Mesenchymal stem cell therapy for knee osteoarthritis. Preliminary report of four patients Musculoskeletal Atrophy in an Experimental Model of Knee Osteoarthritis: The Effects of Exercise Training and Low-Level Laser Therapy Nonrandom evolution of end-stage osteoarthritis of the lower limbs. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial [Is competitive running associated with osteoarthritis of the hip or the knee?]. Systems to Assess the Progression of Finger Joint Osteoarthritis and the Effects of Disease Modifying Osteoarthritis Drugs Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis? Prevalence of Radiographic Knee Osteoarthritis in Saudi Arabia Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow‐up of three patients S-Adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: A double-blind cross-over trial. [ISRCTN36233495] Therapeutic effects of short-term monochromatic infrared energy therapy on patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis The prevalence and progression of radiographic knee osteoarthritis over 6 years in a population-based cohort of middle-aged subjects The Bristol 'OA500 study': progression and impact of the disease after 8 years. A double-blind randomized controlled trial appraising the symptom-modifying effects of colchicine on osteoarthritis of the knee. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol The Effects of Various Kinds of Lateral Wedge Insoles on Performance of Individuals with Knee Joint Osteoarthritis Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis Whole body vibration compared to conventional physiotherapy in patients with gonarthrosis: a protocol for a randomized, controlled study Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis
Background : Osteoarthritis ( OA ) is a cartilage degenerative process , involving the immune system , producing local inflammatory reactions , with production of pro‐inflammatory cytokines and metalloproteinases . No treatment is still available to improve or reverse the process . Stem cell therapy opened new horizons for treatment of many incurable diseases . Mesenchymal stem cells ( MSCs ) due to their multi‐lineage potential , immunosuppressive activities , limited immunogenicity and relative ease of growth in culture , have attracted attentions for clinical use Objective The aim of this study was to evaluate the effects of an exercise training protocol and low-level laser therapy ( and the association of both treatments ) on musculoskeletal atrophy using an experimental model of knee osteoarthritis ( OA ) . Design Fifty male Wistar rats were r and omly divided into five groups : control group , knee OA control group , OA plus exercise training group , OA plus low-level laser therapy group , and OA plus exercise training associated with low-level laser therapy group . The exercise training and the laser irradiation started 4 wks after the surgery , 3 days per week for 8 wks . The exercise was performed at a speed of 16 m/min , 3 days per week , 50 mins per day , for 8 wks . Laser irradiation was applied at two points of the left knee joint ( medial and lateral ) , for 24 sessions . Results The results showed that both trained groups ( irradiated or not ) presented a significant increase in the muscle cross-sectional area and a decrease in muscle fiber density compared with the knee OA control group . Moreover , both trained and laser-irradiated groups demonstrated decreased muscle-specific ring-finger protein 1 and atrogin-1 immunoexpression . Conclusions These results suggest that exercise training and low-level laser therapy were effective in preventing musculoskeletal alterations related to atrophy caused by the degenerative process induced by knee OA OBJECTIVE Patients with unilateral hip or knee replacements for end-stage osteoarthritis ( OA ) are at high risk for future progression of OA in other joints of the lower extremities , often requiring additional joint replacements . Although the risks of future surgery in the contralateral cognate joints ( i.e. , contralateral hip replacement after an initial hip replacement ) have been evaluated , the evolution of end-stage hip OA to OA involving the knee joints , and vice versa ( i.e. , noncognate progression ) has not been investigated . Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA , we investigated the pattern of evolution of end-stage lower extremity OA in a large , clinical cohort . METHODS Total joint replacement ( TJR ) was selected as a marker of end-stage OA , and a data base comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed . Of the 5,894 patients identified , 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement  were analyzed to determine the relative likelihood of subsequent TJRs .  