Orientador: Ibsen Bellini Coimbra / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T17:23:25Z (GMT). No. of bitstreams: 1 Barcelos_CarolineCoutinhode_D.pdf: 1979405 bytes, checksum: cec79f3f27610781d0bff4ab161fc971 (MD5) Previous issue date: 2014 / Resumo: A osteoartrite (OA) é a enfermidade articular mais prevalente entre os idosos e pode causar incapacidades. Representa importante causa de morbidade, alto custo para o paciente e para a sociedade, além de afetar significativamente a qualidade de vida relacionada à saúde. O objetivo deste projeto foi estimar a influência da osteoartrite (OA) de joelhos no equilíbrio e a composição corporal do idoso. A amostra foi constituída por 94 idosas (188 joelhos) acima de 60 anos. As idosas foram submetidas a uma entrevista, radiografia de ambos os joelhos, densitometria corporal, avaliação do equilíbrio através de uma plataforma de força AMTI e antropometria; a dor no joelho foi graduada de 0 (sem dor) à 10 (dor máxima) através da Escala Visual Analógica e a caracterização da síndrome metabólica foi obtida por meio de auto relato das comorbidades. A análise dos resultados foi realizada por meio da ANOVA, regressão logística univariada e multivariada, Tukey e correlação linear de Spearman, tendo o nível de significância estabelecido em 5% (p<0,05), com 95% de intervalo de confiança. Em relação à presença ou ausência de OA no joelho as variáveis sobrepeso, obesidade (p=0,025) e dor (p<0,001) apresentaram influência estatisticamente significante; o mesmo ocorreu em relação à massa muscular e massa gordurosa (p=0,002) e OA. Durante os ensaios sobre a plataforma, a presença ou ausência de OA nos joelhos não apresentaram diferença estatística em relação ao equilíbrio estático. Quando houve manipulação da informação visual, as idosas apresentaram significância estatística para a maioria das variáveis (p=0,0007). As idosas caracterizadas com síndrome metabólica por auto relato tiveram pior desempenho nos teste de equilíbrio dinâmico. A maior massa gorda nos membros inferiores apresentou prevalência sobre a ocorrência de OA de joelhos bem como à sua gravidade; a OA, isoladamente, não interferiu no equilíbrio estático das idosas; apesar da dor ser um fator limitante, ela não interferiu nos testes / Abstract: Osteoarthritis (OA), the most prevalent joint disorder causing disability in the elderly, represents an important cause of morbidity and significantly affects quality of life, leading to high costs for both patients and society. This work aimed to identify the influence of OA in the knees in balance and body composition in elderly. The sample comprised 94 elderly individuals (188 knees; all women) over 60 years of age. The subjects were interviewed and underwent PA radiography of both knees, total body densitometry, balance assessment using an AMTI force platform and anthropometry; knee pain was graded using a visual analogue scale and characterization of the metabolic syndrome was obtained through self-report of comorbidities. Statistical analysis of the results was performed using ANOVA, univariate and multivariate regression analyses, Tukey¿s test and Spearman¿s linear correlation coefficient, with a 5% significance level (p <0.05) and 95% confidence interval (CI). Overweight, obese (p = 0.025) and pain (p <0.001) variables, as well as muscle mass and fat mass (p = 0.002), showed a statistically significant influence on the presence or absence of knee OA. During platform tests, the presence or absence of knee OA showed no statistical association with static balance. When there was manipulation of visual information, elderly subjects demonstrated statistical significance for most variables (p= 0.0007). Elderly with metabolic syndrome characterized by self-report had worse performance in dynamic balance test. The results indicated that increased fat mass in the lower limbs was associated with the prevalence and severity of knee OA. OA alone did not affect the static equilibrium of elderly subjects, and although pain was a limiting factor, it did not interfere with the testing / Doutorado / Clinica Medica / Doutora em Clínica Médica

