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Wanstrath, Audrey Wysocki. "Intra-articular Injection of Autologous Protein Solution for Treatment of Canine Osteoarthritis." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429814573.
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Bengtsson, Py, and Klara Carlsson. "Treatment Results after Intra-articular Injection of Corticosteroids in Patients with TMJ Arthritis." Thesis, Umeå universitet, Tandläkarutbildning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-97854.
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Arthritis is a common disease affecting the temporomandibular joint. The inflammation causes local pain and decreased function of the masticatory system. Temporomandibular joint arthritis can result from mechanical overloading, general autoimmune disease or individual susceptibility. The aim of this study was to investigate objective and subjective treatment results after intra-articular injection of corticosteroids in patients with temporomandibular joint arthritis. The hypothesis was that treatment with intra-articular injection of corticosteroids relieves clinical signs and subjective symptoms and no difference between objective and subjective treatment outcome was anticipated. An outcome assessment study with consecutive sample was performed. Objective and subjective data was registered from 70 subjects treated with intra-articular injection of corticosteroids. Statistics were analyzed in SPSS. Subgroup analysis was performed to evaluate and distinguish confounding variables such as sex, age, autoimmune disease (general), previous physical trauma and hard tissue changes. Maximum mouth opening capacity was increased by 8.7% after treatment demonstrating an objective improvement. Subjects with an initial impaired maximum mouth opening capacity <40 mm showed a greater increase compared to those within the normal range. Subjective assessment at follow-up presented a self-reported improvement in 77% of the subjects. The routines regarding follow-up were found to be inconsistent and subjective assessments scales were missing in about 50% of the cases. Objective and subjective improvement was observed after intra-articular injection of corticosteroids. This confirms the present treatment recommendations that intra-articular injection is an effective method in relieving signs and symptoms of temporomandibular joint arthritis.
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Hirsch, George. "Somatic and psychological predictors of response to intra-articular corticosteroid injection in knee osteoarthritis." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/somatic-and-psychological-predictors-of-response-to-intraarticular-corticosteroid-injection-in-knee-osteoarthritis(71560311-5029-4b00-9547-52d65358a768).html.
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Background: Intra-articular corticosteroid injections (IACI) are a commonly used treatment for painful knee osteoarthritis (OA). Response to treatment varies the reason for which is unclear. Further there are no data concerning the impact of accuracy of injection and psychological factors including illness perceptions, pain catastrophizing and depression on outcome following IACI.Objectives: i) to undertake a systematic review looking at predictors of response to IACI in patients with symptomatic knee OA and, ii) to determine the role of psychological factors and accuracy of injection in predicting response to IACI.Methods: A systematic review was conducted using electronic databases for randomised trials and observational studies looking at predictors of response to IACI in knee and hip OA. An observational study of 141 consenting patients (105 primary OA and 36 secondary OA in the context of well controlled rheumatoid arthritis) receiving routine IACI as part of clinical care for knee OA was conducted including baseline assessment and outcome assessments at 3 and 9 weeks. Response was defined as at least 40% reduction of pain from baseline, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Assessment included ultrasound (US) for features of synovial inflammation), radiographs, and assessment of psychological factors including the revised illness perception questionnaire (IPQR). Accuracy of injection was assessed using US. Characteristics of responders and non-responders to IACI at 3 and 9 weeks were determined using univariate statistics and significant factors entered into logistic regression models. Results: The systematic review found no consistent evidence for any disease or non-disease related predictor of response and no systematic exploration of the effects of psychological factors or accuracy of injection on treatment response. In the observational study, 83 (53%) of 141 subjects were responders to IACI at 3 weeks and 56 (44%) at 9 weeks. In univariate analysis, responders to treatment had higher scores for the IPQR domain treatment control and lower scores for IPQR consequences, depression and pain catastrophizing at both 3 and 9 weeks. Physical and patient related factors, including accuracy of injection and US features, were not associated with outcome, with the exceptions of higher baseline pain and previous experience of injection being associated with non-response at 9 weeks. In multiple regression, treatment control was the only independent predictor of response at 3 weeks. At 9 weeks, treatment control, consequences and depression were independent predictors of treatment outcome. Conclusion: In this observational study illness perceptions and depression predicted the outcome of IACI at 3 and 9 weeks. By contrast, physical factors including accuracy of injection did not influence outcome. Further work is needed to replicate these findings and elucidate mechanisms for these effects.
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Liu, Shao-Hsien. "Impact of Intra-Articular Injection Use on Patient-Reported Outcomes Among Patients with Knee Osteoarthritis." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsbs_diss/897.
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Background: Knee osteoarthritis (OA) is the most common type of OA and is a major cause of pain and thus results in disability for daily activities among persons living in the community. OA currently has no cure. In addition to the conflicting recommendations from clinical guidelines, evidence about the extent to which long-term use of intra-articular injections improves patient outcomes is also lacking.
Methods: Using data from the Osteoarthritis Initiative (OAI), marginal structural models (MSMs) applying inverse probability treatment weights (IPTW) were used to examine the effectiveness of intra-articular injections and changes in symptoms over time. The specific aims of this dissertation were to: 1) evaluate longitudinal use of intra-articular injections after treatment initiation among persons with radiographic knee OA; 2) quantify the extent to which intra-articular injection relieves symptoms among persons with radiographic knee OA; and 3) evaluate the performance of missing data techniques under the setting of MSMs.
Results: Of those initiating injections, ~19% switched, ~21% continued injection type, and ~60% did not report any additional injections. For participants initiating corticosteroid (CO) injections, greater symptoms post-initial injection rather than changes in symptoms over time were associated with continued use compared to one-time use. Among participants with radiographic evidence of knee OA, initiating treatments with either CO or hyaluronic acid (HA) injections was not associated with reduced symptoms compared to non-users over two years. Compared to inverse probability weighting (IPW), missing data techniques such as multiple imputation (MI) produced less biased marginal causal effects (IPW: -2.33% to 15.74%; -1.88% to 4.24%). For most scenarios, estimates using MI had smaller mean square error (range: 0.013 to 0.024) than IPW (range: 0.027 to 0.22).
Conclusions: Among participants with radiographic evidence of knee OA living in the community, the proportion of those switching injection use and one-time users was substantial after treatment initiation. In addition, initiating injection use was not associated with reduced symptoms over time. With respect to issues of missing data, using MI may confer an advantage over IPW in MSMs applications. The results of this work highlight the importance of using comparative effectiveness research with non-experimental data to study these commonly used injections and may help to understand the usefulness of these treatments for patients with knee OA.
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Liu, Shao-Hsien. "Impact of Intra-Articular Injection Use on Patient-Reported Outcomes Among Patients with Knee Osteoarthritis." eScholarship@UMMS, 2003. http://escholarship.umassmed.edu/gsbs_diss/897.
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Background: Knee osteoarthritis (OA) is the most common type of OA and is a major cause of pain and thus results in disability for daily activities among persons living in the community. OA currently has no cure. In addition to the conflicting recommendations from clinical guidelines, evidence about the extent to which long-term use of intra-articular injections improves patient outcomes is also lacking.
Methods: Using data from the Osteoarthritis Initiative (OAI), marginal structural models (MSMs) applying inverse probability treatment weights (IPTW) were used to examine the effectiveness of intra-articular injections and changes in symptoms over time. The specific aims of this dissertation were to: 1) evaluate longitudinal use of intra-articular injections after treatment initiation among persons with radiographic knee OA; 2) quantify the extent to which intra-articular injection relieves symptoms among persons with radiographic knee OA; and 3) evaluate the performance of missing data techniques under the setting of MSMs.
Results: Of those initiating injections, ~19% switched, ~21% continued injection type, and ~60% did not report any additional injections. For participants initiating corticosteroid (CO) injections, greater symptoms post-initial injection rather than changes in symptoms over time were associated with continued use compared to one-time use. Among participants with radiographic evidence of knee OA, initiating treatments with either CO or hyaluronic acid (HA) injections was not associated with reduced symptoms compared to non-users over two years. Compared to inverse probability weighting (IPW), missing data techniques such as multiple imputation (MI) produced less biased marginal causal effects (IPW: -2.33% to 15.74%; -1.88% to 4.24%). For most scenarios, estimates using MI had smaller mean square error (range: 0.013 to 0.024) than IPW (range: 0.027 to 0.22).
Conclusions: Among participants with radiographic evidence of knee OA living in the community, the proportion of those switching injection use and one-time users was substantial after treatment initiation. In addition, initiating injection use was not associated with reduced symptoms over time. With respect to issues of missing data, using MI may confer an advantage over IPW in MSMs applications. The results of this work highlight the importance of using comparative effectiveness research with non-experimental data to study these commonly used injections and may help to understand the usefulness of these treatments for patients with knee OA.
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Giangarra, Jenna Elizabeth. "Effect of a single intra-articular injection of bupivacaine on synovial fluid prostaglandin E2 concentrations in normal canine stifles." Thesis, Virginia Tech, 2018. http://hdl.handle.net/10919/95970.
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Intra-articular bupivacaine is a common analgesic used in dogs with orthopedic disease. Bupivacaine has been linked to chondrotoxicity. The mechanism for bupivacaine's chondrotoxicity is unknown, but may involve inflammation. Prostaglandin E2 (PGE2) is an inflammatory mediator and a marker of joint inflammation. The aim of this study was to compare synovial fluid PGE2 concentrations after a single intra-articular injection of bupivacaine with a saline control in normal canine stifles. We hypothesized that bupivacaine stifles would have a significantly elevated PGE2 concentration compared to controls. Stifles from eight healthy, adult Beagles were randomly selected as the treated stifle and infused with bupivacaine. The contralateral stifle was injected with saline. Synovial fluid was collected before and after injection. PGE2 was quantified using a commercial ELISA. Data were transformed and mixed model ANOVA was performed with significance set at p<0.05. There were no significant differences in PGE2 concentration between treatment groups or times. Samples acquired with one or two aspiration attempts had significantly lower PGE2 concentrations than samples with =3 aspiration attempts (p=0.001). When adjusted for number of attempts, PGE2 concentrations were significantly higher 24 (p=0.003) and 48 (p=0.041) hours after injection compared to baseline in the bupivacaine group, but not in the saline group. Intra-articular bupivacaine injection did not result in increased synovial fluid PGE2 concentrations compared to controls; however, multiple aspiration attempts did, suggesting that synovial fluid PGE2 concentration is sensitive to multiple fluid collection attempts. Future studies investigating synovial fluid inflammatory mediators should consider methods to minimize aspiration attempts.M. S.
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Dulin, Jennifer Anne. "Influence of Exercise on the Distribution of 99mTechnetium-Methylene Diphosphonate Following Intra-articular Injection in Horses." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306159915.
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GOKER, FUNDA. "EVALUATION OF ARTHROCENTESIS WITH HYALURONIC ACID INJECTIONS FOR MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/820923.
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Objectives: Although, arthrocentesis is an accepted safe treatment modality used for the management of TMD patients with pain, the benefit of hyaluronic acid (HA) injections remains uncertain. The aim of this study was to investigate whether intra-articular injections of hyaluronic acid as an adjunct therapy with arthrocentesis can be more effective than other medications for the improvement of symptoms associated with temporomandibular disorders.
Materials and methods: For this purpose, an electronic search of Medline, Scopus and Cochrane databases was performed up to September 2020. No language, and publication date limitation was set. The following search terms were used: “arthrocentesis”, “hyaluronic acid”, “intra-articular injections”, “viscosupplementation”, with “temporomandibular disorders”. Inclusion criteria was prospective or retrospective studies, case reports, and randomized clinical trials that reported the application of HA injections compared to other intra-articular drugs for the treatment of temporomandibular disorders. Exclusion criteria included systemic reviews, animal studies. Additionally, a retrospective clinical study was performed on 12 TMD cases for evaluation of changes before and after arthrocentesis with hyaluronic acid (HA) injections in quality of life (QoL) of these patients.