Patients with the systemic inflammatory arthropathy , rheumatoid arthritis ( RA ) , were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process . RESULTS The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups . However , in OA patients for whom the second TJR was in a noncognate joint , that joint was > 2-fold more likely to be on the contralateral limb than on the ipsilateral limb ( hip to knee P < 0.001 ; knee to hip P = 0.013 ) . In contrast , among the RA cohort , the evolution was r and om and no laterality for noncognate TJR was observed at either the hip or the knee ( P = 0.782 ) . CONCLUSION This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonr and omly ; after 1 joint is replaced , the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb . Thus , OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints . The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading Background : Knee osteoarthritis ( OA ) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair , st and ing , walking and climbing stairs . Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocol s in combination to conventional conservative therapy for knee OA . Methods : It was a single blind RCT study with a 12-months follow-up . Totally , 56 patients with knee OA were assigned into 2 r and om groups . The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs ( NSAIDs ) and 10 sessions acupuncture and physiotherapy modalities . Non-exercise group received similar treatments except exercise program . The changes in patients ’ pain and functional status were evaluated by visual analog scale ( VAS ) , knee and osteoarthritis outcome score ( KOOS ) question naire and functional tests ( 4 steps , 5 sit up , and 6 min walk test ) before and after treatment ( 1 and 3 months after intervention ) , and 1 year later at the follow-up . Results : The results showed that the patients with knee OA in exercise group had significant improvement in pain , disability , walking , stair climbing , and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group . At third follow up ( 1 year later ) there was significant difference between groups in VAS and in three items of KOOS question naire in functional status . Conclusion : Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy , acupuncture , and modalities for knee OA BACKGROUND The aim of the study was to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects ' joints differ from those of control persons . METHODS Twenty former elite German marathon runners ( active careers 1972 - 86 ) underwent clinical ( FFbH-OA [ hip joint ] and AKSS [ knee joint ] ) and radiographic ( hip and knee joints , Kellgren and Lawrence classification ) examination . X-Rays of the hip joints were compared with those of controls matched for age , gender and BMI who did not engage in much sport .  RESULTS In the group of former elite marathon runners , 3 of the 38 knee joints for which comparison with control joints was possible were found to be affected by grade 2 osteoarthritis . In the same group , severe osteoarthritis ( Kellgren and Lawrence grade 3 ) was documented in 1 and moderate osteoarthritis ( grade 2 ) in 6 of the 28 hips for which direct comparison against the controls was possible , as against 1 hip affected by grade 2 osteoarthritis in the entire control group . The clinical evaluation showed high scores in all athletes . CONCLUSIONS Osteoarthritis of the knee joint is rare in former elite marathon runners . The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport Abstract : Our objective was to assess the progression of osteoarthritis ( OA ) using scoring systems based on the anatomical changes recorded in the finger joints on st and ard radiographs and to test how far these scoring systems could be used to evaluate the effects of c and i date ‘ disease modifying osteoarthritis drugs ’ ( DMOAD ) . The appearance and growth of osteophytes , narrowing of the joint space and subchondral bone changes allowed the classic OA-associated anatomical lesions to be used to score the progression of finger joint OA . Progression of OA in the finger joints was also assessed by the their evolution through previously described and predictable anatomical phases on st and ard X-rays . These phases were characterised by complete loss of the joint space preceding or coinciding with the appearance of subchondral cysts eroding the entire subchondral plate , and have been described in ‘ inflammatory ’ or ‘ erosive ’ OA . The erosive episodes were followed by processes of remodelling . In order to interfere with the progression of osteoarthritis , two chondroitin sulphates with possible DMOAD effects were used in two series of patients with OA of the finger joints . The patients were included in two separate r and omised , double-blind placebo-controlled trials : 46 of them received chondroitin polysulphate and 34 received chondroitin sulphate .  Eighty-five patients were kept on placebo medication and were used as controls . All 165 patients were followed for 3 years .  