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La osteoartritis (OA) es considerada como la enfermedad articular degenerativa más frecuente en la población adulta, siendo una causa importante de discapacidad a nivel mundial, y su prevalencia va en aumento asociada a diferentes factores entre ellos la obesidad. La obesidad junto con el síndrome metabólico se han asociado con un estado pro inflamatorio debido a la liberación de citocinas que inducen cambios en el metabolismo del cartílago. La quemerina es una adipocina secretada principalmente por adipocitos, y tiene como acción final, el aumento de la producción de IL-6, IL-8, IL-1b, TNF-a y metaloproteinasas por parte de macrófagos, células dendríticas y condrocitos, las cuales son encargadas del daño del cartílago articular. Esta es una de las razones por la que se ha relacionado la obesidad y la inflamación con la OA. El objetivo principal de este estudio consiste en determinar si las concentraciones de quemerina en suero de un grupo de pacientes con OA primaria son mayores al compararlos con individuos controles sanos; y adicionalmente determinar la relación entre la presencia de obesidad/sobrepeso con la severidad de la enfermedad medida por una escala radiológica. Se realizó un estudio de corte transversal analítico donde se cuantificaron los niveles de quemerina en suero mediante ensayo por inmunoadsorción ligado a enzimas (ELISA), en pacientes con OA primaria de cadera, rodilla y mano con criterios del American College Of Reumathology (ACR) y controles sanos. Se analizaron los estudios radiológicos de los pacientes y controles para determinar la severidad del compromiso articular aplicando el sistema de clasificación de Kellgren y Lawrence (KL). Se verificó la significación estadística de la diferencia de los valores de quemerina sérica entre los dos grupos y se analizó la correlación entre las variables de índice de masa corporal (IMC) con severidad radiológica, número de regiones articulares y niveles de quemerina sérica. Durante el período de julio de 2015 a julio de 2016 fueron recolectadas muestras de suero y radiografías de las articulaciones comprometidas de 40 pacientes con OA primaria que cumplieron los criterios de inclusión, así como muestras de suero de 20 controles sanos. La concentración promedio de quemerina fue más alta en el grupo de pacientes con OA comparado con el con el grupo control, siendo de 373 ng/ml y 175,55 ng/ml respectivamente (p < 2,2 × 10−16). No se encontraron asociaciones significativas entre los diferentes grados severidad de la enfermedad medida por escala radiológica KL como con el número de regiones articulares comprometidas y el IMC. En un grupo de pacientes con OA primaria de mano, rodilla o cadera, los valores de quemerina fueron superiores a los encontrados en los controles sanos, sin asociación significativa con la severidad de la enfermedad establecida radiológicamente por escala K/L, el número de regiones articulares comprometidas y el IMC. Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-α and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale. An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the American College Of Rheumatology (ACR) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed. During the period from July 2015 to July 2016, serum samples and radiographs of compromised joints were collected from 40 patients with primary OA who met the inclusion criteria, as well as serum samples from 20 controls. The average concentration of chemerin was higher in the group of patients with OA compared to that of the control group, being 373 ng / ml and 175.55 ng / ml respectively (p<2.2×10−16). No significant associations were found between the different degrees of disease severity measured by the KL radiological scale, such as the number of involved joint regions and BMI. In a group of patients with primary OA of the hand, knee or hip, the values of chemerin were higher than those found in controls, without significant association with the severity of the disease established radiologically by K/L scale, the number of involved joint regions, and the BMI. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most prevalent articular disease worldwide, and its prevalence is highly variable depending on the classification criteria, population studied, and/or affected joints considered. Reporting epidemiologic data about clinical and radiological OA prevalence in Mexico has not been done before. A descriptive cross-sectional study was carried out with participants of Mexico City, and included both men and women above 40 years of age. All participants were evaluated with radiological and clinical criteria for OA. Two hundred and four individuals participated in the study: 80 men (39.2%) and 124 women (60.8%). The average age was 57.4 ± 10.9 years. Using clinical criteria alone, 36 participants were found to have hand OA (17.6%; 95% CI, 13–23.4), 37 with hip OA (18.1%; 95% CI 13.4–24), and 40 with knee OA (19.6%; 95% CI 14.7–25.6). When radiological criteria were used, 51 individuals were reported as having hand OA (25%; 95% CI 19.5–31), 54 with hip OA (26.5%; 95% CI 20.8–32.9), and 52 with knee OA (25.5%; 95% CI 20–31.8). When clinical criteria were used and then corroborated with radiological criteria, the prevalence was 28 individuals with hand OA (13.7%; 95% CI 9.6–19), 31 with hip OA (15.1%; 95% CI 10.9–20.7), and 36 with knee OA 36 (17.6%; 95% CI 12.2–26.2). The prevalences found in this study are greater than those found in other studies in Mexico that only report clinical criteria. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the implementability of the “2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care” within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Methods: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Results: Reviewers’ agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients’ beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. Conclusions: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers. [ABSTRACT FROM AUTHOR]

