The Open Arthritis Journal最新文献

{"title":"Treating Osteoarthritic Joints Using Dextrose Prolotherapy and Direct Bone Marrow Aspirate Injection Therapy","authors":"R. Hauser, B. Woldin","doi":"10.2174/1876539401407010001","DOIUrl":"https://doi.org/10.2174/1876539401407010001","url":null,"abstract":"Osteoarthritis is a chronic, progressive disease of the articular joints, and to date, has no cure or effective long- term treatment. Objective: To determine if bone marrow prolotherapy (BMP), a combined treatment protocol employing separate injections of hypertonic dextrose prolotherapy and bone marrow aspirate, would be effective as a means of reduc- ing joint pain and improving function in osteoarthritic joints. Design: Patients with a clinical diagnosis of radiographic os- teoarthritis who visited our pain clinic and underwent BMP treatments (N = 24, mean age 64.9) were asked to complete a questionnaire assessing their condition before and after treatment. Methods: BMP treatments (average 3.6) were conduct- ed at 6 to 8 week intervals and involved autologous harvesting and aspiration of the patient's tibial bone marrow, after which a hypertonic dextrose solution was injected at sites in and around the index joint (prolotherapy), followed by injec- tions of the bone marrow aspirate directly into and around the joint. At 6 months post-treatment, patients were e-mailed a questionnaire asking them to rate their condition before and after BMP treatment in terms of pain levels at rest, perform- ing activities of daily living, and during exercise (Visual Analog Pain Scale), as well as their degree of stiffness, range of motion, and level of crepitus. Changes in the self-reported scores of these variables for each patient were analyzed to de- termine the effectiveness of BMP treatment. Data were obtained by comparing the differences between baseline and post- treatment scores and analyzed utilizing a two-tailed paired t test. Results: Patient-reported improvements in pain relief and joint function were statistically significant (P < .001), as were gains in activities of daily living, exercise ability, and range of motion and losses in stiffness and crepitus. No adverse events occurred. Conclusion: Our survey of patient- reported outcomes supports the use of BMP as an effective therapy for treating osteoarthritis and suggests that BMP has potential for enhancing the quality of life of individuals with the disease.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115688889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Duration of Stationary Bicycling Does Not Increase Serum COMP in Subjects With and Without Joint Pathology","authors":"T. Cooney, J. Delullo, Michael Ghassibi, A. Jones","doi":"10.2174/1876539401306010001","DOIUrl":"https://doi.org/10.2174/1876539401306010001","url":null,"abstract":"Objective: Exercise has purported benefits for patients with osteoarthritis but dosing effects are not remarkable and poorly understood. We used serum levels of cartilage oligomeric matrix protein (COMP) to determine the effect of exercise duration on cartilage stress. Methods: Six men and 11 women, mean age 49.3 years (range: 25-69) who met inclusion criteria were enrolled with in- formed consent. The cohort consisted of those with (n=6) and without (n=11) joint pathology. Two separate bicycling ses- sions were conducted lasting 20 or 40 minutes. Session order was randomized. Pedaling resistance was adjusted to enable consistent speed (50 RPM) without exceeding 65% maximum HR. Venous blood, obtained before and after each session, was analyzed using a commercial COMP ELISA. Subjects also completed an AAOS Hip and Knee Outcomes Question- naire. Data were analyzed by repeat measures ANOVA and Pearson correlation. Results: After 20 minutes, mean COMP levels decreased from 811 ± 326.8 ng/ml to 768 ± 337.3 ng/ml; after 40- minutes,from 723 ± 311.8 to 693 ± 312.2 ng/ml. Neither duration of exercise or pathology significantly affected COMP. AAOS outcome scores were 83.7 (range: 65 to 94) for those with and 99.1 (range: 94 to 100) for those without pathol- ogy/OA; scores did not correlate to COMP. Conclusion: Our data show that moderate, non-weight bearing exercise up to 40 minutes does not elevate serum COMP, suggesting it is to be non-injurious to joint cartilage for periods of this duration. Given the small subset of subjects with OA, additional study is warranted.