RESUMO
BACKGROUND: Thumb carpometacarpal osteoarthritis (CMC OA) is characterized by chronic progressive degeneration of the joint cartilage, with high prevalence. Patients present with pain at the base of the thumb, morning stiffness, and muscle weakness, symptoms that affect hand function and therefore interfere in activities and social participation. Movements that involve grip or lateral pinch are the most affected and directly impact independence, self-care, and leisure activities. In the literature consulted, several protocols with exercises for these patients were found. However, most do not compare the same intervention modality and only provide basic methodological information, with no consistent information on training load and load progression. In addition, most protocols only address the strengthening of the abductor and extensor thumb muscles and pinching or grasping exercises. However, some biomechanical and electromyographic studies have demonstrated the important role of the first dorsal interosseous muscles as stabilizers of the thumb carpometacarpal joint. METHODS: This is a randomized, controlled, double-blind, and parallel clinical trial that will include 56 participants, over 40 years old, with radiographic evidence of thumb base osteoarthritis. Participants will be randomly allocated into two groups: control and intervention. The following evaluations will be conducted: the Australian/Canadian Hand Osteoarthritis Index, Canadian Occupational Performance Measure, Nine-Hole Peg Test, grip and pinch strength associated with muscle activation assessment, and Bilateral Upper Limb Function Test at four different times: baseline, session 13, session 18, and follow-up. Treatment will take place over 6 weeks, with reassessments in the fourth and sixth weeks and 3 months after the end of the intervention (follow-up). Qualitative variables will be expressed as frequency and percentage, and quantitative variables as mean and standard deviation. Intergroup comparison of the intervention will be performed by repeated measures ANOVA, considering the effect of the two groups and four assessments, and interactions between them. DISCUSSION: This study will demonstrate whether the specific strengthening of the first dorsal interosseous muscle has a superior and positive effect on the clinical picture of patients with CMC OA. Additionally, if specific strengthening of the muscle is not superior to the traditional protocol in the literature, it will also be determined whether the two protocols are equivalent in terms of the best clinical picture. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) RBR-8kgqk4 . Prospectively registered on 15 January 2020.
Assuntos
Articulação da Mão , Osteoartrite , Adulto , Austrália , Canadá , Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Polegar , Resultado do TratamentoRESUMO
Abstract Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing posttraumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.
Resumo A osteoartrite (OA) é caracterizada por uma degradação crônica, progressiva e irreversível da superfície articular, associada a inflamação articular. A principal etiologia da OA do tornozelo é pós-traumática e sua prevalência é maior entre os jovens e obesos. Apesar dos avanços no tratamento das fraturas ao redor do tornozelo, o risco geral de desenvolver OA pós-traumática do tornozelo após 20 anos do trauma é de quase 40%; especialmente nas fraturas bimaleolares de Weber tipo B e C e fraturas envolvendo a borda tibial posterior. Nas fraturas do tálus, essa prevalência se aproxima de 100%, dependendo da gravidade da lesão e do tempo de seguimento. Nesse cenário, é fundamental a compreensão atual das vias de sinalização moleculares envolvidas na senescência e apoptose dos condrócitos. O tratamento da OA do tornozelo é estagiado e guiado pelos sistemas de classificação, condições locais e do paciente. Os principais problemas são a limitada capacidade de regeneração da cartilagem articular, o baixo suprimento de sangue e a escassez de células-tronco progenitoras. A presente atualização resume evidências científicas básicas recentes da OA póstraumática do tornozelo, com foco principal nas alterações metabólicas da sinóvia, da cartilagem e do líquido sinovial. Epidemiologia, fisiopatologia, implicações clínicas, e opções de tratamento são também discutidas.
