Search

[Resumen] Introducción y objetivo. El uso de cohortes de osteoartritis bien caracterizadas es obligatorio para estudiar y profundizar en el conocimiento en esta enfermedad. En España no existe actualmente ninguna cohorte prospectiva en este ámbito; por ello, el objetivo de este trabajo es describir la primera cohorte de osteoartritis en España: la PROCOAC (PROspective COhort of A Coruña). Material y métodos. El Servicio de Reumatología del Hospital Universitario de La Coruña inició un estudio de seguimiento prospectivo en el año 2006. Los criterios de inclusión fueron: a) pacientes mayores de 55 años a los que se les realizó una radiografía abdominal que permitiese estudiar ambas caderas; b) pacientes diagnosticados de osteoartritis radiográfica de mano según los criterios ACR; c) pacientes diagnosticados de osteoartritis radiográfica de rodilla o cadera según los criterios ACR. Se realizó seguimiento cada 2 años y se recogió información clínica, analítica, genética y radiográfica. Resultados. La cohorte consta de 937 individuos; 873 tienen osteoartritis radiográfica de rodilla, 783 de cadera y 679 de mano. La edad media de la población es 63,9 ± 8,9 años y el IMC promedio de 29,6 ± 5,1. Más de la mitad de la población tiene hipertensión arterial y el 17%, diabetes. La osteoartritis predominante en la mano es la nodular (78,1%), seguida de la rizartrosis (55,3%) y la erosiva (18,4%). El 21,4% y el 43,1% tienen sanas la rodilla y la cadera, respectivamente. Se observa un grado 1 en el 26% y 37%; un grado 2 en el 26,7% y 11,5%; un grado 3 en el 14,9% y 4%; y un grado 4 en el 9,4% y 3,7%, respectivamente. El 44,1% de la población tiene una articulación afectada, el 39,9% tiene 2 y el 13,4% tiene las 3 articulaciones afectadas. La edad (OR = 1,11; p < 0,001), el IMC (OR = 1,11; p = 0,002) y el WOMAC total (OR = 1,03; p = 0,005) son los únicos factores de riesgo si comparamos la afectación de una sola ubicación frente a 3. También se detectó una discrepancia entre el dolor y el daño radiográfico articular en pacientes con grado KL ≤ 2, de modo que un porcentaje significativamente mayor de pacientes con osteoartritis de rodilla experimentaron dolor (66,1%) en comparación con los pacientes de cadera (21,1%) (p < 0,001). Conclusión. La cohorte PROCOAC es un instrumento que permite realizar estudios de incidencia y progresión en la osteoartritis de mano, rodilla y cadera, así como conocer factores que se asocian con los diferentes fenotipos de osteoartritis. [Abstract] Introduction and objective. The use of well characterized osteoarthritis cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). Methods. The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: a) patients older than 55 years who underwent an abdominal x-ray to study both hips; b) patients diagnosed with radiographic hand osteoarthritis according to ACR criteria; c) patients diagnosed with radiographic knee or hip osteoarthritis according to ACR criteria. Follow-up was performed every 2 years collecting clinical, analytical, genetic and radiographic information. Results. The cohort consists of 937 patients, 873 have radiographic knee osteoarthritis, 783 hip osteoarthritis and 679 hand osteoarthritis. The mean age of the population is 63.9 ± 8.9 years and the average BMI is 29.6 ± 5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Of them, 21.4% and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7%, respectively. Of the population, 44.1% has only one joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR = 1.11; P < .001), BMI (OR = 1.11; P = .002) and total WOMAC (OR = 1.03; P = .005) are the only risk factors if we compare the involvement of a single location versus 3. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL ≤ 2 grade, and therefore a significantly higher percentage of patients with knee osteoarthritis experienced pain (66.1%) compared to patients with osteoarthritis hip (21.1%) (P< .001). Conclusions. The PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip osteoarthritis; as well as determining factors that are associated with the different osteoarthritis phenotypes.

Osteoartritis je vrlo često upalno stanje u mačaka starijih od 12 godina, a najnovija istraživanja pokazuju da se OA radiografski često dijagnosticira i kod mlađih mačaka. OA je poremećaj na razini organa, kroničnog je tijeka te polagano progredira. U nastanku same bolesti veliku ulogu imaju biomehanički i genetski čimbenici, dok je nastanak upale povezan sa progresijom bolesti i degradacijom hrskavice. Stanice unutar oštećenih zglobova otpuštaju protupalne citokine koji pojačavaju i produljuju upalni proces. Bolest zahvaća cijeli zglob i okolne strukture. Životinje otežano ustaju, šepaju, pokazuju znakove boli te je vidljiva smanjena pokretljivost zglobova. Jednom kad se postavi dijagnoza putem općeg kliničkog pregleda, ortopedskog i neurološkog pregleda te RTG metode, dva su cilja terapije: uklanjanje boli i očuvanje funkcije zgloba. Liječenje se temelji na multimodalnoj terapiji kojoj je cilj smanjenje upale, smanjenje boli u zglobu te smanjenje funkcionalne nesposobnosti. Dostupno je mnogo lijekova protiv bolova, uključujući nesteroidne protuupalne lijekove i opioide. Također, regulacija tjelesne težine i nutritivna potpora zglobovima važni su aspekti liječenja OA. Konačno, fizikalna rehabilitacija izvrstan je način za poboljšanje mobilnosti i olakšavanja svakodnevnih aktivnosti kućnih ljubimaca. Rana dijagnostika i aktivno praćenje stanja životinje mogu poboljšati kvalitetu života mačaka koje pate od bolova i smanjene pokretljivosti povezanih s osteoartritisom.