Results: In the systemic review, the initial screening included 1327 articles. After a more detailed evaluation of the titles, abstracts, and full texts; a total of 29 studies were selected (26 randomized studies, 2 controlled clinical trials, 1 retrospective report). In the clinical study 12 patients were included. According to the results, intra-articular injections of HA and other medications together with arthrocentesis seemed to be beneficial for improvement of functional symptoms of TMD and pain. The case series also supported support the efficacy of HA injections with a significant improvement of QoL of these patients. However, after the evaluation of the reports in literature, it was impossible to identify an optimum drug or a protocol in improving the pain and/or functional symptoms of temporomandibular problems due to diversity of treatment modalities and conflicting results.
Conclusion: As a conclusion, there was no consensus in the studies that HA injections showed better results in comparison with other treatment modalities. According to the results of this systematic review and clinical study HA injections with/without arthrocentesis seems to be beneficial in terms of clinical symptoms and QoL of the patients.
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Alamilla-Daniel, Ma de los Angeles. "Development of a haptic simulator for practicing the intraarticular needle injection under echography." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSEI017.
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La ponction articulaire est une technique courante utilisée par les rhumatologues pour soulager la douleur. L'utilisation de repères anatomiques aide à guider l'aiguille à l'intérieur de l'articulation. Cependant, sans l'aide de l'imagerie, les praticiens ont du mal à placer correctement l'aiguille et la plupart du temps il est nécessaire de réaliser une deuxième insertion articulaire. L'injection intra-articulaire de l'aiguille sous échographie est une solution pour faciliter la procédure. Il s'agit cependant d'un processus difficile car le praticien doit développer une coordination motrice-visuelle pour insérer l'aiguille et la guider en utilisant comme référence une image 2D générée par la sonde ultrasonore. Pour maîtriser cette technique, les pratiquants peuvent s'exercer sur des cadavres, des mannequins et des simulateurs. Les simulateurs offrent certains avantages par rapport aux cadavres et aux mannequins, mais la plupart d'entre eux ne permettent pas de modifier l'environnement de travail (morphologie et / ou pathologie du patient,…) ou de choisir le point d'insertion, ce qui limite le réalisme de la formation. Sous l'impulsion de SAMSEI, le projet SPARTE vise à développer un simulateur d'injection intra-articulaire entièrement fonctionnel. Ce projet est soutenu par 4 laboratoires et un établissement de santé. Dans ce travail de doctorat, les principales contributions sont: une nouvelle méthode à faible coût de calcul appelée «mur de suivi» couplée à des dispositifs virtuels pour le contrôle de la position et de l'orientation de l’aiguille, afin de restituer les forces lors de l'insertion de l'aiguille; l'étude et la validation de trois lois de commande différentes appliquées à un actionneur pneumatique pour restituer les forces lors de l'utilisation d'une sonde à ultrasons; et enfin la conception d'un simulateur fonctionnel complet où les utilisateurs peuvent expérimenter l'insertion de l'aiguille avec un guidage échographiqueThe articular puncture is a common technique used by rheumatologists to relieve pain. The use of anatomical landmarks helps to guide the needle inside the articulation. However, without the help of imaging guidance, practitioners have difficulty to place correctly the needle and most of the cases lead to an extra articular insertion. The intraarticular needle injection under echography is a solution to ease the procedure. It is however a challenging process since the pratitioner must develop motor-visual coordination to insert the needle and guided it using as a reference a 2D image generated by the ultrasound probe. To master this technique, practitioners can practice on corpses, manikins, and simulators. Simulators give some advantages over corpses and manikins, but most of them do not allow to modify the working environment (patient morphology and/or pathology, …) or to choose the insertion point, which limit the realism of the training. Under the impulsion of SAMSEI, SPARTE project aims to develop a fully functional intraarticular needle injection simulator. This project is supported by 4 laboratories and one health facility. In this PhD thesis, the main contributions are: a new low-computational cost method called “Tracking wall” coupled with virtual fixtures for position and orientation control to render forces during the needle insertion ; the study and validation of three different control laws applied on a pneumatic actuator to render the forces while using a ultrasound probe; and finally the design of a complete functional simulator where users can experiment the needle insertion with echographic guidance
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Mohamad, Bustaman Ahmad Fahmi. "The effectiveness of intra-articular hyaluronic acid in temporomandibular disorders." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44661150.
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Weitoft, Tomas. "Intra-articular Glucocorticoid Treatment : Efficacy and Side Effects." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5897.
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Lourenço, Mariana de Almeida [UNESP]. "Avaliação da força muscular, dor, edema, amplitude de movimento e capacidade funcional em mulheres com artrite reumatoide após infiltração intra-articular de hexacetonide de triancinolona no joelho: um ensaio clínico randomizado, controlado, cego." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/180601.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A articulação do joelho é frequentemente acometida por sinovite em pacientes com artrite reumatoide (AR). Esse processo inflamatório provoca um reflexo de inibição muscular artrogênica e consequente diminuição de força nos extensores de joelho, além de dor, edema e prejuízos funcionais. A infiltração intra-articular (IIA) com hexacetonide de triancinolona (HT) tem se mostrado eficaz no controle do acometimento articular em pacientes com AR. O objetivo geral do presente estudo foi analisar os efeitos da infiltração intra-articular em mulheres com AR de HT ou solução salina em parâmetros como força muscular de extensores de joelho, dor, edema, funcionalidade e amplitude de movimento. Vinte e uma mulheres com AR foram randomizadas aleatoriamente para receber 3ml de HT (GI) ou de solução salina (GC) no joelho, com avaliações feitas em 4 momentos: imediatamente antes a IIA, após 2, 6 e 12 semanas. Foram aplicados questionários para funcionalidade (WOMAC, Lequesne, HAQ), escala visual analógica para dor ao repouso e ao movimento, circumetria, teste de força de extensores de joelho, biofotogrametria para amplitude de movimento e os testes físicos Timed Up And Go (TUG) e Teste de Sentar e Levantar. Na análise estatística foi realizado teste de normalidade de Shapiro-Wilk, Teste de Levene para homogeneidade dos grupos, análise de variância (ANOVA) mista com medidas repetidas para comparação intra e inter grupos, correlação de Pearson e regressão linear com significância de P< 0,05. Foi observado diminuição da dor ao repouso e ao movimento, redução do edema e melhora da funcionalidade no grupo que recebeu o medicamento, porém não houve diferença significativa entre os grupos com relação à força muscular e amplitude de movimento. O presente estudo mostrou que, embora não haja diferença na força muscular e amplitude de movimento, a eficácia da IIA com HT em joelho parece ser superior na melhora da dor, edema e funcionalidade quando comparada a solução salina em mulheres com AR.
The knee joint is often affected by synovitis in rheumatoid arthritis (RA) patients. This inflammatory process causes a reflex of arthrogenic muscle inhibition and consequent decrease of strength in the knee extensors, pain, swelling and functional impairment. Intra-articular infiltration (IIA) with triamcinolone hexacetonide (HT) has been shown to be effective in controlling joint involvement in RA patients. The general objective of the present study was to analyze the effects of intraarticular infiltration in RA women´s knee with HT or saline solution in parameters such as knee extensors muscle strength, pain, swelling, functionality and range of motion. Twenty-one RA women were randomly assigned to receive 3ml of TH (GI) or saline solution (GC) in the knee, with assessments made in 4 moments: immediately before the IIA, after 2, 6 and 12 weeks. Functional questionnaires (WOMAC, Lequesne, HAQ), visual analogue scale for pain, circummetry, knee extensor strength test, biophotogrammetry for range of motion and the physical test Timed Up And Go (TUG). Statistical analysis was performed using the Shapiro-Wilk normality test, Levene test for homogeneity of groups, mixed analysis of variance (ANOVA) with repeated measures for intra and inter group comparison, Pearson's correlation and linear regression with significance of P <0,05. Decreased pain at rest and movement, reduction of swelling and improvement of functionality in the group receiving the medication were observed, but there was no significant difference between the groups in relation to muscle strength and range of motion. The present study showed that, although there is no difference in muscle strength and range of motion, the effectiveness of IIA with HT in knee appears to be superior in improving joint inflammation and functionality when compared to saline solution in RA women.
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Okamoto-Okubo, Celina Emiko. "Efeito analgésico do plasma rico em plaquetas e células-tronco na dor crônica de cães com displasia coxofemoral." Botucatu, 2016. http://hdl.handle.net/11449/139558.
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Orientador: Stelio Pacca Loureiro LunaResumo: Este estudo clínico, controlado, aleatório, duplo cego, investigou o efeito intra-articular do plasma rico em plaquetas (PRP) (n = 8) ou de células-tronco alogênicas (CT) (n = 8) na dor crônica de cães com displasia coxofemoral (DCF) bilateral. Os proprietários avaliaram o Breve Inventário de Dor Canina (BIDC), o Índice de Dor Crônica de Helsink (IDCH), a Escala Analógica Visual para dor (EAVdor) e claudicação (EAVloc), e a Qualidade de Vida (QV). Uma médica veterinária avaliou a Escala Visual Analógica da dor à palpação (EAVpalp), a Escala Numérica Descritiva para dor (END) e a porcentagem de distribuição de peso corporal. As avaliações foram realizadas antes, aos 30 e 60 dias após o tratamento. Depois de CT, IDCH, EAVdor e EAVpalp foram reduzidos, QV aumentou aos 60 dias e BIDC reduziu aos 30 e 60 dias. Após PRP, EAVloc e END reduziram em 60 dias e BIDC aos 30 e 60 dias. Não houve diferença entre os grupos. Ambos CT e PRP foram aparentemente benéficos para reduzir a dor crônica em cães que sofrem de DCF bilateral por 60 dias, mas CT foi superior nas variáveis de dor crônica em comparação com PRP. O benefício clínico de ambos os tratamentos é que eles produzem um alívio da dor a longo prazo em cães com DCF sem efeitos adversos aparentes.
Abstract: Analgesic effect of platelet-rich plasma and stem cells in chronic pain in dogs with hip dysplasia. 2016. 66p. Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, 2015. This randomized, controlled, double-blind clinical study investigated the effect of intra-articular platelet-rich plasma (PRP) (n=8) or allogeneic stem cells (SC) (n=8) in chronic pain of dogs with bilateral hip dysplasia (HD). The owners evaluated the Canine Brief Pain Inventory (CBPI), the Helsinki Chronic Pain Index (HCPI), a Visual Analogue Scale for pain (VASpain) and lamness (VASloc) and the quality of life (QL). A veterinarian evaluated the Visual Analogue Scale of pain in response to palpation (VASpalp), the descriptive numerical scale for pain (DNS) and the percentage of body weight distribution. All evaluations were performed before, at 30 and 60 days after treatment. After SC, HCPI, VASpain and VASpalp reduced and QL increased at 60 days and CBPI reduced at 30 and 60 days. After PRP, VASloc and DNS reduced at 60 days and CBPI at 30 and 60 days. There was no difference between groups. Both SCs and PRP were apparently beneficial to reduce chronic pain in dogs suffering from bilateral hip dysplasia for 60 days, but SCs improved more chronic pain variables compared to PRP. The clinical benefit of both treatments is that they produce a long term pain relief in dogs with hip dysplasia with no apparent adverse effects.
Mestre
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Parmigiani, Leandro [UNIFESP]. "Lavagem articular em osteoartrite de joelhos: um estudo controlado randomizado duplo-cego." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/9780.