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123182192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labral Tears and Femoroacetabular Impingement: Clinical Features and Arthroscopic Management","authors":"S. Martin, J. Katz","doi":"10.2174/1876539401205010001","DOIUrl":"https://doi.org/10.2174/1876539401205010001","url":null,"abstract":"Context: Labral tears and femoroacetabular impingement (FAI) are increasingly recognized sources of hip pain and disability. FAI has two pathoanatomic phenotypes, Cam and Pincer impingement, and both of these lesions can cause labral tear and its associated symptoms, which can in turn lead to osteoarthritis. Hip arthroscopy is an increasingly popular technique with the potential to address these conditions. Evidence Acquisition: The authors performed a PubMed search on labral tears, FAI, and hip arthroscopy, and further re- fined the search by pulling relevant citations from the retrieved articles. Evidence Synthesis: Advances in hip arthroscopic techniques have made it possible to perform osteoplasty to treat the source of FAI and to perform labral repair. These procedures appear to be effective in relieving hip pain. However, ran- domized trials will be needed to perform a rigorous assessment of the efficacy of these procedures in pain relief. Long- term follow-up will be required to determine whether these surgical approaches reduce the risk of osteoarthritis. Conclusions: Clinicians should be aware of labral tears and FAI as common causes of hip and groin pain and disability. Successfully addressing these conditions with hip arthroscopy requires advanced training and a detailed knowledge of the anatomy of the hip. Results have been favorable, but further study is needed to fully document the outcomes of arthro- scopic interventions.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"346 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131814543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of the Rituximab in ANCA-Associated Vasculitis (RAVE) Trial","authors":"U. Specks, P. Merkel, G. Hoffman, C. Langford, R. Spiera, P. Seo, C. Kallenberg, E. Clair, L. Ding, L. Webber, M. Mokhtarani, N. Tchao, P. Sayre, V. Seyfert-Margolis, D. Ikle, P. Brunetta, David Y. Zhang, L. P. Sejismundo, M. Mueller, J. Stone","doi":"10.2174/1876539401104010001","DOIUrl":"https://doi.org/10.2174/1876539401104010001","url":null,"abstract":"Granulomatosis with polyangiitis (formerly Wegener's) (GPA) and microscopic polyangiitis (MPA) share many clinical and pathological features, including antineutrophil cytoplasmic antibodies (ANCA) directed against either proteinase 3 (PR3) or myeloperoxidase (MPO). These two \"ANCA-associated\" vasculitides (AAV) are associated with a high mortality in untreated patients, substantial morbidity from standard therapies, and a significant risk of disease relapse. The Rituximab in ANCA-Associated Vasculitis (RAVE) trial is a randomized, double-blind, double-dummy, active- controlled, non-inferiority trial of a new approach to the induction of remission. The RAVE trial represents the first chal- lenge of a biologic agent to CYC as the standard of care for remission induction in AAV. The primary outcome analysis, reported in 2010, compared conventional therapy (the combination of cyclophosphamide (CYC) and glucocorticoids) to the combination of rituximab (RTX) and glucocorticoids. Longer term outcomes to 18 months and beyond have not been reported. The trial aimed to determine if the combination of RTX plus glucocorticoids was non-inferior to the combination of CYC and glucocorticoids. To test this hypothesis, eight clinical centers planned to enroll 200 patients. The randomization was stratified by center and by ANCA subtype. Patients were assigned randomly to each treatment arm in an allocation ratio of 1:1. The primary outcome had two components: 1) the ability of the assigned regimen to induce disease remission by month 6; and, 2) successful discontinuation of prednisone by month 6. All primary analyses were performed on an inten- tion-to-treat basis. A major secondary outcome of interest was the restoration of immune tolerance, defined as disease quiescence and the absence of ANCA following the reconstitution of normal B cell numbers. To meet this definition, pa- tients were required to achieve and maintain disease remissions, complete the prednisone taper, and remain on no immu- nosuppressive medications after discontinuing prednisone. Patients were followed for 18 months after the final patient was enrolled to evaluate the impact of the two treatment regimens on tolerance restoration. In this paper, we describe the development and design of the RAVE trial as a pivotal trial in an orphan disease indication. We illuminate the unique challenges involved in comparing a new treatment approach against an entrenched standard of care in a double-blind, double-dummy trial of a biologic for the treatment of a rare disease.