Background: The burden of knee osteoarthritis (OA) in Latin America is unknown. Objective: To determine the demographic, clinical, and therapeutic characteristics of patients with OA in Argentina, Brazil, and Mexico. Material and methods: This is an observational, cross-sectional study of patients with symptomatic knee OA referred from first care medical centers to Rheumatology departments. Results: We included 1210 patients (Argentina 398, Brazil 402, Mexico 410; mean age 61.8 [12] years; 80.8% females). Knee OA pain lasted for 69 months; the duration and severity of the last episode were 190 days and (SD 5.2 [3.3]; 74% had functional limitations, but very few patients lost their job because of knee OA. Around 71% had taken medications, but 63% relied on their own pocket to afford knee OA cost. Most demographic and clinical variables differed across countries, particularly the level of pain, disability, treatment, and access to care. The variable country of origin influenced the level of pain, disability, and NSAIDs use in logistic regression models; age, pain, treatment, and health care access influenced at least 2 of the models. Conclusions: The burden of knee OA in Latin American depends on demographic, clinical, and therapeutic variables. The role of such variables differs across countries. The level of certain variables is significantly influenced by country of origin and health care system. [ABSTRACT FROM AUTHOR]

Objectives: In the year 2006 the Hospital Complex of Jaén began a new model of attention for consultation of knee osteoarthritis (CMAR), to offer quality treatment to the patient based on clinical practice guidelines. The objective of this study was to analyze the efficiency of the unit, in terms of delaying the time until a knee prostheses is needed. Patients and methods: An analysis of a retrospective cohort of patients seen at the CMAR was made, with a minimum available data set, and a Kaplan-Meier analysis carried out in order to evaluate the time until the referral of the patient to surgery, as well as a Cox regression analysis in order to study the factors related with the time until the referral. Results: 224 patients were included, with mean age of 65.7 years (95% CI 64-67), 67.9% women. 48.2% had a stage III affection (Kellgren-Lawrence), 27.5% stage 2, 15.3% stage 4, and 9% stage 1. 90.2% (202) received treatment with viscosupplementation (Hialuronic acid NASHA). Single joint affection (P<.0001; OR 0.267,95% CI 0.130-0.549), a higher degree of osteoarthritis (P=.048; OR 0.410,95% CI 0.169-0.992), and lower intensity of pain (P<.0001; OR 1.091,95% CI 1.044-1.141) were the factors related with shorter time until surgery. Treatment with viscosupplementation increased the time until surgery in all patients. Conclusions: Factors like a lower age of the patient and the involvement of a single joint influenced the referral of the patient to surgery. The administration of viscosupplementation delayed the time until the patient was finally referred to surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the annual number and trend of prostheses implanted in patients with rheumatoid arthritis (RA) at our hospital during the past decade. Materials and methods: Retrospective observational study. Patients were collected through an extensive search of the database of the Clinical Documentation Service between 1998 and 2007. The data was extracted from medical records using a predesigned questionnaire. Statistical analysis of longitudinal prostheses was made by Cochrane's Q test and the Kaplan-Meier method. Results: Sixty-one RA patients were operated on with 78 prostheses as a direct result of their disease at our hospital between 1998 and 2007. Most were women (80%) with positive rheumatoid factor (84%). The mean age was 58 years, and the average time since onset of RA was 13 years. All hut one had previously received antirheumatic drugs (88% methotrexate), hut only 11% had biological therapy. No changes were observed in the number of arthroplasties as a whole over a decade, although there was a trend towards reduction in the number of patients that required a knee replacement for the first time (Cochrane Q, P = o.o5). Conclusion: We observed no significant changes in trends in the number of new joint replacement procedures as a whole in the past decade at our hospital, although the number of patients that required knee replacement for the first time as a direct result of their underlying disease seems to have declined in the last decade. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of joint lavage in patients with osteoarthritis of the knee. Design: We conducted an open prospective study involving 111 patients of whom 77% were females, The patients' age range was 43-81 years and the average age 64±8.7 years, All patients had gonarthrosis as diagnosed according to the (ACR) American College of Rheumatology criteria (Kellgren radiographic grades II and III). Patients were randomly distributed between two treatment groups: a) Joint lavage without nonsteroidal anti-inflammatory drugs (NAIL n = 57). and b) non-steroidal anti-inflammatory drugs alone (NSAIDs. n = 54). Evaluations were done at baseline and one, three, and six months after enrollment. Clinical and demographic variables, and WOMAC index scores, were recorded and patient improvement was determined by following the OARSI guidelines. Statistical analyses included chi-square, analysis of covariance (baseline WOMAC) with one between-subject factor (treatment). Post-hoe comparisons were made with Sidak's adjustment. Results: The respective improvement rates as measured by the OARSI index for the patients in the JL and NSAIDs groups were 50.9 and 31.5% at 1 month: 55.4 and 38.9% at three months; and 63.2 and 64.8% at six months. The patients in both groups were seen to improve from the first month (P = .038). At the end of the six-month follow-up period, the WOMAC score had decreased significantly in both groups (P = .000), with no significant differences between them. [ABSTRACT FROM AUTHOR]