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Previous issue date: 2009-11-26Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Objetivo: Comparar efetividade e tolerância, a médio prazo, entre lavagem articular associada à infiltração intra-articular (IIA) com hexacetonide de triancinolona (HT) versus a IIA isolada de HT em pacientes com osteoartrite (OA) primária de joelhos. Material e Métodos: Foi realizado um estudo controlado, randomizado, duplo-cego com 60 pacientes que apresentavam OA primária de joelhos com dor em pelo menos um dos joelhos e índice de Kellgren Lawrence (KL) II e III divididos em dois grupos de intervenção: Grupo LA/HT: submetidos à LA com SF 0,9% (1000ml), finalizada pela introdução de HT 60 mg; Grupo HT: submetidos apenas à simulação de LA finalizada pela IIA de HT 60 mg. Os pacientes foram avaliados durante 12 semanas em cinco tempos de avaliação (T0, T1, T4, T8 e T12 semanas) por um avaliador “cego” através dos seguintes instrumentos de avaliação: escala visual analógica (EVA) para dor em repouso e ao movimento, goniometria, índice de WOMAC, questionário funcional de Lequesne, tempo de caminhada de 50 pés, porcentagem subjetiva de melhora, escala visual analógica de melhora (EVAM), segundo o paciente e segundo o avaliador, necessidade de anti-inflamatórios e analgésicos, número e tipo de efeitos colaterais locais. Foi realizada subanálise estatística na amostra segundo a classificação radiológica (KL II e KL III). Foi considerada uma significância estatística de 5%. Resultados: A média de idade foi de 63,7 (±8,59) anos, média de tempo de doença de 5,69 (±5,01) anos, proporção KL II/III de 33/27, sendo 88,3% de mulheres e 48,3.% de brancos. Apesar de ambos os grupos melhorarem estatisticamente na avaliação intragrupo, exceto para consumo de anti-inflamatório e EVAM, segundo o paciente, não houve diferença estatística na avaliação intergrupo para todas as variáveis estudadas no período de 12 semanas. De acordo com a subanálise realizada, observou-se, nos pacientes KL II, diferença estatística significante a favor do grupo HT para a variável flexão articular (p=0,03) no T4. Para os pacientes KL III, observou-se diferença estatística significante a favor do grupo LA/HT para as variáveis Lequesne (p=0,021) e WOMAC dor (p=0,01), assim como para a variável EVAM, segundo paciente (p=0,028) e avaliador (p=0,034) no T8. Conclusão: A combinação de LA à IIA com HT se mostrou mais efetiva a médio prazo que a IIA isolada com HT para o tratamento da OA primária de joelhos em pacientes KL III. Não houve diferença estatística quanto a tolerância destas duas intervenções.
Objective: Compare the medium-term effectiveness and tolerance intraarticular injection (IAI) with triamcinolone hexacetonide (TH) associated to joint lavage versus IAI with TH alone in patients with primary osteoarthritis (OA) of the knee. Methods: A randomized, double-blind, controlled study was carried out on 60 patients with primary OA of the knee, with pain in at least one of the knees and Grades II and III on the Kellgren-Lawrence index (KL II and III). Patients were randomized into two intervention groups: JL/TH Group – patients submitted to joint lavage with 0.9% saline solution (1000 ml) followed by a 60-mg injection of TH (3 ml); and TH Group – patients submitted to simulated joint lavage (sham) followed by a 60-mg injection of TH (3 ml). Patients were followed up for 12 weeks by a blinded observer using: visual analogue scale (VAS) for pain at rest and on movement; range of movement; Womac index; Lequesne’s questionnaire; timed 50-foot walk; subjective perception of improvement; Likert scale (0-5) for improvement assessment; the need for non-hormonal anti-inflammatory medication and analgesics; the local side effects. Results: Average age was 63.7 (± 8.59) years; mean duration of disease was 5.69 (± 5.01) years; the KL II/III proportion was 33/27; 88.3% were women and 48.3% were Caucasian. Although both groups demonstrated statistically significant improvement in the intra-group evaluation (except for Likert improvement scale according to the patient and the use of anti-inflammatory drugs), there were no statistically significant differences in the inter-group analysis for any of the variables studied over the 12-week period. In the KL II and III sub-analysis, there was a statistically significant difference regarding joint flexion among patients classified as KL II, favoring the TH group (p=0.03). For the KL III patients there were statistically significant differences favoring the JL/TH group regarding Lequesne score (p=0.021), WOMAC-pain score (p=0.01) and Likert improvement scale according to the patient (p=0.028) and the physician (p=0.034) at eight weeks. Conclusion: The combination of joint lavage and IAI with TH was more effective than IAI with TH alone in the treatment of primary OA of the knee in KL 3 patients.
TEDE
BV UNIFESP: Teses e dissertações
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Pape, Elise. "Intérêt de la Rapamycine en Pharmacologie et en Ingénierie articulaires." Thesis, Université de Lorraine, 2021. http://www.theses.fr/2021LORR0290.
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La rapamycine est un inhibiteur de mTOR actuellement utilisé comme immunosuppresseur, notamment dans le domaine des greffes. Elle inhibe la voie de signalisation mTOR entrainant la restauration de l'autophagie, processus déficient lors de la physiopathologie de l'arthrose, rendant son utilisation intéressante dans le traitement des arthropathies dégénératives. La rapamycine est cependant responsable d'effets indésirables médicamenteux systémiques notables. Pour réduire ce risque, son injection locale, au sein de l'articulation, est une alternative avantageuse. Néanmoins, cette voie d'administration a des inconvénients : le contact direct du tissu articulaire à des concentrations importantes de principe actif, sa clairance à partir de la cavité articulaire, et la difficulté d'administrer un tel composé hydrophobe. De fait, le développement de nanoparticules est une alternative séduisante pour améliorer son utilisation par voie intra-articulaire. Dans ces travaux, nous avons évalué la cytotoxicité de la rapamycine sur les cellules de l'articulation, à savoir les chondrocytes et les synoviocytes à différentes concentrations et différents temps. Nous avons observé une cytotoxicité dose-dépendante, et une sensibilité plus importante des synoviocytes par rapport aux chondrocytes. La cytotoxicité sur des cellules souches mésenchymateuses osseuses, qui sont utilisées en ingénierie articulaire, a également montré une toxicité dose-dépendante. La rapamycine à 10 µM, décrite comme retardant les lésions cartilagineuses dans l'arthrose expérimentale, n'induit pas de toxicité et permet de réduire l'effet catabolique de la MMP13 induite par l'IL-1ß sur les chondrocytes et les synoviocytes. Dans cette étude, des nanoparticules de PLGA ont été développées pour libérer de façon prolongée la rapamycine après une administration intra-articulaire à cette concentration. Elles n'ont pas été responsables de cytotoxicité sur les chondrocytes, les synoviocytes. Enfin, nous avons constaté in vivo que l'administration de 50 µL de rapamycine à 10 µM sous forme de nanoparticules par voie intra-articulaire chez le rat augmentait sa demi-vie et son temps de rétention moyen dans l'articulation comparativement à une administration locale de la forme libre, tout en diminuant sa diffusion systémiqueRapamycin is an mTOR inhibitor currently used as an immunosuppressant, particularly in the field of transplantation. It inhibits the mTOR signaling pathway leading to the restoration of autophagy, a process that is deficient in the pathophysiology of osteoarthritis, making its use interesting in the treatment of degenerative arthropathies. However, rapamycin is responsible for significant systemic adverse drug reactions. To reduce this risk, its local injection, within the joint, is an advantageous alternative. Nevertheless, this route of administration has disadvantages: direct contact of the joint tissue with high concentrations of active drug, its clearance from the joint cavity, and the difficulty of administering such a hydrophobic compound. Therefore, the development of nanoparticles is an attractive alternative to improve its use by intra-articular application. In this work, we evaluated the cytotoxicity of rapamycin on joint cells, namely chondrocytes and synoviocytes at different concentrations and different times. We observed a dose-dependent cytotoxicity, and a higher sensitivity of synoviocytes compared to chondrocytes. Cytotoxicity on bone mesenchymal stem cells, which are used in cartilage engineering, also showed dose-dependent toxicity. Rapamycin at 10 µM, described as delaying cartilage damage in experimental osteoarthritis, does not induce toxicity and reduces the catabolic effect of IL-1ß-induced MMP13 on chondrocytes and synoviocytes. In this study, PLGA nanoparticles were developed to release rapamycin in a sustained manner after intra-articular administration at this concentration. Free and rapamycin-loaded nanoparticles were not responsible for cytotoxicity on chondrocytes, synoviocytes. Finally, we found in vivo that administration of 50 µL of 10 µM rapamycin-loaded nanoparticle intra-articularly in rats increased its half-life and mean retention time in the joint, compared to local administration of the free form, while decreasing its systemic diffusion
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Lomonte, Andrea Barranjard Vannucci. "Eficácia da infiltração intra-articular de triancinolona hexacetonida versus acetato de metilprednisolona na osteoartrite de joelho: um estudo randomizado, duplo cego de 24 semanas." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5164/tde-27102015-122038/.
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Introdução: Os corticosteroides intra-articulares (IA) são amplamente utilizados no tratamento da osteoartrite (OA) de joelho, porém é desconhecido qual dentre estes agentes é o mais eficaz. Objetivo: O objetivo do presente estudo foi comparar a eficácia das infiltrações IA de triancinolona hexacetonida (TH) e de acetato de metilprednisolona (AM) na OA de joelho. Pacientes e Métodos: Pacientes com OA sintomática de joelho, graus II ou III de Kellgren-Lawrence, foram randomizados para receber uma única infiltração IA com 40mg de TH ou AM. As avaliações clínicas foram realizadas nas semanas 4, 12 e 24. O desfecho primário do estudo foi a melhora da dor do joelho pelo paciente por escala visual analógica (EVA) da visita basal à semana 4. Os desfechos secundários incluíram a avaliação global da doença pelo paciente e pelo médico, o questionário de osteoartrite Western Ontario and McMaster Universities (WOMAC), o índice de Lequesne e o critério de resposta Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI). Na análise estatística, foram empregadas equações de estimativa generalizada, com estatística de Wald para contrastes do tipo 3 e ajustes de Tukey-Kramer para comparações múltiplas. Resultados: Cem pacientes foram incluídos na população com intenção de tratar, 50 em cada braço do estudo. Uma melhora significativa na dor pela EVA foi observada na semana 4 para ambos os grupos (P < 0,0001), não havendo diferença entre eles (P=0,352). Esta melhora foi sustentada até a semana 24. Uma melhora significativa em relação à avaliação basal foi observada na avaliação global da doença pelo paciente e pelo médico, no questionário WOMAC e no índice de Lequesne, não havendo diferença entre os grupos. A melhora nos desfechos secundários de avaliação foi sustentada durante o estudo, exceto para a avaliação global da doença pelo paciente. O critério de resposta OMERACT-OARSI foi alcançado por 74% e 72% dos pacientes dos grupos TH e AM, respectivamente. Conclusão: TH e AM são igualmente eficazes na OA de joelho, e a melhora na dor e na função física pode ser sustentada por até 24 semanasIntroduction: Intra-articular (IA) corticosteroid injections are broadly used in the treatment of knee osteoarthritis (OA), but it is unknown which of these agents is the most effective. Objective: The aim of the present study was to compare the efficacy of triamcinolone hexacetonide (TH) and methylprednisolone acetate (MA) IA injections in knee OA. Patients and Methods: Patients with symptomatic knee OA, Kellgren-Lawrence grades II or III, were randomized to receive a single IA injection with 40mg of TH or MA. Evaluations were performed at 4, 12 and 24 weeks. The primary outcome of the study was to evaluate the improvement in the patient\'s knee pain by visual analogue scale (VAS) from baseline to week 4. Secondary outcomes included the global assessment of the disease by the patient and the physician, the Western Ontario and McMaster Universities osteoarthritis questionnaire (WOMAC), the Lequesne index and the Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI) criteria of response. Generalized estimating equations with Wald statistics for type 3 contrasts and Tukey-Kramer multiple comparison adjustment were employed in statistical analysis. Results: The intention-to-treat population included one hundred patients; 50 in each study arm. A significant improvement in pain by VAS was observed at week 4 for both groups (P<0.0001), with no difference between them (P=0.352). This improvement was sustained up to week 24. A significant improvement from the baseline was observed for the patients\' and the physicians\' global assessments, WOMAC questionnaire, and Lequesne index, with no differences between the groups. Improvements in the secondary outcomes were sustained during the study, except for the patients\' global assessment of disease. OMERACT-OARSI criteria of response was achieved by 74% and 72% of patients in the TH and the MA groups, respectively. Conclusion: TH and MA are equally effective in knee OA and improvement in pain and physical function can be sustained for up to 24 week
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Campos, Gustavo Constantino de. "Efeito da associação da triancinolona à viscossuplementação do joelho." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-21052014-123756/.
