Magnetic resonance therapy in the treatment of osteoarthritis: A scoping review

ObjectivesTo primarily assess the existing literature about Magnetic Resonance Therapy (MRT) or Molecular Biophysical Stimulation Therapy (MBST) in the treatment of patients with osteoarthritis (OA). The scoping review question was: What has been reported about MRT or MBST concerning treatment of patients with OA?Key findingsThe applied treatment program consisted of one hour daily treatment for patients in all the included studies. In terms of duration of treatment, four studies suggested treatment for nine consecutive days, two for five days and one study reported treatment on weekdays for two weeks. Six of the studies investigated the effect of MRT on the knee and one study for finger, ankle, and hip, respectively. Consensus across studies was that MRT had a positive, almost always significant, effect. Six out of the seven studies had subjective outcome measurements such as pain, quality of life and joint function, which were measured through self-reported questionnaires. One study combined ultrasonography with Magnetic Resonance Imaging (MRI) to evaluate structural joint changes. This evaluation was performed by a radiologist. One study used objective measurement of cartilage thickness through a minimal distance algorithm. All tests used MBST-systems.ConclusionThis scoping review showed that there seems to be a beneficial effect of MRT in the treatment of patients with OA in relation to improvement in pain, joint function, and quality of life. However, more robust research and further evaluation of MRT are needed.Implications for practiceTreating patients diagnosed with OA with MRT for one hour for five to ten days seemed to improve pain, joint function, quality of life as well as regeneration of cartilage. However, limitations of the included studies in this scoping review, such as a general lack of control groups, low sample sizes, lack of control for confounding factors such as medication, calls for more robust research with stronger study designs.     

A Case of Anterior Open Bite Developing During Adolescence

Abstract

Imaging studies have reported on the relationship between temporomandibular joint (TMJ) degeneration and facial deformity. These studies have suggested that mandibular growth is affected by TMJ degeneration, resulting in altered skeletal structure as mandibular retrustion. However, there are very few longitudinal case reports on TMJ osteoarthrosis (OA).

Progressive open bite occurred in an adolescent patient with TMJ OA. Cephalometric analysis showed a downward and backward rotated mandible, and a labial inclination of the upper incisor. Magnetic resonance imaging showed internal derangement without reduction and erosion in the right and the left condyles. Although the cause of open bite is unclear in this case, tongue thrusting, and internal derangements in the temporomandibular joint were suspected as causes of the open bite.     

Proteoglycan turnover during development of spontaneous osteoarthrosis in guinea pigs

OBJECTIVE: The study was performed to clarify the metabolic background of the variations in proteoglycan concentrations, relating to ageing and the spontaneous development of osteoarthrosis in guinea pigs. METHODS: Six-, 9- and 12-month-old Hartley guinea pigs were injected intraperitoneally with Na2(35)SO4. The incorporation and degradation of various proteoglycans were analyzed in different areas of tibial articular cartilage during the development of osteoarthrosis. RESULTS: Proteoglycan synthesis was most active in the uncalcified cartilage of 6-month animals and highest in the medial compartment with its presumably higher load. The breakdown of proteoglycans decreased with age. The onset of osteoarthrosis was associated with decreased synthesis of large and small proteoglycans, while the rate of degradation remained unchanged. CONCLUSION: During onset of osteoarthrosis the synthesis of large proteoglycans gradually becomes insufficient to compensate for the simultaneous degradation. This differs from findings in more rapidly progressing, experimental secondary osteoarthrosis, where a substantial increase in the rate of degradation is more conspicuous.     

保留股骨颈型人工全髋关节置换术初步观察

目的：探讨保留股骨颈型人工全髋关节置换的近期疗效。方法：采用保留股骨颈型人工全髋关节置换术治疗髋关节骨关节病20例（24髋）。结果：本组经过0．5—5a随访，24个人工髋关节临床效果良好。人工髋关节的活动和其后关节功能良好，影像学检查显示人工髋关节位置良好，假体无松动和下沉。结论：保留股骨颈型人工全髋关节置换治疗髋关节骨关节病近期疗效较好，尤其适用于可能需要行假体翻修的中青年患者。     

