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RESUMO Introdução: A artrite pós-traumática é uma complicação frequente nas fraturas intra-articulares de joelho, que ocasiona dor e limitação funcional. Uma opção terapêutica que tem mostrado resultados promissores é a infusão intra-articular do ácido hialurônico (viscossuplementação), associada ou não a exercícios e dieta para perder peso. Objetivo: Verificar a resposta ao tratamento de artrite pós-traumática de joelho com uso de viscossuplementação associada ou não a exercícios físicos. Métodos: Avaliaram-se o arco de movimento articular, ângulo de retração poplíteo, a escala visual de dor, o escore de Lysholm e a circunferência da coxa em pacientes submetidos à correção cirúrgica de fratura do platô tibial em nossa instituição, os quais, depois de alta cirúrgica e fisioterápica, foram tratados com viscossuplementação em infusão única associada ou não a exercícios físicos programados, durante seguimento de 12 meses. Resultados: Houve diferença significativa a favor do grupo submetido à viscossuplementação associada a exercícios para o ângulo de retração poplíteo (p = 0,012) e espessura da coxa 10 cm acima da patela (p = 0,047). Em todas as demais variáveis estudadas, os resultados nesse grupo também foram superiores, porém sem alcançar significância estatística correspondente. Todos os pacientes estariam dispostos a repetir a infusão após 12 meses. Conclusão: A viscossuplementação trouxe melhora da dor e função aos pacientes com artrite pós-traumática de joelho e a melhora é maior quando os exercícios são associados em seguimentos de 12 meses. ABSTRACT Introduction: Post-traumatic arthritis is a frequent complication of intra-articular fractures of the knee, which causes pain and functional limitation. A therapeutic option that has shown promising results is the intra-articular infusion of hyaluronic acid (viscosupplementation), with or without exercise and diet to lose weight. Objective: To assess the response to treatment of post-traumatic arthritis of the knee with use of viscosupplementation with or without exercise. Methods: We evaluated the arc of joint motion, popliteal retraction angle, visual pain scale, Lysholm score, and thigh circumference in patients undergoing surgical correction of the tibial plateau fracture at our institution, which, after surgical and physical therapy discharge, were treated with viscosupplementation in a single infusion with or without programmed exercise during follow-up of 12 months. Results: There was significant difference in favor of the group subjected to viscosupplementation associated with exercises for the retraction popliteal angle (p=0.012) and thickness of the thigh 10 cm above the patella (p=0.047). In all the other variables, the results in this group were also higher, but did not reach the corresponding statistical significance. All patients would be willing to repeat the infusion after 12 months. Conclusion: The viscosupplementation brought improvement in pain and function to patients with post-traumatic arthritis of the knee and the improvement is greater when exercises are associated in follow-ups of 12 months. RESUMEN Introducción: La artritis postraumática es una complicación frecuente en las fracturas intraarticulares de rodilla, que ocasiona dolor y limitación funcional. Una opción terapéutica que ha mostrado resultados promisorios es la infusión intraarticular del ácido hialurónico (viscosuplementación), asociada o no a ejercicios y dieta para perder peso. Objetivo: Verificar la respuesta al tratamiento de artritis postraumática de rodilla con uso de viscosuplementación asociada o no a ejercicios físicos. Métodos: Se evaluaron el arco de movimiento articular, ángulo de retracción poplíteo, la escala visual de dolor, el score de Lysholm y la circunferencia del muslo en pacientes sometidos a corrección quirúrgica de fractura del platillo tibial en nuestra institución, los que después de alta quirúrgica y fisioterápica, fueron tratados con viscosuplementación en infusión única asociada o no a ejercicios físicos programados, durante seguimiento de 12 meses. Resultados: Hubo diferencia significativa a favor del grupo sometido a viscosuplementación asociada a ejercicios para el ángulo de retracción poplíteo (p = 0,012) y espesor del muslo 10 cm por encima de la rótula (p = 0,047). En todas las demás variables estudiadas, los resultados en ese grupo también fueron superiores, aunque sin alcanzar significancia estadística correspondiente. Todos los pacientes estarían dispuestos a repetir la infusión después de 12 meses. Conclusión: La viscosuplementación trajo mejora del dolor y función a los pacientes con artritis postraumática de rodilla y la mejora es mayor cuando los ejercicios son asociados en seguimientos de 12 meses.

ResumenLa artrosis de rodilla (OA) es uno de los principales problemas de salud a nivel mundial debido a su alta prevalencia y costos asociados. Los conocimientos disponibles demuestran que el componente inflamatorio es fundamental en el desarrollo de esta condición, abandonándose el concepto de que la OA es una enfermedad puramente degenerativa. En el presente escrito revisaremos, basándonos en la literatura disponible, la epidemiología y los factores de riesgo involucrados, los nuevos conocimientos fisiopatológicos, el enfrentamiento clínico y los tratamientos disponibles tanto médicos como quirúrgicos de esta condición.AbstractKnee osteoarthritis (OA) is one of the major public health problems worldwide, due to its high prevalence and associated costs. The available knowledge shows that the inflammatory component is critical in the development of this condition, abandoning the concept that OA is only a degenerative disease. A review is presented in this article, based on the available literature, on the epidemiology and risk factors involved, recent knowledge about the pathophysiological and clinical management, and the medical and surgical treatments available for this condition.

