Objective: To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. Methods: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. Results: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p?=?0.042) and 0.34 (p?=?0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. Conclusion: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.

No abstract

No abstract

Introduction: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease which often found in daily practice and requires certain considerations in recognizing clinical appearance also managing the disease as it often causes permanent joint damage, disability, even premature death. This recommendation is expected to become the latest reference for diagnosis and management of RA in Indonesia. Methods: The steering committee was formed by the Indonesian Rheumatology Association (IRA) to formulate key questions; conduct literature search, selection, and review; then formulate recommendation statements for diagnosis, therapy, and monitoring of RA. Furthermore, the steering committee determined the level of evidence and grades of the recommendations. After that, the level of agreement (LOA) was determined for each item by panelists including rheumatology consultants who have been appointed by IRA to represent Indonesia regions. Results: The steering committee established 30 recommendations including diagnosis, the role of laboratory and radiology tests, general treatment, the use of glucocorticoids, sDMARD, bDMARD, and tsDMARD. This recommendation also discusses guidelines on monotherapy, combination therapy, treatment strategies (treat-to-target), tapering, and continuous clinical remission. Treatment on co-morbidities and complications are also included in brief. Conclusion: IRA recommendations regarding the diagnosis and management of RA was made by considering various aspects such as the availability of drugs and supporting facilities, socioeconomic and cultural conditions in Indonesia, as well as the latest research that can be applied to Indonesian population.

AbstractIntroduction. Central obesity is characterized by the accumulation of abdominal fat which may lead to several diseases including insulin resistance. The prevalence of central obesity is higher in male and the incidence in young adult males is increased. Central obesity is also related to low testosterone levels. The research aimed to assess the relationship between the testosterone levels and insulin resistance of young adult males with central obesity.Methods. This was a cross-sectional study, the subjects were young adult males of 18 to 25 years old. The central obesity consisted of 50 samples and non-central obesity comprised 70 samples. The examination of testosterone and insulin was performed by the ECLIA method, glucose used the enzymatic method, the insulin resistance was calculated by using the HOMA-IR index.Results. The mean of the testosterone level in central obesity was lower than non-central obesity (5.24 + 1.17 vs 7.18 + 1.54 ng/mL, p < 0.001). HOMA-IR index in central obesity was higher than non-central obesity (4.29 + 2.23 vs 2.46 + 1.72, p < 0.001). Testosterone levels had negative correlation with HOMA-IR (r = –0.470, p < 0.001). There was significant difference in HOMA-IR among the quartiles of testosterone levels.Conclusion. There is negative correlation between testosterone level with HOMA-IR, the lower the testosterone level the higher the insulin resistance in young adult males.

Case series Patients: Male, 66-year-old • Male, 65-year-old Final Diagnosis: Frozen shoulder Symptoms: Limited range of motion of shoulder • pain radiating into the neck and elbows • shoulder pain Medication: — Clinical Procedure: Injection of prolotherapy • physical therapy Specialty: Rehabilitation Objective: Unknown etiology Background: Frozen shoulder (FS) is a common conditions that causes significant morbidity. It is characterized by restriction of both active and passive shoulder motion (ROM) of the glenohumeral joint. The etiology, pathology, and most efficacious treatments are unclear. The purpose of FS treatment is complete elimination of pain and recovery of shoulder joint function. Prolotherapy injects certain compounds into articular spaces, ligaments, and/or ten-dons to relieve pain and disability around joint spaces and to stimulate a proliferation cascade to enhance tissue repair and strength. This case report aims to describe functional outcome changes in 2 patients with FS, comparing prolotherapy combined with physical therapy vs physical therapy only. Case Reports: We report the cases of 2 patients with confirmed FS. Patient A was 66-year-old man with chief concern of right shoulder pain and limited ROM in the past 3 months, which disrupted daily life, with a visual analog scale (VAS) of 6 out of 10. Patient B was 65-year-old man with chief concern of right shoulder pain and limited ROM in the past 2 months. The symptoms affected his general quality of life, with a VAS of 5 out of 10. Patient A underwent prolotherapy combined with physical therapy and had significantly improved ROM after 2 weeks, with relieved pain and improved shoulder function. Patient B underwent physical therapy only and showed similar ROM and no significant pain improvement. Conclusions: Initial treatment with prolotherapy combined with physical therapy for patients with frozen shoulder achieved fast improvement of active and passive ROM, significantly decreased pain, and improved quality of life compared to physical therapy intervention only.

