Clinical
Sarah Gear in The Complete nMRCGP® Study Guide, 2018
Around 20–25% of visits to GPs relate to the musculoskeletal system. Most of these cases are secondary to osteoarthritis. Osteoarthritis, by definition, cannot be cured, but the previously held belief that it would inevitably progress is being challenged as the understanding of the metabolic process develops. Risk factors for development of osteoarthritis include being female, older age, obesity, nutrition, bone density and muscle strength.
Actions of Dopamine on the Skin and the Skeleton
Nira Ben-Jonathan in Dopamine, 2020
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that affects many tissues and organs, but principally attacks synovial joints. The process involves an inflammatory response of the capsule around the joints (synovium), secondary to hyperplasia of synovial cells, excess synovial fluid, and development of fibrous tissue in the synovium. As a chronic inflammation, RA can lead to articular bone erosion and consequently to joint destruction [70], which can cause severe disability that affects all aspects of motor function, from walking to fine movements of the hand. Another disease with a similar presentation is Osteoarthritis (OA), the most common form of arthritis, which affects millions of people worldwide. It occurs when the protective cartilage that cushions the ends of bones wears down over time. Although osteoarthritis can damage any joint, it mostly affects joints in hands, knees, hips, and spine. The major complaint by individuals with arthritis is joint pain, which can be constant and localized to the joint affected. Arthritis is the most common cause of disability in the United States. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes, orthopedic bracing, and medications. The medications can help reduce inflammation in the joint which decreases pain and slow the joint damage. Joint replacement surgery may be required in eroding forms of arthritis. There is increasing evidence on the involvement of DA in the pathogenesis of RA [71–73]. A recent extensive review [70] covered multiple studies showing direct effects of DA on the systemic immune response as well as on bone remodeling and joint inflammation, both in humans and in animal models of arthritis. These data are briefly summarized below, and are presented as a diagram in Figure 11.13 on human (Panel A) and animal (Panel B) studies. The author concluded that while more research is necessary to accurately determine the effect of DA in RA, these results support a possible use of dopaminergic drugs for the future treatment of arthritis.
Monoterpenes-Based Pharmaceuticals: A Review of Applications In Human Health and Drug Delivery Systems
Megh R. Goyal, Durgesh Nandini Chauhan in Plant- and Marine-Based Phytochemicals for Human Health, 2018
In the inflammatory response, macrophages have the ability to produce pro-inflammatory cytokines (such as IL-1β, IL-6, and TNF-α) in order to recruit immune cells. , Therapeutic agents that inhibit the expression of these inflammatory cytokines have potential to treat inflammatory diseases. Kim et al. confirmed the anti-inflammatory efficacy of α-pinene. Their study demonstrated that α-pinene treatment reduced the production of IL-6, TNF-α, and NO in mouse peritoneal macrophages stimulated with the endotoxin, lipopolysaccharide. The inhibited expression of inflammatory mediators occurred because α-pinene blocks the activation of MAPK and NF-κB pathways. Acute pancreatitis is a multifactorial inflammatory disease characterized by an increase in cytokine production and the release of digestive enzymes to systemic circulation which causes adverse effects not only in pancreas but also in other systemic organs. The results of Bae et al. suggested that α-pinene possessed anti-inflammatory effect on cerulein-induced acute pancreatitis. The authors administered intraperitoneally α-pinene after inducing acute pancreatitis with cerulein in mice models. α-pinene reduced myeloperoxidase activity and the production of pro-inflammatory cytokines. Furthermore, the administration of α-pinene inhibited cerulein-induced cell death in pancreatic cells. Osteoarthritis is a painful degenerative joint disease that causes articular cartilage damages, which lead to the progressive reduction of joint function. Local inflammation in joint characterizes osteoarthritis. The essential oil extracted from Juniperus oxycedrus L. subsp. Oxycedrus leaves demonstrated the capacity to reduce joint inflammation in osteoarthritis disease models. In fact, Rufino et al. confirmed that the beneficial effects of the essential oil of J. oxycedrus L. subsp. Oxycedrus is due to the α-pinene, the main component of this plant species. In human chondrocytes, the enantiomer (+)-α-pinene inhibited the activation of NF-κB and JNK pathways, production of IL-1β and the expression of inflammatory genes. Therefore, (+)-α-pinene maybe a potential antiosteoarthritic drug. According to recent studies, oral supplementation of limonene demonstrated intestinal anti-inflammatory effects. , D’alessio et al. confirmed that limonene reduced serum TNF-α levels, an effect comparable to ibuprofen in mice 5,6-trinitrobenzene sulfonic acid-induced colitis. In the human trials, the diet supplementation with D-limonene-containing orange peel extract also decreased peripheral IL-6 levels in the healthy elderly patients.