Osteoarthritis is the result of several patterns of joint dysfunction and is characterized by degeneration of articular cartilage and simultaneous proliferation of bone tissue, cartilage and connective tissue. And it is often associated with significant restriction and reduced quality of life. In Brazil, it ranks third in the list of Social Security insured persons, with 65% of causes of disability. Given this context, the objective of this study is to analyze hospitalizations for osteoarthritis in people aged between 50 and 80 years or older in Brazil and its regions in the last 5 years. This is a descriptive, retrospective and analytical study about hospitalizations resulting from osteoarthritis, in people between 50 and 80 years of age or older, from 2017 to 2021, in Brazil and its macro-regions. In the analyzed period, 74,730 hospitalizations for osteoarthritis were recorded in people aged between 50 and 80 years or older in Brazil. Regarding geographic regions, the largest number of hospitalizations is concentrated in the Southeast region. Regarding the age group, patients aged 60 to 69 years were the most affected. As for the reported ethnicity of the hospitalized patients, the highest number of cases prevailed among those hospitalized of white ethnicity. This research demonstrates that osteoarthritis is a public health problem, being susceptible to early diagnosis and preventive care, and there should be actions such as health education, aiming to minimize unnecessary expenses and improve people's quality of life. La osteoartritis es el resultado de varios patrones de disfunción articular y se caracteriza por la degeneración del cartílago articular y la proliferación simultánea de tejido óseo, cartílago y tejido conectivo. Y a menudo se asocia con una restricción significativa y una calidad de vida reducida. En Brasil, ocupa el tercer lugar en la lista de asegurados de la Seguridad Social, con el 65% de las causas de invalidez. En ese contexto, el objetivo de este estudio es analizar las hospitalizaciones por artrosis en personas con edades entre 50 y 80 años o más en Brasil y sus regiones en los últimos 5 años. Se trata de un estudio descriptivo, retrospectivo y analítico sobre internaciones por artrosis, elaborado a partir de datos secundarios, en personas entre 50 y 80 años o más, de 2017 a 2021, en Brasil y sus macrorregiones. En el período analizado, se registraron 74.730 hospitalizaciones por artrosis en personas con edades entre 50 y 80 años o más en Brasil. En cuanto a las regiones geográficas, el mayor número de hospitalizaciones se concentra en la región Sudeste. En cuanto al grupo de edad, los pacientes de 60 a 69 años fueron los más afectados. En cuanto a la etnia reportada de los pacientes hospitalizados, el mayor número de casos prevaleció entre los hospitalizados de etnia blanca. Esta investigación demuestra que la osteoartritis es un problema de salud pública, siendo susceptible de diagnóstico precoz y atención preventiva, y debe haber acciones como la educación en salud, con el objetivo de minimizar los gastos innecesarios y mejorar la calidad de vida de las personas. A osteoartrose é o resultado de vários padrões de disfunção articular e caracteriza-se por degeneração da cartilagem articular e simultânea proliferação de tecido ósseo, cartilagem e tecido conectivo. E, frequentemente, está associada a significante restrição e redução da qualidade de vida. No Brasil, ocupa o terceiro lugar na lista dos segurados da Previdência Social, com 65% das causas de incapacidade. Diante desse contexto, o objetivo deste estudo é analisar as internações por osteoartrite, em pessoas entre 50 e 80 anos ou mais, no Brasil e suas regiões, nos últimos 5 anos. Trata-se de um estudo descritivo, retrospectivo e analítico, acerca das internações decorrentes de osteoartrite, elaborado através de dados secundários, em pessoas entre 50 e 80 anos ou mais, no período de 2017 a 2021, no Brasil e suas macrorregiões. No período analisado, foram registradas 74.730 internações por osteoartrite, em pessoas entre 50 a 80 anos ou mais, no Brasil. No que tange às regiões geográficas, o maior número de internações concentra-se na região Sudeste. Em relação à faixa etária, os pacientes de 60 a 69 anos foram as mais acometidas. Em relação ao sexo, o sexo feminino foi o que predominou. Quanto à etnia informada dos internados, o maior número de casos prevaleceu nos hospitalizados de etnia branca. Esta pesquisa demonstra que a osteoartrose é um problema de saúde pública, sendo passível de diagnóstico precoce e cuidados preventivos, devendo haver ações como educação em saúde, visando minimizar gastos desnecessários e melhorar a qualidade de vida das pessoas.

Osteoartritis jedna je od najčešćih reumatskih bolesti u današnjem vremenu. Ova degenerativna bolest kroničnog i progresivnog tijeka zahvaća populaciju starije životne dobi. Dijagnoza osteoartritisa koljena postavlja se na temelju subjektivnih simptoma bolesnika i objektivnog kliničkog nalaza, a definitivna dijagnoza se postavlja radiološkom pretragom koljena. Liječenje osteoartritisa koljena je može biti farmakološko i nefarmakološko. U nefarmakološko liječenje spadaju konzervativne i kirurške metode. Nefarmakološko konzervativno liječenje podrazumijeva promjenu načina života bolesnika i adekvatnu fizikalnu terapiju. U kirurško liječenje osteoartritisa koljena spadaju palijativni artroskopski i klasični kirurški zahvati. Za uznapredovale slučajeve osteoartritisa koju su rezistentni na konzervativnu terapiju pogodniji su zahvati ugradnje endopropteza i artrodeza. Fizikalna terapija je i dalje zlatni standard u liječenju OA koljena. Fizikalne terapije mogu biti aktivne ili pasivne metode. U aktivne metode fizikalne terapije spadaju terapijsko vježbanje i hidroterapija. Dok ultrazvuk, kriomasaža i svi ostali elektroterapijski modaliteti spadaju u pasivne metode fizikalne terapije. Osteoarthritis is one of the most common rheumatic diseases nowadays. This degenerative disease with a chronic and progressive course affects the elderly population. The diagnosis of osteoarthritis of the knee is made on the basis of a patient's subjective symptoms and objective clinical findings. However, the definitive diagnosis is established based on a radiological examination of the knee. The treatment of knee osteoarthritis can be pharmacological and non-pharmacological. Non-pharmacological treatment includes conservative and surgical methods. Non-pharmacological conservative treatment implies a change in a patient's lifestyle and adequate physical therapy. The surgical treatment of knee osteoarthritis includes palliative arthroscopic and classical surgical procedures. For the advanced cases of osteoarthritis that are resistant to conservative therapy, endoprosthesis and arthrodesis procedures are more suitable. Physical therapy remains the gold standard in the treatment of knee osteoarthritis. Physical therapies can be active or passive methods. Active methods of physical therapy include kinesiotherapy and hydrotherapy, while ultrasound, cryomassage and all other electrotherapeutic modalities belong to passive methods of physical therapy.