BACKGROUND<br />High-sensitivity C-reactive protein (hsCRP) has been widely accepted as a predictor of future cardiovascular risk that reflects a microinflammatory state. Obesity linked to microinflammation increases the prevalence of metabolic disorders and cardiovascular diseases. This study aimed to determine the association between several obesity indices namely body mass index (BMI), waist circumference (WC), body fat percentage (fat), and visceral fat (VF) with hsCRP in non-diabetic adults. <br /><br />METHODS<br />This was a cross-sectional study performed on 80 non-diabetic adults with ages ranging from 20-40 years. The obesity indices BMI, WC, body fat percentage, and VF were measured. We then measured the hsCRP levels using an immunoturbidimetric method. Simple and multiple linear regression tests were used to analyze the association between obesity indices and hsCRP levels. <br /><br />RESULTS<br />Mean of log BMI, log WC, and log VF was 1.41 ± 0.08 kg/m2, 1.93 ± 0.06 cm, and 0.95 ± 0.27 units, respectively. Simple linear regression tests showed that log BMI (â=3.506; p&lt;0.001), log WC (â=3.672; p&lt;0.001), log VF (â=0.833; p&lt;0.001), and log systolic blood pressure (â=3.739; p=0.024) had a significant positive correlation with log hsCRP levels. Further multiple linear regression test showed that log BMI (â=3.772; Beta=0.674; p&lt;0.001) had the greater effect on log hsCRP levels compared to other indices. <br /><br />CONCLUSIONS    <br />BMI had a greater influence on hsCRP levels compared to other obesity indices in non-diabetic adults. Body mass index can be used as a better index in predicting hsCRP levels compared to other indices.

Introduction: The risk factors most strongly associated with knee osteoarthritis (OA) are old age and obesity. However, few studies have evaluated the interaction between aging and obesity in conjunction with inflammatory markers and knee OA severity as part of a complete assessment of knee OA management. Therefore, this study aims to evaluate the interaction between obesity, age, inflammation [including the I/D polymorphism of angiotensin converting enzyme-1 (ACE-1)], and the severity of knee OA. Methods: A total of 80 knee OA patients were included in this cross-sectional study. The severity of knee OA was determined based on the Kellgren–Lawrence system. All patients underwent physical and radiological examination; monocyte chemoattractant protein 1 (MCP-1) markers were measured. The parameters of the ACE-1 gene were examined with sequencing DNA. Results: There was a significant relationship between age and severity of knee OA (P=0.007), with subjects aged greater than or equal to 65 having a 3.56-fold higher risk of developing moderate to severe OA than subjects aged less than 65. There was a significant difference between body weight and knee OA severity (P=0.026), in which subjects weighing greater than or equal to 60 kg had 3.14 times the risk of experiencing severe knee OA. Multivariate regression analysis indicated that age was the strongest independent variable for knee OA severity compared with body weight. MCP-1 levels were significantly higher in mild knee OA than in moderate to severe knee OA. The DD genotype of the ACE-1 gene increases the risk of severe knee OA by four times in subjects aged greater than or equal to 65 compared to subjects aged less than 65. However, the DD genotype of the ACE-1 gene does not increase the risk of severe knee OA in subjects weighing greater than or equal to 60 kg. Conclusion: While obesity and age were found to be associated with the severity of knee OA, age emerged as the independent risk factor for knee OA severity. Furthermore, MCP-1 levels were significantly higher in cases of mild knee OA compared to severe knee OA. It was observed that the DD genotype of the ACE-1 gene increases the risk of severe knee OA in individuals aged 65 years or older.