Assuntos
Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Líquido Sinovial , Cartilagem , Cartilagem Articular , Prevalência , Fraturas Ósseas , Fraturas do Tornozelo , Tornozelo/fisiopatologiaRESUMO
BACKGROUND: Osteoarthritis is the most common form of hand arthritis and arthritis of the carpometacarpal joint of the thumb is a potentially limiting disease. There is no homogeneity in the evaluation of outcomes for the rhizarthrosis treatment. In an attempt to standardize the evaluation of results, some subjective questionnaires, non-specific, were used to evaluate rhizarthrosis. Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) was described by Becker et al.with the purpose of evaluating symptom intensity and degree of disability, as to compare results after treatment. Our objective is to translate, validate and do the cultural adaptation of the questionnaire TASD into the Brazilian Portuguese. METHODS: The questionnaire was translated, with reverse translation. The translations were evaluated and synthesized by a committee, arriving at TASD-BR. Thirty-one patients with a diagnosis of rhizarthrosis answered the questionnaire. We evaluated, the internal consistency, reliability, agreement and ceiling and floor effect for validation. RESULTS: The questionnaires were translated and adapted according to defined protocols. The internal consistency, through Cronbach's α coefficient for TASD-BR, was 0.927. The questionnaire's reliability, through the Intraclass Correlation Coefficient, was also shown to be quite high, with κ = 0.961 (0.954-0.967). The agreement, measured through the Standard Error Measurement, remained with standardized values below 5%. There was no ceiling and floor effect. CONCLUSION: Through specific methodology we consider TASD-BR translated and valid for the Brazilian Portuguese.
Assuntos
Osteoartrite , Inquéritos e Questionários , Brasil , Comparação Transcultural , Humanos , Osteoartrite/diagnóstico , Reprodutibilidade dos Testes , TraduçõesRESUMO
Abstract Medial arthrosis of the knee is an evolutionary pathology that occurs due to progressive muscle imbalance. The muscles of the knee region have a large imbalance caused by the difference of power and lever arm. With the progression of life, this imbalance manifests itself more importantly, especially due to the loss of muscle strength due to aging. Pathological postures begin to occur and determine areas of support and pressure harmful to the joint. Meniscal injury is typical in the evolution of this pathology, as well as cartilage injury. The recognition of this pathology enables good results with less aggressive treatments, such as correction of muscle imbalance and consequent reeducation of joint support. Economic and partial meniscectomy brings good results in the early stages of the degenerative process. Progressive evolution leads to knee degeneration and the consequent need for broader surgeries.
Resumo A artrose medial do joelho é uma patologia evolutiva que ocorre em decorrência de desequilíbrio muscular progressivo. Os músculos da região do joelho têm um grande desequilíbrio, provocado pela diferença de potência e braço de alavanca. Com a progressão da vida, este desequilíbrio se manifesta de forma mais importante, especialmente em decorrência da perda de força muscular em função do envelhecimento. Posturas patológicas passam a ocorrer e determinar zonas de apoio e pressão lesivas para a articulação. A lesão meniscal é típica na evolução desta patologia, assim como a lesão da cartilagem. O reconhecimento desta patologia possibilita resultados bons com tratamentos menos agressivos, como a correção do desequilíbrio muscular e consequente reeducação do apoio da articulação. A meniscectomia econômica e parcial traz bons resultados nas fases iniciais do processo degenerativo. A evolução progressiva leva à degeneração do joelho e à consequente necessidade de cirurgias mais amplas.
Assuntos
Osteoartrite/diagnóstico , Osteoartrite/terapia , Osteonecrose , Menisco/lesõesRESUMO
STUDY DESIGN: This is a cross-sectional study. INTRODUCTION: The wrist extensor muscles have a fundamental role in the stabilization of the wrist while performing manual activities. However, it is unknown if the clinical signs of hand osteoarthritis (HOA) cause impairment in the activation of these muscles PURPOSE OF THE STUDY: The purpose of this study was to investigate whether early-stage HOA affects the magnitude of activation and coactivation between the wrist extensor and flexor muscles METHODS: Thirty-two subjects were divided into two groups: control group (n = 16; 55 ± 7.42 years) and a group with HOA grades 2 or 3 (HOAG; n = 16; 57 ± 7.82 years). Muscle activation was measured in m. flexor digitorum superficialis, m. flexor carpi ulnaris (FCU) and extensors (EXT) during the evaluation of grip strength and three manual activities (write, cut a paper with scissors, and close and open a bottle). The coactivation index was calculated between the electromyography of the flexors (FCU and FSD) and wrist EXT. RESULTS: HOAG presented reduced muscle activation in all tasks, with a statistical difference for the flexor digitorum superficialis and EXT in the scissors activity, and for the FCU in the bottle activity. No differences were found between groups for the coactivation index and grip strength. DISCUSSION: The reduced muscle activity may be due to an inability of the patients of the HOAG to recruit all motor units or to an inhibition related to the presence of pain. CONCLUSION: In the early stages of HOA, there is a functional deficit associated with a reduced muscle activity of the wrist muscles during manual activities.