Posteroanterior X-rays of the metacarpophalangeal and interphalangeal ( IP ) finger joints were obtained at the start of this prospect i ve study and at yearly intervals thereafter . Almost 80 % of the distal IP and 50 % of the proximal IP were affected at study entry . In approximately 40 % of the patients the classic picture of OA of the IP joints was complicated by manifest erosive OA changes . The two systems to score the progression of OA ( Anatomical Lesion and Anatomical Phase Progression Score System ) showed definite progression within 3 years of follow-up , especially in the IP joints . When compared with the placebo controls , none of the chondroitin sulphates prevented OA from occurring in previously normal finger joints . However , when the classic OA-associated anatomical lesions were considered , OA was less progressive in both active treatment groups . Furthermore , fewer patients from both chondroitin sulphate- and chondroitin polysulphate-treated groups developed ‘ erosive ’ osteoarthritis . In conclusion , conventional radiographs can be used to assess the morbidity and progression of h and OA . The systems used to score the progression of finger joint OA allowed the DMOAD effects of both chondroitin sulphates to be evaluated . The data recorded during these pilot studies should help investigators to design future long-term clinical experiments Background : Osteoarthritis ( OA ) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults . As OA symptoms typically involve knee pain and stiffness , individuals with knee OA are often insufficiently physically active , have low levels of physical function , and are at increased risk of other comorbidities and reduced quality of life . While moderate-intensity continuous training ( MICT ) cycling is often recommended , little is known about the feasibility , safety , and benefits of high-intensity interval training ( HIIT ) cycling for this population , even though the feasibility , safety , and benefits of HIIT have been demonstrated in other chronic disease groups . Purpose : The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA . A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status ( pain , stiffness , and disability ) , muscle function , and body composition in this population . This study protocol is being published separately to allow a detailed description of the research methods , explain the rationale for choosing the method ological details , and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment . Study Design : R and omized pilot study protocol . Methods : This trial sought to recruit 40 middle-aged and older adults with knee OA . Participants were r and omly allocated to either continuous ( MICT ) or HIIT home-based cycle training programs , with both programs requiring the performance of 4 cycling sessions ( approximately 25 minutes per session ) each week . Participants were measured at baseline and postintervention ( 8 weeks ) . Feasibility and safety were assessed by adherence rate , dropout rate , and number of adverse events . The relative efficacy of the cycling programs was investigated by 2 knee OA health status question naires ( Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC ] and the Lequesne Index ) as well as the timed up and go , sit to st and , preferred gait speed , and body composition . Discussion : This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA . As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status , body composition , and /or muscular function in other chronic disease groups , the current study has the potential to improve patient outcomes and inform the design of future r and omized controlled trials Abstract : In this cross-sectional study we looked at the radiographic evidence of  osteoarthritis ( OA ) of the knee in 300 r and omly chosen patients attending 14 primary care facilities for different medical conditions .  Radiographic OA was seen in 89 out of 167 males ( 53.3 % ) and in 81 out of 133 females ( 60.9 % ) . The patella was involved with radiographic osteoarthritic changes in 80.7 % and 87.8 % of female and male OA patients , respectively . In most cases the medial compartment joint space was narrowed . Radiographic OA of the knee is very common in Saudi patients , especially in the patellofemoral compartment Osteoarthritis is a degenerative joint disease characterized by the destruction of joint cartilage . Mesenchymal stem cells ( MSCs ) are found in low numbers in normal cartilage , mainly in the superficial layer , acting as repairing agents . In OA , MSCs are seen in larger numbers , but act chaotic and are unable to repair the cartilage . The synovial membrane becomes inflamed and interacts with the cartilage . Transplanted MSC have the ability to normalize them , redirecting them to their normal function . In a preliminary study , we showed that MSC could improve knee OA in four patients at 6 months . This report shows their long‐term follow‐up at 5 years Background S-Adenosylmethionine ( SAMe ) is a dietary supplement used in the management of osteoarthritis ( OA ) symptoms . Studies evaluating SAMe in the management of OA have been limited to Non Steroidal Anti-inflammatory Drugs ( NSAIDs ) for comparison . The present study compares the