Partial trapeziectomy and interposition of fascia lata allograft in the operative treatment of thumb base osteoarthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2016
Anne J. Spaans, Marieke E. Weijns, Assa Braakenburg, Leo Paul van Minnen, Aebele B. Mink van der Molen
Aim: The purpose of this retrospective cohort study was to evaluate the results of fascia lata allograft interposition after partial trapeziectomy in patients with symptomatic first carpometacarpal joint osteoarthritis. Methods and results: Twenty-one patients (22 thumbs) with Eaton-Glickel stage II or III first carpometacarpal joint osteoarthritis were included. After a mean follow-up duration of 70.2 months, most patients experienced minimal pain. The operation was graded excellent or good by 15 patients (15 hands). Active range of motion and strength measurements were comparable to the contralateral hand, except for extension, which was slightly better in the contralateral hand. The mean radiologically measured difference pre- and postoperatively in distance between distal part of the trapezium and base of the metacarpal was 2.7 mm. Two patients had reoperations in the first year after the initial operation because of ongoing pain. Conclusion: Partial trapeziectomy with interposition of fascia lata allograft in patients with symptomatic first carpometacarpal joint osteoarthritis can achieve reasonable results. It may be considered a reliable operative treatment option in patients with first carpometacarpal joint osteoarthritis.
Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study
Published in Physiotherapy Theory and Practice, 2014
Sudarshan Anandkumar, Shobhalakshmi Sudarshan, Pratima Nagpal
Study design: Double blind pre-test post-test control group design. Objectives: To compare the isokinetic quadriceps torque, standardized stair-climbing task (SSCT) and pain during SSCT between subjects diagnosed with knee osteoarthritis pre and post kinesio tape (KT) application with and without tension. Background: Strength of the quadriceps and torque producing capability is frequently found to be compromised in knee osteoarthritis. The efficacy of KT in improving isokinetic quadriceps torque in knee osteoarthritis is unknown, forming the basis for this study. Methods and measures: Forty subjects were randomly allocated to either the experimental (therapeutic KT with tension) or control group (sham KT without tension) with the allocation being concealed. Pre and post test measurements of isokinetic quadriceps torque, SSCT and pain during SSCT were carried out by a blinded assessor. Results: A large effect size with significant improvements in the peak quadriceps torque (concentric and eccentric at angular velocities of 90° per second and 120° per second), SSCT and pain were obtained in the experimental group when compared to the control group. Conclusion: Application of therapeutic KT is effective in improving isokinetic quadriceps torque, SSCT and reducing pain in knee osteoarthritis.
Managing the Pain of Knee Osteoarthritis
Published in The Physician and Sportsmedicine, 2014
Scott A. Hrnack, F. Alan Barber
Pain from knee osteoarthritis creates a significant burden for symptomatic patients, who are often forced to change their lifestyle because of their symptoms. Activity modification, therapy, weight loss, nonsteroidal anti-inflammatory drugs, shoe orthotics, bracing, and injections are the nonoperative options available. New technologies are also emerging in the treatment of knee osteoarthritis. Ultimately, these therapeutic modalities should reduce pain and increase the overall functioning of patients. These nonoperative modalities give the clinician several effective options before surgical management is considered.