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Osteoarthritis is among the most prevalent of musculoskeletal disorders in the world that causes joint pain, deformity, and limited range of movement. The resulting osteochondral defect can significantly decrease the patient's quality of life, but current treatment options have not demonstrated the capacity to fully regenerate the entire osteochondral microenvironment. Structurally, the osteochondral unit is a composite system composed of three layers-articular cartilage, calcified cartilage, and subchondral bone. Collectively these distinct layers contribute to the distinct biomechanical properties that maintain the health and aid in load transfer during joint articulation. The purpose of this review was to examine the role of the osteochondral interface in tissue engineering. Topics of discussion include the biomechanics of the osteochondral unit and an overview of various strategies for osteochondral interface tissue engineering, with a specific focus on three-dimensional bioprinting. The goal of this review was to elucidate the importance of the osteochondral interface and overview some strategies of developing an interface layer within tissue engineered scaffolds. Impact Statement This review provides an overview of interface tissue engineering for osteochondral regeneration. It offers a detailed investigation into the biomechanics of the osteochondral unit as it relates to tissue engineering, and highlights the strategies that have been utilized to develop the osteochondral interface within tissue engineering scaffolds.

Charcot Marie Tooth disease (CMT) is the most common inherited neuropathy and is also called Hereditary Motor Sensory Neuropathy (HMSN). Whilst both motor and sensory deficits are present, motor deficits tend to predominate over sensory deficits. Charcot neuroarthropathic joints occur in conditions, most commonly diabetes nowadays, where joints are destroyed in association with reduced protective sensation, pain in particular. Three cases of development of Charcot joint disorders in patients with CMT are discussed and the literature is reviewed. Orthopaedic surgeons should be aware that Charcot joints can occur in CMT and surgery can be complicated by Charcot joints.

Spondylosis is one of the commonest forms of joint disorder. Mostly it comes under concept of Vatavyadhi which mainly occurs due to vitiated vat dosha which is due to dhatukshaya (1) Basically this disease involves asthi and majja dhatu. This disease limits our daily activities such as walking, running, gait up, dressing, cycling, bathing etc.which makes patient disabled or handicapped. It is a kashtasadhya vatavyadhi due to intensive pain and restricted movements of joints. Here we discuss a case report of asthimajjgat vatavyaddhi which is best treated by ayurvedic concepts which was described by acharyas in vatvyadhi chikitsa adhyaya.

Purpose Painful osteoarthritis is common in elderly patients, and low-dose radiotherapy has been demonstrated to provide effective symptomatic treatment. We examined the analgesic effects of low-dose radiotherapy for osteoarthritis in the elderly aiming to reveal potential differences in the response rates relating to increasing age. Methods A retrospective analysis was performed at two university hospitals including elderly patients (≥ 65 years) undergoing radiotherapy for osteoarthritis between 2008 and 2020. Pain intensity and response were quantified using the numerical rating scale (NRS) and the Pannewitz score. Age groups were defined for young old (65–74 years), older old (75–84 years), and oldest old patients (≥ 85 years). Results In all, 970 patients with 1185 treated sites and a median age of 76 years were analyzed. Mean NRS was 66 at baseline (t0), 53 after radiotherapy (t1), and 44 at first follow-up (t2) (p p = 0.172) or t2 (p = 0.684). In addition, pain response after re-irradiation (n = 384 sites) was 61.0% and was comparable between age groups (p = 0.535). Conclusion Low-dose radiotherapy results in pain reduction in about two-thirds of treated sites with no difference relating to increasing age, showing that radiotherapy is an effective analgesic treatment for osteoarthritis even at advanced ages.

The Temporomandibular joint is an atypical synovial joint that is dynamic in structure. A delicate balance between the musculature, the condylar cartilage and the bony structures is maintained for harmonious functioning of the joint. Over the years the role of occlusion in temporomandibular disorders (TMD) has been extensively debated, leading to many opinions and much controversy. The changes in the joint caused in response to orthodontic therapy as well the adverse reactions caused have been studied. The present article is a review on the effects of Orthodontic appliance therapy on the joint and the present modalities opted to treat the joint disorders. Keywords: Temporomandibular Joint, Orthodontics, Functional appliances, Twin Block, TMD, Growth, Cartilage.