Assuntos
Osteoartrite , Punho , Estudos Transversais , Eletromiografia , Força da Mão , Humanos , Músculo Esquelético , Osteoartrite/diagnósticoRESUMO
Os principais sinais clínicos da osteoartrose incluem a claudicação e a diminuição da amplitude de movimento articular. A diminuição do espaço articular é uma característica importante e comum em osteoartrose femorotibial, podendo induzir ao aumento da pressão intra-articular dentro do espaço fascial ou osseofascial e desencadear a Síndrome Compartimental Articular, quer pela diminuição do tamanho do espaço intra-articular ou pelo acúmulo de líquido sanguinolento, seroma ou linfa. Essa síndrome pode resultar na inadequada perfusão sanguínea e causar isquemia local, e consequentemente, maior dano articular. Visto que a aferição da pressão intra-articular não é uma prática comum na Medicina Veterinária, o presente estudo teve como objetivo realizar uma revisão da literatura sobre a pressão intra-articular da articulação femorotibial de cães acometidos por osteoartrose.(AU)
The main clinical signs of osteoarthrosis includes lameness and decreased range of joint motion. The decreased joint space its an important and common feature in femorotibial osteoarthrosis of the and may induce an increased intra-articular pressure within the fascial or osteofascial space, triggering the Joint Compartment Syndrome, either by decreasing the size of the joint space or through the accumulation of bloody fluid, seroma or lymph. This Syndrome can result on inadequate blood flow and create an hypoxic joint, leading to greater joint damage. Since intra-articular pressure measurement is not a common practice in Veterinary Medicine, the present study aimed to review the literature on intra-articular femorotibial pressure in dogs with osteoarthrosis.(AU)
Las principales manifestaciones clínicas de osteoartrosis incluyen cojera y disminución de la amplitud del movimiento articular. El estrechamiento del espacio articular es una importante y común característica en la osteoartrosis femorotibial, y puede inducir una elevación de la presión dentro del espacio fascial u osofascial, con la consiguiente síndrome compartimental articular, ya sea decreciendo el tamaño del espacio intra articular o mediante acumulación de líquido sanguinolento, seroma o linfa. Esta síndrome puede provocar una perfusión sanguínea inadecuada y causar una isquemia articular, resultando en, un mayor daño articular. Dado que la medición de la presión sobre las articulaciones no es una práctica común en medicina veterinária, el presente estudio tuvo como objetivo revisar la literatura acerca de la presión de la articulación femorotibial de perros con osteoartrosis.(AU)
Assuntos
Animais , Cães , Osteoartrite/diagnóstico , Osteoartrite/veterinária , Hipóxia/veterinária , Síndromes Compartimentais/veterinária , Articulação do Joelho/patologia , Tíbia/patologia , Fêmur/patologiaRESUMO
Osteoarthritis is a degenerative disease that causes substantial changes in joint tissues, such as cartilage degeneration and subchondral bone sclerosis. Chondroitin sulfate and glucosamine are commonly used products for the symptomatic treatment of osteoarthritis. The aim of the present study was to investigate the effects of these products when used as structure-modifying drugs on the progression of osteoarthritis in the rabbit temporomandibular joint. Thirty-six New Zealand rabbits were divided into 3 groups (n = 12/group): control (no disease); osteoarthritis (disease induction); and treatment (disease induction and administration of chondroitin sulfate and glucosamine). Osteoarthritis was induced by intra-articular injection of monosodium iodoacetate. Animals were killed at 30 and 90 days after initiation of therapy. The treatment was effective in reducing disease severity, with late effects and changes in the concentration of glycosaminoglycans in the articular disc. The results indicate that chondroitin sulfate and glucosamine may have a structure-modifying effect on the tissues of rabbit temporomandibular joints altered by osteoarthritis.
