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Turkish Journal of Haematology :... Jun 2016Haemophilia is an inherited bleeding disorder that can lead to degenerative joint arthropathy due to recurrent bleeding episodes affecting the musculoskeletal system of... (Review)
Review
Haemophilia is an inherited bleeding disorder that can lead to degenerative joint arthropathy due to recurrent bleeding episodes affecting the musculoskeletal system of the patient. The cause of bleeding can be either traumatic or spontaneous. The pathogenesis of haemophilic arthropathy is unclear as many factors like iron, inflammatory cytokines, and angiogenic factors contribute to this process. Blood into joints can deteriorate the bone to such an extent that the patient experiences pain, reduction of the range of movement, and deformity of the joint, conditions that could have a great impact on quality of life. Over the years, management of haemophilic arthropathy has changed. Nowadays, early diagnosis with high resolution imaging like magnetic resonance imaging along with application of prophylaxis regimens can reduce the extent of damage to the joints. However, not all haemophilia patients have access to these interventions as cost may be prohibitive for some of them. The need for new, easy, and cost-effective strategies with the ability to identify early changes could be beneficial and could make a difference in the management of haemophilic arthropathy. Understanding the mechanism of processes like angiogenesis in the mechanism of developing arthropathy could be innovative for these patients and could help in the detection of new early diagnostic and therapeutic markers.
Topics: Hemophilia A; Hemophilia B; Humans; Joint Diseases; Joints; Neovascularization, Pathologic; Neovascularization, Physiologic
PubMed: 27211044
DOI: 10.4274/tjh.2016.0031 -
Archives of Iranian Medicine Sep 2020This brief review presents Razi's concepts of bone and joint disorders. Razi differentiated between ligaments, tendons, and nerves and recognized the role of the brain,...
This brief review presents Razi's concepts of bone and joint disorders. Razi differentiated between ligaments, tendons, and nerves and recognized the role of the brain, spinal cord, and peripheral nervous system in the perception of senses and voluntary movements. He described paralysis and loss of sensation following brain, spinal cord, and peripheral nervous system injuries. Razi presented an early concept of compartment syndrome. Razi's approach to fracture management is very similar to the current concept of functional bracing for some fractures. Razi mentioned suturing the wounds and ligation of bleeding large vessels. He cautioned about phlebotomy in the antecubital fossa as it may become complicated by the adjacent arterial and nerve injuries. Razi treated osteomyelitis by removing the infected and necrotic bone by sawing, cutting, and rasping. He also documented arthralgia, painful hip, and sciatic pain and made a sharp distinction between arthralgia and gout. He indicated the gout origin as the production of a waste substance that the body fails to expel. Razi's basic concepts on the bone and joint disorders established a foundation for modern orthopedic science.
Topics: Bone Diseases; History, Medieval; Iran; Joint Diseases; Orthopedics
PubMed: 32979910
DOI: 10.34172/aim.2020.74 -
International Journal of... 2010Limited joint mobility is frequently observed in elderly people and in patients suffering from diabetes, who represent a growing segment of the population of western... (Review)
Review
Limited joint mobility is frequently observed in elderly people and in patients suffering from diabetes, who represent a growing segment of the population of western countries. Our review wishes to offer the state of art about this interesting topic, which may have important clinical implications, leading to impairment of both basic and instrumental activities of daily living. The main causes of a reduced range of motion are degenerative joint diseases and increased stiffness of collagen tissue. The main biochemical abnormality, common to aging and diabetes, is the non-enzymatic glycosilation of collagen, with advanced glycation end product (AGE) formation, which in turn leads to an increase of collagen cross-links. The most extensive accumulation of AGEs occurs in tissues that contain proteins with low turnover, such as the collagen in the extracellular matrix of articular capsule, ligaments and muscle-tendon units. The increase in collagen cross-linking alters the mechanical properties of these tissues with a decrease in elasticity and tensile strength, and an increase in mechanical stiffness. Besides this, AGEs react with specific cell surface receptors (RAGEs). The engagement of the ligand by RAGEs triggers cell-specific signalling, resulting in enhanced generation of reactive oxygen species and sustained up-regulation of pro-inflammatory mediators and adhesion molecules. An appropriate control of the glucose levels and a diet rich in antioxidant agents are recommended in patients with diabetes. Stretching and strengthening programmes are widely used, in order to prevent and to reduce joint stiffness, but the improvements with physiotherapy are little and short-lasting. Several drugs, which can interfere with AGE formation and removal, or with the cellular effects of AGEs, are under study (among them pyridoxamine, an active form of Vitamin B6, AGE-breaker compounds, glucosamine, rutin and derivatives, soluble RAGE isoforms, and statins). In experimental animal models, these drugs are effective in reducing diabetic complications due to AGE formation; however, further study is necessary before their extensive use in the clinical setting.