Osteoartritis (OA) je bolest zglobova, a sam proces bolesti zahvaća cijeli zglob, uključujući kost, hrskavicu i druge strukture koje okružuju zglob (ligamente i mišiće). Posljedica je mehaničkih i bioloških promjena koje remete normalne odnose u zglobu, a najčešći uzrok ovakvog stanja je oštećenje funkcionalnih komponenti lokomotornog sustava. Genetska predispozicija, poremećaji u razvoju, endokrini poremećaji, pretilost i česte traume zglobova neki su od čimbenika rizika koji pridonose razvoju ovog stanja. Moguće je da zahvati bilo koji zglob u tijelu, ali najčešće na malim zglobovima šake i koljena, kao i na tzv. nosećim zglobovima (koljeno i kuk). Najvažniji klinički znak je bol, koja se u početku manifestira tijekom kretanja i opterećenja. Međutim, kako se stanje pogoršava, bol se može osjetiti i kada pacijent miruje. Ostali simptomi uključuju krepitacije u zglobu, ograničenu pokretljivost i ukočenost u zahvaćenom zglobu. Budući da okolni mišići slabe kako bolest napreduje, zahvaćeni zglob postaje sve nestabilniji i kao rezultat toga gubi dio opsega pokreta. Patološki proces bolesti počinje na površini i rubovima hrskavice u zglobu, gdje najprije dolazi do promjena, gubi elastičnost, stvara manja oštećenja, a zatim i dublja oštećenja. Proces se potom širi i zahvaća dijelove subhondralne kosti. Postoji nešto što se zove primarna artroza, a dolazi iz nepoznatog izvora, a postoji i nešto što se zove sekundarna artroza (koja nastaje kao posljedica traume, prirodnih anomalija, metaboličkih i genetskih čimbenika). Anamneza, klinički pregled bolesnika i nalazi eventualne radiološke dijagnostike ono su što se koristi za postavljanje dijagnoze osteoartritisa. Suženje zglobne pukotine, skleroza subhondralne kosti, cistične promjene na subhondralnoj kosti i osteofiti su radiološke promjene koje se najčešće javljaju u zglobu. Liječenje bolesti sastoji se od kombinacije nefarmakološkog (fizikalni postupci) i farmakološkog (analgetici, glukokortikoidi) liječenja, te operativnog liječenja bolesnika koji nisu povoljno odgovorili na druge metode liječenja. Osteoarthritis (OA) is a disease of the joints, and the disease process itself affects the entire joint, including bone, cartilage and other structures surrounding the joint (ligaments and muscles). It is the result of mechanical and biological changes that disrupt normal relations in the joint, and the most common cause of this condition is damage to the functional components of the locomotor system. Genetic predisposition, developmental disorders, endocrine disorders, obesity and frequent joint trauma are some of the risk factors that contribute to the development of this condition. It can affect any joint in the body, but most often the small joints of the hands and knees, as well as the so-called bearing joints (knee and hip). The most important clinical sign is pain, which initially manifests itself during movement and loading. However, as the condition worsens, the pain can be felt even when the patient is resting. Other symptoms include crepitations in the joint, limited mobility and stiffness in the affected joint. As the surrounding muscles weaken as the disease progresses, the affected joint becomes increasingly unstable and as a result loses some of its range of motion. The pathological process of the disease begins on the surface and edges of the cartilage in the joint, where changes first occur, it loses elasticity, causes minor damage, and then deeper damage. The process then spreads and affects parts of the subchondral bone. There is something called primary arthrosis, which comes from an unknown source, and there is something called secondary arthrosis (which occurs as a result of trauma, natural anomalies, metabolic and genetic factors). Anamnesis, clinical examination of the patient and the findings of possible radiological diagnostics are what are used to establish the diagnosis of osteoarthritis. Narrowing of the joint fissure, sclerosis of the subchondral bone, cystic changes in the subchondral bone and osteophytes are the most common radiological changes in the joint. The treatment of the disease consists of a combination of non-pharmacological (physical procedures) and pharmacological (analgesics, glucocorticoids) treatment, and operative treatment of patients who have not responded favorably to other treatment methods.

Osteoartritis koljena predstavlja stanje u kojem dolazi do patoloških promjena na zglobnoj hrskavici, progresijom bolesti ono prelazi na okolne strukture. Sam degenerativni proces najzastupljeniji je na opterećenim zglobovima, točnije zglobovima koji su odgovorni za prijenos najveće sile tijekom pokretanja, među kojima je koljeno. Istraživanja su pokazala kako sve više osoba starijih od 65 godina boluje od degenerativnih promjena. Sam tijek nastanka osteoartritisa još nije dovoljno istražen, ali su poznati neki rizični faktori. Prema tome ih dijelimo na primarne i sekundarne. Primarni uzrok najčešće nije dovoljno istražen, ali se povezuje sa starenjem, dok u sekundarnim uvijek prethodi neko stanje ili u većini slučajeva razni biomehanički poremećaji koji su okidač za nastanak. Uz sva stanja navodi se kako je i sam način života bolesnika jedan od rizičnih faktora. Prvi i najznačajniji simptom je bol koja se javlja nakon određenih pokreta ili cjelodnevnog opterećenja. Progresijom bolesti simptomi su sve češći i jači, kretnje u samom zglobu su ograničene, dolazi do nastanka oteklina, krepitacija i razvoja sekundarnih deformacija na samom zglobu. Prilikom dijagnostike važno mjesto zauzima klinička slika i rendgenološki nalaz, uz obaveznu magnetsku rezonanciju. Liječenje je podijeljeno na konzervativno i operacijsko. Konzervativne metode su medikamentno liječenje i fizikalna terapija, čime pokušavamo rasteretiti sam zglob i naučiti bolesnika kako živjeti s osteoartritisom. Ako konzervativno liječenje nije dalo dobre rezultate prelazi se na metode palijativnog i kauzalnog liječenja te u krajnjem slučaju aloartroplastike ili artrodeze zgloba. Neovisno kojim tijekom će liječenje ići, važno mjesto zauzima fizioterapija, no prije same primjene metoda terapije bitno je učiniti detaljnu procjenu pomoću subjektivnog i objektivnog pregleda. Prilikom objektivnog pregleda dolazimo u kontakt sa samim zglobom putem inspekcije i palpacije. Važno je procijeniti snagu mišića putem manualnog mišićnog testa te izmjeriti koliki je opseg kretnji te izmjeriti obujam