effectiveness of SAMe to a cyclooxygenase-2 ( COX-2 ) inhibitor ( celecoxib ) for pain control , functional improvement and to decrease side effects in people with osteoarthritis of the knee . Methods A r and omized double-blind cross-over study , comparing SAMe ( 1200 mg ) with celecoxib ( Celebrex 200 mg ) for 16 weeks to reduce pain associated with OA of the knee . Sixty-one adults diagnosed with OA of the knee were enrolled and 56 completed the study . Subjects were tested for pain , functional health , mood status , isometric joint function tests , and side effects . Results On the first month of Phase 1 , celecoxib showed significantly more reduction in pain than SAMe ( p = 0.024 ) . By the second month of Phase 1 , there was no significant difference between both groups ( p < 0.01 ) . The duration of treatment and the interaction of duration with type of treatment were statistically significant ( ps ≤ 0.029 ) . On most functional health measures both groups showed a notable improvement from baseline , however no significant difference between SAMe and celecoxib was observed . Isometric joint function tests appeared to be steadily improving over the entire study period regardless of treatment . ConclusionS AMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis . Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used STUDY DESIGN R and omized , double-blind , placebo-controlled study . OBJECTIVES To examine the short-term therapeutic effects of monochromatic infrared energy ( MIRE ) on participants with knee osteoarthritis ( OA ) . Patients were assessed according to the International Classification of Functioning , Disability and Health . BACKGROUND MIRE is commonly used in therapy for patients with peripheral neuropathies . However , research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA . METHODS This study enrolled 73 participants with knee OA . Participants received six 40-minute sessions of active or placebo MIRE treatment ( 890-nm wavelength ; power , 6.24 W ; energy density , 2.08 J/cm2/min ; total energy , 83.2 J/cm2 ) over the knee joints for 2 weeks . International Classification of Functioning , Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score , Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire . Data were analyzed by repeated- measures analysis of variance . RESULTS No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores , including pain , other symptoms , function in daily living , function in sport and recreation , and knee-related quality of life . Scores on the Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire also showed no significant differences between the 2 groups at any of the 4 follow-up assessment s. CONCLUSION Short-term MIRE therapy provided no beneficial effects to body functions , activities , participation , and quality of life in patients with knee OA Introduction Osteoarthritis ( OA ) is a chronic joint disease that usually occurs in older people and leads to pain and disabilities . OA treatment ranges from drug therapy to surgery . Drug and rehabilitation therapy are preferred over surgery , and , especially , there is a tendency toward compounds causing regenerative changes in the knee joint . In the present study , the effects of platelet-rich plasma ( PRP ) injection and prolotherapy ( PRL ) were examined on the level of pain and function of the knee joint in patients with OA . Methodology After fulfilling the inclusion criteria and signing the informed consent form , 42 patients with knee OA were scheduled for intra-articular injection in the present r and omized , double-blind , clinical trial . Following admission to the operating pain room , the condition of the patient ’s knee was evaluated first via the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and , then , ultrasound-guided knee injection was done . Accordingly , patients in the PRP therapy group received 7 mL PRP solution and those in the PRL group received 7 mL 25 % dextrose . Using the WOMAC , levels of pain and knee function were evaluated and recorded for each patient immediately prior to the first injection as well as at 1 month ( immediately prior to the second injection ) , 2 months ( a month after the second injection ) , and 6 months later . Data collected were analyzed using the SPSS v.20 . Results During the first and second months , a rapid decrease in the overall WOMAC score was observed in both groups . The overall WOMAC score increased at the sixth month , but was lower than the overall WOMAC score in the first month . Statistical analysis indicated that the overall WOMAC score significantly decreased in both groups of patients over 6 months . Conclusion Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL . This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection . PRP injection is more effective than PRL in the treatment of knee OA Details of the development of early knee osteoarthritis ( OA ) are largely unknown . The prevalence and progression of  radiographic knee OA  over 6 years in