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PubMed2000

[Conservative and surgical treatment possibilities in temporomandibular joint diseases].

For the most frequent TMJ derangements, highly efficient nonsurgical treatment is preferable. Within this concept, the interdependence between the TMJ and the jaw musculature is increasingly focussed. Surgical therapy is only an option under defined circumstances in cases resistant to nonsurgical treatment, or if nonsurgical treatment is meaningless from the beginning. Within surgical concepts, arthroscopy is becoming increasingly important. A close interdisciplinary cooperation between the dentist and oral and maxillofacial surgeon seems to improve the potential outcome in these cases.

Arthroscopy↗
PubMed1998

Elevated nerve growth factor levels in the synovial fluid of patients with inflammatory joint disease.

A novel pH shock extraction procedure was used to measure nerve growth factor (NGF) levels in both normal and inflamed synovial fluids using a sensitive and specific two-site enzyme linked immunosorbant assay. To date no data is available on NGF levels in normal synovial fluids. Synovial fluids were taken from 5 normal volunteers, 12 patients with rheumatoid arthritis and 10 patients with other inflammatory arthropathies. The mean +/- SEM NGF concentration in normal synovial fluids was 95 +/- 33.2 pg/ml (range 39.1-143.1 pg/ml), whereas the mean NGF concentration in the synovial fluids taken from patients with rheumatoid arthritis was 532.5 +/- 123.8 pg/ml (range 152-1686 pg/ml). The mean NGF concentration in patients with other inflammatory arthropathies was also raised (430.6 +/- 90 pg/ml; range 89-1071 pg/ml). The NGF concentrations were significantly higher in the synovial fluids from both inflamed groups (ANOVA p < 0.05) compared to normals. Raised levels of NGF in synovial fluid may contribute directly to joint inflammation via activation of inflammatory cells.

Arthritis↗
PubMed1989

[Double-blind study of the effect of tiaprofenic acid in comparison with indomethacin in patients with degenerative joint diseases].

The research of the effect and tolerance of tiaprophenic acid comprised 32 patients (10 male and 22 female) aged 53.7 years on average. 16 patients were treated by tiaprophenic acid and the other 16 by indomethacin. Among them 23 patients suffered from gonarthrosis and 9 patients from coxarthrosis. The tested subjective and objective parameters were markedly improved in 66.7% and less well in further 10.4% of patients (a total of 77% examinees). Side-effects were more various and developed more frequently in patients treated by indomethacin.

Adult↗
PubMed1990

Immunohistopathologic findings in synovial biopsies before and after synovectomy in patients with chronic inflammatory joint diseases and their relation to clinical evaluation. A prospective study of biopsies taken from areas selected by arthroscopy.

Synovial biopsies were obtained from 28 patients with various kinds of chronic arthritis, at synovectomy and 6 and 12 months later. The tissues were examined by immunofluorescence technique, recording the quantities of cells and extracellular deposits staining with polyclonal antisera to IgG, IgA, IgM, C3c, fibrinogen, and chi and lambda light chains, and monoclonal antibodies to CD3, CD5, CD11b, HLA DR, and TCC (Terminal Complement Complex). These parameters were compared with scores obtained by arthroscopy and clinical evaluation (Colorado Knee Score) performed at the same time. Taken as a group, the immunological parameters showed reduction in activity 6 months after synovectomy (p less than 0.01), and a tendency to revert to base-line values after 12 months. A similar reduction in activity after 6 months was also found by arthroscopic and clinical evaluation. Thus, this longitudinal study demonstrated a relationship between changes in immunologic activity, arthroscopic findings and clinical activity after synovectomy in patients with chronic arthritis. This is consistent with an immunological pathogenesis for the inflammation in these joints.

Adolescent↗
PubMed1986

Mseleni joint disease. Part II. Low serum calcium and magnesium levels in women.

