Intra-articular Hymovis injection for managing hip OA in active sportsmen. A 24-month observational retrospective clinical investigation

BackgroundHip Osteoarthitis (OA) risk is sport-specific and depends on frequency, intensity, and type of mechanic stress the hip is subjected to. This retrospective observational study aims to investigate the safety and performance of Hymovis (HYADD-4) injection, a hexadecyl (C-16) HA-derivative, when used to manage symptomatic hip OA in active middle-aged sportsmen over a 24-month observation period.MethodsThe retrospective analysis included clinical records of active sportsmen, aged between 40 and 65 years, and suffering from symptomatic Kellgren-Lawrence grade II to III hip OA, treated with two (24 mg/3 ml) Hymovis injections, two weeks apart, every 3–4 months, for two years. When available, data on MRI examination were included in the analysis as well as Heidelberg Sports Activity Score (HAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaires.ResultsThirty patients (56.4 ± 7.3 years) were included in the study, sixteen cyclists and 14 tennis players. For all patients, HAS and most HAGOS scores improved significantly (p < 0.05) at the first control visit (4 months) and further improved over time. For all other scores an important clinical benefit was experienced by more than 50% of participants. No adverse events were recorded.ConclusionTreatment of hip OA in active sportsmen with Hymovis seems a safe and effective approach for the management of OA symptoms, by potentially protecting cartilage and subchondral bone from further damage.     

基于信息化的社区骨关节炎患者多学科管理模式构建及应用研究

背景 骨关节炎致残、致畸率高，可合并多种身心疾病，但早期症状不明显。当前社区骨关节炎的管理存在管治不协调、方法不健全、制度不完善等问题。 目的 构建并评价基于信息化的社区骨关节炎多学科管理模式，以促进对社区骨关节炎患者的管理，改善患者疾病预后。 方法 首先构建社区骨关节炎患者的多学科管理模式，包含基于危险因素分层的患者分级管理流程、多学科管理团队及其诊治分工，然后构建基于信息化的多学科管理流程，并完成信息软件开发。选取2019年7月至2020年7月在上海市定海、大桥社区卫生服务中心全科门诊，以及杨浦区中心医院骨科门诊就诊的膝骨关节炎患者80例为研究对象，采用随机数表法将其分为普通组和多学科组，各40例。普通组采用常规治疗模式，多学科组在此基础上进行基于信息化的多学科管理。分别于治疗前和治疗12周后评估两组患者的视觉模拟评分法（VAS）评分、西安大略麦克马斯特大学（WOMAC）骨关节炎指数、关节炎生活质量测量量表（AIMS2）评分、健康素养管理量表（HeLMS）评分、体质指数（BMI）。 结果 治疗前，多学科组和普通组膝骨关节炎患者的VAS评分、WOMAC骨关节炎指数、AIMS2评分、HeLMS评分、BMI比较，差异均无统计学意义（P>0.05）；治疗12周后，多学科组和普通组膝骨关节炎患者的VAS评分、WOMAC骨关节炎指数低于治疗前，AIMS2总分、HeLMS总分高于治疗前，差异有统计学意义（P<0.05）；治疗12周后，多学科组患者AIMS2总分、HeLMS总分高于普通组，VAS评分、WOMAC骨关节炎指数、BMI均低于普通组，差异有统计学意义（P<0.05）。 结论 对膝骨关节炎患者实施基于信息化的社区骨关节炎患者多学科管理模式，可有效减轻患者的关节疼痛和体质量，提高患者的日常生活能力和健康素养，改善患者的生活质量，延缓患者的病情进展。     

Effects of total knee arthroplasty for primary knee osteoarthritis on postural balance: A systematic review

BackgroundKnee osteoarthritis is often related to physical function impairment. Although total knee arthroplasty is considered effective for advanced cases of knee osteoarthritis, its effects on postural balance is a topic of debate.Research questionWhat are the effects of total knee arthroplasty for primary knee osteoarthritis on postural balance compared to preoperative status and/or to healthy controls?.MethodsLongitudinal studies (with more than 1-month follow-up) assessing postural balance measures (either clinical-based such as balance scales or laboratory-based such as postural sway) were considered eligible and selected in a 2-phase process. Six main electronic databases were searched, complemented by 3 grey literature sources. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tools.ResultsA total of 19 studies were included for qualitative synthesis, of which 14 had low and 5 had a moderate risk of bias. The follow-up period ranged from 1–24 months. Most studies (n = 11) presented comparisons to preoperative status only. From these, 7 studies reported relevant improvements in postural balance, 2 reported partial improvements, and 2 no improvements. The remaining studies (n = 8) presented comparisons to healthy controls and, although improvements following total knee arthroplasty were consistently observed, only one study reported postural balance measures comparable to that of controls.ConclusionsThe majority of studies reported relevant improvements (especially in clinical-based measures) compared to preoperative evaluations, although inconsistencies were found possibly due to variability in studies' populations, assessment tools, and follow-up times. Despite this, persistent deficits in postural balance were commonly observed when compared to healthy controls.SignificanceThis evidence synthesis could better inform clinicians and researchers about the therapeutic effects and limitations of total knee arthroplasty concerning postural balance. Standardization of assessment tools is recommended to strengthen the certainty of cumulative evidence.     

