RESUMEN

INTRODUCTION: knee osteoarthritis, a common condition in Sub-Saharan Africa, affects the quality of life of patients. OBJECTIVE: Identify the factors associated with impaired quality of life. PATIENTS AND METHODS: Cross-sectional and analytical study, carried out in the Department of Rheumatology at the University Teaching Hospital of Brazzaville, in two steps. The first made it possible to collect data of patients diagnosed as having knee osteoarthritis according to the the ACR criteria of 1986 and followed up from January 1st, 2013 to December 31st, 2017. The second step consisted in measuring the quality of life of patients using a specific quality-of-life questionnaire for knee and hip osteoarthritis OAKHQOL, then identifying by bivariate analysis after analysis of variance (ANOVA), the factors associated with an impairment of the quality of life (P≤ 5%). It took place from May 02 to November 02, 2018 (6 months). One hundred and nineteen patients were investigated. RESULTS: We included in this study 103 women and 16 men (sex ratio M / F of 1/6). The average age was 56.1 ± 9 years (range 27 to 77 years). The mean evolution time was 5.1 ± 3.6 years. The knee osteoarthritis moderately impaired the overall quality of life of patients. The most affected dimensions were physical activity and pain (51.3% and 42.9% of patients between 25 and 50 respectively). The evolution time and functional impact were potentially associated with all dimensions of quality of life. Age was associated with poorer quality of life in the physical activities (p = 0.012) and social activities (p = 0.001) dimensions, as was obesity, with the social activities dimension (p = 0.004). CONCLUSION: The duration of evolution and the functional impact were associated with deterioration in the quality of life.

INTRODUCTION: La gonarthrose, affection fréquente en Afrique Sub-saharienne, altère la qualité de vie des patients. OBJECTIF: Identifier les facteurs associés à l'altération de la qualité de vie. PATIENTS ET MÉTHODES: Etude transversale, descriptive et analytique, menée dans le Service de Rhumatologie du CHU de Brazzaville, en deux étapes. La première a permis de colliger les dossiers des patients diagnostiqués selon les critères de l'ACR de 1986 et suivis pour une gonarthrose du 1er janvier 2013 au 31 décembre 2017. La seconde consistait, en la mesure de la qualité de vie des patients identifiés à l'aide du questionnaire AMIQUAL, puis à identifier par analyse bivariée après analyse de la variance (ANOVA), les facteurs associés à une altération de la qualité de vie (P≤ 5%). Elle s'est déroulée du 02 mai au 02 novembre 2018 (6 mois). Cent dix-neuf patients ont été enquêtés. RÉSULTATS: 103 femmes et 16 hommes (sexe ratio H/F de 1/6). L'âge moyen était de 56,1 ± 9 ans (extrêmes 27 à 77 ans). La durée moyenne d'évolution était de 5,1 ± 3,6 ans. La gonarthrose altérait de façon modérée la qualité de vie globale des patients. Les dimensions les plus touchées étaient les activités physiques et la douleur (respectivement 51,3% et 42,9% des patients entre 25 et 50). La durée d'évolution et le retentissement fonctionnel étaient potentiellement associés à toutes les dimensions de la qualité de vie. L'âge était associé à une moins bonne qualité de vie dans les dimensions activités physiques (p=0,012) et activités sociales (p=0,001), de même l'obésité avec à la dimension activités sociales (p=0,004). CONCLUSION: la durée d'évolution et le retentissement fonctionnel étaient associés une altération de la qualité de vie.

