双醋瑞因联合甲氨蝶呤治疗老年类风湿关节炎的临床分析

目的探讨双醋瑞因联合甲氨蝶呤治疗老年类风湿关节炎患者的临床疗效。方法回顾性分析2017年11月-2020年11月在河北北方学院附属第一医院住院治疗的100例老年类风湿关节炎患者的临床资料,根据不同的治疗方法分为试验组(n=50)和对照组(n=50)。对照组采用甲氨蝶呤治疗,试验组采用双醋瑞因联合甲氨蝶呤治疗。2组疗程均为12周。观察并比较2组治疗前后炎性细胞因子[白细胞介素-1(IL-1)、转化生长因子-β(TGF-β)]表达水平、红细胞沉降率(ESR)和类风湿因子(RF)表达水平、相关临床症状指标(关节肿胀个数、关节压痛个数及晨僵持续时间)、关节功能分级及不良反应。结果治疗12周后,2组IL-1、ESR、RF表达水平均较本组治疗前明显下降(P<0.05),TGF-β较本组治疗前明显上升(P<0.05),关节肿胀个数、关节压痛个数及晨僵持续时间较本组治疗前明显降低(P<0.05),且试验组IL-1、ESR、RF表达水平均较对照组明显下降(P<0.05),TGF-β较对照组明显上升(P<0.05),关节肿胀个数、关节压痛个数及晨僵持续时间较对照组明显降低(P<0.05)。2组治疗后关节功能分级差异无统计学意义(P>0.05)。结论双醋瑞因联合甲氨蝶呤可有效的降低老年类风湿关节炎患者炎性水平,恢复自身免疫系统平衡,减少关节疼痛和肿胀,减少晨僵时间,但未能改善已受损的关节功能。     

隐神经脉冲射频联合注射帕瑞昔布改善膝骨关节炎的临床症状及对微炎性反应的影响

目的 探讨隐神经脉冲射频联合注射帕瑞昔布改善膝骨关节炎(KOA)的临床症状及微炎性反应的影响。方法 按照随机数字表法将72例老年KOA患者分为对照组和观察组各36例。对照组口服氨基葡萄糖+关节腔内注射帕瑞昔布,观察组在对照组基础上联用隐神经脉冲射频治疗。比较两组临床症状消失时间(关节疼痛、关节肿胀、关节活动受限)、疼痛程度、膝关节功能、微炎性反应[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-1β]及不良反应(感染、肿胀、皮疹、恶心)。结果 观察组临床症状(关节疼痛、关节肿胀、关节活动受限)消失时间均明显早于对照组(P<0.01)。治疗后两组视觉模拟评分(VAS)评分明显降低,且观察组明显低于对照组(P<0.05,P<0.001)。治疗后两组Lysholm膝关节评分明显升高,且观察组明显高于对照组(P<0.05,P<0.001)。治疗后两组IL-6、TNF-α、IL-1β水平明显降低,且观察组明显低于对照组(P<0.05,P<0.001)。两组不良反应发生率无统计学差异(χ²=0.285,P=0.476)。结论...     

甲氨蝶呤联合来氟米特治疗类风湿关节炎患者临床疗效及安全性

目的评价甲氨蝶呤联合来氟米特治疗类风湿关节炎(RA)患者的临床疗效以及安全性。方法将80例RA患者随机分为单纯甲氨蝶呤治疗组(SMTT组)40例,口服甲氨蝶呤10¹5 mg 1次/w;甲氨蝶呤联合来氟米特治疗组(MTPLFT组)40例,口服甲氨蝶呤1015 mg 1次/w;甲氨蝶呤联合来氟米特治疗组(MTPLFT组)40例,口服甲氨蝶呤10¹5 mg1次/w,来氟米特20 mg 1次/d,持续给药3 d后改为50 mg 1次/d;疗程均为3个月,观察临床症状即晨僵、握力、关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数及血清学检测血沉(ESR)、C反应蛋白(CRP)、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平。结果与治疗前比较,两组治疗后临床症状晨僵、握力、关节肿胀数和关节疼痛数均有明显改善(P<0.01),ESR、CRP、IL-1β、IL-6和TNF-α均明显降低(P<0.01),且MTPLFT组均优于SMTT组(P<0.01)。结论甲氨蝶呤联合来氟米特通过降低ESR、CRP、IL-1β、IL-6和TNF-α明显改善RA患者的临床症状,是一种有效的联合治疗方案。     