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O presente estudo destinou-se a avaliar se os resultados clínicos iniciais da viscossuplementação poderiam ser melhorados com a adição de corticosteróide. As injeções intra-articulares são usadas há muitos anos no tratamento da osteoartrite dos joelhos, principalmente com suspensões cristalinas de corticosteróides. A viscossuplementação é uma intervenção relativamente nova, atualmente recomendada no tratamento da osteoartrite. Trata-se da injeção de ácido hialurônico exógeno em articulações diartrodiais, visando, além de restaurar as propriedades reológicas do líquido sinovial, efeitos modificadores da doença osteoartrite. Revisões sistemáticas mostram que a melhora clínica ocorre em duas a cinco semanas após a viscossuplementação. Comparando-se a viscossuplementação com a injeção intraarticular com corticosteróides, dados recentes sugerem maior eficiência no alívio da dor nas quatro primeiras semanas após a infiltração com corticosteróides, similaridade dos procedimentos ao redor da quarta semana e melhores resultados com a viscossuplementação após a oitava semana. Este inicio de ação mais tardio, associado a relatos de sinovite reacional após a viscossuplementação podem desencorajar médicos e pacientes ao uso desta modalidade de tratamento. No presente estudo foram avaliados 104 pacientes em tratamento para osteoartrite do joelho no grupo de doenças osteometabólicas do Instituto de Ortopedia do Hospital das Clínicas da FMUSP. Os pacientes foram randomizados em dois grupos. Um dos grupos foi denominado VS e recebeu uma única injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) no joelho estudado. O segundo grupo foi denominado VS+T e recebeu uma injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) mais 1ml (20mg) de Hexacetonido de Triancinolona (Triancil®-Apsen). Foram aplicados a escala visual analógica de dor (EVA) e os questionários de WOMAC e Lequesne uma semana antes da injeção e após uma, quatro, 12 e 24 semanas. Os dois grupos com 52 pacientes cada eram homogêneos. Na primeira semana, o WOMAC e a EVA apresentaram melhores resultados no Grupo VS+T (p < 0,01) em relação ao Grupo VS. Na quarta semana não houve diferença entre os grupos. Ambos apresentaram resultados similares nas semanas 12 e 24. Concluiu-se que a adição de hexacetonido de triancinolona melhorou os resultados clínicos da viscossuplementação no curto prazo, sem interferir nos resultados a longo prazo ou na incidência de efeitos adversosThe present study aims to assess if the initial results of viscosupplementation can be improved by the addition of corticosteroid. Intraarticular injections have been used for many years to treat arthritis and other painful articular disorders, mainly using long-lasting crystalline corticosteroid suspensions. Viscosupplementation is a relatively new intervention that is now widely used and recommended for the treatment of knee osteoarthritis. It is comprised of the injection of exogenous hyaluronic acid in diarthrodial joints, in order to restore the rheological properties of synovial fluid and also to promote osteoarthritis disease-modifying effects. Several placebo-controlled studies reported that clinical improvement began only within two to five weeks after viscosupplementation. When comparing viscosupplementation versus intraarticular injection of corticosteroid, recent data suggest that from baseline to week four, intraarticular steroid were more effective for pain relief. By the fourth week, however, both provided similar relief, but beyond the eighth week, hyaluronic acid provided greater pain reduction. The mechanism of action of hyaluronic acid, with delayed onset of pain/functional improvement, combined with reports of reactional sinovitis may discourage physicians and patients regarding this treatment modality. The present study evaluated 104 patients receiving usual care for knee osteoarthritis at the University of São Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) (Group VS) or a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) plus 1ml (20mg) of Triamcinolone Hexacetonide (Triancil®-Apsen) (Group VS+T). VAS, WOMAC and Lequesne questionnaires were applied one week prior the injection, and after one, four, 12 and 24 weeks. The two groups with 52 patients each were homogeneous. At week one, WOMAC and VAS showed better results for Group VS+T compared to Group VS (p < 0,05). At week four the scores did not show statistically significant differences. The groups showed similar results at weeks 12 and 24. In conclusion, the addition of triamcinolone improved first-week symptom and functional scores of viscosupplementation, but not beyond. It did not seem to alter the likelihood of adverse effects
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Bertoni, Lélia. "Évaluation du potentiel thérapeutique des cellules souches mésenchymateuses dans un modèle d'arthropathie expérimentale induite chez le cheval Characterization and use of Equine Bone Marrow Mesenchymal Stem Cells in Equine Cartilage Engineering. Study of their Hyaline Cartilage Forming Potential when Cultured under Hypoxia within a Biomaterial in the Presence of BMP-2 and TGF-ß1 Intra-Articular Injection of 2 Different Dosages of Autologous and Allogeneic Bone Marrow- and Umbilical Cord-Derived Mesenchymal Stem Cells Triggers a Variable Inflammatory Response of the Fetlock Joint on 12 Sound Experimental Horses An experimentally induced osteoarthritis model in horses performed on both metacarpophalangeal and metatarsophalangeal joints: Technical, clinical, imaging, biochemical, macroscopic and microscopic characterization Evaluation of allogeneic bone-marrow-derived and umbilical cord blood-derived mesenchymal stem cells to prevent the development of osteoarthritis in an equine model Chondrogenic Differentiation of Defined Equine Mesenchymal Stem Cells Derived from Umbilical Cord Blood for Use in Cartilage Repair Therapy." Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC417.
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’arthropathie dégénérative est une maladie ayant des répercussions socio-économiques majeures chez l’homme et le cheval. Il n’existe pour l’heure aucun traitement curatif de cette maladie, le cartilage articulaire étant dépourvu de pouvoir de cicatrisation spontané. De nombreux espoirs reposent sur l’utilisation de cellules souches mésenchymateuses (CSM), pour leur potentiel pro-régénératif et anti-inflammatoire. Le premier objectif de cette étude était d’évaluer la tolérance des CSM de sang de cordon ombilical (SCO) et de moelle osseuse (MO) dans des articulations saines. L’étude contrôlée en aveugle menée sur 12 chevaux expérimentaux a démontré que l’injection de CSM-MO provoquait significativement plus de signes de réaction inflammatoire que l’injection de CSM-SCO, et que l’injection des CSM, quelle que soit leur origine, provoquait une réaction inflammatoire discrète à modérée, supérieure à celle d’une injection de placébo, avec une grande variabilité individuelle de sensibilité à une même lignée de cellules. Le second objectif était d’évaluer l’efficacité des CSM-MO et -SCO dans un modèle d’arthropathie induite. L’étude contrôlée en aveugle menée sur 8 chevaux expérimentaux a mis en évidence une réduction significative de la progression des signes indicateurs d’arthropathie à l’imagerie après injection de CSM-MO allogéniques par rapport à l’injection du placébo. Ces résultats encourageants, à considérer à la lumière des limites des études menées, indiquent un effet bénéfique des CSM-MO allogéniques dans la prise en charge de l’arthrose chez le cheval. Ils soulignent la nécessité de poursuivre les recherches afin de confirmer ces résultats, et d’optimiser les effets des CSM à travers leur combinaison à un vecteur ou par une approche acellulaire avec administration des nanovésicules qu’elles sécrètent, et considérées être à l’origine de leurs effets thérapeutiquesOsteoarthritis is a common cause of pain and economic loss in both humans and horses. There is currently no curative treatment for osteoarthritis, because of the lack of spontaneous regenerative capacity of the articular cartilage. Mesenchymal stem cells (MSC) based regenerative medicine comes across as a promising strategy given their pro-regenerative and anti-inflammatory potential. The first objective of this study was to evaluate the safety of umbilical cord blood (UCB) and bone marrow (BM) derived MSC in healthy joints. The blind controlled study conducted on 12 experimental horses showed that the injection of BM-MSC caused significantly more signs of inflammatory reaction than the injection of UCB-MSC, and that the injection of MSC, regardless of their origin, caused a discrete to moderate inflammatory reaction, greater than that of the placebo, with great individual variability in sensitivity to the same cell line. The second objective was to evaluate the efficacy of BM-MSC and UCB-MSC in a model of induced osteoarthritis. The blind controlled study conducted on 8 experimental horses showed a significant reduction in the progression of osteoarthritis associated signs with imaging techniques after injection of allogeneic BM-MSC compared to placebo. These promising results, to be considered in light of the limitations of the studies, indicate a beneficial effect of allogeneic BM-MSC in the management of osteoarthritis in horses. They underline the need for further research to confirm these results, and to optimize the effects of MSC through their combination with a vector or through an acellular approach with administration of the nanovesicles they secrete that ared considered to be responsible for their therapeutic effects
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Rigor, Joana de Sá Alves. "Efeito Condrotóxico da injecção intra-articular de fármacos the chondrotoxic effect of the intra-articular injection of pharmaceuticals." Master's thesis, 2013. https://repositorio-aberto.up.pt/handle/10216/71842.
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Rigor, Joana de Sá Alves. "Efeito Condrotóxico da injecção intra-articular de fármacos the chondrotoxic effect of the intra-articular injection of pharmaceuticals." Dissertação, 2013. https://repositorio-aberto.up.pt/handle/10216/71842.
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Subedi, N., N. S. Chew, M. Chandramohan, Andy J. Scally, and C. Groves. "Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis." 2015. http://hdl.handle.net/10454/9273.
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NoAIM: To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. MATERIALS AND METHODS: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6-8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren-Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. RESULTS: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55-9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6-8 weeks post-injection. No associated complications were observed. CONCLUSION: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times.
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Chung, Pei-Chun, and 鍾佩君. "Intra-articular injection Sodium Hyaluronate Combined with Bone Marrow Stem Cell for Articular Cartilage Regeneration of Stifle Joint in Rabbits Model." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/05459104043446438867.
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碩士臺灣大學
獸醫學研究所
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Articular cartilage does not contain blood vessels, so it does not have the ability to regenerate and repair. Therefore, in tissue engineering studies, materials that promote articular cartilage regeneration are very important. Sodium hyaluronate is one of the critical molecules for the maintenance of the physico-chemical characteristics of cartilage extracellular matrix. Mesenchymal stem cells are multipotent stem cells and can differentiate into a variety of cell types, involving: adipocytes, chondrocytes, and osteoblasts. We want to know the effect of intra-articular injection of hyaluronan plus bone marrow stem cells (BMSC) promote cartilage regeneration in the treatment of osteoarthritis. In this study, an injectable sodium hyaluronate combine bone marrow stem cells (BMSC) was used for articular cartilage regeneration. Female 16-week-old New Zealand white rabbits were divided into four groups for treatment (n=6 per group): (1) control group - no treatment; (2) injected BMSC 3×106 cells/0.5 ml PBS; (3) injected sodium hyaluronate 0.1ml/kg; (4) injected sodium hyaluronate 0.1ml/kg combine BMSC 3×106 cells/0.2 ml PBS. Each animal underwent surgery to create full thickness cartilage defects on the articular surface of the medial femoral condyle of right stifle joint. The defects were 3 mm diameter and 2 mm depth. At 1 and 2 weeks after surgical, experiment material was injected into the right articular capsule of each rabbit in the transplanted group. At 14 weeks after surgical, the regenerated cartilage was examined using the International Cartilage Repair Society (ICRS) Macroscopic Score and the ICRS Visual Histological Score. A statistically significant difference between the experimental and control groups was observed. The forth group closest to the normal cartilage tissue structure, then followed by the third group. It is a promising therapeutic approach to joint damage. The combination of BMSC and HA yield good results and are beginning to gain recognition in regenerative medicine.