samog zgloba. Na temelju dobivenih informacija kreira se daljnji plan i program rehabilitacije. Najvažniji dio rehabilitacije je primjena terapijskih vježbi koje su nadopunjene primjenom termoterapije, elektroterapije te krioterapije. Osteoarthritis of the knee is a condition in which pathological changes occur in the articular cartilage and with the progression of the disease it spreads to the surrounding structures. The degenerative process itself is most prevalent on loaded joints, more precisely the joints that are responsible for transmitting the greatest force during movement, among which is the knee. Research has shown that more and more people over the age of 65 suffer from degenerative changes. The course of osteoarthritis itself has not yet been sufficiently investigated, but some risk factors are known nonetheless. Accordingly, we divide them into primary and secondary. The primary cause is usually not sufficiently investigated, but is associated with aging, while secondary arthrosis is always preceded by a condition or, in most cases, by various biomechanical disorders that are the trigger for its occurrence. In addition to all conditions, it is stated that the patient's lifestyle itself is one of the risk factors. The first and most significant symptom is pain that occurs after certain movements or all-day exertion. As the disease progresses, symptoms become more frequent and stronger, movements in the joint itself are limited, swelling, crepitations and the development of secondary deformations in the joint itself occur. When diagnosing, important methods include clinical picture and X-ray findings, along with mandatory magnetic resonance imaging. The treatment is divided into conservative and operative. Conservative methods are medical treatment and physical therapy, by which we try to relieve the joint itself and teach the patient how to live with arthrosis. If conservative treatment did not give good results, palliative and causal treatment methods are used. Moreover, if none of the treatments mentioned before do not give any results, alloarthroplasty or joint arthrodesis are used. Regardless of the course of treatment, physiotherapy plays an important role, but before the actual application of therapy methods, it is important to make a detailed assessment using a subjective and objective examination. During the objective examination, we come in contact with the joint itself through inspection and palpation. It is important to assess muscle strength through a manual muscle test, measure the range of motion and measure the volume of the joint itself. Based on the received information, a further rehabilitation plan and program is created. The most important part of rehabilitation is the application of therapeutic exercises, which are complemented by the application of thermotherapy, electrotherapy and cryotherapy.

[ES] La osteoartritis (OA) es una enfermedad degenerativa, crónica y compleja que provoca la alteración estructural y funcional de las articulaciones y que afecta actualmente a 300 millones de personas. El objetivo fundamental de este proyecto es tratar la OA mediante el desarrollo de un hidrogel de ácido hialurónico (HA) de alto peso molecular (1.5-1.8 MDa) modificándolo mediante sulfhidrilos (SH) que permiten el entrecruzamiento in situ y posteriormente injertar condroitín sulfato (CS), la biomolécula condroprotectora anclada al hidrogel cuya liberación estará mediada por la degradación hidrolítica del punto de unión. Se pretende mimetizar uno de los componentes fundamentales de la matriz extracelular del cartílago (MEC) con el objetivo de obtener un producto que sea capaz de extenderse en el lugar del daño y que tenga propiedades muy similares a este en cuanto a viscoelasticidad, retención de agua, estimulación de los condrocitos para sintetizar nueva matriz. Surge la necesidad de desarrollar este producto porque durante las últimas dos décadas, la mayor parte de las líneas de investigación para obtener los proteoglicanos miméticos, emplean intermediarios polipeptídicos basados en proteínas de naturaleza xenogénica, con amplia variabilidad en su estructura, y por tanto activan una respuesta inmunológica en el organismo. Es por ello por lo que existe un reciente interés por desarrollar estructuras exclusivamente basadas en glicosaminoglicanos (GAG) ya que sus funciones naturales en el cartílago están relacionadas con efectos físicos (retener agua, limitar el rozamiento¿) que biológicos. La alumna empleará la técnica EDC/NHS para introducir grupos sulfhidrilo terminales en el HA para conferirle la posibilidad de gelificar in situ mediante puentes de disulfuro porque es una técnica sencilla y viable en medio acuoso, a diferencia de otras líneas de investigación que requieren transformaciones químicas muy complejas. Actualmente existen productos basados en HA de un peso alrededor de 250-500 kDa antes de la modificación, pero hay evidencias de que hidrogeles de HA tiolado (modificado mediante sulfhidrilos) de alto peso molecular presenta mejores propiedades reológicas que HA de bajo peso molecular. Se usará la ruta química EDC/NHS tanto para la tiolación como para el injerto, algo que aún no ha sido probado simultáneamente. Este hidrogel carecería del riesgo inmunogénico asociado a las proteínas, permitiría una mejora en las propiedades viscoelásticas del tejido donde se inserta durante varios meses y garantizaría una liberación controlada y focalizada de estas biomoléculas. La función del alumno en este proyecto es conseguir un hidrogel de HA de alto peso molecular cuyo entrecruzamiento sea controlable. También se desea lograr que este hidrogel tenga un grado de tiolación adecuado, para ello se probarán distintas concentraciones de HA. Por último, participará en la obtención del hidrogel de HA con CS Injertado mediante tres técnicas diferentes para posteriormente caracterizarlos y ver qué línea es la que mejor grado de injerto tiene, [CAT] L'osteoartritis (OA) és una malaltia degenerativa que provoca l'alteració estructural i funcional de les articulacions amb una elevada prevalença a nivell mundial. Per a tractar l'OA, actualment hi ha teràpies injectables que només servixen com a tractament simptomàtic per a alleujar el dolor, però sense l'objectiu de regenerar, per tant, amb escàs fi clínic. Per això es pretén desenrotllar un producte mèdic que consistisca en un hidrogel d'àcid hialurónico (HI