复方四黄液外敷治疗急性痛风性关节炎效果及对炎症反应指标的影响

目的探讨复方四黄液外敷治疗急性痛风性关节炎的疗效及其对炎性指标的影响。方法选取2014年10月至2016年4月收治的急性痛风性关节炎患者72例,按照随机数字表法分为研究组和对照组,每组36例,均给予常规治疗,研究组加用复方四黄液外敷,两组均治疗1 w,比较两组临床疗效及治疗前、治疗1 w后临床症状积分、血尿酸(BUA)、红细胞沉降率(ESR)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1、C反应蛋白(CRP)水平。结果研究组总有效率为83.3%(30/36),显著高于对照组的66.7%(24/36),差异有统计学意义(P<0.05);治疗后两组ESR、TNF-α、IL-1、CRP水平、关节疼痛评分、关节肿胀评分、关节肤色评分、关节皮温评分和受累关节评分较治疗前显著降低,且研究组比对照组降低更多(P<0.05),治疗后研究组BUA水平较对照组降低,但差异无统计学意义(P>0.05)。结论复方四黄液外敷治疗急性痛风性关节炎临床疗效显著,能有效改善临床症状和炎症反应。     

甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹联合治疗老年类风湿关节炎患者的疗效及对血脂的影响

目的探讨甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹联合治疗对老年性类风湿关节炎(RA)患者疗效及血脂影响。方法选取2012年9月至2013年9月间该院住院治疗的老年RA患者80例,随机分为观察组和对照组,每组各40例。观察组联合给予甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹,对照组在观察组基础上加服血脂康。对比两组患者治疗前及治疗6个月后的血脂指标:总胆固醇(TC),甘油三酯(TG),高、低密度脂蛋白(HDLC、LDL-C);风湿性关节炎相关指标:红细胞沉降率(ESR),C-反应蛋白(CRP)水平、关节压痛数、关节肿胀数、晨僵时间、DAS28活动评分。结果治疗6个月后,两组患者TC、TG、LDL-C水平均明显低于治疗前,HDL-C水平明显高于治疗前,差异均有统计学意义(P0.05);两组治疗前后各血脂指标水平之间差异均无统计学意义(P0.05)。两组患者DAS28、关节压痛数、关节肿胀数、僵硬时间、ESR、CRP水平均明显低于治疗前,差异均有显著统计学意义(P0.01)。两组患者治疗前后DAS28、关节压痛数、关节肿胀数、僵硬时间、ESR、CRP水平均无统计学意义(P0.05)。结论老年RA患者存在血脂异常,甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹联合治疗有效控制患者关节病情的同时,也对血脂具有较好的调节作用。     

甲氨蝶呤与来氟米特联合功能锻炼治疗晚期类风湿关节炎患者疗效观察

目的探讨甲氨蝶呤与来氟米特联合功能锻炼治疗晚期类风湿关节炎患者的临床疗效及对患者关节功能和血清生化指标水平的影响。方法选取本院收治的晚期类风湿关节炎患者120例作为研究对象,采用随机数字表法分为锻炼组和治疗组,每组60例。治疗组患者采用甲氨蝶呤联合来氟米特治疗,锻炼组在治疗组患者治疗的基础上,结合功能锻炼治疗,疗程3个月。比较两组患者的临床疗效,关节肿胀、压痛、晨僵、握力等情况;检测比较两组患者的血清C反应蛋白(CRP)、血沉(ESR)、类风湿因子(RF)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)水平及不良反应发生率。结果治疗3个月后,锻炼组患者的治疗总有效率为96.67%,治疗组为83.33%,两组比较差异有统计学意义(P0.05);两组患者晨僵时间显著缩短、关节肿胀及压痛个数显著减少、握力明显提高;锻炼组患者缓解情况显著优于治疗组(P0.01);两组患者的关节功能均显著改善,锻炼组患者关节功能显著优于治疗组(P0.05);两组患者的CRP、ESR、RF、IL-1β、IL-6及TNF-α水平均显著降低,锻炼组患者的CRP、ESR、RF、IL-1β、IL-6及TNF-α水平显著低于治疗组(P0.05或0.01)。治疗过程中,锻炼组患者的不良反应总发生率为11.67%,治疗组为13.88%,两组比较差异无统计学意义(P0.05)。结论甲氨蝶呤与来氟米特联合功能锻炼治疗晚期类风湿关节炎患者临床疗效显著,能明显缓解临床症状,改善关节功能,降低炎症反应水平,值得推广应用。     