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Mueller, Carrie. "Effects of Intra-Articular Lipopolysaccharide Injection on Systemic Cytokine Gene Expression and Leukocyte Population in Young Horses." Thesis, 2011. http://hdl.handle.net/1969.1/ETD-TAMU-2011-12-10291.
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Nineteen yearling Quarter Horses were utilized in a randomized, complete block design to evaluate systemic cytokine gene expression and circulating leukocyte population in young horses following an intra-articular lipopolysaccharide (LPS) challenge. Horses were administered an injection of 0.25 ng (n = 7) or 0.50 ng (n = 6) of LPS or lactated Ringer?s solution (n = 6; control). Blood was collected via jugular catheter at pre-injection h 0 and at 2, 6, 12, and 24 h following aseptic injection of the left radiocarpal joint. Aseptic arthrocentesis was performed at the same times to sample synovial fluid for a companion study. Total RNA was isolated from leukocytes using a commercially available kit and real-time PCR was used to determine relative gene expression of the cytokines; interleukin (IL)-1beta (beta), IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-alpha). Determination of total leukocyte subpopulations and differentials was performed by Texas Veterinary Medical Diagnostic Laboratory.
Data were analyzed using the PROC MIX procedure of SAS. Gene expression of all cytokines analyzed was unaffected by treatment. However, changes over time were observed in some cytokines. Interleukin-1? was increased above baseline at 6, 12, and 24 h (P = 0.04), IL-6 was decreased slightly at 6 and 12 h and then increased at 24 h (P = 0.002), and TNF-alpha was increased at 6 and 12 h (P = 0.01). Only IL-8 exceeded a 2-fold change in expression (P = 0.01), peaking at 12 h and indicating greater responsiveness to arthrocentesis than was observed in the other cytokines. No treatment effects on the leukocyte population were observed; however, total circulating leukocytes increased over time (P = 0.04), peaking at 6 h post-injection. Similarly, an increase over time was observed in monocytes (P = 0.002) and in platelets (P = 0.01) at 24 h post-injection.
The results indicate that regardless of treatment, a mild immune response was elicited, likely due to repeated arthrocentesis. Future experiments should consider the effects of arthrocentesis and potential systemic inflammatory response, even in control animals, when administering intra-articular LPS to young horses.
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Lin, Tsung-Hsing, and 林宗興. "The Influence of Intra-articular Hyaluronic Acid Injection on Adipokine Levels in Synovial Fluid of Knee Osteoarthritis." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/44201976708029416130.
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Guan, Dechi. "Preparation and characterization of paclitaxel-loaded poly(d,l-lactide-co-glycolide) microspheres for intra-articular injection." Thesis, 1999. http://hdl.handle.net/2429/9672.
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Paclitaxel has been shown to cause significant regression of existing rheumatoid
arthritis and to prevent the induction of collagen-induced arthritis (CIA) in animal
models. Paclitaxel suppresses arthritis because rapidly proliferating inflammatory pannus
cells in the joint are susceptible to the phase-specific cytotoxic effects of paclitaxel.
Intra-articular therapy using anti-inflammatory steroids is used for patients in
whom rheumatoid arthritis manifests itself in only a limited number of joints. The
objective of the research was to prepare and characterize paclitaxel-loaded microspheres
using lactide:glycolide (LA:GA) polymers, which might potentially be suitable for the
intra-articular delivery of paclitaxel in arthritis.
Paclitaxel-loaded poly(J,/-lactide-co-glycolide) (PLG) microspheres were
prepared using the solvent evaporation method. PLG polymers having different
compositions of lactide and glycolide as well as having different molecular weights with
the same lactide and glycolide composition were chosen to study the influences of these
factors on the paclitaxel release rate. The effects of paclitaxel loading in the polymer
matrix and the sizes of the microspheres on the paclitaxel in vitro release behavior were
also assessed.
Paclitaxel was loaded into PLG microspheres with encapsulation efficiencies of
over 90% due to the hydrophobicity of the drug. Differential scanning calorimetry (DSC)
thermograms indicated that the glass transition temperatures increased with an increase in
paclitaxel loading in the PLG matrices, which was believed to be due to an interaction
involving the formation of hydrogen bonds between paclitaxel and PLG polymers. X-ray
diffraction data showed only the presence of an amorphous matrix, with no evidence by
either X-ray diffraction or DSC, of crystalline paclitaxel present in the microspheres
matrix.
Degradation studies of both control and paclitaxel-loaded microspheres in
phosphate buffered saline (PBS) containing albumin at 37°C showed that the molecular
weights of P L G microspheres with a 50:50 lactide:glycolide composition decreased
rapidly with time. The molecular weights of PLG microspheres with higher lactide
content (> 50 mole% of lactide) did not decrease significantly until after 3 weeks of
incubation in PBS-albumin.
The release profiles of paclitaxel from all PLG microsphere formulations showed
a burst phase of release, followed by a phase of relatively steady release. The burst phase
was caused by rapid release of paclitaxel from the superficial surface layers of the
microspheres. The release rates of paclitaxel from PLG50:50 microspheres were
influenced by paclitaxel loading and molecular weights of the PLG50:50 polymers.
Increased loading and decreased molecular weight led to faster paclitaxel release rates.
PLG microspheres prepared from polymers with LA : GA ratios of 85:15, 75:25 and 65:35
showed that the LA : GA compositions had minimal effect on paclitaxel release rates. The
two size ranges of microspheres showed minimal effects on the rates of paclitaxel
releases from the microspheres.
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McKinney, Jay Michael. "Intra-articular delivery of encapsulated human mesenchymal stem cells reduces osteoarthritis progression in a rat model." Thesis, 2017. https://hdl.handle.net/2144/23714.
Full textAbstract:
Osteoarthritis (OA) is a degenerative disease of the joint that leads to joint instability, degradation of the articular cartilage surface and eventually joint failure. Articular cartilage surfaces exhibit unique mechanical behaviors, bearing and distributing loads across joint surfaces, but have poor regenerative capacities. Human Mesenchymal Stem Cells (hMSCs) present a promising treatment to target OA, relying on their regenerative capacity and structural contributions to tissue repair, along with their immunomodulatory and anti-inflammatory properties. The multipotency of hMSCs allow these cells to differentiate towards osteogenic, chondrogenic and adipogenic lineages and directly incorporate into native tissue. hMSCs also possess the capacity to induce numerous paracrine-mediated processes including the recruitment of stem and progenitor cells, prevention of apoptosis, facilitation of beneficial remodeling and modulation of the immune response. Through encapsulating hMSCs, the effects of their paracrine action were studied directly, as the capsule presents a mechanical barrier for direct physical interaction and integration of these cells within the native tissue. The objective of this study was to utilize encapsulation of hMSCs to determine the paracrine effects of hMSCs on the progression of OA. OA was surgically induced in rats via the medial meniscus transection (MMT) surgery, which presents the phenotypical cartilage degradation associated with OA at 3 weeks. The efficacy of hMSC intervention was assessed using Lewis Rats with MMT (n=5 per group). Intra-articular injections of encapsulated hMSCs were given one day post-op and 3 weeks post-op for the 3-week and 6-week MMT studies, respectively. Animals were euthanized on the final day for both the immediate and delayed treatment studies. Micro-structural changes of the articular cartilage, osteophytes and subchondral bone of the medial tibial plateau were assessed using contrast enhanced microCT. We hypothesized that the intra-articular delivery of encapsulated hMSCs will have a positive effect, via paracrine-mediated action, on the onset and development of OA. The capsules also have the potential to improve retention and cell viability in the knee joint space. Each of these factors could contribute to enhanced therapeutic potential of the hMSC treatment. Utilizing NIR labeled sodium alginate capsules, a retention profile for the capsules yielded a tau value of 11.48 days, whereas previous studies have shown scaffold free hMSCs show complete clearance in 7 days. The 3-week MMT, run to analyze the effects of immediate treatment of encapsulated hMSCs on the onset of OA, showed a trend towards decreased cartilage thickness and a decreased surface roughness for the hMSC group in comparison to the Saline group, specifically. Additionally, the hMSC group showed a trend towards increased mineralized osteophyte volume for the hMSC group in comparison to the Saline group. Analysis of the subchondral bone yielded no differences between the hMSC and Saline groups for bone morphology. The 6 week MMT study was run to analyze the effects of a delayed treatment of encapsulated hMSCs on OA after the disease had developed. This study showed a similar result with the immediate treatment study for surface roughness, with the hMSC group showing a decrease in comparison to the Saline group. However, no differences were noted for cartilage thickness between the two respective groups. To further analyze the cartilage in the later stages of OA, exposed bone was quantified yielding a trend towards decreased exposed bone in the hMSC group in comparison to the Saline group. The mineralized osteophyte volume for the hMSC group, of the delayed treatment study, yielded a significantly higher value than all other groups. Additionally, the subchondral bone of the hMSC group trended towards a decreased porosity in comparison to the Saline group. This is one of the first studies to use sodium alginate encapsulation of hMSCs as an innovative scaffold means for intra-articular injections into the knee space. Encapsulated hMSCs permitted not only enhanced cellular retention in the knee space but showed a potential chondroprotective role of the paracrine signaling properties of hMSCs in the early stages of OA. These advantages of encapsulated hMSCs were countered by enhancements of secondary OA phenotypic changes, mainly increased mineralized osteophyte volume and a trend towards increased subchondral bone sclerosis in the later stages of OA. hMSCs have shown great potential as disease modifying drugs and through this study we have further explored the efficacy of these drugs for future treatments of OA. This study has high clinical relevance and with clinical practice running well ahead of current scientific evidence, it is imperative that these findings be considered not only in pre-clinical work but in current and future clinical trials.2018-07-11T00:00:00Z
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Lu, Hsien-Tsung, and 呂憲宗. "Therapeutic effects evaluation of oral chondroprotective and intra-articular modified hyaluronic acid injection on experimental rabbit osteoarthritis model." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/44593437147718472413.