Purpose The role of women in the United States military is expanding. Women are now authorized to serve in all military occupations, including special operations and frontline combat units, which places them at increased risk of combat exposure and injury. Little is known regarding the impact of these injuries on the health of military women. Methods We conducted a retrospective matched cohort study of women service members who were injured during combat operations in Iraq and Afghanistan. Injured women were individually matched to non-injured controls at a 1:4 ratio. Medical diagnostic codes were abstracted from outpatient encounters in electronic health records, and hierarchical clustering was conducted to identify clusters of diagnostic codes, termed “health profiles.” Conditional logistic regression was used to determine whether combat-related injury predicted membership in the profiles. Results The study sample included 590 injured women and 2360 non-injured controls. Cluster analysis identified six post-deployment health profiles: low morbidity, anxiety/headache, joint disorders, mixed musculoskeletal, pregnancy-related, and multimorbidity. Combat-related injury predicted membership in the anxiety/headache (odds ratio, 1.73; 95% confidence interval, 1.38–2.16) and multimorbidity (odds ratio, 3.43; 95% confidence interval, 2.65–4.43) profiles. Conclusions Combat-related injury is associated with adverse post-deployment health profiles among military women, and women with these profiles may experience increased health care burden. As future conflicts will likely see a greater number of women with combat exposure and injury, health outcomes research among military women is paramount for the purposes of medical planning and resource allocation.

Frozen shoulder is very common suffering among the all joint disorder. It is more common in diabetes mellitus patient. About 77 million people suffering from diabetes mellitus in India. The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. As the diabetes suffering increases the frequency of frozen shoulder cases will also increase. Since the developing country like India & other South Asian Countries can’t afford the expansive surgical intervention. Homoeopathy can deals with the situation in cost-effective, simple and reliable way and can serve the humanity through medicine along with recommended exercises. Thus, taking an overview on frozen shoulder with its homoeopathic treatment and managements is the need of time.

Background Knee osteoarthritis (KOA) is a common joint disorder in elderly individuals, causing pain, loss of physical functioning, disability, and reduction of life quality. Home exercise programs (HEP) serve as a crucial complement to outpatient rehabilitation therapy, as they save the cost of supervised physical therapy sessions, while also offering a high level of treatment. The aim of this study was to evaluate the effectiveness of the 6-month HEP on pain, quality of life, and self-efficacy in patients with primary KOA and to identify the adherence level to exercises and associations with patients’ characteristics and clinical outcomes. Results After 6 months of HEP, there were statistically significant differences between groups for self-efficacy (p ≤ 0.001, from 58.29 to 71.5) (p = 0.23, from 55.98 to 57.72), quality of life (p ≤0.001, from 60.1 to 72.2) (p = 0.074, from 60.35 to 60.92), and pain severity (P ≤0.001, from 58.29 to 41.4) (P = 0.88, from 61.2 to 60.9) in favor of exercise group. Conclusions Home-based exercise program improves pain score, self-efficacy, and quality of life in patients with knee osteoarthritis. Adherence level to the exercise program may have a positive impact on patient improvement.