middle-aged subjects with chronic knee pain is investigated . In a prospect i ve population -based study , tibiofemoral ( TF ) and patellofemoral ( PF ) radiographs were grade d in 128 subjects ( mean age 45 ± 6.2 years ) for the presence of osteophytes and joint space narrowing ( JSN ) . Radiographic progression was defined as : ( i ) the presence of osteophytes and /or JSN in subjects with no previous OA or ( ii ) an increase in the grade and /or number of already existing osteophytes and /or JSN . Altogether 56 % ( 72/128 ) of subjects had knee OA , the majority of them was diagnosed with OA grade 1 . In 57 % of cases , radiographic OA was based on the presence of osteophytes alone versus 13 % on JSN . More than 1/3 of subjects had isolated PF joint involvement . Knee OA progression rate over 6 years was 56 % ( 71/128 ) . During 6 years , a non-linear course of radiographic OA progression with intermittent periods of progression and stabilization was observed . Individual course of OA revealed distinct subsets of radiographic progression . Osteophytosis is an important early radiographic sign of OA and its progression . Isolated PF joint involvement is a frequent expression of knee OA . In middle-aged subjects , the progression rate of knee OA over 6 years was 56 % . A non-linear course of radiographic OA progression was observed . Several radiographic subsets refer to the heterogeneity of the OA process OBJECTIVE To study the natural history of peripheral joint osteoarthritis ( OA ) and assess its impact over eight years in a prospect i ve study of 500 patients . METHODS 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic . All were invited for review 3 and 8 years after entry . Joint sites involved , pain severity , change in index joints , global change in the condition , use of medication , surgery and walking aids were all recorded at each visit , and after eight years disability was assessed by the  health assessment question naire ( HAQ ) and  anxiety and depression by the Hospital anxiety and depression scale ( HAD ) . RESULTS At eight-year review , 349 patients were seen : 90 % of those remaining alive . Outcome was heterogeneous . Sixty patients ( 17.2 % ) reported worsening in all three subjective parameters ( pain , index joint and global change ) compared with 22 ( 6.3 % ) who improved in all three parameters . Using this definition of worsening or improvement , strong baseline predictors of clinical outcome did not emerge . For further description , the group was split according to the index joint sites involved at entry to the study , there being 111 with knee OA alone , 87 with h and and knee OA , 72 with h and disease alone , and 29 with hip disease alone . Forty-four percent of those with lone h and disease at entry had acquired significant knee or hip OA 8 years later . The mean HAQ and HAD scores at 8 years were high , especially in those with knee disease , indicating significant disability as a result of the disease . Those with knee or knee and h and disease had the worst outcome in all parameters recorded . The data showed a general decrease in use of NSAIDs over the eight years , but an increase in utilization of analgesics , surgery ( especially for hip disease ) and walking aids . CONCLUSIONS Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous , but generally bad outcome over 8 years , the disease result ing in high levels of physical disability , anxiety and depression , with a high level of utilization of healthcare re sources , including joint replacement , drugs and walking aids . The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites . Progression and outcome may depend on a complex set of psychosocial factors , as well as biological ones OBJECTIVES Osteoarthritis ( OA ) is the most common articular disease . Common OA treatments are either not effective or associated with side effects . Calcium-containing crystals are quite common in primary OA and they worsen or may cause OA through induction of inflammation by neutrophils . Colchicine inhibits urate-crystal and calcium-pyrophosphate ( CPP ) crystal induced inflammation and elastase , a matrix-metalloproteinase ( MMP ) that play a pivotal role in degenerative joint processes . Hence , it was hypothesized that it may have symptom-modifying effects on OA . METHODS Sixty-one postmenopausal patients with primary knee OA were enrolled . None of them had joint involvement atypical for OA or evidence s of chondrocalcinosis in radiographic studies suggesting the presence of calcium-pyrophosphatedeposition-disease ( CPPD ) . Participants were allocated to two groups receiving 0.5 mg colchicines BID or placebo . Both groups received common OA treatments . Acetaminophen less than 2gr/day was used as rescue-analgesic . The efficacy end points were : patients ' global assessment and physician 's global assessment , recorded on a VAS ( visual analogue scale ) . Statistical analysis was performed 3 months later . RESULTS Thirty-one patients were assigned to the colchicine  group . Fifty-eight patients were present for the last survey . Only 1 patient in colchicine group encountered adverse effect  of colchicine without significant difference between the two groups . Acetaminophen consumption was significantly less in the colchicine ( 879.3±369.7 ) compared to placebo group ( 1620.7±393.1 , p=0.000 ) . Improvement rate at the end of 3 months was significantly higher in the colchicine group for both patients ' global assessment and physician 's global assessment measures compared to placebo group , ( 11.14±4.06 vs. 3.14±2.18 , p=0.000 ) and ( 9.83±3.799 vs. 3.72±3.35 , p=0.000 ) , respectively . CONCLUSIONS The efficacy and safety of colchicine for pain reduction in OA was affirmed by our double-blind r and omised controlled trial Osteoarthritis is a common , chronic , progressive , skeletal , degenerative disorder , which commonly affects the knee joint . Boswellia serrata tree is commonly found in India . The therapeutic value of its gum ( guggulu ) has been known . It posses good anti-inflammatory , anti-arthritic and analgesic activity . A r and omized double blind placebo controlled crossover study was conducted to assess the efficacy , safety and tolerability of Boswellia serrata Extract ( BSE ) in 30 patients of osteoarthritis of knee , 15 each receiving active drug or placebo for eight weeks . After the first intervention , washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks . All patients receiving drug treatment reported decrease in knee pain , increased knee flexion and increased walking distance . The frequency of swelling in the knee joint was decreased . Radiologically there was no change . The observed differences between drug treated and placebo being statistically significant , are clinical ly relevant . BSE was well tolerated by the subjects except for minor gastrointestinal ADRs . BSE is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis Background Knee osteoarthritis ( OA ) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability . Many people with knee OA also experience co-morbidities that further add to the OA burden . Uptake of and adherence to physical activity recommendations is suboptimal in this patient population , leading to poorer OA outcomes and greater impact of associated co-morbidities . This pragmatic r and omised controlled trial will investigate the clinical - and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA . Methods / Design 168 people with clinical ly diagnosed knee OA will be recruited from the community in metropolitan and regional areas and r and omly allocated to physiotherapy only , or physiotherapy plus nurse-delivered telephone coaching . Physiotherapy involves five treatment sessions over 6 months , incorporating a home exercise program of 4–6 exercises ( targeting knee extensor and hip abductor strength ) and advice to increase daily physical activity . Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia ( HCA ) Model of Health Change to provide behaviour change support . The telephone coaching intervention aims to maximise adherence to the physiotherapy program , as well as facilitate increased levels of participation in general physical activity . The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months . Secondary outcomes include physical activity levels , quality -of-life , and potential moderators and mediators of outcomes including self-efficacy , pain coping and depression . Relative cost-effectiveness will be determined from health service usage and outcome data . Follow-up assessment s will also occur at 12 and 18 months . Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background : Knee joint osteoarthritis ( OA ) is one of the most incapacitating diseases affecting older population , which is associated with pain and functional limitation . Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease . There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA . Methods : A total of 36 subjects with medial knee compartment OA were recruited in this research project . Subjects were r and omized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants . Some parameters such as severity of knee pain , Tibiofemoral angle ( TFA ) , severity of OA , and quality of life were selected in this research project . Results : The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain . However , the effect of 7 mm lateral wedge insole was more than that of 3 mm . Conclusion : Using lateral wedge insole is a simple , inexpensive therapy for decreasing pain and improving quality of life ; however , most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA Background Osteoarthritis ( OA ) is a degenerative disease that can lead to painful and dysfunctional joints . Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint . Intra-articular injections are controversial because of the introduction of needles into the articular capsule . Objectives To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA . Study design R and omized double-blind controlled clinical trial . Setting Single center , university hospital ( Imam Hossein Hospital , Tehran , Iran ) . Methods A total of 104 patients with chronic knee OA were enrolled . In the intra-articular group , 8 mL of 10 % dextrose and 2 mL of 2 % lidocaine were injected . Injections were repeated at 1 and 2 weeks after the first injection . In the periarticular group , 5 mL of 20 % dextrose and 5 mL of 1 % lidocaine were injected subcutaneously at 4 points in the periarticular area . Pain and disability , as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , were recorded at each follow-up visit at 1 , 2 , 3 , 4 , and 5 months post-injection . Results The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2- , 3- , 4- , and 5-month visits but not at 1 month . Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups . Pain , joint locking , and limitation scores were all improved in both groups . Difficulty in walking on flat surfaces or climbing stairs , and sitting and st and ing pain , were all improved in both groups from 1 to 5 months after treatment . Limitations WOMAC scores are subjective and could be a limitation of the study . Conclusion Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections , while avoiding risks of complications Background Osteoarthritis ( OA ) is the most common degenerative arthropathy . Load-bearing joints such as knee and hip are more often affected than spine or h and s. The prevalence of gonarthrosis is generally higher than that of coxarthrosis . Because no cure for OA exists , the main emphasis of therapy is analgesic treatment through either mobility or medication . Non-pharmacologic treatment is the first step , followed by the addition of analgesic medication , and ultimately by surgery . The goal of non-pharmacologic and non-invasive therapy is to improve neuromuscular function , which in turn both prevents formation of and delays progression of OA . A modification of conventional physiotherapy , whole body vibration has been successfully employed for several years . Since its introduction , this therapy is in wide use at our facility not only for gonarthrosis , but also coxarthrosis and other diseases leading to muscular imbalance . Methods / Design This study is a r and omized , therapy-controlled trial in a primary care setting at a university hospital . Patients presenting to our outpatient clinic with initial symptoms of gonarthrosis will be assessed against inclusion and exclusion criteria . After patient consent , 6 weeks of treatment will ensue . During the six weeks of treatment , patients will receive one of two treatments , conventional physiotherapy or whole-body-vibration exercises of one hour three times a week . Follow-up examinations will be performed immediately after treatment and after another 6 and 20 weeks , for a total study duration of 6 months . 20 patients will be included in each therapy group . Outcome measurements will include objective analysis of motion and ambulation as well as examinations of balance and isokinetic force . The Western Ontario and McMaster Universities Arthritis Index and SF-12 scores , the patients ' overall status , and clinical examinations of the affected joint will be carried out . Discussion As new physiotherapy techniques develop for the treatment of OA , it is important to investigate the effectiveness of competing strategies . With this study , not only patient-based scores , but also objective assessment s will be used to quantify patient-derived benefits of therapy . Trial registration Deutsches Register Klinischer Studien ( DRKS ) DRKS00000415 Clinical trials.gov NCT01037972EudraCT 2009 - 017617 - Purpose Osteoarthritis ( OA ) is a progressive , chronic and degenerative joint disease characterized by a loss of articular cartilage . Treatment of OA is largely palliative based on nonsteroidal anti-inflammatory drugs , opioids and injections of steroids . Regarding conservative treatment , intra-articular injections of hyaluronic acid ( HA ) can play a role in early symptomatic knee OA . Material s and methods Between August 2015 and September 2015 , sixty patients ( 32 males and 28 females ) between 40 and 70 years old were r and omly allocated into two groups : Half were treated with three weekly intra-articular injections of hyaluronic acid 1.6 % ( group A ) , while the others were treated with Syalox 300 Plus ® ( hyaluronic acid 300 mg + Boswellia serrata extract 100 mg ) 1 tab/die for 20 days and afterward Syalox 150 ® ( hyaluronic acid 150 mg ) 1 tab/die for other 20 days ( group B ) . All patients were evaluated clinical ly with American Knee Society Score ( AKSS ) and visual analogue scale ( VAS ) for the pain before the treatment and after 3 months . Results AKSS of the patients in both groups was significantly increased by the treatment , and VAS score was significantly reduced . In both groups , two subgroups were created with patients older than 60 years and patients younger than 60 years . Better results are reported in younger patients of group