Orientador: João Batista de Miranda / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:46:17Z (GMT). No. of bitstreams: 1 Muszkat_Carlos_M.pdf: 807816 bytes, checksum: df5b34a3b17698df3a8b73ff4b02643f (MD5) Previous issue date: 2011 / Resumo: Objetivos: Avaliar a altura da patela e a função do joelho, pós-osteotomia medial e valgizante, supra tuberositária da tíbia (OMV-ST). Métodos: Vinte e cinco pacientes portadores de osteoartrite (OA) medial do joelho e instabilidade ligamentar, associados à deformidade em varo, foram submetidos à correção da deformidade, por meio de osteotomia medial e valgizante, de cunha aberta, supra tuberositária da tíbia. Estes pacientes e seus dados radiológicos foram avaliados pré e pós-operatoriamente, sendo medido a altura da patela e a função do joelho. Para estas medidas foram utilizados os Índices de Insall-Salvati(IIS), Caton-Deschamps(ICD) e o Knee Score(KS). Resultados: Pré-operatoriamente, a média das medidas da altura patelar, determinado pelo método de Insall-Salvati, resultou em 0,88+/-0,17. Após a cirurgia foi de 0,92+/-0,20, sem diferença estatística (p=0,186). Pelo método de Caton-Deschamps, a média da altura da patela antes da cirurgia foi de 0,64+/-0,14. Após a cirurgia houve uma redução significativa da altura da patela, com média de 0,53+/-0,11(p=0,0004). A média dos valores do Knee Score variou de 48,25+/-15,15 a 72,08+/- 16,87(p<0,001), aumento estatístico significativo após a cirurgia. Conclusão: Concluiu-se que após a osteotomia medial e valgizante, de cunha aberta, supra tuberositária da tíbia, o Índice de Caton-Deschamps indicou a ocorrência de patela baixa. O mesmo não ocorreu quando foi utilizado o Índice de Insall-Salvati. Houve melhora da função do joelho, segundo o Knee Score / Abstract: Objective: To measure patella height and knee function after medial opening-wedge high tibial osteotomy (MOW-HTO). Methods: MOW-HTO was carried out on 25 patients with osteoarthritis, or deficient knee ligament, associated with varus deformity. The patella height was measured before and after MOW-HTO with the Caton-Deschamps and Insall-Salvati Indices. The Knee Score was used to evaluate Knee Function. Results: Before surgery the average patella height using the Caton-Deschamps Index was 0.64+/-0.14. After surgery there was a significant reduction of patella height with an average of 0.53+/-0.11(p=0,0004). Using the Insall-Salvati Index the average pre-operation patella height was 0.88+/-0.17 and post-operatively 0.92+/-0.20 without any statistical significance(p=0.186). The average pre-operative Knee Score was 48.25+/-15,15 and 72,08+/-16,87 post-operative with a statistically significant improvement (p<0,001). Conclusion: After MOW-HTO there was patella baja when the Caton-Deschamps Index was used to measure height but the same did not occur when the Insall-Salvati Index was used. There was an improvement in Knee Function according to the Knee Score / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

M.Tech. / Osteoarthritis (OA) is a common and severely disabling disease (I). Chiropractic mobilisation functions well to improve mobility, relieve pain and promote healing (2). Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for the treatment of OA. Their role in OA, however, is not clearly understood (3). Adverse side effects and the cost of NSAIDs also remain a problem (4). Seatone is a health supplement that has therapeutic properties that provides symptomatic relief of OA by means of its anti-inflammatory action (5,6). Seatone produces a slow, but progressive relief from pain and stiffness and improves quality of life (7' 8). The purpose of this study was to determine the effect of Seatone on the treatment of OA. This was achieved by comparing Chiropractic mobilisation (in preference to Chiropractic manipulation) in conjunction with oral administration of Seatone to Chiropractic mobilisation or oral administration of Seatone alone, by means of subjective and objective measurements. The study required forty-five subjects, above the age of thirty-eight years, suffering from OA of the knee joint, according to the classification criteria (Appendix A). The subjects were screened according to the exclusion and inclusion criteria and all the relevant forms, questionnaires and clinical examinations were completed. The subjects were randomly assigned to one of three treatment groups. Treatment was conducted over a period of eight weeks. Objective or goniometer readings and subjective measurements were done prior to and following treatment to determine the effect of the therapies. The subjective measurements were taken from the Numerical Rating Scale (NRS), the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire. The Cincinnati Knee Rating System, a comprehensive knee questionnaire, was completed at the initial and final consultation. A combined treatment of Chiropractic mobilisation and oral administration of Seatone or oral administration of Seatone alone showed a greater mean improvement than Chiropractic mobilisation alone, in mobility. There was no significant difference in the assessment of pain between the three groups. However, results show that Seatone has a positive effect in the treatment of OA of the knee, for improving mobility.