Objective Osteoarthritis (OA) is a common joint disorder, accompanied by extracellular matrix (ECM) degradation. Reportedly, long noncoding RNAs (lncRNAs) are involved in OA pathogenesis. However, the role of lncRNA FYVE, RhoGEF, and PH domain containing 5 antisense RNA 1 (FGD5-AS1) in OA development is still not fully clarified. This study was aimed to clarify the role of FGD5-AS1 in OA. Methods FGD5-AS1 and miR-302d-3p expression levels were determined in cartilage tissues and chondrocytes by quantitative real-time polymerase chain reaction (qRT-PCR). Chondrocytes (C20/A4 cells) were stimulated with interleukin 1β (IL-1β) to mimic the inflammatory environment of OA. Cell viability was detected by cell counting kit-8 and 5-ethynyl-2′-deoxyuridine assays. Cell apoptosis was measured by the caspase-3 activity assay and flow cytometry. Transforming growth factor beta receptors II (TGFBR2), matrix metalloproteinase 13 (MMP-13), and ADAM metallopeptidase with thrombospondin type 1 motif 5 expression levels were examined by qRT-PCR or Western blot. The regulatory relationships among FGD5-AS1, miR-302d-3p, and TGFBR2 were predicted by the StarBase v2.0, miRanda, miRDB, and TargetScan databases, and confirmed by dual-luciferase reporter assay and RNA immunoprecipitation assay. Results FGD5-AS1 and TGFBR2 expression levels were downregulated while miR-302d-3p expression was increased in cartilage tissues of OA patients. Knocking down FGD5-AS1 inhibited the viability of C20/A4 cells but induced apoptosis and ECM degradation, while FGD5-AS1 overexpression exerted opposite effects. MiR-302d-3p was identified as a target of FGD5-AS1, and TGFBR2 was identified as a target of miR-302d-3p. FGD5-AS1 positively regulated TGFBR2 expression by repressing miR-302d-3p expression, and miR-302d-3p inhibition or TGFBR2 restoration reversed the changes of cell viability, apoptosis, and ECM degradation induced by FGD5-AS1 knockdown. Conclusion FGD5-AS1 can probably inhibit OA progression by regulating miR-302d-3p/TGFBR2 axis.

Maintaining good mobility with ease and freedom of movement is important for an individual’s health and active aging. The knee joint, being the primary bearer of the body weight, plays a vital role in mobility. Continuous monitoring of the knee joint can potentially provide important information related to knee health and mobility which can be used for health assessment, early diagnoses of mobility-related problems, and monitoring recovery from injury or surgery. Therefore, we developed a simple, low-cost multi-sensor-based smart wearable device to monitor and assess the knee joint and mobility. The system is composed of miniaturized sensors (motion, temperature, pressure and galvanic skin response) to measure acceleration, angular velocity, skin temperature, muscle pressure and sweat rate of the knee joint during different activities. A database is constructed from 70 healthy adults aged 18-86 years that contains sensor data measured using the proposed knee joint monitoring system. To extract key knee and gait features from the datasets, we employed computationally efficient methods such as complementary filter and wavelet packet decomposition. The variations in the characteristics of the obtained parameters were analyzed in terms of gender and age groups. This simple, easy-to-use, cost-effective, non-invasive and unobtrusive knee monitoring system can be used for real-time monitoring, evaluation and early diagnoses of joint disorders, fall detection, mobility monitoring and rehabilitation.

Emery-Dreifuss muscular dystrophy is a slowly progressive skeletal muscle and joint disorder associated with cardiac complications. Dilated cardiomyopathy was the initial manifestation of Emery-Dreifuss muscular dystrophy in an 8-year-old girl. Despite normal muscle and myocardial biopsies, genetic testing revealed LMNA mutations. As Emery-Dreifuss muscular dystrophy is associated with minimal skeletal muscle weakness, cardiac complications can facilitate its diagnosis.