针刀与中药洗剂联合治疗膝关节骨性关节炎的临床观察

目的：观察针刀与中药洗剂联合治疗膝关节骨性关节炎的临床疗效。方法：将90例膝关节骨性关节炎患者以随机数字表法分为对照组与观察组,每组各45例。对照组患者给予常规西药治疗,使用地塞米松磷酸纳注射液冲洗关节腔,静脉滴注硫酸庆大霉素注射液＋氯化钠注射液,并于髌骨部分注射玻璃酸钠注射液;观察组给予针刀与中药洗剂联合治疗,采用小针刀治疗,1周1次,若患者疼痛感未改善,则于1周后重复小针刀治疗,于针刀术后3d给予中药洗剂进行骨关节熏洗。疗程均为5周,对比观察2组患者的临床疗效及治疗前后临床症状积分变化情况。结果：观察组患者的总有效率高于对照组[95．56％（43／45）相比64．4％（29／45）],差异有统计学意义（P＜0．05）;治疗后,观察组患者膝关节各症状积分明显低于对照组,差异有统计学意义（ P＜0．05）。结论：针刀与中药洗剂联合治疗膝关节骨性关节炎,效果显著,可缓解膝关节疼痛等症状,值得推广。     

Eficiencia de la combinación naproxeno/esomeprazol para el tratamiento de la artrosis en España

ObjectiveTo assess, from the perspective of the National Healthcare System, the efficiency of a fixed-dose combination of naproxen and esomeprazole (naproxen/esomeprazole) in the treatment of osteoarthritis (OA) compared to other NSAID, alone or in combination with a proton pump inhibitor (PPI).MethodsA Markov model was used; it included different health states defined by gastrointestinal (GI) events: dyspepsia, symptomatic or complicated ulcer; or cardiovascular (CV) events: myocardial infarction, stroke or heart failure. The model is similar to the one used by NICE in its NSAID evaluation of OA published in 2008.The total costs (€, 2012), including drug and event-related costs, and the health outcomes expressed in quality-adjusted life years (QALY) were estimated in patients with increased GI risk, aged 65 or over, for a 1-year time horizon and a 6-month treatment with celecoxib (200 mg/day), celecoxib + PPI, diclofenac (150 mg/day) + PPI, etoricoxib (60 mg/day), etoricoxib + PPI, ibuprofen (1,800 mg/day) + PPI, naproxen (1,000 mg/day) + PPI or naproxen/esomeprazole (naproxen 1,000 mg/esomeprazole 40 mg/day). The selected PPI was omeprazole (20 mg/day).ResultsNaproxen/esomeprazole was a dominant strategy (more effective and less costly) compared to celecoxib, etoricoxib and diclofenac + PPI. Celecoxib + PPI and etoricoxib + PPI were more effective.Considering a cost-effectiveness threshold of €30,000 per additional QALY, naproxen/esomeprazole was cost-effective compared to ibuprofen + PPI and naproxen + PPI with incremental cost-effectiveness ratios (ICER) of €15,154 and €5,202 per additional QALY, respectively.ConclusionsA fixed-dose combination of naproxen and esomeprazole is a cost-effective, and even dominant, alternative compared to other options in OA patients with increased GI risk     

关节盘穿孔致大鼠颞下颌关节骨关节病的形态学及组织病理学观察

目的通过关节盘穿孔建立大鼠颞下颌关节骨关节病(temporomandibular joint osteoarthrosis,TMJOA)模型,并观察颞下颌关节(temporomandibular joint,TMJ)髁突的形态学特征及组织病理学变化。方法8只12周龄雄性SD大鼠购自重庆医科大学,体质量200~250 g,通过随机数表法将其分为1周组和4周组,每组各4只。用齿科慢机球钻在每只大鼠左侧(模型侧)关节盘中后部形成直径1.5 mm的规则圆形穿孔,右侧(对照侧)不予处理。1周组和4周组大鼠分别于处理后1、4周时处死,获取双侧TMJ组织,通过形态学观察、影像学检查分析关节软骨的退化程度及软骨下骨的结构变化。通过免疫组织化学染色、苏木精染色、番红O-固绿染色、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)染色,分析大鼠TMJ髁突软骨的组织病理学变化。结果形态学观察显示1周组模型侧关节盘红肿明显,4周组模型侧可见典型的骨关节病鸟嘴样改变,1周组和4周组模型侧髁突的高度[分别为(2.73±0.14)和(2.49±0.25)cm]均显著低于对照侧[分别为(3.30±0.09)和(3.30±0.12)cm](P<0.01);影像学结果显示4周组模型侧骨小梁微观结构破坏明显;番红O-固绿染色结果显示1周组及4周组模型侧的蛋白聚糖均显著低于对照侧(P<0.01);TRAP染色结果显示1周组及4周组模型侧的破骨细胞数目均显著多于对照侧(P<0.01);免疫组织化学染色、苏木精染色结果显示1周组及4周组模型侧的胶原纤维密度较对照侧均显著减少(P<0.01),而基质金属蛋白酶显著增多(P<0.01)。结论大鼠关节盘穿孔后,模型侧髁突软骨出现了典型的TMJOA病理改变。     