Osteoarthritis of the hip frequently occurs in the absence of osteoarthritis in other large joints, suggesting that local factors are important in its pathogenesis. Hip morphology has been recognised as a potential local biomechanical risk factor for the development of hip osteoarthritis. There are no adequate studies examining osteoarthritis development in the hip. Historical cohorts are either limited by a short follow up or by small numbers. This thesis explores the natural history of hip osteoarthritis in a large population cohort with particular attention to hip morphology as a predictor of osteoarthritis development. Software was developed which allows objective measurements of hip morphology in a reproducible manner. Hip morphology was then measured in a 1000 subject cohort. A detailed description of hip morphology is presented in this thesis, with interesting observations of wide variation and a bimodal distribution for alpha angle (a measure of cam-type femoroacetabular impingement). This is suggestive of a discrete pathological entity, which was associated with osteoarthritis in the cross-sectional analysis. No significant changes exist in terms of morphology during the course of the study and no significant relationship exists between age and hip morphology. Longitudinal analysis of hip morphology with radiographic osteoarthritis and total hip replacement revealed a significant association between cam-type femoroacetabular impingement and acetabular dysplasia with both outcome measures. Measurements of hip morphology were independently predictive of outcome when controlling for baseline age, BMI and joint space width, and significantly increased our ability to predict osteoarthritis and total hip replacement. Similar associations were seen when considering hip pain and symptomatic osteoarthritis as the outcome measures of interest. Pincer-type femoroacetabular impingement was not significantly associated with any of the outcome measures of interest and pain remains relatively poorly explained by both hip morphology and/or radiographic change. The understanding of hip morphology and its role in the natural history of osteoarthritis is significantly improved by this research. Further research is now required to determine whether these morphological abnormalities represent modifiable risk factors for osteoarthritis progression.

Abstract Collagen XI is a minor component of articular cartilage collagen fibrils together with collagen IX. They are in close functional relationship with the major cartilage collagen II. Collagen XI has been suggested to play a role in regulating the diameter of collagen II fibrils. Together these collagens form a supportive framework in the extracellular matrix. Besides articular cartilage, these three collagens can also be found in the vitreous body of the eye, the intervertebral disc, the inner ear and in various tissues during embryonic development. As the major cartilage collagen, collagen II has been studied quite extensively. Several syndromes ranging from lethal to milder ones have been shown to result from collagen II gene defects. Far less is known about defects in genes coding for the minor cartilage collagens, IX and XI. By identifying mutations in the coding genes and observing the resulting phenotypes, the function and importance of these genes start to unravel. The goal of this study was to provide more information about collagen XI. As a quantatively minor cartilage component, it is a good candidate for mild disease phenotypes. Collagen XI gene mutations have been shown to cause relatively mild phenotypes, such as Stickler and Marshall syndromes and non-syndromic hearing loss. Seven families with a recessive chondrodysplasia, otospondylomegaepiphyseal dysplasia (OSMED), were analysed for mutations in COL11A2. This study showed that OSMED is typically caused by the absence of the α2(XI) chains. Sixty-two patients with isolated Robin sequence, cleft palate or micrognathia were analysed for COL11A2 gene mutations. Six unique nucleotide changes were found that are likely to associate with the phenotype. The results showed that collagen XI gene defects can play a role in the etiology of oral clefting, but are not common causes of these phenotypes. Altogether 72 unrelated osteoarthrosis (OA) patients and one family with OA were analysed for mutations in genes coding for collagens II, IX and XI. Eighteen percent of them were found to have a unique sequence variation. An association analysis of OA patients failed to reveal any common predisposing alleles in these genes.

M.Tech. (Somatology) / Osteoarthritis (OA) is considered a degenerative form of arthritis that affects the smooth cartilage covering the ends of bone (Sharma, 2006; Flynn & Ohnson, 2007). It is currently estimated to be the leading cause of musculoskeletal disability and pain amongst those 65 years and older (McKay et al., 2012; Vuolteenaho et al., 2013). Disease progression is slow as smooth cartilage at the ends of bone is worn away causing painful bone on bone friction. Any joint may be affected, the hips, spine, knees, small bones of the fingers and the base of the thumbs are commonly affected. Massage therapy is an age old practice that may be dated back to the ancient Roman, Geek and Egyptian dynasties (Braun & Simonson, 2008). Massage once formed a significant part of mainstream medical and nursing occupations, forming the basis for present day physiotherapy. To this day, numerous occupations still incorporate various aspects of massage (Casanelia & Stelfox, 2010). Swedish massage or Remedial massage, as still used today, found its origins in the early 19th century during the “Swedish Movement Cure”. Henrik Ling coined the phrase “Swedish Massage” when he developed a series of movements that he used in the treatment of various conditions and ailments. Ling did however not intend for these movements to be done for extended and frequent periods of time, which is necessary when it is ones occupation, and by the conclusion of the 19th century it was found that therapists were already presenting with strain injuries (Prichard, 2007). Western massage has been adapted into numerous forms over the past 100 years. Pyves (2001) explains that the early techniques were not intended to be used for prolonged and frequent sessions. Such massage sessions, he feels, may be to the detriment of the therapist. Prichard (2007) explains that the massage therapist experiences physical problems that arise mostly from cumulative effects. Cumulative joint stress may be caused by the awkward, physically stressful and/ or repetitive movements whilst applying pressure. Individual injuries or strains may over months or years accumulate into an overuse injury (Prichard, 2007). Many other occupations have been identified as inducing a greater risk for the development of OA, such as the agricultural sector (Thelin et al., 2004), the housekeeping industry (Caspi et al., 2001; Rossignol et al., 2003 and Vingard et al., 1991), the construction industry (Dillon et al., 2002; O’Reilly et al., 2000 and Sandmark et al., 2000), the clothing industry (Rossignol et al., 2005) and the occupation of physiotherapy (Snodgrass & Rivett, 2002)...

Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: Osteoarthritis (OA) is one of the prevalent debilitating diseases in South Africa, often leading to activity limitations, participation restrictions and a poor quality of life. Older people often lead more sedentary lifestyles, which may further aggravate their symptoms. Exercise therapy has demonstrated good outcomes in the OA population. Many dance interventions have become popular in OA treatment and results suggest their effects to be more successful than traditional physiotherapy exercises regimes. Ballet dance exercises have not yet been explored in the treatment of OA, even though it has been proposed to have positive effects on the body. Purpose: to determine the effect of a program of ballet dance exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee, compared to the existing Midros Clinic program of exercise classes. Methods: The study used a randomized, cross-sectional, quantitative, experimental study using pre- and post-intervention as well as multiple time-point testing. A sample of 52 males and females were recruited in Midros, Middelburg Cape. The inclusion criteria of the study were persons aged 65 years and older, with OA of the hip and/or knee, clinically diagnosed according to the criteria of the American College of Rheumatology. The VAS, Timed Up and Go Test (TUGT), WOMAC and the SF-8 Index, respectively measured reported perceived pain, physical function, quality of life and health status in the study groups. BMI, pulse and blood pressure were also recorded to further monitor the effects of the interventions. A comparable number of scores were obtained over six weeks of bi-weekly ballet exercise classes (intervention group = IG), and nine weeks of two-weekly exercise classes at the Midros Clinic (comparison group = CG). Descriptive statistics were used to analyse the demographic information and inferential statistics were used to determine the associations for parametric data; a two tailed p-value was calculated; the 95% CI was calculated using the approximation of Katz. The p-value was classified as significant if p<0.05. Results: The demographics and baseline measurements of the IG and CG were comparable. A series of five exercise classes (over nine weeks) had a significantly beneficial effect on BMI and systolic BP, perceived and actual physical function, and QOL, whereas a series of 12 ballet exercise classes ( over six weeks) had a significant positive effect on BMI and diastolic BP, perceived pain, perceived physical function, and QOL. The comparison of responses to the outcome measures by male and female participants demonstrated that, contrary to findings in the reviewed literature, females held more positive perceptions than males on their perceived severity of joint pain and function, physical and mental health, and well being. A series of the existing exercise classes of Midros Clinic brought about more significant changes than a program of ballet exercise classes in the research parameters measured, despite exercise classes taking place much less frequently than the ballet classes. Conclusion: Although both interventions were found to both bring about positive changes in older persons with OA, a series of ballet exercises classes did not result in better outcomes than the currently existing Midros Clinic group exercise classes. The results of the current study demonstrate that exercise interventions are found to be the most beneficial in improving the quality of life of OA sufferers.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23379号 / 医博第4748号 / 新制||医||1052(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 戸口田 淳也, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Osteoarthritis is a progressive degenerative disease which affects the cartilage in articulating joints. The progression of osteoarthritis is known to be mechanically mediated, though specific mechanical factors have yet to be identified. In particular, the effects of frictional interactions and altered mechanical homeostasis remain unknown, and the inability to link specific mechanisms to disease advancement hinders the development of treatment strategies. The overarching objective of this dissertation is to study the mechanically-mediated fatigue failure process in articular cartilage through a validated computational model to ascertain the relative importance of mechanical factors, including surface friction and bulk cyclic stresses, on progression of osteoarthritis. Fatigue failure in cartilage progresses as a function of multiple mechanical and physicochemical interactions. Collagen fibrils are the primary constituents that fail under fatigue loading. As the collagen fails, homeostasis between osmotic pressure and collagen tension is disrupted and the cartilage imbibes water and swells, producing softening. This entire process occurs under frictional contact loading. From a modeling standpoint, several primary challenges arise: (1) Accounting for the osmotic swelling of cartilage, which has not been sufficiently characterized experimentally; (2) Developing finite element algorithms to handle frictional contact of charged multiphasic (solid-fluid-solute) materials such as cartilage; (3) Modeling fatigue mechanics with observable state variables representing measures of