HA) autorreticulable i injectable in situ i que al seu torn tinga condroitín sulfat (CS) empeltat per al seu posterior alliberament controlada en el lloc del defecte. Es pretén que l'hidrogel servisca com viscosuplement, per tant, que tinga propietats molt semblants al cartílag quant a viscoelasticitat, retenció d'aigua i estimulació dels condrocitos a partir del CS per a sintetitzar nova matriu. En este treball, a diferència de les línies d'investigació de les últimes dècades de mimetitzar un dels components fonamentals de la matriu extracel·lular del cartílag (MEC), sorgix l'interés de desenvolupar estructures basades en glicosaminglicanos (GAG) per tindre efectes físics desitjables en compte d'obtindre els proteoglicans mimètics emprant intermediaris polipeptídics que provoquen l'activació d'una resposta immunològica en l'organisme. Aquest hidrogel no tindrà el risc inmunogénico associat a les proteïnes, permetrà una millora en les propietats viscoelástiques del teixit on s'inserix durant uns quants mesos, tindrà una funció condroprotectora i garantirà un alliberament controlada i focalitzada d'estes biomolécules. S'empra HA d'alt pes molecular (1.5-1.8 MDa) modificant-lo mitjançant la química EDC/NHS per introduir grups sulfhidril (SH) terminals a l'HA per conferir-li la possibilitat de gelificar in situ a través dels ponts de disulfur. Fent ús d'aquesta tècnica es pretén aconseguir que aquest hidrogel tingui un grau de tiolació adequat, per això es proven diferents concentracions d'HA. Finalment, per empeltar CS, també es fa servir la química EDC/NHS i diferents concentracions per obtenir així la concentració òptima a través de la tècnica de la fluorescamina. Alhora es proven dues tècniques diferents per empeltar i es determina el punt de gel dels hidrogels., [EN] Osteoarthritis (OA) is a degenerative, chronic and complex disease that causes structural and functional alteration of the joints and currently affects 300 million people. The main objective of this project is to treat OA by developing a high molecular weight (1.5-1.8 MDa) hyaluronic acid (HA) hydrogel, modifying it by means of sulfhydryls (SH) that allow cross-linking in situ and subsequently grafting chondroitin sulfate (CS), the chondroprotective biomolecule anchored to the hydrogel whose release will be mediated by the hydrolytic degradation of the attachment point. It is intended to mimic one of the fundamental components of the extracellular matrix of cartilage (ECM) with the aim of obtaining a product that is capable of spreading in the place of damage and that has properties very similar to it in terms of viscoelasticity, water retention, stimulation of chondrocytes to synthesize new matrix. The need to develop this product arises because during the last two decades, most of the lines of research to obtain mimetic proteoglycans use polypeptide intermediates based on proteins of a xenogeneic nature, with wide variability in their structure, and therefore activate an immune response in the body. This is why there is recent interest in developing structures exclusively based on glycosaminoglycans (GAG) since their natural functions in cartilage are related to physical effects (retaining water, limiting friction...), rather than biological ones. The student will use the EDC/NHS technique to introduce terminal sulfhydryl groups in HA to give it the possibility of gelling in situ through disulfide bridges because it is a simple technique, viable in aqueous media, unlike other lines of research that require very complex chemical transformations. Currently there are products based on HA weighing around 250-500 kDa before modification, but there is evidence that high molecular weight thiolated HA hydrogels (modified by sulfhydryls) have better rheological properties than low molecular weight HA. EDC/NHS chemical route for both thiolation and grafting will be used, something that has not yet been tested simultaneously. This hydrogel would lack the immunogenic risk associated with proteins, would allow an improvement in the viscoelastic properties of the tissue where it is inserted for several months and would guarantee a controlled and focused release of these biomolecules. The role of the student in this project is to achieve a high molecular weight HA hydrogel whose crosslinking is controllable. Another aim is achieving that this hydrogel has an adequate degree of thiolation, for which different concentrations of HA will be tested. Finally, it will participate in obtaining the hydrogel of HA with CS Grafted using three different techniques to later characterize them and see which line has the best degree of grafting.

Introduction: Chronic inflammatory conditions related to joints are a source of intense daily suffering. The reduction in the life quality of its patients and the working capacity of some are related to intense pain and deterioration of the tissues that compose the cartilage by cells of the immune system. Cannabinoids have gained considerable relevance as objects of study regarding their vast applicable properties to pharmacological therapies, including anti-inflammatory and analgesic effects. This article aims to analyze the academic production on the implication of the use of cannabinoids as therapy in rheumatoid arthritis and osteoarthritis. Methodology: 5 articles were selected from the Virtual Health Library, published between 2017 and 2021, to compose this Integrative Literature Review. Discussion: In particular, cannabidiol has been shown to act upon receptors that participate in cellular pathways related to pain regulation and that delay the destructive process of affected tissues. The use of Cannabis derivatives for therapeutic purposes has gained great adherence, especially in countries where there is already legislation which allows it, especially by people living with chronic neuropathic pain. Conclusions: Pain control is the most emphasized symptom in the literature, due it’s impact on life quality of those affected. There is great interest from the scientific community in the advancement of cannabinoid study techniques. In parallel, people affected by diseases that could possibly benefit from cannabinoids therapeutic effects have sought them as an alternative to regularly prescribed drugs. Introducción: Introducción: Las condiciones inflamatorias crónicas relacionadas con las articulaciones son fuente de intenso sufrimiento diario. La