Background Total hip arthroplasty (THA) is the benchmark surgical treatment of advanced and symptomatic hip osteoarthritis. Preliminary evidence suggests that the robotic arm-assisted (RAA) technology yields more accurate and reproducible acetabular cup placement, which may improve survival rate and clinical results, but economic considerations are less well-defined. The purpose of this study was to compare the cost effectiveness of the RAA THA with manual THA (mTHA) modalities, considering direct medical costs and utilities from a payer's perspective. Methods A Markov model was constructed to analyze two potential interventions for hip osteoarthritis and degenerative joint disorder: RAA THA and mTHA. Potential outcomes of THA were categorized into the transition states: infection, dislocation, no major complications, or revision. Cumulative costs and utilities were assessed using a cycle length of 1 year over a time horizon of 5 years. Results RAA THA cohort was cost effective relative to mTHA cohort for cumulative Medicare and cumulative private payer insurance costs over the 5-year period. RAA THA cost saving had an average differential of $945 for Medicare and $1,810 for private insurance relative to mTHA while generating slightly more utility (0.04 quality-adjusted life year). The preferred treatment was sensitive to the utilities generated by successful RAA THA and mTHA. Microsimulations indicated that RAA THA was cost effective in 99.4% of cases. Conclusions In the Medicare and private payer scenarios, RAA THA is more cost effective than conventional mTHA when considering direct medical costs from a payer's perspective. Level of evidence Economic Level III. Computer simulation model (Markov model).

Musculoskeletal disorders have a very diverse aetiology. They have a significant impact on each individual sufferer's quality of life and society as a whole. The last three decades have seen revolutionary changes in the management of autoimmune-related muscle and joint disorders due to the introduction of biologics. Management of spasticity disorders remain challenging, although implantable technology has broadened mode of delivery.

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by progressive joint disorders with significant pain and stiffness. In the past, RA was a difficult -to-treat ailment, but nowadays with the advent of biologics and better treatment strategies, disease remission is an achievable goal. Tumor necrosis factor α (TNFα) inhibitors were the first category of biologics to emerge with adalimumab being the first fully human TNFα.Areas covered: the authors provide an overview of the historical events that led to the discovery of TNFα inhibitors and more specifically the drug adalimumab. Several key trials are presented regarding the safety of the drug as well as its successful journey, but there is also a narrative description of the drug's future after patent expiration.Expert opinion: Adalimumab is a fully human TNFα inhibitor with a fairly rapid onset of action. It has a generally good safety and efficacy profile. Clinicians must be aware of the possible side effects and treat them in a timely manner or discontinue the drug where appropriate. Due to the success of the bio-originator adalimumab, a multitude of biosimilars have emerged but not, thus far, for all of the indications of the bio-originator.

Knee osteoarthritis is a major diarthrodial joint disorder with profound global socioeconomic impact. Diagnostic imaging using magnetic resonance image can produce morphometric biomarkers to investigate the epidemiology of knee osteoarthritis in clinical trials, which is critical to attain early detection and develop effective regenerative treatment/therapy. With tremendous increase in image data size, manual segmentation as the standard practice becomes largely unsuitable. This review aims to provide an in-depth insight about a broad collection of classical and deep learning segmentation techniques used in knee osteoarthritis research. Specifically, this is the first review that covers both bone and cartilage segmentation models in recognition that knee osteoarthritis is a “whole joint” disease, as well as highlights on diagnostic values of deep learning in emerging knee osteoarthritis research. Besides, we have collected useful deep learning reviews to serve as source of reference to ease future development of deep learning models in this field. Lastly, we highlight on the diagnostic value of deep learning as key future computer-aided diagnosis applications to conclude this review.

Background Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. Case presentation In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated “shining metal artefacts” in xSPECT Bone reconstruction. Conclusion While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific “shining metal artefacts” caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction.