Posttraumatske deformacije i artroze gornjega nožnog zgloba liječe se artrodezom. Autori su željeli utvrditi uspješnost te metode liječenja. Kontrolirani su bolesnici liječeni na ortopedskom odjelu KBC "Firule" Split, od siječnja 1976, do prosinca 1987. godine. Na temelju kliničkih i radioloških kriterija vrednovan je funkcionalni rezultat. U tom razdoblju liječeno je ukupno dvadeset bolesnika. Kod četrnaestorice je nađen odličan (70%) a kod šestorice (30%) dobar rezultat. Svi su u roku od 3 do 6 mjeseci osposobljeni za normalan rad. Danas, u vrijeme velikog tehničkog napretka, kada imamo velik izbor mogućnosti zamjene zglobova endoprotezama, artrodeza gornjega nožnog zgloba iako nefiziološki akt, još je uvijek najbolja metoda liječenja kod posttraumatskih deformacija i artroza.

Se presentó el caso de un paciente masculino, con dolor a la movilización del codo derecho y tumefacción desde 2 meses antes, este cuadro se acompañó de fiebre vespertina ocasionalmente, pérdida de 10 libras de peso en el último mes y el antecedente de presentar tos y expectoración durante el último año. Se constataron signos inflamatorios en el codo derecho, con limitación a la flexoextensión y dolor a la palpación de los surcos retroolecraneanos. Los exámenes radiológicos fueron compatibles con una artritis séptica y los hematológicos: eritrosedimentación 92 mm/h y hemoglobina 10.0 g/L, la prueba de la tuberculina fue positiva, lo que nos orientó al diagnóstico presuntivo de tuberculosis osteoarticular, que se confirmó semanas después con el resultado del estudio bacteriológico del líquido sinovial, donde se informó la presencia del bacilo de Koch. Exámenes de laboratorio fueron negativos, se pudo demostrar el foco primario de infección activa. La respuesta al tratamiento aplicado, según el Programa Nacional de Control de la Tuberculosis Pulmonar, fue efectiva. A los 7 meses de iniciado el tratamiento el paciente fue dado de alta sin secuela.It is presented the case of a male patient complaining of pain on moving the right elbow and of tumefaction over the past two months. He had also noted occasional morning fever, s 10-pound weight loss, and episodes of coughing with expectoration during the last year. Inflammatory signs were observed on the right elbow with limitation to flexoextension and pain on palpation over the retro-olecranal grooves. The radiological examinations were compatible with a septic arthritis. The results of the hematological tests were: erythrosedimentation 92 mm/h and hemoglobin 10.0 g/L. The tuberculin test was positive. This led us to the presumptive diagnosis of osteoarticular tuberculosis that was confirmed some weeks later with the result of the bacteriological study of the synovial fluid, where the presence of Koch´s bacillus was reported. Laboratory tests were negative. The response to the treatment applied according to the National Program for the Control of Pulmonary Tuberculosis was effective. Seven months after treatment the patient was discharged with no sequela.

Purpose: The etiology of pain in osteoarthritis (OA) is complex and multifactorial. A growing number of studies suggest that modification of pain-transmission in the peripheral and central nervous system, leading to sensitization, plays a role in OA pain. Sensitization seems to be associated with neuropathic pain-like symptoms and assessment of these symptoms can help to identify patients who could benefit from additional treatment options. Several questionnaires are available to distinguish neuropathic from nociceptive pain symptoms. The modified painDETECT questionnaire (mPDQ) is a self-reported questionnaire developed to discriminate between nociceptive- and possible/likely neuropathic pain in knee OA patients. Recently the mPDQ was translated into Dutch and adjusted to also fit hip OA patients. The aim of this study was to assess the validity of the mPDQ-NL in patients with hip or knee OA. Methods: Primary hip and knee OA patients were recruited from three Dutch hospitals. Based on previous research, confirmatory factor analysis for two principal components was performed to assess structural validity. Construct validity (both convergent and divergent) was assessed using hypothesis testing. Predefined hypotheses were formulated concerning the correlation between the mPDQ-NL and the Self-reported Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), subscales of the Knee injury and Osteoarthritis Outcome score/ Hip disability and Osteoarthritis Outcome Score (KOOS/HOOS), Visual Analogue Scale for pain (VAS pain), and subscales of the RAND-36 health survey (RAND-36). According to the COSMIN criteria, construct validity of a questionnaire is sufficient if 75% of predefined hypotheses are met. Additionally, convergent validity was assessed with blunt Pain Pressure Thresholds (PPTs) in a subsample of participants. A reduced PPT is a somatosensory abnormality that is considered an indication of sensitization in OA. Therefore it was expected that reduction of PPTs was associated with higher mPDQ scores. Results: 168 participants were included. PPT measurements were performed in a sample of 46 participants. Factor analysis confirmed two principal components. The items that loaded on the first component could be described as “evoked neuropathic sensations”, the items that loaded on the second component as “spontaneous neuropathic sensations”. However there were two items that substantially loaded on both components. The item regarding pain pattern did not load on any component. Considering construct analysis, 80% of the predefined hypotheses concerning the correlation between mPDQ and self-reported questionnaires were met. Considering the correlation with PPT measurements, 50% of the predefined hypotheses were met. Conclusions: The mPDQ-NL seems to adequately reflect neuropathic pain-like symptoms experienced by hip and knee OA patients. Concerning structural validity, two determinative components seem to be present, in line with previous research. However, one particular item regarding pain pattern might not reflect the construct of neuropathic pain-like symptoms in hip or knee OA. Therefore, when using the mPDQ in hip or knee OA patients, it might be considered to skip this particular item. Construct validity can be considered sufficient, with over 75% of the predefined hypotheses regarding correlation between the mPDQNL and other questionnaires were met. However, only 50% of the hypotheses concerning PPT measurements were met, probably due to heterogeneity and limited sample size of this subgroup. To our knowledge, this study is the first to assess the structural validity of the mPDQ knee and hip by using factor analysis and to assess construct validity using elaborate hypothesis testing as proposed by the COSMIN guidelines.