Low calcium and magnesium levels were found in serum from women domiciled in an area where an osteo-arthrosis with a female preponderance is endemic. Despite decreased serum calcium, the methodology used indicated low circulating parathyroid hormone, while values for phosphorus, total alkaline phosphatase and the serum proteins were not remarkable. Alcoholism was excluded as a factor influencing the measured variables. The results reported, together with previous findings, justify intensified investigation into the link between diet-induced mineral deficiencies and endemic osteo-arthrosis at Mseleni.

Adult↗
PubMed1988

[Basic therapy of chronic inflammatory joint diseases with D-penicillamine and disorders of wound healing in rheumatoid orthopedic interventions].

In the past, D-penicillamine has been thought to cause wound healing disturbances due to its influence on connective tissue. A series of 217 operations in 150 patients with rheumatoid arthritis on D-penicillamine treatment were performed and compared with controls (106 operations in 86 patients with rheumatoid arthritis). It was shown that disturbances of wound healing were less in patients on D-penicillamine therapy (12.4%) than in patients who did not receive D-penicillamine (18.9%). A perioperative withdrawal of D-penicillamine therefore does not seem justified.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Cartilage contribution to gender differences in joint disease progression. A study with rat articular cartilage.

OBJECTIVE: Rheumatoid arthritis is associated with a worse prognosis in females and is influenced by sex hormone changes. Similar observations in osteoarthritis support the hypothesis that gender differences in cartilage make a hitherto unrecognized contribution to gender differences in arthritis. The aim of the present study was to investigate potential gender differences in articular cartilage biochemistry, metabolism and response to inflammatory mediators. METHODS: Femoral head cartilages from age-matched male and female Wistar rats were analysed for the water, glycosaminoglycan, hydroxyproline and collagen crosslink contents. Proteoglycan loss and synthesis were assessed in vitro, and in the presence and absence of serum and interleukin-1. An in vivo model of inflammation-induced cartilage degradation was employed to investigate gender differences in cartilage susceptibility to erosion caused by granulomatous tissue. RESULTS: Articular cartilage from male Wistar rats presented higher levels of both proteoglycan and collagen and showed a lower spontaneous glycosaminoglycan loss and higher proteoglycan synthesis in vitro than cartilage from females. Proteoglycan synthesis from female, but not male, cartilage was significantly stimulated by foetal calf serum. Female cartilage was more sensitive to IL-1 inhibition of proteoglycan synthesis while the opposite was observed in IL-1-induced proteoglycan loss. Female cartilage was more susceptible to granuloma-induced degradation than male when implanted into female mice, but no differences were observed between male and female cartilage implanted in male mice. CONCLUSION: These results demonstrate important gender differences in cartilage biochemistry, metabolism and susceptibility to inflammatory mediators which may have important consequences for the joint destruction in arthritis and support a role for hormone therapy.

Animals↗
PubMed1978

A new anti-inflammatory drug, proquazone, and ibuprofen in the treatment of degenerative joint disease of the knee (gonarthrosis). A double-blind comparative study.

The therapeutic effect and the tolerance of a new non-steriod anti-inflammatory compound, proquazone, were compared with those of ibuprofen in a double-blind, randomized study on patients with gonarthrosis. Totally 39 patients participated in the study: 19 patients in the proquazone group and 20 patients in the ibuprofen group. The two drugs were given in daily doses of 900 mg and 1200 mg respectively during 3 weeks. In both treatment groups a good result was achieved in more than 70% of the cases, but proquazone seemed to be more effective in reducing swelling and pain of knee. There were more side effects in the proquazone group than in the ibuprofen group, but they were generally mild and disappeared spontaneously. Only one patient in the proquazone group withdrew, because of epigastric discomfort.

Adult↗
PubMed1975

Behaviour of synovial complement C3 and C4 components in inflammatory and degenerative joint diseases, before and after synoviorthesis.