We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though arthroscopic techniques are only useful for a specific group of patients and that the procedure does not modify disease's natural history, it is an accessible therapeutic option. [ABSTRACT FROM AUTHOR]

Background and Purpose: Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-a and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale., Patients and Methods: An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the ACR (American College Of Rheumatology) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed., Results: During the period from July 2015 to July 2016, serum samples and radiographs of compromised joints were collected from 40 patients with primary OA who met the inclusion criteria, as well as serum samples from 20 controls. The average concentration of chemerin was higher in the group of patients with OA compared to that of the control group, being 373ng / ml and 175.55ng / ml respectively (p<2.2×10-16). No significant associations were found between the different degrees of disease severity measured by the KL radiological scale, such as the number of involved joint regions and BMI., Conclusions: In a group of patients with primary OA of the hand, knee or hip, the values of chemerin were higher than those found in controls, without significant association with the severity of the disease established radiologically by K/L scale, the number of involved joint regions, and the BMI., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

The article presents the case of a patient who after her first pregnacy, during the immediate postpartum period, suffered a femoral supracondylar fracture complicated by bone marrow edema syndrome (BMES), also known as regional temporary osteoporosis (RTO). The fracture of the distal femur was treated with an open reduction and internal fixation of the distal femur by means of a minimally invasive procedure. [ABSTRACT FROM AUTHOR]

Introduction: In patients with rheumatoid arthritis (RA), knee pain can be inflammatory, mechanical or extraarticular. The physical examination (PE) doesn't always detect the presence of knee joint effusion or Baker's cyst (BC) in the knees of these patients. Objective: To determine the diagnostic accuracy of PE in the diagnosis of effusion and BC in patients with RA evaluated with musculoskeletal ultrasound (MSUS), using this technique as the gold standard for comparison. Material and method: Three different models of ultrasound machines with a 7.5 MHz linear probe were used (Toshiba Tosbee, Toshiba Capasee and Siemens Sonoline). A rheumatologist evaluated the presence or absence of knee joint effusion or BC in patients. We registered age, gender, time of evolution of RA, rheumatoid factor, treatment, functional class of RA (FCRA) and previous clinical diagnosis to the MSUS study. Results: 40 patients (80 knees) with RA were evaluated. Eighty percent were women, mean age 61.3 ± 15 years. Time since onset of RA was 9.5 ± l 1.3 years, rheumatoid factor was positive in 80%, FCRA I (3 patients), FCRA II (27), FCRA III (8), FCRA IV (2). Fifty five percent of the patients received methotrexate. Patients reffered pain in 26 knees (32.5%). Joint effusion was reported by the clinician in 35 knees (43.7%) and corroborated by MSUS in 31 knees (38.75%), BC was reported by the clinician in 12 knees (15%) and corroborated by MSUS in 6 knees (7.5%). The sensitivity of the PE for detection of joint effusion was 0.63 and specificity of 0.87, for the detection of BC was 0.43 and 0.91, respectively. Conclusions: The PE showed acceptable diagnostic accuracy for the clinician. The complementary use of the MSUS can change the therapeutic and diagnostic approach in patients with RA. [ABSTRACT FROM AUTHOR]

Background and Purpose: Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-α and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale., Patients and Methods: An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the American College Of Rheumatology (ACR) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed., Results: During the period from July 2015 to July 2016, serum samples and radiographs of compromised joints were collected from 40 patients with primary OA who met the inclusion criteria, as well as serum samples from 20 controls. The average concentration of chemerin was higher in the group of patients with OA compared to that of the control group, being 373 ng / ml and 175.55 ng / ml respectively (p<2.2×10 -16 ). No significant associations were found between the different degrees of disease severity measured by the KL radiological scale, such as the number of involved joint regions and BMI., Conclusions: In a group of patients with primary OA of the hand, knee or hip, the values of chemerin were higher than those found in controls, without significant association with the severity of the disease established radiologically by K/L scale, the number of involved joint regions, and the BMI., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)