RESUMEN

INTRODUCTION: La viscosupplémentation du liquide synovial par injections intra articulaires (IA) d'acide hyaluronique (AH), est un traitement symptomatique bien connu dans la gonarthrose. La question se pose de savoir si les traitements par injection unique (mono-injection) peuvent présenter autant d'efficacité que les multi-injections (3 à 5). MÉTHODES: Une méta-analyse des résultats publiés pour les essais de mono-injections IA de AH a été réalisée. Le critère d'efficacité retenu a été le sous-score douleur de l'indice Western Ontario and MacMaster universities (WOMAC A). Toutes les conceptions d'études ont été admises, depuis les essais randomisés contrôlés jusqu'aux études observationnelles ouvertes à simple bras. Une recherche extensive a été effectuée à partir de PubMed, Google, Google Scholar, et des listes de références trouvées dans les méta-analyses récentes, pour obtenir tous les articles publiés avant fin avril 2018. Les profils des populations furent analysés en termes d'âge, de sexe, d'indice de masse corporelle (IMC) et de stade radiologique selon Kellgren-Lawrence (KL). Les résultats d'injection IA unique de placebo, ont été pris en compte pour créer une base permettant des comparaisons post-hoc. Chaque bras AH IA étudié a été comparé à un bras placebo IA (seul ou mixé), de manière à présenter un profil KL similaire, contrôlé à l'aide du test Chi2. Les tailles de l'effet (ES) avec intervalles de confiance (IC 95%) et p-valeurs furent calculées et synthétisées pour chacune des visites de contrôle à 1, 2, 3 et 6 mois. En parallèle, une approche globale a été utilisée afin de représenter les variations par rapport à la baseline, pour chacun des sous-groupes étudiés. RÉSULTATS: En partant de 1 547 citations, 28 études ont été incluses dans la méta-analyse, décrivant 4 129 patients traités par mono-injection: 3 360 ont reçu de l'AH IA et 769 patients ont reçu du placebo IA. Le patient moyen (SD) traité par AH IA était âgé de 61,2 (9,6) ans dont 63% de femmes, avec un IMC de 28,0 (4,1) kg/m2, et un stade radiologique à 47% KL III pour 3% KL IV. Un bon appariement du profil KL a été obtenu pour 26 des 31 bras AH IA. Sur l'ensemble de la population AH IA, ES = 0,30 (0,25; 0,35) à 3 mois et ES = 0,39 (0,33; 0,44) à 6 mois. Dans une analyse restreinte, après élimination des cas aberrants, des KL mal appariés et des bras actifs < 30 patients, les résultats sont restés inchangés, ES = 0,29 (0,23; 0,34) et ES = 0,40 (0,34; 0,45) à 3 et 6 mois respectivement, tandis que l'hétérogénéité était améliorée. DISCUSSION: Il existe certainement des limites à la méthode de comparaison post-hoc versus placebo, appliquée à des essais individuels. Mais pour chaque synthèse par sous-groupe ou groupe, les résultats ont été confirmés en utilisant plusieurs approches statistiques et différentes méthodes de pondération. Cette méta-analyse suggère que les résultats des mono-injections sont similaires à ceux des multi-injections d'acide hyaluronique intra articulaire en termes de soulagement de la douleur, dans le traitement de la gonarthrose.

RESUMEN

Hydrogen sulfide (H2S) is found in both the plasma and synovial fluid of patients with gonarthrosis. In the present study, we investigated whether intra-articular injection of sodium hydrosulfide (NaSH) (1 mM, 30 µL), a H2S donor, might affect gonarthrosis in rats. Gonarthrosis was induced surgically in the left knees of rats and left for 6 weeks for the development of disease. Then, intra-articular injections of NaSH or methylprednisolone (1 mg/kg, 30 µL) were administered to rats. Half of each group was sacrificed at the end of the first day and the other half was sacrificed at the end of 4 weeks to evaluate early and later effects of injections on gonarthrosis. The injury induced by anterior cruciate ligament resection and medial meniscectomy in rats caused the development of gonarthrosis. As the duration lengthened after gonarthrosis induction, the progression of the disease continued. According to the modified Mankin Scoring System, intra-articular injection of NaSH histopathologically slowed the progression of gonarthrosis, whereas methylprednisolone was ineffective. In addition, NaSH decreased apoptosis in rat knees with gonarthrosis. Each treatment did not cause injury to healthy knees. Our results lead to the consideration that intra-articular NaSH administration may be effective in the progression of gonarthrosis.

Asunto(s)

RESUMEN

Often linked to sequelae of a knee injury or knee deformities, gonarthrosis is the most frequent form of osteoarthritis of the limbs. A variety of methods and therapies can be used to treat it. For advanced conditions, treatment may involve partial or total replacement.