reducción de la calidad de vida de sus pacientes y de la capacidad de trabajo de algunos se relaciona con el dolor intenso y el deterioro de los tejidos que componen el cartílago por parte de las células del sistema inmunitario. Los cannabinoides han ganado una gran relevancia como objetos de estudio debido a sus vastas propiedades aplicables a las terapias farmacológicas, incluidos los efectos antiinflamatorios y analgésicos. Este artículo tiene como objetivo analizar la producción académica sobre la implicación del uso de cannabinoides como terapia en la artritis reumatoide y la osteoartritis. Metodología: Se seleccionaron 5 artículos de la Biblioteca Virtual en Salud, publicados entre 2017 y 2021, para componer esta Revisión Integrativa de Literatura. Discusión: En particular, se ha demostrado que el cannabidiol actúa sobre los receptores que participan en las vías celulares relacionadas con la regulación del dolor y que retrasan el proceso destructivo de los tejidos afectados. El uso de derivados del Cannabis con fines terapéuticos ha ganado una gran adherencia, especialmente en países donde ya existe una legislación que lo permite, especialmente por parte de personas que viven con dolor neuropático crónico. Conclusiones: El control del dolor es el síntoma más destacado en la literatura, por su impacto en la calidad de vida de los afectados. Existe un gran interés por parte de la comunidad científica en el avance de las técnicas de estudio de los cannabinoides. Paralelamente, las personas afectadas por enfermedades que posiblemente podrían beneficiarse de los efectos terapéuticos de los cannabinoides los han buscado como una alternativa a los medicamentos recetados regularmente. Introdução: Quadros inflamatórios crônicos relacionados às articulações são fonte de intenso sofrimento diário. A redução da qualidade de vida de seus portadores e da capacidade laborativa de alguns estão relacionados às intensas dores e à deterioração por células do sistema imune dos tecidos que constituem a cartilagem. Os canabinoides, ganharam bastante relevância como objetos de estudo quanto às suas vastas propriedades aplicáveis a terapêuticas farmacológicas, dentre as quais os efeitos anti-inflamatórios e analgésicos. Este trabalho tem como objetivo analisar a produção acadêmica acerca da implicação do uso de canabinoides como terapêutica nos quadros de artrite reumatoide e osteoartrite. Metodologia: Foram selecionados 5 artigos a partir da Biblioteca Virtual de Saúde, publicados entre 2017 e 2021, para compor esta Revisão Integrativa de Literatura. Discussão: Em especial, o canabidiol demonstrou agir sobre receptores que participam de vias celulares relacionadas à regulação da dor e que retardam o processo destrutivo dos tecidos acometidos. O uso de derivados da Cannabis para fins terapêuticos tem ganhado grande aderência, especialmente em países onde já existe legislação que a permita, sobretudo por pessoas que convivem com dor neuropática crônica. Conclusões: O controle da dor é o sintoma mais enfatizado na literatura, pelo impacto sobre a qualidade de vida dos acometidos. Há grande interesse da comunidade científica no avanço das técnicas de estudo dos canabinodes. Em paralelo, pessoas acometidas por doenças que possivelmente se beneficiariam dos efeitos terapêuticos de DC os têm buscado como alternativa a medicamentos regularmente prescritos.

The thoracic spine manifests degenerative changes from aging, obesity, repetitive strain and occupational stress, although sex differences are poorly understood. In this work we examine whether differences in the expression of thoracic degenerative joint changes can be found in females and males with respect to age. The two age groups included in the study are older adults between 50 and 55 years and elderly individuals between 70-75 years from the William M. Bass osteological collection of the University of Tennessee, Knoxville (USA). The first interval represents the onset of skeletal decline. The second is correlated with reduced mobility and an increase in arthritic pain. The thoracic vertebrae from 99 individuals (52 females and 47 males) were macroscopically examined on superior and inferior centra and zygapophyses for lipping, porosity and eburnation following Buikstra and Ubelaker’s (1994) scoring system. Elderly females and males exhibit a higher severity of degenerative changes than older adults, and in males the degree of lipping was extreme. Regarding older adults, males present a greater severity of lipping, extent of lipping, porosity, and extent of porosity than females. However, females show a greater degree of eburnation among older adults, particularly in the lower thoracic vertebrae. When elderly adults are compared, males express a higher degree of lipping, extent of lipping and extent of porosity than females. Like their older adult counterparts, elderly females show evidence of a greater severity in eburnation than males, suggesting hormonal profile disruption associated with reproductive cessation as well as occupational stress, may also cause the deterioration of the intervertebral discs, particularly in the lower thoracic skeleton., La columna vertebral torácica manifiesta cambios degenerativos por envejecimiento, obesidad, actividad repetitiva y estrés ocupacional, aunque las diferencias por sexo son poco conocidas. Examinamos si existen diferencias en la expresión de los cambios articulares degenerativos en las vértebras torácicas en mujeres y hombres con respecto a la edad. Los dos grupos de edad incluidos en el análisis corresponden a adultos maduros entre 50 y 55 años y entre 70 y 75 años pertenecientes a la colección osteológica William M. Bass de la Universidad de Tennessee, Knoxville (EEUU). El primer intervalo representa el inicio del declive esqueletal, mientras que el segundo está relacionado con una movilidad reducida y un aumento en el dolor articular. Se examinaron macroscópicamente las vértebras torácicas de 99 individuos (52 mujeres y 47 hombres) en las articulaciones superiores e inferiores de los cuerpos y en las zigapófisis, relevando la presencia de osteofitos, porosidad y eburnación según el sistema de puntuación no métrico de Buikstra y Ubelaker (1994). Tanto los individuos femeninos como los masculinos de mayor edad presentan una mayor severidad en los cambios degenerativos que los adultos mayores, y para los hombres el grado de osteofítos fue extremo. Para los adultos mayores, los hombres presentan una mayor severidad de osteofítos, extensión de osteofítos, porosidad y extensión de la porosidad, que las mujeres. Sin embargo, las mujeres presentan un mayor grado de eburnación, particularmente en las vértebras torácicas inferiores. Cuando se comparan los adultos mayores, los hombres expresan un mayor grado de osteofitosis, extensión de osteofitos y extensión de la porosidad, que las mujeres. Al igual que sus contrapartes de mayor edad, las mujeres adultas maduras muestran evidencia de una mayor severidad en eburnación que los hombres, lo que sugiere que la alteración del perfil hormonal asociada con el cese reproductivo de las mujeres, así como el estrés ocupacional, pueden afectar el deterioro de los discos intervertebrales, particularmente en el esqueleto torácico inferior., Asociación de Antropología Biológica Argentina