透明质酸钠治疗膝骨关节炎疗效观察

对46例65个膝关节炎(OA)采用透明质酸钠治疗,结果疼痛、晨僵、步行不适、步行距离均有明显改善。21.5％临床缓解,43.1％显效,29.2％有效,有效率达93.8％。除个别注射后关节红肿、痛外,未见其他毒副作用。注射后关节肿痛经NSAIDs治疗2天～3天缓解,且病情比注射前有所改善。透明质酸钠治疗膝OA,除缓解疼痛外,还可改善关节功能,疗效持续时间长,且无毒副作用。     

老年强直性脊柱炎患者血清白细胞介素-28A、-28B、-29的水平及临床意义

目的探讨老年强直性脊柱炎(AS)患者血清白细胞介素(IL)-28A、IL-28B、IL-29的水平及临床意义。方法选择老年AS患者90例作为AS组,同期老年健康体检者90例作为对照组(C组)。收集患者年龄、性别、病程、Bath强直性脊柱炎疾病活动性指数(BASDAI)、C反应蛋白(CRP)、红细胞沉降率(ESR)等临床及检验结果资料。采用酶联免疫吸附试验(ELISA)测定血清IL-28A、IL-28B、IL-29水平。结果AS组血清IL-28A水平显著高于C组(P<0.05),IL-28B水平显著低于C组(P<0.05),两组IL-29水平差异无统计学意义(P>0.05)。AS患者治疗后BASDAI、CRP、ESR、IL-28A水平显著低于治疗前(P<0.05),IL-28B显著高于治疗前(P<0.05),AS患者治疗前后IL-29水平差异无统计学意义(P>0.05)。AS患者治疗前血清IL-28A水平与BASDAI、CRP、ESR呈正相关(P<0.05),IL-28B与BASDAI、CRP、ESR呈负相关(P<0.05),IL-29与BASDAI、CRP、ESR无相关性(P>0.05)。AS患者治疗后血清IL-28A水平与BASDAI、CRP、ESR呈正相关(P<0.05),IL-28B与BASDAI、CRP、ESR呈负相关(P<0.05),IL-29与BASDAI、CRP、ESR无相关性(P>0.05)。结论老年AS患者血清IL-28A水平升高、IL-28B水平降低,IL-28A、IL-28B水平可反映治疗效果,与疾病严重程度关系密切。     

全膝关节置换联合云南白药治疗膝关节骨性关节炎的疗效及对ESR、血清CRP、MMP-9水平的影响

目的探讨云南白药联合全膝关节置换对膝关节骨关节炎(OA)及对红细胞沉降率(ESR)、血清C反应蛋白(CRP)、基质金属蛋白酶(MMP)-9的影响。方法 OA患者80例,根据随机数字表法分观察组和对照组,每组40例,均实行全膝关节置换术,对照组于术后第1天始,给予云南白药胶囊4 w,4次/d,2粒/次。比较两组术后疼痛程度及治疗前后血清ESR、血清CRP、MMP-9水平。结果与治疗前相比,治疗后两组ESR、CRP、MMP-9水平均下降且观察组低于对照组(均P<0.05),观察组治疗优良率高于对照组(P<0.05)。结论云南白药联合全膝关节置换术能够降低OA患者血清CRP、ESR、MMP-9水平。     

关节腔冲洗联合注射透明质酸钠治疗膝骨性关节炎的临床疗效及患者促炎因子变化

目的 分析关节腔冲洗联合注射透明质酸钠治疗膝骨性关节炎的临床疗效及促炎因子变化。方法 70例KOA患者采用随机数字表法分为两组,对照组35例患者采纳单纯关节腔注射透明质酸钠法治疗,治疗组35例患者采纳关节腔冲洗联合注射透明质酸钠法治疗。对比两组在治疗前后及治疗后4 w的临床疗效差异[视觉模拟评分(VAS)、麦克玛斯特大学OA指数(WOMAC)、膝关节损伤和骨关节炎评分(KOOS)],并评估促炎因子[白细胞介素(IL)-1、IL-6、IL-15、IL-17、IL-18、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、转化生长因子(TGF)-β]的变化。结果 两组治疗后VAS、WOMAC评分显著比治疗前低,KOOS显著比治疗前高(P<0.05)。治疗后治疗组VAS、WOMAC评分显著比对照组低,KOOS显著比对照组高(P<0.05)。两组治疗后IL-1、IL-6、IL-15、IL-17、IL-18、TNF-α、CRP、TGF-β水平显著比治疗前低(P<0.05);治疗后治疗组IL-1、IL-6、IL-15、IL-17、IL-18、TNF-α、CRP、TGF-β水平均显著...     

Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized,double-blind,placebo-controlled trial

OBJECTIVE: To evaluate the safety and efficacy of long-term intraarticular (IA) steroid injections for knee pain related to osteoarthritis (OA). METHODS: In a randomized, double-blind trial, 68 patients with OA of the knee received IA injections of triamcinolone acetonide 40 mg (34 patients) or saline (34 patients) into the study knee every 3 months for up to 2 years. The primary outcome variable was radiologic progression of joint space narrowing of the injected knee after 2 years. Measurements of minimum joint space width were performed by an automated computerized method on standardized fluoroscopically guided radiographs taken with the patient standing and with the knee in a semiflexed position. The clinical efficacy measure of primary interest was the pain subscale from the Western Ontario and McMaster Universities OA Index (WOMAC). Efficacy measures of secondary interest were the total score on the WOMAC, physician's global assessment, patient's global assessment, patient's assessment of pain, range of motion (ROM) of the affected knee, and 50-foot walking time. Clinical symptoms were assessed just before each injection. RESULTS: At the 1-year and 2-year followup evaluations, no difference was noted between the two treatment groups with respect to loss of joint space over time. The steroid-injected knees showed a trend toward greater symptom improvement, especially at 1 year, for the WOMAC pain subscale, night pain, and ROM values (P = 0.05) compared with the saline-injected knees. Using area under the curve analyses, knee pain and stiffness were significantly improved throughout the 2-year study by repeated injections of triamcinolone acetonide, but not saline (P < 0.05). CONCLUSION: Our findings support the long-term safety of IA steroid injections for patients with symptomatic knee OA. No deleterious effects of the long-term administration of IA steroids on the anatomical structure of the knee were noted. Moreover, long-term treatment of knee OA with repeated steroid injections appears to be clinically effective for the relief of symptoms of the disease.     

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Objective

Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients.

Methods

In a crossover study, 34 healthy subjects were tested on 3 different days; gait analyses were conducted before, during, and after pain induced by hypertonic saline injections (0.75 ml) into the infrapatellar fat pad. Isotonic saline and sham injections were used as control conditions. Peak moments in frontal and sagittal planes were analyzed. The results were compared with data from 161 medial knee OA patients. The patients were divided into less severe OA and severe OA categories, which was based on radiographic disease severity of the medial compartment.

Results

Experimental knee pain led to reduced peak moments in the frontal and sagittal planes in the healthy subjects, which were similar to the patterns observed in less severe OA patients while walking at the same speed.

Conclusion

In healthy subjects, pain was associated with reductions in knee joint moments during walking in a manner similar to less severe knee OA patients. The experimental model may be used to study mechanically‐driven knee OA progression and preventive measures against abnormal joint loading in knee OA.     

Safety and efficacy of long‐term intraarticular steroid injections in osteoarthritis of the knee: A randomized,double‐blind,placebo‐controlled trial

Objective

To evaluate the safety and efficacy of long‐term intraarticular (IA) steroid injections for knee pain related to osteoarthritis (OA).

Methods

In a randomized, double‐blind trial, 68 patients with OA of the knee received IA injections of triamcinolone acetonide 40 mg (34 patients) or saline (34 patients) into the study knee every 3 months for up to 2 years. The primary outcome variable was radiologic progression of joint space narrowing of the injected knee after 2 years. Measurements of minimum joint space width were performed by an automated computerized method on standardized fluoroscopically guided radiographs taken with the patient standing and with the knee in a semiflexed position. The clinical efficacy measure of primary interest was the pain subscale from the Western Ontario and McMaster Universities OA Index (WOMAC). Efficacy measures of secondary interest were the total score on the WOMAC, physician's global assessment, patient's global assessment, patient's assessment of pain, range of motion (ROM) of the affected knee, and 50‐foot walking time. Clinical symptoms were assessed just before each injection.

Results

At the 1‐year and 2‐year followup evaluations, no difference was noted between the two treatment groups with respect to loss of joint space over time. The steroid‐injected knees showed a trend toward greater symptom improvement, especially at 1 year, for the WOMAC pain subscale, night pain, and ROM values (P = 0.05) compared with the saline‐injected knees. Using area under the curve analyses, knee pain and stiffness were significantly improved throughout the 2‐year study by repeated injections of triamcinolone acetonide, but not saline (P < 0.05).