Full textAbstract:
博士臺北醫學大學
臨床醫學研究所
103
Osteoarthritis (OA) is the most common chronic joint disorder. Advanced medical technology promote the older segment of the population to be the fastest growing. Although related arthritis surgery are popular, however, situation presents the orthopaedic surgeon with many medical comorbidities especially cardiovascular disease which make surgical arthritis treatment more difficult and risky. Research has been carried out continuously, and there is still an unmet need to develop specific drugs with high efficacy with mild invasive and low side effects for the treatment of degenerative arthritis. Some of conducted arthritis researches have modified known arthritis medicine to be the connective tissue structure-modifying agents (CTSMAs) and disease-modifying osteoarthritis drugs (DMODs). In our series of animal experiments, we evaluated I: Alterative effects of an oral alginate extract on experimental rabbit osteoarthritis and II: Injectable hyaluronic-acid-doxycycline hydrogel therapy in experimental rabbit osteoarthritis I: Alterative effects of an oral alginate extract on experimental rabbit osteoarthritis In this study, we evaluated the effects of the alginate extract named CTX in cell and rabbit OA models. Methods and Results. CTX was formulated by hydrolyzing sodium alginate polymers with alginate lyase and then mixing with pectin. HPLC was used to analyze the CTX content. Human chondrosarcoma SW1353 cells treated with interleukin-1β were used as OA model cells to investigate the effects of CTX on chondrocyte inflammation and anabolism. CTX at concentrations up to 1000 μg/ml exerted low cytotoxicity. It inhibited the gene expression of proinflammatory matrix metalloproteinases (MMPs) including MMP1, MMP3 and MMP13 in a dose-dependent manner and increased the mRNA level of aggrecan, the major proteoglycan in articular cartilage, at 1000 μg/ml. Thirteenweek-old New Zealand White rabbits underwent a surgical anterior cruciate ligament transection and were orally treated with normal saline, glucosamine or CTX for up to 7 weeks. Examinations of the rabbit femur and tibia samples demonstrated that the rabbits taking oral CTX at a dosage of 30 mg/kg/day suffered lesser degrees of articular stiffness and histological cartilage damage than the control rabbits. Conclusions. The gene expression profiles in the cell and the examinations done on the rabbit cartilage suggest that the alginate extract CTX is a pharmaco-therapeutic agent applicable for OA therapy. II: Injectable hyaluronic-acid-doxycycline hydrogel therapy in experimental rabbit osteoarthritis We evaluated the therapeutic effects of intra-articular injections of hydrogels containing hyaluronic acid (HA) and doxycycline (DOX) in a rabbit OA model. Methods and Results: Thirteen week old New Zealand White rabbits undergone a partial meniscectomy and unilateral fibular ligament transection were administered with either normal saline (NT), HA, DOX or HA-DOX hydrogels on day 0, 3, 6, 9 and 12; animals were also examined the pain assessment in every three days. The joint samples were taken at ay 14 post-surgery for further histopathological evaluation. The degree of pain was significantly attenuated after ay 7 post-treatment with both HA and HA-DOX hydrogels. In macroscopic appearance, HA-DOX hydrogel group showed a smoother cartilage surface, no or minimal signs of ulceration, smaller osteophytes, and less fissure formation in compare to HA or DOX treatment alone. In the areas with slight OA changes, HA-DOX hydrogel group exhibited normal distribution of chondrocytes, indicating the existence of cartilage regeneration. In addition, HA-DOX hydrogels also ameliorated the progression of OA by protecting the injury of articular cartilage layer and restoring the elastoviscosity. Conclusion: both macroscopic and microscopic data of this study indicate the injectable HA-DOX hydrogels presented as a long-lasting pharmacotherapeutic agent to apply for OA therapy.
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Yi-TingLin and 林宜亭. "Evaluation of Intra-articular Acetylglucosamine and Hyaluronan Injection Combined with PLGA Scaffolds for Osteochondral Defect Repair in Rabbits." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/61324478006489554256.
Full textAbstract:
碩士國立成功大學
生物醫學工程學系
101
Repairing damaged articular cartilage is particularly challenging because of the limited self-repair ability of hyaline cartilage. Nowadays, several treatments are available for repairing damaged cartilage, but all of them still present numerous problems. For instance, the repaired tissues by autologous osteochondral plug (mosaicplasty) are turned into fibrocartilage, and limited source and even dedifferentiation of chondrocytes are the limitation for autologous chondrocyte implantation when chondrocytes are in vitro monolayer culture. So far, no defined conclusions for cartilage repair are reported. Glucosamine and N-acetyl-D-glucosamine (GlcNAc) have been used as supplements for the treatment of osteoarthritis for several years and have shown ability in cartilage protection. However, through either oral administration or intravenous injection (IV), the diffusion of glucosamine from the circulation into the joint is very inefficient. Therefore, this study examines the effect of direct intra-articular injection of GlcNAc and/or hyaluronan (HA) for repairing osteochondral defects in rabbit knee joints. Part I of this study, the effect of intra-articular injection of GlcNAc for osteochondral defects in rabbits was investigated. Full-thickness osteochondral defect was created in the medial femoral condyle, then GlcNAc (G group) or normal saline were injected into joint capsulate twice a week starting 1 week postoperatively for a period of 5 weeks. Euthanasia was conducted at 4 weeks and 12 weeks after operation. Part II of this study, the efficacy of two supplementation solutions, GLcNAc and HA, combined with degradable functional Poly (lactide-co-glycolide) (PLGA) porous scaffold implantation in osteochondral defect regeneration was investigated. Three experiment groups of intra-articular injections include GlcNAc only (PLGA+G), clinical viscosupplementation HA only (PLGA+HA), and GlcNAc and HA combination (PLGA+G+HA), as well as a control group with PLGA implantation without any injection (PLGA). The HA and mixture solution groups were injected once a week starting 1 week postoperatively for a period of 3 weeks. GlcNAc was injected twice a week starting 1 week postoperatively for a period of 5 weeks. Euthanasia was conducted at 4 weeks and 12 weeks. The knees were evaluated by macroscopic evaluation, micro CT scanning, histology, and IHC staining. Part I of this study, the results demonstrated that intra-articular administration of GlcNAc had better hyaline-like cartilage regeneration and promoted bone regeneration. The thickness of trabecular bone (Tb.Th) value of G group was significantly higher than control group and the bone volume/tissue volume (BV/TV) ratio of G group was near the BV/TV ratio of normal subchondral bone at 12 weeks. Histologic analysis revealed that the G group exhibited hyaline-like cartilage, better cartilage alignment compared with control group and the chondrocytes had Sox9 expression at 12 weeks. Part II of this study, all of groups were completely filled with repaired tissue and PLGA scaffold at 4 weeks after operation. The PLGA+G, PLGA+HA and PLGA+G+HA groups had greater regeneration with nearly normal cartilage morphology that score of PLGA+G, PLGA+HA and PLGA+G+HA groups were significantly higher than PLGA group at 4 and 12 weeks. The BV/TV ratio and Tb.Th value were significantly higher in the PLGA+G, PLGA+HA and PLGA+G+HA groups compared with the PLGA group. The BV/TV ratio was significantly increased in the PLGA and PLGA+G+HA groups from 4 weeks through 12 weeks, and the Tb.Th value was significantly increased in all of the groups from 4 weeks through 12 weeks. Histologic analysis revealed that the PLGA+G, PLGA+HA and PLGA+G+HA groups exhibited hyaline-like cartilage and bone regeneration compared with PLGA group and the chondrocytes still had positive Sox9 expression at 12 weeks. In summary, intra-articular injection of glucosamine promotes osteochondral regeneration and chondroprotective function. In addition, the acellular functional porous scaffold combined with intra-articular injecting supplementation solutions such as GlcNAc, HA, or GlcNAc with HA solution show great gross appearance, hyaline-like cartilage and bone regeneration, well collagen alignment and abundant amount of glucosaminoclycans (GAGs) expression, particularly in the injected PLGA+G group.
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Barsalou, Julie. "The impact of early intra-articular corticosteroid injections on the outcome of oligoarticular juvenile idiopathic arthritis." Thèse, 2014. http://hdl.handle.net/1866/11848.
Full textAbstract:
Contexte Un objectif important de la prise en charge de l'arthrite juvénile oligoarticulaire serait d'altérer le cours de la maladie à l'aide d'une thérapie hâtive. Nous avons étudié l'effet des injections intra-articulaires de corticostéroïdes hâtives sur les chances d'atteindre un décompte d'articulation active de zéro et une maladie inactive.
Méthode Les données démographiques, cliniques et thérapeutiques des patients avec oligoarthrite juvénile enrôlés dans une étude prospective longitudinale pancanadienne ont été collectées pendant 2 ans. Une injection hâtive était définie comme étant reçue dans les 3 premiers mois suivant le diagnostic. Les équations d'estimation généralisées ont été utilisées pour l'analyse statistique.
Résultats Trois cent dix patients ont été inclus. Cent onze (35.8%) ont reçu une injection hâtive. Ces derniers avaient une maladie plus active lors de l'entrée dans l'étude. Les patients exposés à une injection hâtive avaient une chance similaire d'obtenir un décompte d'articulation active de zéro, OR 1.52 (IC95% 0.68-3.37), p=0.306 mais étaient significativement moins à risque d'avoir une maladie inactive, OR 0.35 (IC95% 0.14-0.88), p=0.026.
Interprétation Dans cette cohorte de 310 patients avec oligoarthrite juvénile, les injections hâtives de corticostéroïdes n'ont pas mené à une probabilité plus élevée d'atteindre un décompte d'articulation active de zéro ou une maladie inactive. Des problématiques méthodologiques intrinsèques à l'utilisation de données observationnelles pour fins d'estimation d'effets thérapeutiques auraient pu biaiser les résultats. Nous ne pouvons affirmer avec certitude que les injections hâtives n'améliorent pas le décours de la maladie. Des études prospectives adressant les limitations soulevées seront requises pour clarifier la question.Background One of the goals in oligoarticular juvenile idiopathic arthritis would be to alter the disease course with early therapy. We examined the association between early intra-articular corticosteroid injections and the achievement of an active joint count of zero and inactive disease during the first two years after study enrollment. Methods We included oligoarticular juvenile idiopathic arthritis patients enrolled into a prospective longitudinal cohort across Canada. Demographic, clinical and treatment-related information were collected. Early intra-articular corticosteroid injections was defined as having received the first injection within 3 months of diagnosis. Generalized estimating equations were used for data analysis. Results A total of 310 patients were included, of whom 111 (35.8%) received an early injection. Participants who received an early injection had more severe disease at baseline. Patients exposed to early injections had a similar chance to achieve an active joint count of zero, OR 1.52 (95%CI 0.68-3.37), p=0.306 but were significantly less likely to achieve inactive disease, OR 0.35 (95%CI 0.14-0.88), p=0.026. Interpretation In this cohort of 310 oligoarticular juvenile idiopathic arthritis patients, early intra-articular corticosteroid injections did not result in an increased risk of achieving an active joint count of zero or inactive disease. Methodological issues encountered when estimating treatment effect using observational data might have biased the estimates obtained. Firm conclusion on the inefficacy of early injections in improving outcomes in this population cannot be drawn from this study. Prospective studies addressing the limitations raised will be needed to clarify if early injections can alter the disease course.
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Tang, Shu-Chen, and 唐淑貞. "The effect of osteoarthritis patients with intra-articular injection of hyaluronic acid on use of National Health Insurance resources." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/97592115090589811997.
Full textAbstract:
碩士國防醫學院
公共衛生學研究所
98
Background The clinical treatment of osteoarthritis (OA) tends to be divided into two primary categories, traditional treatment and alternative therapy. Injection of hyaluronic acid which belongs to the latter has shown positive results in most papers. This research evaluates utilizations of OA patients, who had or had not received injection of hyaluronic acid in 2002, with respect to injection of hyaluronic acid, rehabilitation, analgesics and Viartril-s from 2005 to 2006. Aim 1.To analyse the differences among OA patients in respect to variables of gender, age, clinic departments in first-time registration, branches of Bureau of National Health Insurance, and hospital levels when they received injection of hyaluronic acid. 2.To explore the utilization of other treatments, such as rehabilitation, analgesics and Viartril-s, for OA patients with intra-articular injection of hyaluronic acid during the following-up of 2 years. 3.To investigate treatments, such as rehabilitation, analgesics and Viartril-s, for OA patients who didn’t receive intra-articular injection of hyaluronic acid, during follow-up of 2 years. Methods and Materials OA patients were recruited from the claims data of National Health Insurance. Those who received hyaluronic-acid injection therapy in 2002 were compared to those who did not. There were 3,853 persons in case-group and 103,100 in control-group. Result Case group: The patients received rehabilitation accounting for 19.47% in 2002, 11.60% in 2003 and 9.40% in 2004, 8.18% in 2005 and 7.32% in 2006 ; those took Viartril-s that made up 44.25% in 2002, 34.86% in 2003 and 29.77% in 2004, 24.21% in 2005 and 19.98% in 2006; analgesics-used patients accounted for 84.58% in 2002, 61.72% in 2003 and 54.22% in 2004, 48.36% in 2005 and 45.39% in 2006; patients receiving hyaluronic-acid injection therapy made up 100% in 2002, 29.82% in 2003 and 22.32% in 2004, 17.62% in 2005 and 15.65% in 2006. Control group: The patients received rehabilitation accounting for 12.96% in 2002,6.89% in 2003 and 5.94% in 2004, 5.12% in 2005 and 4.31% in 2006; those take Viartril-s that made up 21.28% in 2002,16.23% in 2003 and 15.31% in 2004, 12.12% in 2005 and 10.10% in 2006; analgesics-used patients accounted for 92.42% in 2002, 51.07% in 2003 and 43.94% in 2004, 37.82% in 2005 and 33.75% in 2006; patients receiving hyaluronic-acid injection therapy made up 0% in 2002, 2.20 % in 2003 and 2.87% in 2004, 3.11% in 2005 and 3.17% in 2006. In case group, therapies of rehabilitation, analgesics, Viartril-s and hyaluronic-acid injection have decreased statistically significantly in our model of multiple logistic regression. In control group, therapies of rehabilitation, Viartril-s and hyaluronic-acid injection have increased significantly. In addition, utilization of analgesics in control group decreased significantly. Conclusion Those who received hyaluronic-acid injection therapy in 2002 used less resources of NHI resources. For the other group, the utilization increased. Both groups took less analgesics.