Background Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity of literature on patient-specific preoperative risk factors that are associated with adverse outcomes after PIPJ arthrodeses. Therefore, the primary purpose of this study was to assess preoperative predictors of nonunion and reoperation after PIPJ arthrodesis. Methods This study identified all patients who underwent PIPJ arthrodesis at a single community practice between 1987 and 2013. The final analysis included 415 PIPJs treated with arthrodesis. The mean follow-up was 1.3 years. Data on preoperative diagnosis, demographics, comorbidities, and operative techniques were recorded, as well as the occurrence of nonunions and reoperations. Logistic regression models were used to identify independent risk factors of nonunion and reoperation. Results There were 40 nonunions (10%) and 62 reoperations (15%). Of the reoperations, there were 39 incidences of isolated hardware removal, 9 irrigation and debridement, 8 amputations, 5 revision arthrodeses, and 1 corrective osteotomy. The highest number of nonunions occurred in the traumatic diagnosis group (37%), followed by the rheumatoid group (23%) and the scleroderma group (15%). The highest number of reoperations occurred within the traumatic joint disorder group (40%), followed by the rheumatoid group (24%) and the scleroderma group (11%). Multivariate analysis revealed that male sex ( P < .01) and hepatic disease ( P = .03) were significant risk factors of nonunion. Male sex was also significantly associated with increased reoperation risk ( P < .01). Conclusion Risks of nonunions and reoperations after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks.

Introduction: Osteoarthritis (OA) is a common joint disorder, with the knee being one of the most frequently involved sites. Knee OA causes pain and stiffness and can lead to considerable disability and consequently to impaired quality of life. Aim of the work: Clinical evaluation of participant with painful knee OA to detect the possible causes of pain knee OA.Patients and Methods: Our study included 50 knee OA patients, attending to Sohag university hospitals rheumatology and rehabilitation outpatient clinic. They were divided according to pain into 2 groups. Group 1 with painful OA and group 2 with painless OA. Both groups were age and sex-matched.Results: Our study showed that the group 1 participants had more varus deformities, more and significant effusion and Baker cyst. Among painful OA patients, all factors showed non-significant relation to the degree of VAS.Conclusion: Our study found that knee effusion and Baker cyst were the main possible causes of pain in knee OA.

Background Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. Purpose We reviewed the literature on the efficacy of PRF for controlling pain in joint disorders. Methods We searched PubMed for papers published prior to September 7, 2019, that used PRF to treat pain due to joint disorders. The key search phrases for identifying potentially relevant articles were (PRF AND joint) OR (PRF AND arthritis) OR (PRF AND arthropathy). The following inclusion criteria were applied for the selection of articles: (1) patients' pain was caused by joint disorders; (2) PRF stimulation was applied to manage joint-origin pain; and (3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain intensity. Moreover, joints with more than 3 reported PRF studies were included in our review. Results The primary literature search yielded 141 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included 34 publications in this review. Based on the positive therapeutic outcomes of previous studies, PRF stimulation seems to be an effective treatment for cervical and lumbar facet, sacroiliac, knee, and glenohumeral joint pain. PRF appears to be beneficial. For confirmation of the effectiveness of PRF on joint pain, more high-quality studies are needed. Conclusions Our review provides insights on the degree of evidence according to pain in each joint, which will help clinicians make informed decisions for using PRF stimulation in various joint pain conditions.

There are many factors affecting knee osteoarthritis (OA) as genetic and metabolic factors, obesity, mechanical trauma, osteoporosis, inflammatory joint disorders, previous joint infection, and lax...

Arthritis is a chronic joint disorder which imparts a major cause of disability globally. It usually targets the older population and arised due to improper regulation of pro-inflammatory cytokines and enzymes which lead to elevated levels of chemical mediators like prostaglandins, leukotrienes, nitric oxide, adhesion molecules and matrix metalloproteinase enzyme. Arthritis is treated by certain synthetic drugs which only provide symptomatic relief to the patients. Synthetic drugs have no any evidence to cure the disease, however they exhibits various toxic effects, side effects or recurring of symptoms on discontinuation of drugs. Therefore, it is an urgent need of alternative treatments against arthritis. On view of these facts, this review emphasizes the medicinal plants, herbal supplements and spices, herbal formulations and some traditional approach to treat arthritis.