The synovial fluid beta1a (C3) and beta1e (C4) expressed by their ratio to corresponding serum concentrations) were studied in 31 cases of seropositive rheumatoid arthritis (RA+), 5 cases of seronegative rheumatoid arthritis (RA-1), and 15 cases of osteoarthrosis (OA) before osmic acid synoviorthesis on knees. This was repeated after synoviorthesis in the synovial fluid (SF) of 24 RA+, 4 RA-, and 10 OA patients. The following studies were undertaken: (a) the relationship between these components; (b) their correlation with the SF protein concentration and rheumatoid factor titre, when present. This analysis led us to the following conclusions. (1) Before synoviorthesis (a) The SF beta1e is significantly lower than beta1a in RA+. In OA, an inverse phenomenon is observed. (b) The concentration of beta1a and beta1e are proportional to the protein concentration in the SF of OA. A significant inverse relationship between beta1a, beta1e, and the titre of rheumatoid factor is found. (2) after synoviorthesis the same studies performed on knees at the time of one or more relapses shows that the same pathogenetic process is involved and that the immunological mechanism is little influenced by this treatment. In OA also the relapse differs very little from the initial process observed before synoviorthesis.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Safety and efficacy of etodolac compared with piroxicam in patients with degenerative joint disease of the knee.

The efficacy and safety of etodolac and piroxicam were compared in a double-blind, randomized, parallel-group outpatient study at four sites. Patients with active osteoarthritis of the knee were assigned to receive etodolac 600 mg/day (57 patients) or piroxicam 20 mg/day (59 patients) for 6 weeks. Efficacy assessments were made at the pretreatment screening, at baseline, and at treatment weeks 2, 4, and 6 for patient and physician global evaluations, night pain, spontaneous pain intensity, weight-bearing pain variables, measures of inflammation, morning stiffness, and knee flexion. An analysis was also done based on each patient's final evaluation, regardless of the week at which it occurred. Safety assessments were made before treatment and at the completion of therapy. A therapeutic response was obtained in both treatment groups by the end of the second week of treatment. At the final evaluation, both groups showed significant improvement (P less than or equal to 0.05) from baseline for most efficacy assessments. The physician's global assessment indicated improvement in the condition of 60% of the etodolac-treated patients and 39% of the piroxicam-treated patients at the final evaluation. There was no significant difference between treatment groups in the number of patient withdrawals due to adverse reactions or in the number of patients reporting side effects. The results of this study indicate that, compared with piroxicam 20 mg/day, etodolac 600 mg/day is effective and well tolerated in the treatment of patients with osteoarthritis.

Adult↗
PubMed1984

Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years.

We analyzed the records of 103 conventional hip arthroplasties in seventy-five active patients who were between the ages of forty and sixty years. After five to ten years of follow-up, an excellent or good clinical result was evident in 90 per cent. The radiographic appearance of the cement-bone interface of the acetabular component was stable in those hips, and no progressive acetabular radiolucency was found in 80 per cent of the hips. Of twenty hips with a complete acetabular radiolucency (Grade III or IV), only three had a secondary revision operation, two in conjunction with a fracture of the stem of the prosthesis and one for migration (Grade IV). Eight additional hips showed migration. Seventy per cent of the femoral components were well fixed, without radiographic evidence of loosening. A fracture of the femoral stem occurred in eight hips, all of which had a revision operation. One revision operation was done for loosening of the femoral stem. Seven femoral stems showed either shift or subsidence. An isolated radiolucency in the superolateral zone was present in four hips and an isolated lucency in other zones, measuring one millimeter or less, was present in ten hips. Thus, radiographic evidence of loosening, including the hips with a fractured stem, was present in 29.9 per cent. One additional revision, making ten in all, was done for symptomatic acetabular loosening. Based on this study, we concluded that conventional hip arthroplasty is a highly successful treatment in active patients between forty and sixty years old who have osteoarthritis of the hip.