Articular cartilage repair & joint preservation: A review of the current status of biological approach

The articular cartilage of the joint is the thin viscoelastic layer of the connective tissue. It has a unique anatomy and physiology, which makes the repair of the articular cartilage damage more difficult and challenging due to its limited healing capacity. Increasing knowledge regarding the importance of articular cartilage for joint preservation has led to increased attention on early identification of cartilage damage as well as degeneration in order to delay osteoarthritis. There are various treatment modalities ranging from preventive management, physical therapy, pharmacological, non-pharmacological and surgical treatments exist in current literature. However most of the studies have limited long term follow up and mainly consists of small case series and case reports. This is an up to date concise review discussing the available management options for articular cartilage damage starting to lifestyle modification to pharmacotherapy, physiotherapy, and osteobiologics till various joint preservation techniques that have been in use currently.     

羌活汤离子导入联合关节松动术治疗膝骨关节炎寒湿痹阻证临床研究

目的评价羌活汤离子导入联合关节松动术治疗膝骨关节炎(knee osteoarthritis,KOA)寒湿痹阻证的疗效。方法将本院2017年10月-2018年10月符合入选标准的98例KOA患者,按随机数字表法分为2组,每组49例。2组均给予关节松动术治疗,在此基础上,对照组口服硫酸氨基葡萄糖胶囊,观察组经离子导入羌活汤。2组均治疗6周。分别于治疗前后从关节疼痛、关节得温痛减、晨僵、腰身重痛方面行寒湿痹阻证症状评分,采用西安大略和麦克马斯特大学骨关节炎指数(The Osteoarthritis Index at the Universities of Western Ontario and McMaster,WOMAC)评估膝关节功能障碍程度,采用ELISA法检测血清Ⅰ型胶原C端肽(typeⅠcollagen C-terminal peptide,CTX-Ⅰ)、CTX-Ⅱ、抗酒石酸酸性磷酸酶5b(tartrate-resistant acid phosphatase isoform 5b,TRACP-5b)及前列腺素E2(prostaglandin E2,PGE2)、P物质(substance P,SP)、多巴胺(dopamine,DA)、5-羟色胺(5-hydroxytryptamine,5-HT)水平,评价临床疗效。结果观察组总有效率为93.9%(46/49)、对照组为77.6%(38/49),2组比较差异有统计学意义(χ^2=4.083,P=0.043)。治疗后,观察组WOMAC指数中关节疼痛、关节僵硬、日常活动受限评分低于对照组(t值分别8.430、9.986、12.776,P<0.01);症状评分中关节疼痛、关节得温痛减、晨僵、腰身重痛评分低于对照组(t值分别为8.825、9.043、7.230、7.034,P<0.01)。治疗后,观察组血清CTX-Ⅰ[(404.99±43.35)μg/L比(458.69±48.61)μg/L,t=21.005]、CTX-Ⅱ[(414.99±43.39)μg/L比(484.06±50.77)μg/L,t=18.991]、TRACP-5b[(2.98±0.35)U/L比(5.67±0.61)U/L,t=9.043]水平均低于对照组(P<0.01);血清PGE2[(167.81±18.79)μg/L比(252.61±27.34)μg/L,t=26.389]、SP[(143.67±15.92)μg/L比(179.55±19.53)μg/L,t=25.416]、DA[(9.15±1.15)μg/L比(13.17±1.81)μg/L,t=10.445]、5-HT[(615.08±63.95)μg/L比(712.69±72.88)μg/L,t=31.004]水平均低于对照组(P<0.01)。结论羌活汤离子导入联合关节松动术可改善KOA患者骨代谢水平,降低疼痛介质分泌,改善临床症状,提高疗效。     

Knockdown of PVT1 inhibits IL-1β-induced injury in chondrocytes by regulating miR-27b-3p/TRAF3 axis

Long noncoding RNA plasmacytoma variant translocation 1 (PVT1) has been identified to implicate in the progression of osteoarthritis (OA). However, the mechanism underlying PVT1 in OA development remains largely unknown. This study aimed to investigate the effect of PVT1 on interleukin-1 beta (IL-1β)-induced injury in chondrocytes and explore potential mechanism. The cartilage tissues from 25 OA patients and normal controls were collected. Human transformed chondrocytes C28/I2 were stimulated by IL-1β. The levels of PVT1, microRNA (miR)-27b-3p, and tumor necrosis factor receptor-associated factor 3 (TRAF3) were detected by quantitative real-time polymerase chain reaction or western blot. IL-1β-induced injury was investigated by cell viability, apoptosis, autophagy and inflammatory response using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide, flow cytometry, western blot and enzyme linked immunosorbent assay, respectively. The target association between miR-27b-3p and PVT1 or TRAF3 was explored by luciferase reporter, RNA immunoprecipitation and RNA pull-down assays. We found that PVT1 expression was enhanced in OA patients and IL-1β-treated C28/I2 cells. Silence of PVT1 promoted cell viability and autophagy but suppressed apoptosis and inflammatory response in IL-1β-treated C28/I2 cells. miR-27b-3p was confirmed as a target of PVT1 and its deficiency reversed the suppressive effect of PVT1 knockdown on IL-1β-induced injury. TRAF3 was a target of miR-27b-3p and attenuated the effect of miR-27b-3p on IL-1β-induced injury in C28/I2 cells. Moreover, TRAF3 expression was positively regulated by PVT1 via sponging miR-27b-3p. Collectively, knockdown of PVT1 increased cell viability and autophagy but inhibited apoptosis and inflammatory response in chondrocytes treated by IL-1β via up-regulating miR-27b-3p and down-regulating TRAF3.