Assuntos
Artrite Experimental/tratamento farmacológico , Sulfatos de Condroitina/administração & dosagem , Glucosamina/administração & dosagem , Osteoartrite/tratamento farmacológico , Articulação Temporomandibular/efeitos dos fármacos , Animais , Artrite Experimental/induzido quimicamente , Artrite Experimental/diagnóstico , Artrite Experimental/patologia , Cartilagem Articular/citologia , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/patologia , Modelos Animais de Doenças , Quimioterapia Combinada/métodos , Matriz Extracelular/efeitos dos fármacos , Matriz Extracelular/patologia , Humanos , Injeções Intra-Articulares , Injeções Subcutâneas , Ácido Iodoacético/administração & dosagem , Ácido Iodoacético/toxicidade , Masculino , Osteoartrite/induzido quimicamente , Osteoartrite/diagnóstico , Osteoartrite/patologia , Coelhos , Índice de Gravidade de Doença , Articulação Temporomandibular/patologiaRESUMO
There is a high percentage of error in the approach of patients with joint pain by primary care physicians. An algorithm can help improve this misdiagnosis problem. Our study seeks to determine the effectiveness of an algorithm when used by primary care physicians for the diagnosis of cases of joint pain patients. A randomized clinical experiment was carried out. Primary care physicians from five cities in Colombia developed a series of clinical cases, which were presented to them through a website on their personal cell phones. Half of the doctors developed the cases using the diagnostic algorithm, and the other half developed the cases without the use of the algorithm. Main measures were proportion of correct diagnosis, number, type of laboratory and diagnostic images requested for the diagnostic approach of clinical cases. Two hundred and twenty-four primary care physicians participated. The overall proportion of cases correctly diagnosed was 37.3% higher in the intervention group; we found a greater difference in cases of spondyloarthritis (60.8%), followed by systemic lupus erythematosus with joint involvement (32.2%), rheumatoid arthritis (30.3%) and osteoarthritis (25.9%). The average number of tests requested to develop clinical cases was lower in the intervention group than in the control group, both globally and for each of the four diseases, with statistically significant differences for each of the comparisons. The diagnostic algorithm proved to be an effective tool when used by primary care physicians; the proportion of correct diagnoses increased, and the number of tests requested in the development of the cases decreased.
Assuntos
Algoritmos , Artralgia/diagnóstico , Artrite Reumatoide/diagnóstico , Erros de Diagnóstico/prevenção & controle , Lúpus Eritematoso Sistêmico/diagnóstico , Osteoartrite/diagnóstico , Médicos de Atenção Primária , Espondiloartropatias/diagnóstico , Adulto , Artralgia/etiologia , Artrite Reumatoide/complicações , Colômbia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Distribuição Aleatória , Espondiloartropatias/complicaçõesRESUMO
Os principais sinais clínicos da osteoartrose incluem a claudicação e a diminuição da amplitude de movimento articular. A diminuição do espaço articular é uma característica importante e comum em osteoartrose femorotibial, podendo induzir ao aumento da pressão intra-articular dentro do espaço fascial ou osseofascial e desencadear a Síndrome Compartimental Articular, quer pela diminuição do tamanho do espaço intra-articular ou pelo acúmulo de líquido sanguinolento, seroma ou linfa. Essa síndrome pode resultar na inadequada perfusão sanguínea e causar isquemia local, e consequentemente, maior dano articular. Visto que a aferição da pressão intra-articular não é uma prática comum na Medicina Veterinária, o presente estudo teve como objetivo realizar uma revisão da literatura sobre a pressão intra-articular da articulação femorotibial de cães acometidos por osteoartrose.