Topics: Aging; Animals; Collagen; Diabetes Complications; Glycation End Products, Advanced; Humans; Joint Diseases; Range of Motion, Articular
PubMed: 21244749
DOI: 10.1177/039463201002300404 -
Endocrine Reviews Feb 2004This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases,... (Review)
Review
This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are advantageously benefitted by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.
Topics: Acromegaly; Cardiovascular Diseases; Human Growth Hormone; Humans; Insulin-Like Growth Factor I; Joint Diseases; Lung Diseases; Metabolic Diseases; Neoplasms
PubMed: 14769829
DOI: 10.1210/er.2002-0022 -
TheScientificWorldJournal 2013In patients with haemophilia (PWH) (from Greek "blood love"), the long-term consequences of repeated haemarthrosis include cartilage damage and irreversible arthropathy,... (Review)
Review
In patients with haemophilia (PWH) (from Greek "blood love"), the long-term consequences of repeated haemarthrosis include cartilage damage and irreversible arthropathy, resulting in severe impairments in locomotion. Quantifying the extent of joint damage is therefore important in order to prevent disease progression and compare the efficacy of treatment strategies. Musculoskeletal impairments in PWH may stem from structural and functional abnormalities, which have traditionally been evaluated radiologically or clinically. However, these examinations are performed in a supine position (i.e., non-weight-bearing condition). We therefore suggest three-dimensional gait analysis (3DGA) as an innovative approach designed to focus on the functional component of the joint during the act of walking. This is of the utmost importance, as pain induced by weight-bearing activities influences the functional performance of the arthropathic joints significantly. This review endeavors to improve our knowledge of the biomechanical consequences of multiple arthropathies on gait pattern in adult patients with haemophilia using 3DGA. In PWH with arthropathy, the more the joint function was altered, the more the metabolic energy was consumed. 3DGA analysis could highlight the effect of an orthopedic disorder in PWH during walking. Indeed, mechanical and metabolic impairments were correlated to the progressive loss of active mobility into the joints.
Topics: Gait; Gait Disorders, Neurologic; Hemophilia A; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Joint Diseases
PubMed: 23766686
DOI: 10.1155/2013/284358 -
The Bone & Joint Journal Jan 2013The technical advances in arthroscopic surgery of the hip, including the improved ability to manage the capsule and gain extensile exposure, have been paralleled by a... (Review)
Review
The technical advances in arthroscopic surgery of the hip, including the improved ability to manage the capsule and gain extensile exposure, have been paralleled by a growth in the number of conditions that can be addressed. This expanding list includes symptomatic labral tears, chondral lesions, injuries of the ligamentum teres, femoroacetabular impingement (FAI), capsular laxity and instability, and various extra-articular disorders, including snapping hip syndromes. With a careful diagnostic evaluation and technical execution of well-indicated procedures, arthroscopic surgery of the hip can achieve successful clinical outcomes, with predictable improvements in function and pre-injury levels of physical activity for many patients.This paper reviews the current position in relation to the use of arthroscopy in the treatment of disorders of the hip.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Injuries; Hip Joint; Humans; Joint Diseases; Joint Instability; Preoperative Care; Treatment Outcome
PubMed: 23307667
DOI: 10.1302/0301-620X.95B1.29608 -
Physical Therapy Jul 2011
Topics: Comparative Effectiveness Research; Humans; Insurance, Health; Israel; Joint Diseases; Knee Joint; Patient Selection; Physical Therapy Modalities; United States
PubMed: 21724597
DOI: 10.2522/ptj.20100175.ic -
Respiratory Medicine Feb 2019Recurrent joint pain is frequently observed in patients with CF and can lead to reduced activity and quality of life. We conducted this observational study to assess the... (Observational Study)
Observational Study
BACKGROUND
Recurrent joint pain is frequently observed in patients with CF and can lead to reduced activity and quality of life. We conducted this observational study to assess the clinical manifestations, frequency, and risk factors of CF associated arthropathy.
METHODS
Clinical data were collected using a digital quality management system, medical records, and by conducting structured interviews. Univariate and multivariate statistical analysis were performed for statistical interpretation.
STUDY DESIGN
retrospective observational study including 186 patients.