Asunto(s)

RESUMEN

BACKGROUND: Joint replacement surgery is one of the most often performed routine procedures for the treatment of knee osteoarthritis in Germany. Currently, there is no consensus on indication criteria for total knee arthroplasty (TKA). OBJECTIVES: The topic indication for TKA was processed using six guiding questions concerning: 1) Common practice in determining the indication for TKA; 2) Inclusion criteria in clinical trials; 3) Treatment goals/goal criteria; 4) Predictors for goal attainment; 5) Economic aspects of determining a TKA indication; 6) Guidelines of the "Working Group of Scientific Medical Societies" (AWMF) in other areas. METHODS: The evidence mapping was conducted by systematically searching Medline via Ovid, the Cochrane Library, through hand searching national guidelines and selected journals as well as the AWMF guideline portal. RESULTS OF THE GUIDING QUESTIONS: 1) In Germany there is currently no consented guideline regarding indications for TKA surgery. 2) Indication criteria for clinical trials are: diagnosed osteoarthritis of the knee, limitations of age and BMI. The most common criteria for exclusion include rheumatoid/inflammatory arthritis, secondary diagnoses and allergies. 3) As yet, no international initiatives have been identified which, by involving all relevant stakeholders, have reached consensus regarding the indication criteria for TKA. 4) A variety of predictors were identified with effects on individual treatment goals acting in different directions. 5) Very few studies were identified concerning economic aspects of determining TKA indication. 6) Comparable AWMF guidelines are currently not available. CONCLUSION: The findings of this study suggest that specific systematic reviews are needed to explore the following questions: What are the treatment goals of a TKA intervention? For whom are these relevant? And how are they measured? Continuous analyses are recommended in the field of predictors for a positive TKA outcome.

Asunto(s)

RESUMEN

OBJECTIVE: To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA). METHODS: Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint. RESULTS: Two hundred and forty patients were included (February-June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6±15 at day 0 versus 46.5±22.4 at 12months, P<0.001), but not in the non-thermal group (64.1±15 at day 0 versus 62±29 at 12months, P=0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P=0.08). However, at 12months, the thermal cure group was significantly more improved (P=0.000). CONCLUSION: In our study, crenobalneotherapy had resulted, at 12months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.

Asunto(s)

RESUMEN

OBJECTIVE: To determine whether the addition of spa therapy to home exercises provides any benefit over exercises and the usual treatment alone in the management of generalised osteoarthritis associated with knee osteoarthritis. METHODS: This study was a post-hoc subgroup analysis of our randomised multicentre trial (www.clinicaltrial.gov: NCT00348777). Participants who met the inclusion criteria of generalized osteoarthritis (Kellgren, American College of Rheumatology, or Dougados criteria) were extracted from the original randomised controlled trial. They had been randomised using Zelen randomisation. The treatment group received 18days of spa treatment in addition to a home exercise programme. Main outcome was number of patients achieving minimal clinically important improvement at six months (MCII) (≥-19.9mm on the VAS pain scale and/or ≥-9.1 points in a WOMAC function subscale), and no knee surgery. Secondary outcomes included the "patient acceptable symptom state" (PASS) defined as VAS pain ≤32.3mm and/or WOMAC function subscale ≤31 points. RESULTS: From the original 462 participants, 214 patients could be categorized as having generalised osteoarthritis. At sixth month, 182 (88 in control and 94 in SA group) patients, were analysed for the main criteria. MCII was observed more often in the spa group (n=52/94 vs. 38/88, P=0.010). There was no difference for the PASS (n=19/88 vs. 26/94, P=0.343). CONCLUSIONS: This study indicates that spa therapy with home exercises may be superior to home exercise alone in the management of patients with GOA associated with knee OA.

Asunto(s)

RESUMEN

Introducción: las lesiones completas del cartílago articular hialino de la rodilla son lesiones muy difíciles de reparar debido a las características anatómicas de este tejido, de ahí la importancia de buscar soluciones prácticas y con un alto porcentaje de efectividad. Descripción: la técnica de microfractura constituye un procedimiento de primera línea en el tratamiento de lesiones completas del cartílago en todo su espesor; en este trabajo se exponen los detalles técnicos de ese procedimiento, así como sus indicaciones, selección de los enfermos y se muestran los resultados de los autores en un período de seguimiento de 2 años. Conclusiones: la microfractura constituye un procedimiento seguro, rápido, asociado a un alto porcentaje de efectividad en aproximadamente 80 por ciento de los enfermos con un bajo índice de complicaciones

Introduction: the complex lesions of hyaline articular cartilage of knee are lesions very difficult to repair due to the anatomic features of this tissue, thus the significance of seeking practical solutions and with a high level of effectiveness. Description: the microfracture technique is a first line procedure in the treatment of whole lesions of cartilage in all its thickness; in present paper are expressed the technical details of such procedure, as well as its indications, selection of patients and the results obtained by authors during a 2-years follow-up. Conclusions: the microfracture is a safe, fast procedure associated with a high percentage of effectiveness in almost an 80 percent of patients and with a low rate of complications

Asunto(s)