Objective of the Review: To present provisional guidelines for rheumatologists developed by the European League Against Rheumatism, the British Society for Rheumatology, the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American College of Rheumatology, and the Russian Association of Rheumatologists (a nationwide public organization) Key Points: The authors discuss publications touching on the management of rheumatic disorders during the coronavirus disease (COVID-19) pandemic, primarily medication therapy in patients with these conditions They propose using chondroprotective agents as a possible alternative According to World Health Organization recommendations, elderly people should exercise at home while self-isolating I Conclusion: In attempting to present possible treatments for patients with joint disorders, the authors boldly propose using chondroprotective agents, which have all the properties required for long-term treatment during isolation Цель обзора: представление предварительных рекомендаций для ревматологов Европейской антиревматической лиги (European League Against Rheumatism), Британской ассоциации ревматологов (British Society for Rheumatology), Американского общества регионарной анестезии и обезболивания (American Society of Regional Anesthesia and Pain Medicine) и Европейского общества регионарной анестезии и обезболивания (European Society of Regional Anaesthesia and Pain Therapy), Американской коллегии ревматологов (American College of Rheumatology) и Общероссийской общественной организации «Ассоциация ревматологов России» Основные положения Обсуждаются опубликованные сообщения, затрагивающие вопросы ревматологии в период пандемии коронавирусной инфекции (COVID-19), прежде всего касающиеся лекарственных препаратов, применяемых у пациентов с ревматическими заболеваниями В качестве альтернативных средств терапии рассматриваются хондропротекторы В условиях самоизоляции лицами пожилого возраста, согласно рекомендациям Всемирной организации здравоохранения, предложено выполнять физические упражнения дома Заключение Нами предпринята попытка предоставить выбор терапии больным с заболеваниями суставов, и мы взяли на себя смелость рекомендовать хондропротекторы, обладающие всеми необходимыми свойствами для длительного лечения в условиях изоляции

Temporomandibular disorders (TMDs) are multi-factorial and polysymptomatic pathologies and their management must be customized for every patient. Numerous therapy techniques are available to treat temporomandibular disorders-related muscular discomfort and persistent orofacial pain. Botulinum toxin (BoNT) has emerged as a popular option for patients with myofascial TMD who do not completely recover from their condition after receiving conservative care and medication. A systematic search of the literature, from January 2000 until 1 April 2022, was performed in the MEDLINE (PubMed), Web of Science, and Lilacs databases. The following search terms combination: (temporomandibular disorders) OR (botulinum) OR (toxin) was employed. A total of 357 articles were initially found in the electronic search. After screening, 11 full-text articles satisfied the inclusion criteria. The Cochrane risk of bias tool (RoB 2) tool, which uses seven domains of bias to assess random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment of self-reported outcomes, blinding of outcome assessment of objective measures, incomplete outcome data, selective reporting, and other biases, was employed to analyze randomized controlled trials. The aim of this systematic review of randomized controlled trials is to provide an overview of the use of BoNT for TMDs by comparing the application of BoNT with other therapeutic approaches. BoNT-A could help patients that do not respond to conservative treatments. Low doses are recommended when BoNT-A is considered for persistent orofacial pain related to TMD. Future research should, however, conduct clinical trials with a stricter design. The results of BoNT-A could be confirmed by more randomized controlled trials with larger sample sizes, less bias, and longer follow-up times.

Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications.

Osteoarthritis (OA) is the most common joint disorder due to poor regenerative properties of cartilage. Existing approaches leave a treatment gap for patients with moderate OA. The intra-articular administration of a biological agent derived from adipose tissue is one of the novel therapies currently in development to address the limitations of standard treatments.