The main clinical signs of osteoarthrosis includes lameness and decreased range of joint motion. The decreased joint space its an important and common feature in femorotibial osteoarthrosis of the and may induce an increased intra-articular pressure within the fascial or osteofascial space, triggering the Joint Compartment Syndrome, either by decreasing the size of the joint space or through the accumulation of bloody fluid, seroma or lymph. This Syndrome can result on inadequate blood flow and create an hypoxic joint, leading to greater joint damage. Since intra-articular pressure measurement is not a common practice in Veterinary Medicine, the present study aimed to review the literature on intra-articular femorotibial pressure in dogs with osteoarthrosis.
Las principales manifestaciones clínicas de osteoartrosis incluyen cojera y disminución de la amplitud del movimiento articular. El estrechamiento del espacio articular es una importante y común característica en la osteoartrosis femorotibial, y puede inducir una elevación de la presión dentro del espacio fascial u osofascial, con la consiguiente síndrome compartimental articular, ya sea decreciendo el tamaño del espacio intra articular o mediante acumulación de líquido sanguinolento, seroma o linfa. Esta síndrome puede provocar una perfusión sanguínea inadecuada y causar una isquemia articular, resultando en, un mayor daño articular. Dado que la medición de la presión sobre las articulaciones no es una práctica común en medicina veterinária, el presente estudio tuvo como objetivo revisar la literatura acerca de la presión de la articulación femorotibial de perros con osteoartrosis.
Assuntos
Animais , Cães , Articulação do Joelho/patologia , Hipóxia/veterinária , Osteoartrite/diagnóstico , Osteoartrite/veterinária , Síndromes Compartimentais/veterinária , Fêmur/patologia , Tíbia/patologiaRESUMO
Introducción: La osteoartritis es una de las principales causas de dolor y discapacidad en el mundo. La ozonoterapia actúa como medio terapéutico, mejora la calidad del cartílago articular, disminuye la inflamación producida y presenta propiedades moduladoras del sistema inmune. Objetivo: Evaluar los resultados de la ozonoterapia rectal en pacientes con osteoartritis. Método: Se realizó un estudio descriptivo prospectivo, en el Servicio de Reumatología del Hospital Clínico Quirúrgico Lucía Iñiguez Landín, de Holguín en el período comprendido de julio de 2017 a febrero de 2019. La población del estudio quedó conformada por 101 pacientes. La muestra fue de 60 pacientes, seleccionada según un muestreo aleatorio simple. Resultados: La articulación más afectada fue la rodilla en 100 por ciento de los pacientes estudiados. El mayor número de pacientes presentaba discapacidad física moderada (53,3 por ciento) al inicio del tratamiento y a los 3 meses predominó la discapacidad ligera (26,6 (por ciento). Se logra reducir el uso de analgésicos de forma ocasional al concluir tratamiento. Conclusiones: En los pacientes con discapacidad funcional por osteoartritis tratados con ozonoterapia transrectal el efecto terapéutico fue muy bueno(AU)
Introduction: Osteoarthritis is one of the main causes of pain and disability worldwide. Ozone therapy acts as a therapeutic means, improves the quality of articular cartilage, reduces the resulting inflammation and has modulating properties of the immune system. Objective: To evaluate the results of rectal ozone therapy in patients with osteoarthritis. Method: A prospective descriptive study was carried out in the Rheumatology Service of Lucía Iñiguez Landín Surgical Clinical Hospital, in Holguín from July 2017 to February 2019. One hundred one patients consisted the study population. Sixty patients formed the sample, selected according to a simple random sampling. Results: The most affected joint was the knee in 100 percent of the studied patients. The highest number of patients had moderate physical disability (53.3 percent) at the start of treatment and at 3 months later, mild disability predominated (26.6 percent). It was possible to reduce the use of pain relievers occasionally at the end of treatment. Conclusions: The therapeutic effect of transrectal ozone therapy was very good in patients with functional disability due to osteoarthritis(AU)