Hand osteoarthritis (OA) is a common and potentially disabling disease, with different features from hip and knee OA so that a specific therapeutic approach is required. Evidence based recommendations for the management of hand OA were developed by the European League Against Rheumatism (EULAR) in 2006. The Italian Society for Rheumatology (SIR) aimed to update, adapt to national contest and disseminate the EULAR recommendations for the management of hand OA. The multidisciplinary group of experts included specialists involved in the management of patients with hand OA. In order to maintain consistency with EULAR recommendations, a similar methodology was utilized by the Italian group. The original propositions were reformulated in terms of a search query and for every recommendation a systematic search was conducted updating EULAR recommendations' review. The propositions were translated in Italian and reformulated basing on collected evidences and expert opinion. The strength of recommendation was measured for each proposition with the EULAR ordinal and visual analogue scales. The original 11 propositions of EULAR recommendations were translated and adapted to Italian context. Further evidences were collected about non-pharmacological therapies, local treatments, intra-articular injection with SYSADOA and corticosteroids, and surgery. The SIR has developed updated recommendations for the management of hand OA adapted to the Italian healthcare system. Their implementation in clinical practice is expected to improve the management of patients with hand OA.
Badam Talkh kuhi is an endemic species of Iran commonly used by native people as anti-inflammatory and antimicrobial remedy. The present study was aimed at investigating the folk claims of this plant, identified by us as Amygdalus lycioides Spach. Several extracts were prepared using various extraction procedures combined with solvents of different polarity. A decoction was firstly prepared according to the procedure of the folk medicine. Maceration (ME), Ultrasound-Assisted Extraction (USAE) and Microwave-Assisted Solvent Extraction (MASE) were then experimented using pure methanol (MeOH) and n-hexane-acetone (n-Hex-Ac, 50% v/v). Concerning biological investigation, the antimicrobial potential of all extracts was firstly evaluated by employing the growth inhibition test. Then, the free radical scavenging effect of each extract was measured, given that reactive oxygen species (ROS) are involved in TNF-induced signaling pathways associated with inflammation. Finally, the anti-TNF activity of the most active extracts was evaluated using in vitro and in vivo assays. Regarding the anti-inflammatory activity, decoction and MASE n-Hex/Ac extract inhibited the production of TNF with IC 50 in the range of 120-390 g/ml and 6-20 g/ml, respectively. Interestingly, after oral administration in mice, MASE n-Hex/Ac extract was effective in reducing TNF of about 60%. Moreover, treated animals did not show any signs of toxicity. Results herein reported clearly evidenced that Amygdalus lycioides Spach could be a valuable source of TNF-blockers effective against chronic inflammatory diseases.
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