RESULTS
Of 186 patients (Demographics: Mean age 27 years, female gender 104/186 (57%), CFTR F508del homozygous 82/186 (44%) included in the study, 54/186 (29%) had experienced joint symptoms. Joint pain and swelling were the most frequent symptoms. The joints of the hands (JOH) followed by the joints of the feet were most affected. No specific pattern of autoantibodies was discovered. The level of total serum IgG, age, female gender, and pulmonary exacerbations per year were significant risk factors for arthropathy in the study cohort.
CONCLUSIONS
Joint symptoms in CF are a frequent and clinically relevant phenomenon with a distinct clinical pattern. Pulmonary exacerbations and elevated levels of total serum IgG may reflect chronic inflammation in patients with CF and may lead to a specific arthropathy associated with this condition.
Topics: Adult; Cystic Fibrosis; Disease Progression; Female; Homozygote; Humans; Immunoglobulin G; Incidence; Joint Diseases; Male; Middle Aged; Quality of Life; Retrospective Studies; Risk Factors
PubMed: 30704701
DOI: 10.1016/j.rmed.2019.01.003 -
Medicine Jul 2018Hemophilic arthropathy (HA) is a crucial morbidity and a major cause of joint pain and disability in patients with hemophilia A. Surgical methods, such as total joint... (Review)
Review
RATIONALE
Hemophilic arthropathy (HA) is a crucial morbidity and a major cause of joint pain and disability in patients with hemophilia A. Surgical methods, such as total joint arthroplasty, are of vital importance for end-stage HA treatment, but the feasibility and effects of multi-joint replacement surgery remain debatable.
PATIENT CONCERNS
A 24-year-old patient with advanced HA presented multiple joint pain. Physical examination revealed joint tenderness, swelling, and limited activity. Radiographs revealed bilateral knee joints and left elbow joint damage with joint space narrowing, articular facet erosion, and bone deformation.
DIAGNOSES
The patient was diagnosed with hemophilic arthropathy with multi-joint lesions.
INTERVENTIONS
The key points of this case include arthropathy in multiple joints and the management of simultaneous total multi-joint arthroplasty. We performed bilateral total knee arthroplasty and total left elbow arthroplasty simultaneously after adequate preparations. Special attention was paid to factor VIII infusion, hemorrhage control, and other safety precautions perioperatively.
OUTCOMES
After the surgery, no complications, such as infection or aseptic loosening, occurred, and the joints functioned well at follow-up.
LESSONS
The surgical outcome and safety of multi-joint replacement for HA are attested. Simultaneous multi-joint arthroplasty can ameliorate the quality of life for patients with hemophilia A.
Topics: Adult; Arthroplasty, Replacement; Factor VIII; Hemophilia A; Humans; Joint Diseases; Treatment Outcome
PubMed: 30024499
DOI: 10.1097/MD.0000000000011163 -
Clinical Anatomy (New York, N.Y.) Nov 2022The relationship between degenerative zygapophysial joint (facet) arthropathy and multifidus muscle atrophy has not been rigorously evaluated. The purpose of this study...
The relationship between degenerative zygapophysial joint (facet) arthropathy and multifidus muscle atrophy has not been rigorously evaluated. The purpose of this study was to determine if specific morphological features of degenerative facet arthropathy are correlated with multifidus muscle atrophy. We retrospectively reviewed medical records and imaging studies of patients with lumbar spinal stenosis. Facet overhang, bridging osteophyte formation, facet effusion, and facet angles were evaluated by univariable and multivariable regression to identify independent associations with deep and superficial parts of the multifidus total cross-sectional area (tCSA), functional cross-sectional area (fnCSA), and fatty infiltration (FI). Facet overhang was classified as severe in 50 females (53.2%) versus 56 males (36.9%) (p = 0.030). Severity of facet overhang and female sex were independently associated with smaller deep part of the multifidus tCSA and fnCSA as well as higher FI, reflecting greater atrophy of the deep region compared to total muscle mass. In comparison, severe facet overhang (p < 0.001; OR = 3.47, 95% CI = 2.13-5.66) and female sex (p < 0.001; OR = 4.19, 95% CI = 2.58-6.79) were independently associated only with higher superficial part of the multifidus FI, reflecting muscle steatosis without significant lean muscle atrophy. In patients with degenerative lumbar spinal stenosis, facet overhang is an independent risk factor for deep part of the multifidus atrophy. Bridging osteophyte formation, facet effusion, and facet angles were not independently associated with deep part of the multifidus atrophy.
Topics: Female; Humans; Joint Diseases; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Muscular Atrophy; Osteophyte; Paraspinal Muscles; Retrospective Studies; Spinal Stenosis
PubMed: 35701879
DOI: 10.1002/ca.23923