手骨关节病的危险因素Logistic回归分析

用病例对照调查法观察与中老年人手骨关节病相关的危险因素。按Ｋａｌｌｍａｎ等人制定的标准筛选出１１７例观察例和１１８名对照例，经Ｌｏｇｉｓｔｉｃ回归分析发现，在针对６６项因素中，筛选出有意义的影响因素是：主食中面粉占较大比例，ＯＲ＝３．０２；主食中玉米面占较大比例，ＯＲ＝２．４１，有服用激素类药物史，ＯＲ＝２．８７，以及慢性肾炎患者，ＯＲ＝１．９９，主食大米占较小比例，ＯＲ＝０．３０，与手ＯＡ有联系     

Long-term results of rotational acetabular osteotomy in young patients with advanced osteoarthrosis of the hip

Between 1974 and 1987, we performed 38 rotational acetabular osteotomies to treat advanced coxarthrosis caused by acetabular dysplasia in 38 patients who were aged 40 years old or less at the time of surgery. Of these patients, 28 were followed-up for more than 10 years after surgery. The preoperative severity of coxarthrosis was graded as stage III in 21 hips and as stage IV in 7 hips, according to our modification of the classification of coxarthrosis advocated by the Japanese Orthopaedic Association. At the time of follow-up, 27 patients retained their own hip joints on the operated side 10 to 18 years (average, 13 years) after surgery, and the remaining patient had had a secondary total hip replacement 7 years after the surgery. Of the 27 patients who retained their own hip joints on the operated side, 20 had little or no pain and none suffered from severe pain in the operated hip; the severity of coxarthrosis was graded as stage II in 4 hips, as stage III in 9 hips, and as stage IV in 14 hips. We conclude that rotational acetabular osteotomy can be a useful procedure in young patients who have advanced coxarthrosis secondary to acetabular dysplasia. Received: September 22, 1999 / Accepted: February 7, 2000     

Scaphotrapeziotrapezoid fusion: long-term follow-up study

The long-term effectiveness of scaphotrapeziotrapezoid (STT) fusion is still controversial. We evaluated our clinical and radiological results of 30 STT fusions in 30 patients (average age 41 years; 23 males, 7 females). The follow-up period averaged 84 months. The indications were Kienböck's disease (n = 23), isolated STT arthrosis (n = 6), and dislocation of the trapezium (n = 1). A total of 26 simultaneous associated procedures were performed. Excisional arthroplasty of the lunate was done in all 23 patients with Kienböck's disease. Of the 30 total patients, 5 had postoperative pain ranging from mild to severe; 4 patients were dissatisfied with the results. Postoperative ranges of motion of the wrist were 84% of extension and 91% of flexion compared with preoperative motion. The postoperative grip strength improved to 27?kgf from the preoperative value of 18?kgf. Altogether, 26 patients returned to their previous activities. All patients obtained uneventful STT fusion in an average of 11.2 weeks. Eight patients (27%) experienced postoperative complications; seven had radioscaphoid arthroses, five had trapeziometacarpal arthrodeses, and one had a flexor pollicis longus tendon rupture. Although radioscaphoid arthrosis occurred in 23% of this series after STT fusion, the results suggest that it is an effective procedure for Kienböck's disease and isolated STT arthrosis.