INTRODUCTION: Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS: The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS: The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS: The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
- MeSH
- artróza kolenních kloubů * terapie rehabilitace MeSH
- artróza kyčelních kloubů * terapie rehabilitace MeSH
- hmotnostní úbytek MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- pomůcky pro sebeobsluhu MeSH
- self-management metody MeSH
- terapie cvičením * metody MeSH
- vzdělávání pacientů jako téma metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Evropa MeSH
Background: The knee is the predominant weight-bearing joint affected by osteoarthritis, and knee osteoarthritis (KOA) is the 11th significant cause of disability. As life expectancy has increased, the need for knee replacement procedures has grown, putting a major financial burden on patients and healthcare systems. Intra-articular (IA) injection of platelet rich plasma (PRP) promises to be a potential method in research for the more preservative and biological strategies to treat this chronic degenerative condition. PRP has expected to contain a high number of growth factors and proteins involved in tissue repair mechanisms.Aim: This study aimed to determine the effect of intra-articular injections (IAIs) pure-PRP and their dosage regimen efficacy in patients with mild and moderate knee OA.Material and method: This study included 33 patients (11 male and 22 female). The patient groups included 16 with mild and 17 with moderate knee osteoarthritis. With ages ranged from 32 to 66 years old. These patients were divided into three groups based on dosage (12 received a single injection, 11 received a double injection, and 10 received a triple injection), with a two-week interval between injections. The outcome was measured using WOMAC index for pain, stiffness, and daily functional limitation, as well as laboratory testing for TNF-alpha using the Eliza technique. All the patients were assessed at baseline and after three months of injection. The study was designed as non-randomized controlled trial study during November 2021 to May 2022 at Al-imam Ali hospital, Babylon governorate, Iraq.Results: Regarding severity, In both mild and moderate knee osteoarthritis, serum TNF-alpha was significantly lower after treatment (p < 0.001). All WOMAC scores were showed significantly lower levels after treatment with pure-PRP as compared with their levels before treatment (p ≤ 0.001, Regarding the number of injections, all patients who received a single injection, double injections, and triple injections showed a significant decrease in the serum TNF-alpha and WOMAC scores (p 0.05) in both mild and moderate patients. The triple injections were more effective than double and single injections.Conclusions: In conclusion, the treatment with pure-PRP was safe and satisfactory for patients in terms of relieving clinical symptoms. The WOMAC scores has indicated that improvement in pain relief for patients after injection and could act as an anti-inflammatory, as inflammatory marker TNF-alpha was reduced after injection, and there was a superior outcome to increasing dose numbers, as triple injection gave a positive outcome in both mild and moderate KOA when compared to single and double injection.
- MeSH
- artróza kolenních kloubů * terapie MeSH
- dospělí MeSH
- injekce intraartikulární MeSH
- lidé středního věku MeSH
- lidé MeSH
- plazma bohatá na destičky * MeSH
- statistika jako téma MeSH
- terapeutický index MeSH
- TNF-alfa analýza MeSH
- ukazatele zdravotního stavu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
Background: The level of pro-inflammatory Cluster of Differentiation 68 (CD 68) could be beneficial for examination as a biomarker for identifying cartilage or knee tissue degradation in joint problems. Because Cluster of Differentiation 68 appears to be linked to cell damage in the injury area, its measurement may be an effective and sensitive tool for detecting the early development of knee osteoarthritis (KOA) in people at risk for knee osteoarthritis.Aim of the study: The study aimed to evaluate which type of PRP (Pure-PRP and leukocyte-PRP) are suitable for patients with KOA via assessing the levels of serum CD 68 concentration.Materials and Methods: Serum Cluster of Differentiation 68 level was computed using ELISA kits. The experimental study comprises 21 pure-platelet-rich plasma (P-PRP) injections,11 leukocytes platelet-rich plasma (L-PRP) injections, and 16 control groups. Ranged from 35- 75 years old. All patients with diabetes mellitus, autoimmune disease, and severe knee osteoarthritis were excluded from this study. The period of the study was between November 2021 to June 2022. This study assessed other factors such as age, sex, family inheritance, and body mass index (BMI). The level of CD 68 was measured in the serum before and after the injection for six weeks.Results: The level of the study showed CD 68 elevated before injection in patients with knee osteoarthritis. A significant decrease of CD 68 (P< 0.01-P<0.001) in the serum concentration after injection as compared to before injection. However, the concentration was significantly higher than the control.Conclusions: In conclusion, both P-PRP and L-PRP demonstrated anti-inflammatory properties. Patients in both groups experienced a significant decrease in CD 68 serum levels, however, the P-PRP was more effective than the L-PRP.
