSC-like progenitor cells (CPSC), as a preventive measure against osteoarthritis and cartilage injury. People and medical institutions may also consider cartilage derived MSC as an alternative approach against cartilage degeneration. Moreover, the discussion presented in this study will convey valuable information for future research that will explore the medicinal benefits of cartilage derived MSC.
Topics: Aged; Adult; Middle Aged; Humans; Tissue Engineering; Cartilage, Articular; Osteoarthritis; Mesenchymal Stem Cells; Knee Joint; Mesenchymal Stem Cell Transplantation
PubMed: 37481194
DOI: 10.1016/j.actbio.2023.07.024 -
Orthopadie (Heidelberg, Germany) Jun 2024The term osteoarthritis (OA) of the wrist can be used as an umbrella term for various, often independent areas of OA, as the wrist is made up of several joints.... (Review)
Review
The term osteoarthritis (OA) of the wrist can be used as an umbrella term for various, often independent areas of OA, as the wrist is made up of several joints. Radiocarpal OA often occurs after untreated ligament injuries, incorrectly healed bone fractures in the carpus or after radius fractures involving the joint. A typical sequence of propagation is known for radiocarpal OA following scapholunate (SL) insufficiency or scaphoid pseudarthrosis. Other causes include inflammation, crystal deposits or bone necrosis. Ulnocarpal arthrosis occurs posttraumatically or primarily when there are differences in levels between the ulna and radius. When treating wrist arthrosis, after conservative measures have been exhausted a surgical procedure should be chosen that enables the best possible load-bearing and residual mobility, considering the surgical risks and individual requirements. During salvage operations, the defective cartilage areas are either fused directly or eliminated using appropriate diverting partial fusions and resection arthroplasty. An accurate analysis of the affected zones is crucial for selecting an appropriate intervention.
Topics: Humans; Osteoarthritis; Wrist Joint
PubMed: 38789591
DOI: 10.1007/s00132-024-04502-w -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2023
Topics: Wrist; Wrist Joint
PubMed: 37414048
DOI: 10.1055/a-2077-3074 -
Scientific Reports Jun 2024This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50...
This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50 cadavers were examined. The articular facets of the first metatarsal and medial cuneiform were categorized into four types based on the superior and inferior facets' separation, and the formation of the inferior lateral facet on the lateral plantar prominence: Type I, a single facet with no separation or inferior lateral facet; Type II-a, two facets with separation but no inferior lateral facet; Type II-b, two facets, no separation, but with an inferior lateral facet; Type III, three facets with separation and an inferior lateral facet. When both bone types matched, they were defined as Type I, Type II-a, Type II-b, and Type III joints, respectively; unmatched types were classified as Unpair joints. The severity of articular cartilage degeneration on both bones was assessed using a 5-point scale. The degeneration grade was compared among joint types. Type III joints exhibited significantly milder articular cartilage degeneration in medial cuneiform compared to Type II-a, II-b, Unpair joints. The formation of inferior lateral facet and separation of the superior and inferior facets might be crucial for the joint's stability.
Topics: Humans; Female; Male; Aged; Middle Aged; Aged, 80 and over; Cadaver; Cartilage, Articular; Metatarsal Bones; Tarsal Joints; Foot Joints
PubMed: 38866886
DOI: 10.1038/s41598-024-64064-x