Background Camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome is a rare genetic disorder with autosomal recessive transmission including camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and non-inflammatory pericarditis. We report the observation of a case. Observation S.Y aged 8.5 years, from a consanguineous marriage, presented with a chronic arthropathy affecting wrists, knees and ankles that had been evolving for 6 years and currently, elbows are also affected. The history includes surgery for claw deformity of the hands at the age of 3. No similar cases in the family. Osteoarticular examination showed symmetrical swelling of the elbows, wrists (Fig. 1),knees (Fig. 2) and ankles (Fig. 3.The affected joints were neither red, painful nor warm on palpation, with normal mobility. The onset of symptoms could not be determined due to the indolence of the condition and the rest of the clinical examination was unremarkable. Discussion CACP syndrome is a more common condition in the Middle East and North Africa, with about 20 cases reported worldwide. This syndrome is still poorly understood and is often confused with juvenile idiopathic arthritis. It should be suspected in the presence of any congenital claw deformity of the hands (camptodactyly) with a chronic non-inflammatory arthropathy, which are constant signs. Coxa-vara and pericarditis (found respectively in 60 and 30% of cases) should be systematically sought. The consanguinity reported in the literature is also present in our case. However, there are no similar cases in siblings. The diagnosis is important, thus avoiding the initiation of unnecessary treatments such as corticosteroids, DMARDs or biotherapy. Biology no inflammatory syndrome, FAN negatives. Standard X-ray of the pelvis presence of a coxa-vara on the right Joint ultrasound common tenosynovitis of the extensors of the fingers, effusion with synovial hypertrophy without a Doppler catch of the elbows, knees and ankles Myelogram without abnormality. Cardiac ultrasound without pericarditis. The diagnosis of CACP was made in view of: a history of camptodactyly, chronic non-inflammatory arthropathy and coxa-vara. Analgesic treatment was instituted in case of pain, with cardiac monitoring by ultrasound every 6 months. Conclusion CACP syndrome is a rare disease often confused with juvenile idiopathic arthritis. Congenital camptodactyly and non-inflammatory arthropathy are very evocative of the diagnosis. The absence of similar cases in siblings makes our observation special.

Zusammenfassung: Die Arthrose ist die häufigste Gelenkerkrankung. Sie beeinträchtigt die Lebensqualität der betroffenen Personen ganz wesentlich und führt als altersassoziierte Erkrankung entsprechend der demografischen Entwicklung zu einer zunehmenden finanziellen Belastung des Gesundheitswesens. Das Gelenk ist von der Arthrose in all seinen Strukturen betroffen. Der Schlüssel zum Therapieerfolg ist die Identifikation der Quelle der Beschwerden. Neben nichtmedikamentösen Therapieansätzen werden reine Analgetika, entzündungshemmende Substanzen und Chondroprotektiva eingesetzt. Die therapeutische Endstrecke besteht in operativen Therapieverfahren (Endoprothese, Umstellungsosteotomie, Arthrodese). Diese Übersicht konzentriert sich auf die medikamentöse Therapie. Klinik und nichtmedikamentöse Therapieoptionen streift sie nur am Rande.

Background Haemophilic (HF) arthropathy is a major complication in haemophilia. Collagen factors are responsible for maintaining the integrity of the vessel wall in the joint. Our goal was to assess the haemophilia joint state and its relation to the clinical, laboratory &radiological data. Methods This cross-sectional study included 50 hemophilia A patients recruited from the Pediatric Hematology / Oncology unit, Children’s Hospital, Ain Shams University,Cairo,Egypt. Assessment of joint status clinicallyand radiologically by X-rays& ultrasound was performed. Results 48% of the studied hemophilia A patients had one, 40 % had two target joints or more. The elbow and knee are the most frequently affected joints (46%,62% respectively).There were no significant differences between inhibitor positive and inhibitor negative patients regarding the number of target joints.However, inhibitor positive patients had significantly lower annual bleeding rate; moreover, none of inhibitor positive patients had surgeries done and none were on celecoxib. There were no significant differences between inhibitor positive hemophilia A patients and inhibitor negative regarding US total score, hem QOL, total HJHS and total FISH score. Patients with 2 target joints had significant higher annual bleeding rate, worse quality of life score, higher total HJHS score compared to those with one or without target joints. Conclusion In our study, we argued the lack of significant difference between inhibitor positive and inhibitor negative Hemophilia A patients as regards the occurrence of hemophilic arthropathy. Nevertheless, patients with ≥ 2 target joints had worse annual bleeding rate, quality of life & total HJHS score.