Adult↗
PubMedDate not supplied

Primary glenohumeral degenerative joint disease: factors predisposing to arthroplasty.

OBJECTIVE: To evaluate the natural history of shoulder osteoarthritis (OA), in particular the requirement for arthroplasty over time, and to determine the potential predisposing factors for such arthroplasty. METHODS: In- and out-patients with the diagnosis of OA of the shoulder seen between January 1990 and December 1994 were contacted by mail or telephone in 2000. Evaluation at the time of diagnosis: demographics, clinical and radiological data were evaluated at the time of diagnosis. The follow-up evaluation consisted of a questionnaire sent to each patient inquiring whether they had had recourse to shoulder arthroplasty and, if not, evaluated their willingness regarding this surgical approach. For the statistical analysis the requirement for arthroplasty over time was evaluated using the Kaplan-Meier technique. Potential factors predisposing to arthroplasty were determined using a Cox-model analysis. RESULTS: The questionnaire was answered by 72 of the 86 contacted patients. No difference was observed in clinical and radiological variables at the time of diagnosis between responders and non-responders. The requirement for arthroplasty was low (respectively 5% and 13%, 5 and 10 years following the onset of the symptoms). Nearly half of the patients who had not undergone surgery thought that arthroplasty would have been the treatment of choice to improve their quality of life since more than one year at the time of completing the questionnaire. Two variables were picked up in the Cox analysis, with a probability of shoulder replacement higher in patients with concomitant osteonecrosis of the humeral head (p = 0.02) and a non-eccentric glenohumeral OA (p = 0.011). CONCLUSION: The low percentage of patients with arthroplasty over time, together with patient perception, suggest underuse of this surgical approach in shoulder OA.

Aged↗
PubMed2000

Role of collagen hydrolysate in bone and joint disease.

OBJECTIVES: To review the current status of collagen hydrolysate in the treatment of osteoarthritis and osteoporosis. METHODS: Review of past and current literature relative to collagen hydrolysate metabolism, and assessment of clinical investigations of therapeutic trials in osteoarthritis and osteoporosis. RESULTS: Hydrolyzed gelatin products have long been used in pharmaceuticals and foods; these products are generally recognized as safe food products by regulatory agencies. Pharmaceutical-grade collagen hydrolysate (PCH) is obtained by hydrolysis of pharmaceutical gelatin. Clinical studies suggest that the ingestion of 10 g PCH daily reduces pain in patients with osteoarthritis of the knee or hip; blood concentration of hydroxyproline is increased. Clinical use is associated with minimal adverse effects, mainly gastrointestinal, characterized by fullness or unpleasant taste. In a multicenter, randomized, doubleblind, placebo-controlled trial performed in clinics in the United States, United Kingdom, and Germany, results showed no statistically significant differences for the total study group (all sites) for differences of mean pain score for pain. There was, however, a significant treatment advantage of PCH over placebo in German sites. In addition, increased efficacy for PCH as compared to placebo was observed in the overall study population amongst patients with more severe symptomatology at study onset. Preferential accumulation of 14C-labeled gelatin hydrolysate in cartilage as compared with administration of 14C-labeled proline has been reported. This preferential uptake by cartilage suggests that PCH may have a salutary effect on cartilage metabolism. Given the important role for collagen in bone structure, the effect of PCH on bone metabolism in osteoporotic persons has been evaluated. Studies of the effects of calcitonin with and without a collagen hydrolysate-rich diet suggested that calcitonin plus PCH had a greater effect in inhibiting bone collagen breakdown than calcitonin alone, as characterized by a fall in levels of urinary pyridinoline cross-links. PCH appeared to have an additive effect relative to use of calcitonin alone. CONCLUSIONS: Collagen hydrolysate is of interest as a therapeutic agent of potential utility in the treatment of osteoarthritis and osteoporosis. Its high level of safety makes it attractive as an agent for long-term use in these chronic disorders.

Amino Acids↗