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Chou, Chien-Chi, and 邱千綺. "The Evaluation of Spatial Width of Knee Joint after Intra-Articular Platelet Rich Plasma Injection by X-Ray Images." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/r26yxq.
Full textAbstract:
碩士義守大學
資訊工程學系
106
The application of platelet rich plasma (PRP) is commonly used in clinical, mainly because platelets in the blood contain a large number of growth factors, such as platelet derived growth factor (PDGF) and transforming growth factors (TGF-β), vascular endothelial growth factor (VEGF), and etc., can promote the proliferation of cartilage cells and repair cartilage defects. The main purpose of this study was to compare the variety of joint spatial width (JSW) between before and after treatment in patients with degenerative arthritis treated with high concentrations of platelet plasma. This study used retrospective experimental design with successfully collected 28 patients (40 knees) from January 2016 to December 2017 including knee radiographs of degenerative knee arthritis. PRP was injected to treat degenerative arthritis. There were 9 male and 19 female with average age 59.67±13.25 and 55.57±8.55 years, respectively. The JSW was estimated form an X-ray image by using region of interest (ROI) after boundary detection. According to the results of Logistic Regression decrease one cm in height and 1 kg in body weight, JSW grow 0.134 mm and 0.054 mm respectively(P=0.01 and P=0.03). The body height and body weight were influence the JSW after PRP treatment. The patients with lower body weight and height were the larger JSW after PRP treatment.
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Wang, Chen-Ti, and 王貞棣. "Therapeutic Effects of Intra-Articular Injection of High-Molecular-Weight Hyaluronic Acid on Knee Osteoarthritis: Evidence-based Medicine and Molecular Mechanisms." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/13181977618443179841.
Full textAbstract:
博士國立臺灣大學
臨床醫學研究所
95
Background and objective: Intra-articular injection of high molecular weight hyaluronic acid (HMW-HA) has been used as viscosupplementation for knee osteoarthritis (OA). However, the actual magnitude of the therapeutic effects of intra-articular injection of HMW-HA on knee OA is still a question. The aim of the first-part study was to elucidate the therapeutic efficacy and safety of intra-articular injection of HMW-HA for knee OA by conducting a systematic review and a meta-analysis. In addition, activated synoviocytes play important roles in the progression of human OA. However, the effect of HMW-HA on synoviocytes remains undisclosed. The aim of the second-part study was to investigate the effects of HMW-HA on the gene expression of 16 OA-associated cytokines and enzymes, including interleukin (IL)-1β, IL-6, IL-8, leukemia inhibitory factor (LIF), tumor necrosis factor (TNF)-α, TNF-α converting enzyme (TACE), matrix metalloproteinase (MMP)-1, MMP-2, MMP-3, MMP-9, MMP-13, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, aggrecanase-1, aggrecanase-2, and inducible nitric oxide synthase (iNOS), in fibroblast-like synoviocytes (FLS) from patients with early stage OA. Methods: In the first-part study, we conducted a meta-analysis of 20 blinded randomized controlled trials which compared the therapeutic effect of intra-articular injection of HMW-HA with that of intra-articular injection of placebo on knee OA. The outcome endpoints were classified into three categories: pain with activities, pain without activities, and functioning. The outcome measures of HMW-HA efficacy were the mean differences between HMW-HA and placebo groups for the efficacy scores. The outcome measure of HMW-HA safety was relative risk for adverse events. In the second-part study, synovial fluid-derived FLS were obtained from the knees of 15 patients with early stage OA. IL-1-stimulated or unstimulated FLS were cultured with or without the treatment of 600-800 kDa HMW-HA. Moreover, blocking experiments with anti-CD44 monoclonal antibodies (mAb) were used to examine the involvement of CD44 in HMW-HA effects. We designed and validated the real-time quantitative polymerase chain reaction (Q-PCR) assays with SYBR Green dyes for simultaneous quantification of the gene expression of 16 OA-associated cytokines and enzymes. Results: In the systematic review of the first-part study, intra-articular injection of HMW-HA can improve symptoms of knee OA. We found statistically significant improvements in pain and functional outcomes with few adverse events. However, there was significant between-study heterogeneity in the estimates of HMW-HA efficacy. Subgroup analysis and meta-regression analysis showed that lower methodological quality such as single-blind or single-center design would result in higher estimates of HMW-HA efficacy, introduction of acetaminophen as escape analgesics in trials would result in lower estimates of HMW-HA efficacy, and the patients over 65 years of age or those with the most advanced radiographic stage of OA, which is defined as complete loss of joint space, were less likely to benefit from intra-articular injection of HMW-HA. In the second-part study, we found that HMW-HA down-regulated IL-8 and iNOS gene expression in unstimulated FLS and down-regulated aggrecanase-2 and TNF-α gene expression in IL-1-stimulated FLS. CD44 blocking inhibited the down-regulatory effects of HMW-HA on the expression of these genes. Conclusions: The results of the first-part study confirm the therapeutic efficacy and safety of intra-articular injection of HMW-HA for knee OA. Further well-designed randomized controlled trials with high methodological quality are needed to resolve the continued uncertainty about the therapeutic effects of different types of HMW-HA products on knee OA in various clinical situations and patient populations. The results of the second-part study suggest that HMW-HA may have a structure-modifying effect for OA by down-regulation of aggrecanase-2 in FLS. HMW-HA also has an anti-inflammatory effect by down-regulation of TNF-α, IL-8, and iNOS in FLS. These effects may be mediated through the interaction of CD44 and HMW-HA. These results may clarify the molecular mechanism of HMW-HA in the treatment of OA.
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Romillo, Krystle Marie, and 羅晶晶. "Intra-Articular Injection of Platelet Rich Plasma in Treatment of Temporomandibular Disc Displacement and Osteoarthritis: A Systematic Review and Meta-Analysis." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/5p45bt.
Full textAbstract:
碩士國立陽明大學
牙醫學系
106
Background: Platelet-rich plasma (PRP) is non-invasive and offers an alternative treatment option for managing the symptoms of disc displacements and osteoarthritis Despite some clinical studies demonstrating its effects, uncertainty still exists whether PRP is an effective treatment for disc displacement and TMJ-OA. Objectives: This review aims to investigate the effectiveness of PRP in reducing pain and increasing mouth opening in patients diagnosed with disc displacement and TMJ-OA. Search methods: We performed an electronic database search using MEDLINE for relevant studies published up to May 2018. To identify other additional studies, citation lists and manual hand searched for reference lists was conducted to prevent missing any articles. Selection criteria: RCTs of studies that utilized the intra-articular injection of platelet-rich plasma in patients known to have disc displacement with or without osteoarthritis of the TMJ that assessed VAS and MMO outcomes. Data collection and analysis: Data were extracted and analyzed using Revman software 5.2 version. The Cochrane collaboration tool for bias assessment was utilized to validate the quality of studies included in this review. The authors of the included studies were contacted to clarify and request for additional information. Main results: A total of 293 participants are included in this review, 145 participants for the study group and 148 participants for the control group. All studies in this review were RCTs of patients diagnosed with ADDwR, ADDwoR, ADDwOR, and OA. In the experimental group, one study utilized PRP alone whereas five studies combined PRP injection with either arthrocentesis and arthroscopy. On the other hand, the control group includes arthrocentesis alone, arthrocentesis with HA and arthroscopy with HA. Outcome measures were assessed from 1 month to 24 months. A pooled analysis for VAS showed a clinical statistical significance in pain reduction with an overall effect of (SMD 0.74, 95% CI 0.40 to 1.0, P< 0.05, I2 57%) whereas MMO only showed clinical benefit at 3 months (SMD -0.50, 95% CI -0.88,-0.13,P = 0.009, I2 39%). Conclusions: The results of this meta-analysis showed that PRP might be effective one year after injection in managing pain and increasing mouth opening for patients with disc displacements and osteoarthritis. Keywords: disc displacement, osteoarthritis, platelet-rich plasma
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Stone, N. Craig. "Post injection rest in osteoarthritis of the knee : effect on pain relief and knee function after intra-articular corticosteroids, a prospective randomized controlled trial /." 2004.
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Yang, Jung-Wu, and 楊榮武. "The Clinical Efficacy of Centric Relation Occlusal Splint and Intra-articular Liquid Phase Concentrated Growth Factors Injection for the Treatment of Temporomandibular Joint Osteoarthritis." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/4su963.
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Tsai, Shen-Yang, and 蔡聲揚. "Evidence-based study of intra-articular mesenchymal stem cell injection in animals with traumatic and degenerative arthropathies and evaluation of clinical therapeutic effects in dogs." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/01840890458985937455.
Full textAbstract:
碩士國立臺灣大學
臨床動物醫學研究所
99
Osteoarthritis, also referred as degenerative joint disease(DJD), is a disease process associated with non-inflammatory, degenerative changes in the tissues of synovial joints and loss of articular cartilage, it is a common diagnosis in the clinic of aged population in both human and veterinary medicine. The poor regenerative capacity of cartilage and no available curative treatment options complicate satisfactory management of osteoarthritis. Recently, stem cell therapy plays an important role in regenerative medicine due to its capacity to differentiate into new tissue to achieve proper tissue repair. Intra-articular injection of suspended stem cells, as a minimal invasive surgical option, could provide as an alternative therapy to osteoarthritis due to its effect of cartilage regeneration and immunomodulation mechanism, and therefore, stop or reverse the disease progression of osteoarthritis. In chapter three, we systematically review the articles related to intra-articular mesenchymal stem cell injection in animals and consider them in the light of evidence-based (veterinary) medicine. A total of 11 studies from various animal species including rat、rabbit、porcine、goat、horse and dog were included. The study materials, evaluation methods and primary outcome of each study were analysed along with the evaluation of the study design and grading of the study quality by use of the FDA’s EBM scoring system. Evaluation of efficacy in published trials was hampered by the low number of studies and their heterogeneity nature, but most of individual study shows intra-articular stem cell injection could have positive therapeutic effect to a certain degree. In chapter four, we use porcine adipose-derived mesenchymal stem cells as a stem cell source to treat canine osteoarthritis and evaluate its therapeutic effects. A total of 3 client-owned dogs with nature course of stifle degenerative joint disease were included in our study. We delivered approximately 5x106 stem cells per joint suspended in phosphate buffered saline via direct intra-articular injection. The outcome revealed that the score of doctor assessment, owner assessment, peak vertical force and vertical impulse of affect limb were functionally improved after intra-articular injection of mesenchymal stem cells. Although some studies, whether in experimental animal models or in clinical trial, have provided promising results of intra-articular stem cell therapy in osteoarthritis, the information is still limited. The actual mechanism of stem cells participating in tissue repair, optimal number of cells needed to be injected, proper therapeutic protocols or the appropriate time point of intervention still remains to be discovered in the future.