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"2009 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127334230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Lupus Erythematosus and Osteonecrosis: A Comparison of Patients with Single versus Multiple Joint Involvement","authors":"T. Kermani, C. Crowson, K. Amrami, D. Berry, K. Moder","doi":"10.2174/1876539401003010047","DOIUrl":"https://doi.org/10.2174/1876539401003010047","url":null,"abstract":"Objective: The purpose of this study was to determine the clinical and laboratory features associated with os- teonecrosis of multiple (>/= 3) joints in systemic lupus erythematosus (SLE). Methods: We included all patients with SLE and osteonecrosis evaluated at our institution between January 1, 2000 and June 30, 2006. The patients were divided into three groups based on osteonecrosis of 1 joint, 2 joints and 3 or more joints. Clinical features, laboratory findings and therapies of patients in these groups were compared using Fischer's exact test and rank sum tests. Results: Our study included 4 men and 37 women. Twelve patients (29.3%) had osteonecrosis of 1 joint, 16 patients (39%) had osteonecrosis of 2 joints and 13 patients (31.7%) had osteonecrosis of 3 or more joints. The only clinical fea- ture of SLE significantly associated with osteonecrosis of 3 or more joints was central nervous system (CNS) disease (p = 0.01). The median cumulative and peak corticosteroid doses were similar in all 3 groups (p = 0.70 and p = 0.11 respec- tively). There were no differences in the frequency of anti-cardiolipin antibodies. Conclusions: History of CNS disease was the only variable associated with multiple joint osteonecrosis in patients with SLE. We found no association between corticosteroid doses and multiple joint osteonecrosis.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123835404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of B Cells in Rheumatic Autoimmune Disease","authors":"Vanessa E. Hogan, G. Wheater, C. Huigens, T. Hügle, J. Laar","doi":"10.2174/1876539401003010032","DOIUrl":"https://doi.org/10.2174/1876539401003010032","url":null,"abstract":"There is increasing evidence that B cells can play important roles in the pathogenesis of various autoimmune diseases, either by autoantibody secretion, production of proinflammatory cytokines or autoantigen presentation. An in- creasing number of B cell directed therapies are in development as a possible treatment strategy of rheumatic autoimmune diseases, such as Rituximab which targets the B cell specific CD20 surface marker. This article provides an overview of the principal understandings of B cell immunology in autoimmunity and selected rheumatic autoimmune diseases. Keyword: B cells, Rheumatic autoimmune disease, Autoantibody, Cytokine, B cell depletion, Rituximab","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115878547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macrophage Subsets in Immune-Mediated Inflammatory Disease: Lessons from Rheumatoid Arthritis, Spondyloarthritis, Osteoarthitis, Behçet’s Disease and Gout","authors":"M. Lebre, P. Tak","doi":"10.2174/1876539401003010018","DOIUrl":"https://doi.org/10.2174/1876539401003010018","url":null,"abstract":"Macrophages are a major cell population in most of the tissues, and their numbers increase massively in in- flammation, in wound healing and in tumors. In particular, macrophages contribute to autoimmune events in rheumatic diseases, such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), mainly acting as antigen-presenting cells and also as the major source of inflammatory mediators that are important in joint inflammation. In this respect, macrophages re- lease a variety of pro-inflammatory cytokines and chemokines and events downstream of this cytokine cascade will con- tribute to cartilage and bone destruction. It is becoming clear that differential macrophage activation by distinct mecha- nisms is crucial for their function. This review will discuss several aspects of macrophage function in immune-mediated inflammatory disease with particular emphasis in RA, SpA, osteoarthitis, Behcet's disease and gout.