Osteoarthritis of the knee is a major cause of disability among adults. Electro-acupuncture is considered a potentially useful treatment for osteoarthritis. The purpose of this study is to assess the efficacy of electro-acupuncture on pain control, pain perception, plasma cortisol and beta-endorphin levels, patient-perceived quality of life, and pain medication use in patients with chronic knee pain. This study is a placebo-controlled, randomized, double-blind, parallel design trial. One hundred sixty out-patients who are more than 50 years old and who have osteoarthritis of the knee will be recruited from the island of Mallorca, Spain. Each participant will be randomly placed into one of two groups: (sham) electro-acupuncture non-insertion technique and real electro-acupuncture. Acupuncture treatments will be the Traditional Chinese Medicine type. The patients will be evaluated after a period of 1 month (with two weekly sessions), 3 months (with one monthly session), 6 months (with one session every 45 days), and 1 year later with follow-up sessions at the end of the study (with one session every 2 months). The primary outcomes will be based on the observed changes from the baseline of the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain measured at 12 weeks after the end of treatment. Also to be included in the study are the possible changes in the secondary efficacy variables from baseline as assessed by the Short Form 36 version 2 health survey (patient-perceived quality of life), patient plasma cortisol and beta-endorphin levels at the different treatment stages, the Goldberg Anxiety and Depression Scale, pain medication use, functional capacity and stiffness (WOMAC subscales), and a VAS. These variables will be assessed at 1 month, 3 months, 6 months, and 1 year after study commencement. The findings from this study will help to determine whether electro-acupuncture is effective for chronic knee pain management in older people and whether electro-acupuncture can deliver results for the improvement of pain relief, stiffness, and disability. The study will therefore be a major step toward understanding the roles of the hypothalamic-pituitary-adrenal axis and the endogenous opioid system in the effectiveness of electro-acupuncture for chronic pain. ClinicalTrials.gov identifier NCT02299713 (11 Nov. 2014).

Osteoartritis (OA) je kronična, polagano progredirajuća bolest zglobne hrskavice i okolozglobnih struktura, koju karakterizira postepen nastanak zglobne boli, ukočenosti zgloba i ograničenost pokreta. Muskuloskeletne bolesti su jedan od vodećih medicinskih, socijalnih i ekonomskih problema današnjice, a upravo je OA najučestalija među njima, karakteristična po svojoj incidenciji i utjecaju na promjenu kvalitete življenja. Zbog toga u reumatologiji postoji veliki interes za sve aspekte te bolesti, a poglavito za patofiziologiju OA. Namjera ovog članka je bila da sagleda najvažnije aspekte patofiziološkog događanja u zglobu, jer poznavanje patofiziologije nam omogućava ispravno promišljanje terapijskih postupaka i farmakoterapije OA, usmjerenih na prevenciju, smanjenje simptoma i liječenje posljedica OA., Osteoarthritis (OA) is slowly evolving disease of articular cartilage degneration characterized by the gradual development of joint pain, stiffness and limitation of motion. Musculoskeletal diseases are growing medical, social and economic problem. OA among them takes leading position with incidence, morbidity and poor quality of life. In the last few decades there is increasing interest for better knowledge of all aspects of the disease, especially with regard to its pathophysiology. This paper focuses the recent aspects of patophysiology of OA, because knowledge of patophysiology means the challenge for the clinician to find a way to best prevent articular cartilage degradation, preserve joint function, treat joint pain and treat concurrent inflammation.