A and older subjects in group B. Conclusions Despite several limitations , the results of the study have shown that HA injection and oral administration may have beneficial therapeutic effects on patients with early osteoarthritis . Different outcomes in younger and older subject suggested a combined therapy first with local infiltrations and then with oral composition Objective To investigate the effect of glucosamine sulfate on long-term symptoms and structure progression in postmenopausal women with knee osteoarthritis ( OA ) . Design This study consisted of a preplanned combination of two three-year , r and omized , placebo-controlled , prospect i ve , independent studies evaluating the effect of glucosamine sulfate on symptoms and structure modification in OA and post-hoc analysis of the results obtained in postmenopausal women with knee OA .  Minimal joint space width was assessed at baseline and after 3 years from st and ing anteroposterior knee radiographs . Symptoms were scored by the algo-functional WOMAC index at baseline and after 3 years . All primary statistical analyses were performed in intention-to-treat , comparing joint space width and WOMAC changes between groups by ANOVA . Results Of 414 participants r and omized in the two studies , 319 were postmenopausal women . At baseline , glucosamine sulfate and placebo groups were comparable for demographic and disease characteristics , both in the general population and in the postmenopausal women subset . After 3 years , postmenopausal participants in the glucosamine sulfate group showed no joint space narrowing [ joint space change of + 0.003 mm ( 95 % CI , −0.09 to 0.11 ) ] , whereas participants in the placebo group experienced a narrowing of −0.33 mm ( 95 % CI , −0.44 to −0.22 ; P < 0.0001 between the two groups ) . Percent changes after 3 years in the WOMAC index showed an improvement in the glucosamine sulfate group [ −14.1 % ( 95 % , −22.2 to −5.9 ) ] and a trend for worsening in the placebo group ( 5.4 % ( 95 % CI , −4.9 to 15.7 ) ( P = 0.003 between the two groups ) . Conclusion This analysis , focusing on a large cohort of postmenopausal women , demonstrated for the first time that a pharmacological intervention for OA has a disease-modifying effect in this particular population , the most frequently affected by knee OA Osteoarthritis ( OA ) is one of the leading musculoskeletal disorders in the adult population . It is associated with cartilage damage triggered by the deterioration of the extracellular matrix tissue . The present study explores the effect of intra-articular injection of autologous microfragmented adipose tissue to host chondrocytes and cartilage proteoglycans in patients with knee OA . A prospect i ve , non-r and omized , interventional , single-center , open-label clinical trial was conducted from January 2016 to April 2017 . A total of 17 patients were enrolled in the study , and 32 knees with osteoarthritis were assessed .  Surgical intervention ( lipoaspiration ) followed by tissue processing and intra-articular injection of the final microfragmented adipose tissue product into the affected knee(s ) was performed in all patients . Patients were assessed for visual analogue scale ( VAS ) , delayed gadolinium-enhanced magnetic resonance imaging of cartilage ( dGEMRIC ) and immunoglobulin G ( IgG ) glycans at the baseline , three , six and 12 months after the treatment . Magnetic resonance sequence in dGEMRIC due to infiltration of the anionic , negatively charged contrast gadopentetate dimeglumine ( Gd-DTPA2− ) into the cartilage indicated that the contents of cartilage glycosaminoglycans significantly increased in specific areas of the treated knee joint . In addition , dGEMRIC consequently reflected subsequent changes in the mechanical axis of the lower extremities . The results of our study indicate that the use of autologous and microfragmented adipose tissue in patients with knee OA ( measured by dGEMRIC MRI ) increased glycosaminoglycan ( GAG ) content in hyaline cartilage , which is in line with observed VAS and clinical results
Among all the studies , the most relevant indexes used to measure effectiveness of spa therapy were improved including VAS , Lequesne , and WOMAC Score .
Conclusions The mud-pack therapy , balneotherapy , mud-bath therapy , and spa therapy have proved to be effective in the treatment and in the secondary prevention of knee osteoarthritis , by reducing pain , nonsteroidal anti-inflammatory drug consumption , and functional limitation and improving quality of life of affected patients
Background Osteoarthritis ( OA ) is the most common musculoskeletal disease in the world .
OA is the result of an inflammatory and degenerative process affecting the entire joint .
Osteoarthritis , especially involving the knee , has a relevant socioeconomic impact in terms of drugs , hospital admissions , work absences , and temporary or permanent invalidity .
Therapy of knee osteoarthritis is based on pharmacological and nonpharmacological measures .