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129395821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monocyte Gene Expression Signatures in Rheumatic Diseases: Biomarkers for Disease Activity and Tools for Diagnosis and Classification","authors":"Z. Brkić, E. Olthof, H. Drexhage, M. Versnel","doi":"10.2174/1876539401003010013","DOIUrl":"https://doi.org/10.2174/1876539401003010013","url":null,"abstract":"Monocytes migrate through the blood to the peripheral tissues, where they can develop into dendritic cells (DC) and macrophages. Studies on the phenotype of peripheral blood monocytes in rheumatic diseases revealed changes in the number of CD16+ monocytes and in the adhesive, chemotactic, antigen presenting and inflammatory properties of the cells. However, these studies often resulted in fragmented and inconsistent data and are hampered by the heterogeneity and overlap of the rheumatic diseases. By microarray analysis, changes in gene expression-profiles are detectable and subsequent correlation of the data reveals functional pathways forming a \"gene expression signature\". Determination of monocyte gene expression signatures in pa- tient groups with rheumatic diseases has resulted in the detection of an Interferon (IFN) Type I induced signature in sub- groups of patients with rheumatoid arthritis, Sjogren's Syndrome, systemic sclerosis and systemic lupus erythematosus. We assume that such profiling, which is robust, will lead to the development of better classification criteria and an insight into at least one functional pathogenic pathway leading to disease, i.e. the one mediated by IFN type 1.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133247086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antigen-Presenting Cells and their Fcγ and Toll-Like Receptors: Leading Suspects in Autoimmunity","authors":"K. Santegoets, L. Bon, M. Wenink, W. B. Berg","doi":"10.2174/1876539401003010037","DOIUrl":"https://doi.org/10.2174/1876539401003010037","url":null,"abstract":"Antigen-presenting cells (APCs) play an important role in the development of autoimmune diseases. These cells recognize pathogen associated molecular patterns but also endogenously produced ligands through toll-like receptors (TLRs). Aberrant activation of these receptors and the following intracellular signaling pathways can induce the deleteri- ous production of pro-inflammatory cytokines. In genetically predisposed individuals this might lead to a breach in toler- ance and eventually autoimmunity. IgG and IgG immune complexes (ICs), which are abundantly present in autoimmune diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and systemic sclerosis (SSc) are recognized by APCs via Fc gamma receptors (Fc Rs) and can also modulate their activation state. Upon their uptake specific antigens present in ICs are capable of stimulating APCs via their intracellular TLRs, increasing their capability to induce (autoreac- tive) T and B cell responses. This underscores their likely role in the generation and maintenance of autoimmunity. By fo- cusing on three autoimmune diseases, SLE, RA and SSc, we will illustrate the importance of TLRs and Fc Rs in the pathogenesis of autoimmune diseases.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132250435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolerogenic Dendritic Cells in Clinical Practice","authors":"C. Hilkens, J. Isaacs","doi":"10.2174/1876539401003010008","DOIUrl":"https://doi.org/10.2174/1876539401003010008","url":null,"abstract":"Dendritic cells (DC) play a critical role in maintaining immune tolerance to self-antigens and have become a promising immunotherapeutic tool for treating autoimmune diseases such as rheumatoid arthritis (RA). Tolerogenic DC (tolDC) with stable immunosuppressive function can be generated in the laboratory. These modified tolDC induce anti- gen-specific T cell tolerance in vitro and in vivo, and can prevent or reduce pathogenic autoimmune responses in experi- mental animal models of RA. The current challenge is to translate these findings and to develop tolDC for clinical appli- cation. In this review we discuss various key considerations for designing tolDC therapy for RA.","PeriodicalId":437116,"journal":{"name":"The Open Arthritis Journal","volume":"52 68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124624645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}