Conclusion

Our findings support the long‐term safety of IA steroid injections for patients with symptomatic knee OA. No deleterious effects of the long‐term administration of IA steroids on the anatomical structure of the knee were noted. Moreover, long‐term treatment of knee OA with repeated steroid injections appears to be clinically effective for the relief of symptoms of the disease.

     

Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees

OBJECTIVE: A suspected, but heretofore undemonstrated, limitation of the conventional weight-bearing anteroposterior (AP) knee radiograph, in which the joint is imaged in extension, for studies of progression of osteoarthritis (OA) is that changes in knee pain may affect extension, thereby altering the apparent thickness of the articular cartilage. The present study was undertaken to examine the effect of changes in knee pain of varying magnitudes on radiographic joint space width (JSW) in the weight-bearing extended and the semiflexed AP views, in which radioanatomic positioning of the knee was carefully standardized by fluoroscopy. METHODS: Fifteen patients with knee OA underwent a washout of their analgesic/nonsteroidal antiinflammatory drug (NSAID) agents (duration 5 half-lives), after which standing AP and semiflexed AP knee radiographs of both knees were obtained. Examinations were repeated 1-12 weeks later (median 4.5 weeks, mean 6.0 weeks), after resumption of analgesic/NSAID therapy. Knee pain was measured with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index (Likert scale). JSW was measured with a pair of calipers and a magnifying lens. Mixed model analyses of variance were used to test the significance of changes in pain and JSW within and between 2 groups of knees with mild-to-moderate radiographic severity of OA: (a) "flaring knees," in which the patient rated standing knee pain as severe or extreme after the washout and in which pain decreased to any degree after resumption of analgesics and/or NSAIDs (n = 12) and (b) "nonflaring knees," in which standing knee pain was absent, mild, or moderate after the washout or did not decrease after resumption of treatment (n = 15). RESULTS: After reinstitution of treatment, WOMAC pain scores decreased significantly in both flaring and nonflaring knees (-44%; P < 0.0001 and -18%; P < 0.01, respectively). After adjustment for the within-subject correlation between knees, mean JSW (+/-SEM) in the extended view of the flaring OA knee increased significantly from the first to second examination (0.20 +/- 0.06 mm; P = 0.005). In contrast, the change in adjusted mean JSW in the extended view of the nonflaring OA knee was negligible (-0.04 +/- 0.04 mm) and significantly smaller than that observed in flaring knees (P < 0.01). Mean JSW in the semiflexed AP view was unaffected by the severity or responsiveness of standing knee pain in flaring and nonflaring OA knees. CONCLUSION: JSW in weight-bearing extended-view radiographs of highly symptomatic OA knees can be altered significantly by changes in joint pain. In clinical trials and in epidemiologic studies of OA progression that use this radiographic technique, longitudinal variations in pain may confound changes in the apparent thickness of the articular cartilage.     

关节镜清理术联合玻璃酸钠注射治疗膝关节骨性关节炎的临床观察

目的探讨关节镜清理术联合玻璃酸钠药物注射治疗膝关节骨性关节炎的临床效果。方法将2017年6月至2019年3月本院收治的98例膝关节骨性关节炎患者按随机数字表法分为试验组与对照组,各49例。试验组接受关节镜清理术联合玻璃酸钠药物注射治疗,对照组接受单独关节镜清理术治疗。观察两组治疗前后关节疼痛程度、关节液炎症细胞因子表达、膝关节功能及并发症发生率。结果相较于治疗前、治疗后24小时、4个月两组关节疼痛VAS评分均降低,且试验组评分低于对照组,差异有统计学意义(P<0.05)。相较于治疗前,治疗后4个月两组关节液内IL-1β、TNF-α表达均降低,且试验组IL-1β、TNF-α表达分别为(309.64±20.48)pg/ml、(425.37±32.24)pg/ml,低于对照组的(328.76±21.63)pg/ml、(463.31±35.09)pg/ml,差异有统计学意义(P<0.05)。相较于治疗前,治疗后4个月两组膝关节功能均改善,且试验组(79.53±1.57)分高于对照组的(70.36±1.68)分,差异有统计学意义(P<0.05)。两组并发症总发生率对比(14.29%vs 10.20%),差异无统计学意义(P>0.05)。结论关节镜清理术联合玻璃酸钠药物注射治疗膝关节骨性关节炎疗效确切,能减轻或消除关节疼痛等症状,降低炎症反应,改善患者膝关节功能,且并发症少,值得推广。     

Anterior arthroscopic synovectomy plus capsuloplasty with a pedicle graft for the treatment of rheumatoid popliteal cysts.