Osteoartritis (OA) je jedna od najraširenijih bolesti u našem društvu, odmah iza kardiovaskularnih bolesti i čest je uzrok invaliditeta kod starijih osoba u zapadnom svijetu. Bilo koji zglob može biti zahvaćen, ali najčešće zahvaća zglob koljena, kuka, stopala, kralježnicu, te zglobove šake. Zglob koljena (articulatio genus) je najveći zglob u tijelu čovjeka. Povezuje donji kraj bedrene kosti s gornjim krajem goljenične kosti. Strukture koljena mogu biti podijeljene u nekoliko kategorija. Menisci (menisci articulairs)odnosno ploče vezivne hrskavice, trokutastog oblika na poprečnom presjeku, osiguravaju ujednačenost zglobnih površina bedrene i goljenične kosti. Postoje medijalni i lateralni menisk, a odgovaraju obliku slova C ili srpa. Koljeno je zglob koji ima mnogo ligamenata koji jačaju zglobnu čahuru, a najvažnija su dva kolateralna i dva križna ligamenta. Ligamenti, svi zajedno su najvažnije strukture koje kontroliraju stabilnost koljena. Mišiću su aktivni stabilizatori koljena. U njemu se događa fleksija, ekstenzija, ali i unutarnja i vanjska rotacija. Za stabilnost i mehaniku koljenskog zgloba vrlo su bitne pobočne i ukrižene sveze. OA je degenerativna, kronična progresivna bolest zglobova čiji je glavni uzrok degeneracija zglobne hrskavice. Procjenjuje se da se gonartroza javlja iznad 60-te čak kod 90% ljudi, češće zahvaća žene nego muškarce. U primarne ili idiopatske gonartroze spada više od 50% artroza koljena, odnosno artroze kojima se ne može objasniti nastanak poznatim uzročnim čimbenicima. Sekundarni OA usko je vezan uz bolest ili neki poznati događaj. Razumijevanje promjena u ranoj fazi bolesti je bitno kako bi se lakše moglo liječiti. Prvi znak nastanka gonartroze je bol koja se javlja nakon mirovanja, te potom postupno nestaje, a pacijenti ju opisuju kao tupu ili muklu. Dijagnoza se postavlja na temelju RTG snimke i kliničkog pregleda koljena kojim se utvrđuje stupanj oštećenja zglobne hrskavice. Liječenje osteoartritisa uključuje kirurške i nekirurške metode liječenja. Medicinska sestra mora pružati zdravstvenu njegu najbolje kvalitete, te odluke koje donosi se moraju bazirati na prioritetima. Opća prijeoperacijska priprema može biti psihička i fizička. Prijeoperacijska edukacija bolesnika je važna jer smanjuje mogućnost nastanka poslijeoperacijskih komplikacija. Medicinska sestra u intraoperacijskom periodu ima ulogu pripremiti pacijenta za operaciju te pripremiti aparate i instrumente za anesteziju. Tijekom poslijeoperacijskog razdoblja potrebno je pacijentu objasniti i informirati ga o važnosti vježbi disanja i iskašljavanja. Osteoartritis je bolest koja napada starije osobe, te samim time faza opravka traje druže. Osteoarthritis (OA) is one of the most prevalent diseases in our society, right behind cardiovascular diseases and is often the reason for disability in the elderly of the Western world. Any joint can be affected, but it most commonly affects the knee, hip, foot, spine, and wrist joints. The knee joint (articulatio genus) is the largest joint in the human body. It connects the lower end of the femur and the upper end of the tibia. Knee structures can be divided into several categories. Menisci (menisci articularis) or connective cartilage plates, triangular in cross section, they ensure the comformity of the articular surfaces of femur and tibia. There are medial and lateral menisci, and they correspond to the shape of the letter C or sickle. The knee is a joint rich with ligaments that strengthen the joint capsule, the most important being two collaterals and two cruciate ligaments. Ligaments, all together are the most important structures that control the stability of the knee. Active knee stabilizers are muscles. Flexion, extension, but also internal and external rotation occur in it. Lateral and cruciate ligaments are very important for the stability and mechanics of the knee joint. OA is a chronic, degenerative, progressive disease of the joints, the main cause of which is the deterioration of the articular cartilage. It is estimated that gonarthrosis occurs above 60 in as many as 90% of people, affecting women more often than men. Primary or idiopathic gonarthrosis includes more than 50% of knee arthrosis, or arthrosis where the occurrence cannot be explained with the known causative factors. Secondary OA is closely related to a known event or disease. Understanding the changes in the early stages of the disease is essential to make it easier to treat. The first sign of gonarthrosis is pain that occurs after rest, and then gradually disappears, also patients describe it as dull or numb. The diagnosis is made on the basis of X-rays and a clinical examination of the knee to determine the degree of damage to the articular cartilage. Treatment of osteoarthritis includes surgical and non-surgical methods of treatment. Nurses must provide best quality health care, and the decisions nurses make must be based on the priorities of a patient. General preoperative preparation can be mental and physical. Education of patients in the preoperative period is important because it reduces the possibility of complications in the postoperative period. In the intraoperative period roles of the nurse are: prepares the patient for surgery, preparation of apparatus and instruments for anesthesia. In the postoperative period, the patient should be explained and told about the importance of conducting breathing and coughing exercises. Osteoarthritis is a disease that attacks the elderly and therefore the recovery phase lasts longer.