- MeSH
- artróza kolenních kloubů * imunologie terapie MeSH
- CD antigeny aplikace a dávkování imunologie krev MeSH
- dospělí MeSH
- injekce intraartikulární MeSH
- klinické laboratorní techniky metody přístrojové vybavení MeSH
- lidé středního věku MeSH
- lidé MeSH
- plazma bohatá na destičky * fyziologie imunologie MeSH
- senioři MeSH
- zánět imunologie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
PURPOSE OF THE STUDY The objective of the present study is to compare the efficacy of two different concentrations of diclofenac sodium phonophoresis (DSPH) (1.16% vs 2.32%) in patients with knee osteoarthritis (OA). MATERIAL AND METHODS A randomized, double-blind, controlled design was applied. Ninety patients (mean age± SD, 59.98 ± 8.89 years) who had Kellgren-Lawrence (K-L) grades II to III knee OA were randomly allocated into three groups; 1.16% DSPH, 2.32% DSPH, TUS (30 in each group). Each patient was treated five sessions per week for two weeks. A 100-mm visual analogue scale (VAS) for usual pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated before and after treatment in all groups. RESULTS The VAS pain and WOMAC scores were significantly improved after treatment in all groups (p < 0.05). The 2.32% DSPH showed more significant effects than the 1.16% DSPH, both in improving WOMAC- pain and physical function scores (p = 0.020, p = 0.008) and reducing the VAS pain measure, although it did not reach the level of significance (p = 0.077). The 2.32% DSPH was superior to the TUS, both in reducing the VAS pain measure (p < 0.001) and in improving WOMAC-pain, stiffness, physical function and total scores (p = 0.022, p = 0.016, p < 0.001, p < 0.001 respectively). 1.16% DSPH significantly reduced stiffness and physical function scores compared with TUS (p = 0.042, p = 0.047). CONCLUSIONS DSPH and TUS are effective treatments for knee OA. Our results indicated that 2.32% DSPH produces additional benefits to functional improvement and pain reduction compared with 1.16% DSPH in K-L grades II to III knee OA. Key words: diclofenac sodium, knee osteoarthritis, phonophoresis, therapeutic ultrasound, topical formulation.
- MeSH
- artróza kolenních kloubů chirurgie prevence a kontrola terapie MeSH
- běh MeSH
- lidé MeSH
- ortopedie MeSH
- pohybová aktivita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- populární práce MeSH
- rozhovory MeSH
- MeSH
- artróza kolenních kloubů * terapie MeSH
- injekce intraartikulární metody MeSH
- klinické zkoušky kontrolované jako téma MeSH
- kyselina hyaluronová * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- osteoartróza terapie MeSH
- viskosuplementace metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- MeSH
- artróza kolenních kloubů * terapie MeSH
- injekce intraartikulární MeSH
- kolagen aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- osteoartróza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
Osteoarthritis (OA) is characterized by deterioration of the joints and associated with considerable pain and disability. OA is a chronic disease that requires intervention with both non-pharmacological and pharmacological treatment modalities and, inevitably, disease progression may necessitate successive treatments throughout the course of the disease. There is increasing data on the shortfalls of current pharmacological treatment of OA, and safety concerns associated with analgesic therapy use in OA arising from increasing evidence of gastrointestinal, cardiovascular, hepatic and renal adverse events with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, symptomatic slow-acting drugs for OA (SYSADOAs) may now be considered as a first-line treatment for knee OA, with a particular emphasis placed on the outstanding benefit: risk ratio of pharmaceutical-grade glucosamine and chondroitin sulfate formulations. In this short communication we review recent publications concerned with the safety of paracetamol, NSAIDs and SYSADOAs. Greater understanding of the benefits and limitations of current medications will lead to better disease management in OA. Furthermore, adherence to guideline recommendations across Europe and internationally, such as those from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), will promote evidence-based medicine and patient-centric care, ultimately leading to greater physician and patient satisfaction.
- MeSH
- algoritmy MeSH
- analgetika terapeutické užití MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- artróza kolenních kloubů farmakoterapie terapie MeSH
- lidé MeSH
- medicína založená na důkazech * MeSH
- směrnice pro lékařskou praxi jako téma * MeSH
- terapie cvičením * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