OBJECTIVE: To assess the value of arthroscopic synovectomy plus capsuloplasty with a pedicle graft in patients with rheumatoid cysts of the knee. METHODS: We examined 31 rheumatoid knees in 9 men and 22 women with an average age of 52.5 years at time of operation. Postoperative clinical symptoms were investigated in comparison with each factor examined before the operation. RESULTS: Postoperative results showed that 74% of the patients were grade 0 (no swelling or pain), 23% were grade 1 (swelling and slight discomfort after strenuous work or sports), and 3% were grade 2 (swelling and tenderness after normal activities). The improvement rate of the patients with arthroscopic synovectomy plus pedicle graft capsuloplasty was significantly higher than that of the untreated controls or patients with arthroscopic synovectomy or pedicle graft capsuloplasty. The preoperative degree of joint effusion, acceleration in the erythrocyte sedimentation rate, radiographic grades, and histological activity in the knee joint at the time of operation were correlated with the final clinical symptoms. CONCLUSION: Our method may be useful for preventing recurrence of rheumatoid popliteal cysts.     

The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee

Aim: To evaluate the benefits of knee joint aspiration and injection in knee osteoarthritis (OA). Methods: A retrospective, pilot study involved 110 patients with knee OA from a dedicated OA clinic in a Melbourne tertiary hospital from 2007 to 2009. Only those who had completed two Multiple Attribute Prioritization Tool (MAPT) questionnaires within 6 months of the initial review were included. The MAPT was designed to help prioritise patients on orthopedic waiting lists. Three groups were analyzed: patients who had no corticosteroid injection or aspiration, patients who received corticosteroid injections, and patients who received both joint aspiration with corticosteroid injections. Results: Patients who had both joint aspiration and injection reported an improvement in pain compared with those who had no injection (56.3%vs. 32.2%, P = 0.03). Those who had joint injections also did better than those without injection (62.7%vs. 32.2%, P = 0.001). Reduced analgesia use was noted in 12.5% of patients with aspiration and injection compared with 1.7% with no injection or aspiration (P = 0.03). Improved walking distance was noted in 22.4% of patients who had injections compared with 8.5% of patients with no injections (P = 0.03). No significant differences in MAPT scores among the different treatment groups were noted. Conclusion: This pilot study appears to show a beneficial trend in giving corticosteroid injections and to aspirate the knee in OA patients. Further studies are needed to address the mechanical benefits, quadriceps strengthening and pain reduction with knee aspiration, as well as the effects that different volumes of fluid may have on knee mechanics and symptoms.     

A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis

OBJECTIVE: To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA). METHODS: One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients' functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later. RESULTS: The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment. CONCLUSION AND RELEVANCE : Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time.     

Joint-pain comorbidity, health status, and medication use in hip and knee osteoarthritis: a cross-sectional study

Objective

To determine the prevalence of joint‐pain comorbidities in individuals with hip or knee osteoarthritis (OA) and to assess the differences in the characteristics of people with and without joint‐pain comorbidities.

Methods

In this cross‐sectional study, individuals referred to secondary care for treatment of hip/knee OA completed questionnaires to determine sociodemographic characteristics, disease‐related outcomes, and joint‐pain comorbidities. Joint‐pain comorbidity was defined as pain perceived in a joint, other than the index joint, for more than half of the days in the preceding month. To compare differences in patient‐ and disease‐related characteristics between participants with and without joint‐pain comorbidities, we performed analyses of covariance and logistic regression.

Results

A total of 401 individuals, 117 with hip OA and 284 with knee OA, returned the questionnaire (82% response rate); the mean ± SD age was 58 ± 13 years and 58% of the responders were women. Fifty‐eight percent of the participants reported symptoms in ≥1 other joint. Participants with joint‐pain comorbidities were more likely to be women, less educated, and have more medical comorbidities. Individuals with joint‐pain comorbidities reported unfavorable outcomes on pain, functioning, fatigue, distress, and health‐related quality of life compared with patients without joint‐pain comorbidities (P < 0.001 for all). Moreover, use of nonsteroidal antiinflammatory drugs (P = 0.038), opioids (P = 0.010), and supplements (P = 0.019) was higher in the group with joint‐pain comorbidities.

Conclusion

Our results indicate that individuals with joint‐pain comorbidities represent a clinically relevant and large subgroup of people with OA of the knee or hip. We recommend addressing joint‐pain comorbidities in both research and clinical practice.