espanolAntecedentes El ejercicio acuatico es potencialmente beneficioso para los pacientes con artritis reumatoide y osteoartritis, por lo que una revision sistematica de la literatura es fundamental para aclarar el papel del ejercicio acuatico terapeutico en el manejo de la AR y OA. Objetivos: Analizar sistematicamente la evidencia disponible en la literatura sobre la efectividad del ejercicio acuatico en personas con artritis reumatoide y osteoartritis. Metodo: Se realizo una busqueda amplia en 4 bases de datos (Medline, PubMed, ResearchGate y Embase), en la cual se obtuvo una muestra inicial de 14 articulos de los cuales se obtuvo una muestra final de 8 articulos. Los criterios de seleccion fueron que el tipo de diseno del estudio fuera un ECA, que los participantes tuvieran artritis reumatoide u osteoartritis aceptando el ejercicio acuatico terapeutico y que las publicaciones fueran en ingles. Resultados: Los resultados mostraron mejoras tanto en funcionalidad, alivio del dolor como en calidad de vida en personas con AR y OA, ademas de un aumento de fuerza muscular en sujetos con OA. Conclusiones: El ejercicio acuatico puede reducir significativamente el dolor y aumentar la funcion fisica en pacientes con OA y AR. Se necesitan mas investigaciones de alta calidad a mayor escala para confirmar los resultados. EnglishBackground: Aquatic exercise is potentially beneficial for patients with rheumatoid arthritis and osteoarthritis, so a systematic review of the literature is essential to clarify the role of therapeutic aquatic exercise in the management of RA and OA. Objectives: To systematically analyze the evidence available in the literature on the effectiveness of aquatic exercise in people with rheumatoid arthritis and osteoarthritis. Method: A broad search was carried out in 4 databases (Medline, PubMed, ResearchGate and Embase), in which an initial sample of 14 articles was obtained, from which a final sample of 8 articles was obtained. The selection criteria were that the type of study design was an RCT, that the participants had rheumatoid arthritis or osteoarthritis accepting therapeutic aquatic exercise, and that the publications were in English. Results: The results showed improvements in both functionality, pain relief and quality of life in people with RA and OA, as well as an increase in muscle strength in subjects with OA. Conclusions: Aquatic exercise can significantly reduce pain and increase physical function in OA and RA patients. More high-quality research on a larger scale is needed to confirm the results. portuguesIntroducao: O exercicio aquatico e potencialmente benefico para pacientes com artrite reumatoide e osteoartrite, portanto, uma revisao sistematica da literatura e essencial para esclarecer o papel do exercicio aquatico terapeutico no manejo da AR e OA. Objetivos: Analisar sistematicamente as evidencias disponiveis na literatura sobre a eficacia do exercicio aquatico em pessoas com artrite reumatoide e osteoartrite. Metodo: Foi realizada uma ampla busca em 4 bases de dados (Medline, PubMed, ResearchGate e Embase), na qual foi obtida uma amostra inicial de 14 artigos, da qual foi obtida uma amostra final de 8 artigos. Os criterios de selecao foram o tipo O desenho do estudo foi um RCT, que os participantes tinham artrite reumatoide ou osteoartrite aceitando exercicios aquaticos terapeuticos, e que as publicacoes eram em ingles. Resultados: Os resultados mostraram melhorias na funcionalidade, no alivio da dor e na qualidade de vida em pessoas com AR e OA, bem como um aumento na forca muscular em individuos com OA. Conclusoes: O exercicio aquatico pode reduzir significativamente a dor e aumentar a funcao fisica em pacientes com OA e AR. Mais pesquisas de alta qualidade em uma escala maior sao necessarias para confirmar os resultados.

The increasing rate of orthopedic procedures, hip arthroplasty in particular, requires improvement of surgical techniques, as well as of the respective rehabilitation protocols. The aim of the study was to assess differences in the quality of life and incidence of limping eight years after total hip arthroplasty performed with a minimally invasive or classic approach. This cross-sectional study included 68 patients, i.e. 32 operated with classic approach and 36 with minimally invasive approach during 2011. The following parameters were observed: anthropometric measurements, history of comorbidity, subjective assessment of limping, and SF-36 questionnaire (Short Form Survey Instrument). SF-36 testing, which consists of 8 domains, showed that 5 domains of the quality of life were statistically significantly better in the minimally invasive group (level of significance p, Sve veća učestalost ortopedskih zahvata, osobito artroplastike kuka, zahtijeva unaprjeđenje kirurških i rehabilitacijskih protokola. Cilj istraživanja bio je ispitati razlike u kvaliteti života i incidenciji šepanja osam godina nakon artroplastike zgloba kuka u bolesnika operiranih minimalno invazivnim ili klasičnim pristupom. Provedeno je presječno istraživanje na 68 bolesnika, tj. 32 operirana klasičnim pristupom i 36 minimalno invazivnim pristupom ugradnje umjetnog zgloba kuka tijekom 2011. godine. Proučavali smo antropometrijske mjere, anamnestičke podatke o komorbiditetima, subjektivne procjene šepanja i popunjavanje standardnog upitnika za procjenu kvalitete života, SF-36 (Short Form Survey Instrument). Analizirajući odgovore na SF-36 upitnik koji sadrži 8 domena, kvaliteta života je u pet domena bila statistički značajno bolja kod bolesnika operiranih minimalno invazivnim pristupom: ograničenje zbog tjelesnih poteškoća (p=0,01), razina energije (p=0,02), socijalno funkcioniranje (p=0,02), bol (p=0,02) i percepcija općeg zdravlja (p=0,00). U skupini s minimalno invazivnim pristupom šepanje je bilo statistički značajno manje prisutno (p=0,032). Kvaliteta života nakon operativnog zahvata trebala bi biti glavni kriterij u izboru operacijskog pristupa. Veći broj bolesnika koji šepaju u skupini operiranoj klasičnim pristupom u odnosu na minimalno invazivni pristup možda također doprinosi razlici u kvaliteti života. U zaključku, minimalno invazivni pristup omogućava dugoročno održavanje više razine kvalitete života i bolji oporavak.

La cirugía de rodilla (CR) comprende uno de los grupos procedimientos quirúrgicos más comunes en ortopedia y tienden a realizarse, primordialmente, en pacientes con osteoartritis (OA). Este es un trastorno articular degenerativo, doloroso y debilitante asociado con la obesidad. Se ha demostrado que gran parte de la población obesa presenta OA o dolores articulares, razón por la cual se considera no sólo como un detonante del desarrollo de la OA, sino también como un factor que influye en la necesidad de CR en pacientes obesos. De la misma manera, la obesidad figura como un factor de riesgo para el desarrollo de complicaciones post-CR como infecciones superficiales y profundas, alteraciones en la cicatrización de heridas, trombosis venosa profunda, tromboembolismo pulmonar, entre otras. También, la obesidad se ve implicada en la necesidad de cirugías de revisión y re-operación, lo que se ve relacionado con una menor tasa de supervivencia a los 10 años. Por esto, es necesario que los especialistas realicen un correcto abordaje perioperatorio de los pacientes obesos con OA que necesiten CR, promoviendo cambios en el estilo de vida que les permitan la pérdida de peso, con el fin de disminuir el riesgo de complicaciones post-CR. El objetivo de esta revisión es reseñar la relación de la obesidad con la OA y la CR, así como describir la evidencia clínica que establece a la obesidad como un factor de riesgo para el desarrollo de complicaciones post-CR.