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Bureau, Nathalie. "Transforaminal versus intra-articular facet steroid injections for the treatment of cervical radiculopathy : a randomized, double-blinded, controlled study." Thesis, 2014. http://hdl.handle.net/1866/11252.
Full textAbstract:
Cette étude a été subventionnée par le Fonds de recherche du Québec - Santé (FRQ-S, grant # 21230 – 2)Les infiltrations foraminales cervicales sont associées à un risque de complications neurologiques majeures. Cette étude compare l’efficacité des infiltrations facettaires, plus sécuritaires, à celle des infiltrations foraminales dans le traitement de la cervico-brachialgie secondaire à une spondylose et/ou à une hernie discale, à 4 semaines post traitement. Cinquante-six sujets ont été randomisés pour recevoir une infiltration foraminale (15 hommes, 13 femmes ; âge moyen 52 ans) ou facettaire (8 hommes, 20 femmes ; âge moyen 44 ans). L’issue principale était l’intensité de la douleur mesurée sur une échelle visuelle analogique (0 – 100). Les issues secondaires étaient le Neck Disability Index et le Medication Quantitative Scale. Suivant les analyses en intention-de-traiter et en intention-du-protocole, pour un score de douleur initial moyen, une réduction significative de l’intensité de la douleur a été observée avec les infiltrations facettaires [45.3% (95%CI: 21.4; 69.2) et 37.0% (95%CI: 9.2; 64.7)] contrairement aux infiltrations foraminales [9.8% (95%CI: +11.5; 31.2) et 17.8% (95%CI: +6.6; 42.2)]. Les infiltrations facettaires ont procuré une amélioration cliniquement (mais non statistiquement) significative du Neck Disability Index [24.3% (95%CI: +2.9; 51.5) et 20.7% (95%CI: +6.2; 47.6),], contrairement aux infiltrations foraminales [9.6% (95%CI: +15.2; 34.4) et 12.8% (95%CI: +11.2; 36.7)]. Les infiltrations facettaires étaient au moins aussi efficaces que les infiltrations foraminales pour un score initial de douleur ≤ 60, alors que l’analyse de non infériorité n’était pas concluante pour un score initial ≥ 80, de même que pour le Neck Disability Index. Les infiltrations n’ont pas été associées à une réduction du score de Medication Quantitative Scale. Les infiltrations facettaires sont efficaces dans le traitement de la névralgie cervico-brachiale et représentent une alternative valable et plus sécuritaire aux infiltrations foraminales.
Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks post treatment. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age 52 years; range 28 – 72 years) or facet (8 men, 20 women; mean 44 years; range 26 – 60 years) injections. The primary outcome was pain severity rated on a visual analog scale (0-100). Secondary outcome measures were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95%CI: 21.4; 69.2) and 37.0% (95%CI: 9.2; 64.7), while transforaminal injections showed nonsignificant pain score reduction of 9.8% (95%CI: +11.5; 31.2) and 17.8% (95%CI: +6.6; 42.2). While facet injections demonstrated an improvement in Neck Disability Index score of [24.3% (95%CI: +2.9; 51.5); 20.7% (95%CI: +6.2; 47.6),] as opposed to transforaminal injections [9.6% (95%CI: +15.2; 34.4); 12.8% (95%CI: +11.2; 36.7)], the results did not reach statistical significance. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain score ≤ 60, while noninferiority analysis was inconclusive for baseline pain score ≥ 80 and for the Neck Disability Index score. Neither intervention showed a significant medication intake score reduction over time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.
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Bureau, Nathalie J. "Transforaminal versus intra-articular facet steroid injections for the treatment of cervical radiculopathy : a randomized, double-blinded, controlled study." Thèse, 2004. http://hdl.handle.net/1866/11252.
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Kuan-YuLin and 林冠宇. "Comparing Intra-articular Injections of PRP, HA, and NS in Treatment of Knee Osteoarthritis: A Randomized, Double-blind, Triple-paralleled, Placebo-Controlled Clinical Trial." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/rt32ga.
Full textAbstract:
博士國立成功大學
生物醫學工程學系
107
Osteoarthritis (OA) of the knee is one of the main causes of musculoskeletal disability. It is clinically heterogenous, and the processes that cause deterioration are still poorly understood. Current research efforts are focused on the identification of key biochemical pathways that can be targeted therapeutically through biological intervention and the testing of protein biotherapeutics for restoring the metabolic balance within the joint. Autologous platelet-rich plasma (PRP) is a simple, low cost, and minimally invasive method that allows one to obtain from his/her own blood a natural pool of growth factors. The aim of this prospective study was to evaluate the role of PRP in treating degenerative lesions of articular cartilage of the knee, analyzing and comparing them with the results obtained with another common injectable treatment, hyaluronic acid viscosupplementation, and with normal saline being the placebo control. This study was designed to be a prospective, randomized and placebo-controlled clinical trial. The hypothesis was that PRP would improve symptoms and function both statistically and clinically, possibly through the release of growth factors and bioactive molecules, in patients affected by knee OA. From April to August 2014, a total of 87 osteoarthritic knees (53 patients) who met our inclusion criteria were randomly assigned into 3 groups of 3 weekly injections with either leukocyte-poor PRP (31 knees), HA (29 knees), or normal saline (NS) (27 knees). Functional outcomes evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee (IKDC) subjective score were to be collected at baseline and at 1, 2, 6, and 12 months after treatments. Data were analyzed using generalized estimating equations (GEE). All three groups had statistically significant improvement in both outcome measures at 1 month; however, only the PRP group sustained such significant improvement in both scores at 12 months (WOMAC 63.71±20.67, 21% increased; IKDC 49.93±17.74, 40% increased). For the inter-group comparison, except for the first month, there is a statistically significant difference between the PRP and NS groups in both scores throughout the study duration (WOMAC, regression coefficient / P value: 8.72 / 0.0015, 7.94 / 0.0155, and 11.92 / 0.0014, at 2-, 6-, and 12 months, respectively; IKDC, 9.1 / 0.0001, 10.28 / 0.0002, and 13.97 / 〈0.0001); there was no significant difference in both functional outcomes between the HA and NS groups at any time point. Younger and male patients had statistically significant improvement in outcomes; OA stage and BMI were not influential factors statistically. Only the PRP group reached the minimal clinically important differences of WOMAC at every evaluation (15%, 21%, 18%, and 21% at 1-, 2-, 6, and 12 months, respectively), and that of IKDC at 6 months (improvement of 11.6). In conclusion, intra-articular injections of leukocyte-poor PRP can provide both statistically and clinically significant functional improvement for patients with mild to moderate osteoarthritis of knee for at least one year.
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Albert, Héloïse. "O ácido hialurónico no tratamento das disfunções da articulação temporomandibular." Master's thesis, 2018. http://hdl.handle.net/10284/7126.
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As disfunções temporomandibulares, que envolve a articulação temporomandibular e/ou os músculos da mastigação e as estruturas anexas, são uma das causas mais comuns de dor orofacial.
Dentro dos tratamentos não cirúrgicos, a viscossuplementação, ou seja, a infiltração intra-articular de ácido hialurónico, é uma técnica minimamente invasiva que permite lubrificar e devolver a capacidade funcional à articulação temporomandibular.
Esta revisão bibliográfica narrativa tem como objectivo avaliar a efetividade da viscossuplementação utilizando infiltrações de ácido hialurónico no tratamento dos sinais e sintomas de pacientes com disfunções temporomandibulares articulares.
A pesquisa bibliográfica desta revisão foi realizada a partir das bases de dados on-line B-On, PubMed e Rearchgate.Temporomandibular disorders, which involve the temporomandibular joint and/or the chewing muscles and the attached structures, are one of the most common causes of orofacial pain. Within the non-surgical treatments, the viscossuplementation, that is, intra-articular infiltration of hyaluronic acid is a minimally invasive technique that allows lubrication and restoration of functional capacity to temporomandibular joint. This narrative bibliographic review aims to evaluate the effectiveness of viscossuplementation using hyaluronic acid injections in the treatment of signs and symptoms of patients with articular temporomandibular disorders. The bibliographic search of this review was carried out from the online databases B-On, PubMed and Rearchgate.
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(7424441), Nelda Vazquez-Portalatin. "The Use of Biopolymers for Tissue Engineering." Thesis, 2019.
Find full textAbstract:
Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage damage and loss in the joints that affects approximately 27 million adults in the US. Tissue that is damaged by OA is a major health concern since cartilage tissue has a limited ability to self-repair due to the lack of vasculature in cartilage and low cell content. Tissue engineering efforts aim towards the development of cartilage repair strategies that mimic articular cartilage and are able to halt the progression of the disease as well as restore cartilage to its normal function.
This study harnesses the biological activity of collagen type II, present in articular cartilage, and the superior mechanical properties of collagen type I by characterizing gels made of collagen type I and II blends (1:0, 3:1, 1:1, 1:3, and 0:1). The collagen blend hydrogels were able to incorporate both types of collagen and retain chondroitin sulfate (CS) and hyaluronic acid (HA). Cryoscanning electron microscopy images showed that the 3:1 ratio of collagen type I to type II gels had a lower void space percentage (36.4%) than the 1:1 gels (46.5%) and the complex modulus was larger for the 3:1 gels (G*=5.0 Pa) compared to the 1:1 gels (G*=1.2 Pa). The 3:1 blend consistently formed gels with superior mechanical properties compared to the other blends and has the potential to be implemented as a scaffold for articular cartilage engineering.
Following the work done to characterize the collagen scaffolds, we studied whether an aggrecan mimic, CS-GAHb, composed of CS and HA binding peptides, GAH, and not its separate components, is able to prevent glycosaminoglycan (GAG) and collagen release when incorporated into chondrocyte-embedded collagen gels. Bovine chondrocytes were cultured and embedded in collagen type I scaffolds with CS, GAH, CS and GAH, or CS-GAHb molecules. Gels composed of 3:1 collagen type I and II with CS or CS-GAHb were also studied. The results obtained showed CS-GAHb is able to decrease GAG and collagen release and increase GAG retention in the gels. CS-GAHb also stimulated cytokine production during the initial days of scaffold culture. However, the addition of CS-GAHb into the chondrocyte-embedded collagen scaffolds did not affect ECM protein expression in the gels. The incorporation of collagen type II into the collagen type I scaffolds did not significantly affect GAG and cytokine production and ECM protein synthesis, but did increase collagen release. The results suggest the complex interaction between CS-GAHb, the chondrocytes, and the gel matrix make these scaffolds promising constructs for articular cartilage repair.
Finally, we used Dunkin Hartley guinea pigs, a commonly used animal model of osteoarthritis, to determine if high frequency ultrasound can ensure intra-articular injections of the aggrecan mimic are accurately positioned in the knee joint. A high-resolution small animal ultrasound system with a 40 MHz transducer was used for image-guided injections. We assessed our ability to visualize important anatomical landmarks, the needle, and anatomical changes due to the injection. From the ultrasound images, we were able to visualize clearly the movement of anatomical landmarks in 75% of the injections. The majority of these showed separation of the fat pad (67.1%), suggesting the injections were correctly delivered in the joint space. The results demonstrate this image-guided technique can be used to visualize the location of an intra-articular injection in the joints of guinea pigs and we are able to effectively inject the aggrecan mimic into knee joints.
All of the work presented here suggests that the addition of the aggrecan mimic to collagen I and collagen I and II scaffolds has shown that this type of construct could be useful for treating cartilage damage in the future.