cartilage composition, such that imaging techniques may inform the theory; and (4) Formulating compatible plasticity theories to allow validation of the novel fatigue framework with the extensive literature on fatigue of metals. This dissertation addressed these challenges in pursuit of the overarching objective. Direct experimental measurements revealed the osmotic swelling pressure in cartilage does not obey ideal Donnan law, which significantly overestimates the measured pressure by approximately a factor of three. The aggregate modulus in triphasic theory was found to vary strongly with the external concentration, increasing three- to five-fold between hypertonic and hypotonic solutions. These results allow us to capture the interaction of swelling with damage. The fatigue process is coupled with swelling, and computer modeling must be performed in a multiphasic environment which accounts for flow of charged ions. To address this, a novel surface-to-surface finite element algorithm for frictional contact was developed, providing the capabilities of complex surface-smoothing algorithms while retaining the simplicity of node-to-segment methods. This powerful framework was adapted to model friction between porous-permeable tissues, resulting in the development, implementation, and validation of finite element algorithms for four different types (single-phase elastic, biphasic, biphasic-solute, and multiphasic) of frictional contact. For the latter three, our work represented the first algorithms of this type. These algorithms are applied to model cartilage friction. By using constrained reactive mixture theory, we developed a reactive plasticity framework that reduced to classical Prandtl-Reuss plasticity theory in the limit of infinitesimal deformation, using only scalar state variables representing composition measures. Applying this reaction kinetics-based approach to model fatigue mechanics provided a valid theoretical framework for treating evolving damage, where measures of the mass composition of cartilage served as observable state variables. By incorporating reactive plasticity, our reactive fatigue theory was thoroughly validated against experimental data from metals and biological tissues, including human tendon and human cartilage. These modeling efforts were then synthesized to develop a fully validated computational model of fatigue failure in articular cartilage. For the first time, the role of frictional interactions on the progression of fatigue in articular cartilage was quantified. Results demonstrate that friction has an effect, but it is relatively small compared to the magnitude of the damage which takes place due to contact loads raising the magnitude of stresses in the collagen matrix. The implication of this result is that fatigue accumulation in cartilage is more sensitive to contact loading rather than surface interactions such as friction. This key finding may have clinical implications regarding treatment strategies for early-stage osteoarthritis. This dissertation has generated a novel suite of theoretical and computational tools which have facilitated the development of a fully validated computational model of fatigue failure in articular cartilage. Replicating previous experimental fatigue studies with the model has confirmed that bulk matrix stresses are responsible for the majority of fatigue-induced damage, and that friction plays a relatively minor role. Future work will apply these computational models to further analyze fatigue failure in fibrous biological tissues and study experimentally-generated hypotheses.

Im Rahmen neuer Therapieansätze der Arthrose versucht man mittels Tissue Engineering transplantationsfähige, hochwertige Knorpelkonstrukte zu züchten. Dabei kommen häufig auch expandierte und redifferenzierte zonenspezifische Chondrozyten-Subpopulationen zum Einsatz. Wenige Studien beschäftigten sich bisher mit dem Redifferenzierungspotential dieser Zellen und dem Effekt einer zonalen Schichtung unter verschiedenen Kulturbedingungen. In dieser Arbeit konnten Ähnlichkeiten im Phänotyp sowie der Chondrogenese der redifferenzierten Zellen zu den jeweiligen Subpopulationen in nativem Knorpel nachgewiesen werden. Sowohl die zonale Schichtung als auch Veränderungen im Studienprotokoll zeigten sich als entscheidende Einflussfaktoren auf das Zellverhalten. Die Frage nach den optimalen Kulturbedingungen stellt die Forschung jedoch weiterhin vor eine große Herausforderung. / In the context of new therapeutic approaches for osteoarthritis, attempts are being made to design high-quality cartilage constructs suitable for transplantation by means of tissue engineering. The use of expanded and redifferentiated zone-specific chondrocyte subpopulations is widely reported. Few studies previously addressed the redifferentiation potential of these cells and the effect of mimicking zonal organization under different culture conditions. In this work, similarities in phenotype as well as chondrogenesis of the redifferentiated cells to the respective subpopulations in native cartilage were demonstrated. Both zonal organization and changes in the study protocol were shown to be crucial factors influencing cell behavior. However, the question of optimal culture conditions remains a major challenge for current research.