Background:Avascular necrosis (AN) is a disease, which is the result of blood flow disturbance and necrosis of the bone tissue. It affects predominantly men of working age and steadily progresses to secondary osteoarthritis. AN is a multifactorial disease. In the context of vascular hypothesis it is of particular interest to evaluate homocysteine and its metabolism in patients with AN.Objectives:The aim of the present study was to evaluate some parameters of endothelial function in patients with AN of the femoral head or femoral condyles in order to determine possible treatment and prevention options.Methods:We included 53 patients with AN of the femoral head or femoral condyles into the study. The patients were aged 49 (35-62) years, 58,49% (n=31) were male. The inclusion criteria was diagnosis of AN confirmed by X-Ray, CT or MRI. The exclusion criteria were: traumatic AN, Legg-Calve-Pertes disease, connective tissue systemic diseases. We recruited 51 patients into the control group. The groups were comparable by age and gender. In order to analyse engothelial function in the groups we investigated the following serum parameters: homocysteine, vitamin B12, folate. In order to analyse the data obtained we used non-parametric statistics.Results:We determined a higher level of homocysteine in patients with AN (12,15 (7,55-14,60) vs. 8,18 (6,57-10,70) mcmol/l in the control group, p=0,04). Also we observed almost equal levels of vitamin B12 in patients with AN an in the control group (531,95 (340,80-793,55) vs. 532,75 (417,60-669,7) pg/ml, p=0,99). The level of folate was lower in the study group (5,66 (3,83-6,83) vs. 6,99 (5,02-10,38) ng/ml, p=0,01).Conclusion:The data obtained show that homocysteine level in patients with AN is higher. This can be a consequence of folate deficiency, which takes part in homocysteine metabolism. Therefore, homocysteine metabolism disturbances can lead to endothelial dysfunction, which results in cardiovascular events in the heart, brain, kidneys [1] as well as in the bone, according to the study results. Folate supplement is the possible way of AN treatment and prevention.References:[1]Nowroozpoor A, Gutterman D, Safdar B. Is microvascular dysfunction a systemic disorder with common biomarkers found in the heart, brain, and kidneys? - A scoping review. Microvasc Res. 2021 Mar;134:104123. doi: 10.1016/j.mvr.2020.104123. Epub 2020 Dec 15. PMID: 33333140.Disclosure of Interests:None declared
BackgroundSonography is widely used because of its easy accessibility, relatively low cost. Sonography provides distinct information that bridges the gap between clinical and radiologic evaluation. There has been a growing interest in determining the sources of pain with ultrasound (US) findings in patients with knee osteoarthritis.ObjectivesThe aim of this study was to determine the relationships between clinical parameters and features of US of the knee.MethodsThis was a cross-sectional study, recruiting 47 consecutive patients aged 47 (36- 54), 60,42% (n=29) were female. Those with recent trauma, rheumatic diseases were excluded from the study. Patients underwent assessment for knee pain (Visual Analog Scale (VAS)), US examination of the knee joints according to the 4-point scale (synovial proliferation, joint effusion, power Doppler signal (PD), patellofemoral joint cartilage (PFJ), medial femoral cartilage (MF), medial (MM) and lateral meniscus (LM), osteophytes, Baker cysts). US staging of knee OA was also performed.ResultsPatients were divided into 2 groups: those with knee pain (n=28) and asymptomatic patients (n=19). Pathological US features were found in both groups (Table). In 5 out of 19asymptomatic patients, degenerative changes of different degree of the joint structures were identified (PFJ, MF, osteophytes, MM, LM), in 4 patients – joint effusion. Prevalence of PFJ, MF, MM, LM changes, osteophytes and Baker cysts didn’t differ between groupsG. roups differed in PD signal expression in the synovia (p=0,07). Functional association between VAS score and PD expression (R=1,0, p<0,05) was revealed$ moderate correlation between VAS score and joint effusion (R=0,47, p<0,05), PFJ (R=0,58, p<0,05), osteophytes (R=0,66, p<0,001) was observed.ConclusionIn the patients under study, degenerative and inflammatory findings were common in the symptomatic group, but were also identified in the asymptomatic patients. Clinical parameters were more strongly associated with active inflammation (as verified by US) rather than with degenerative changes.Disclosure of InterestsNone declared
BackgroundIn the literature, no validated definition of Early Symptomatic Knee OsteoArthritis (ESKOA) is available.ObjectivesThe Italian Society of Rheumatology (SIR) organized an international consensus to provide a proposal of a definition of ESKOA.MethodsA set of focus groups were held with expert clinicians, basic science researchers, and patients in order to identify signs, symptoms, and risk factors of ESKOA. In parallel, a systematic literature reviewed the existing definitions of ESKOA. An international panel of experts, convened by the SIR, identified a set of disease constructs; these constructs underwent two Delphi rounds for prioritisation and weighting of items to include in a definition of ESKOA. Finally, during a face to face meeting, the panel agreed on a final proposal for the definition of ESKOA.ResultsThe systematic review failed to identify any validated definition of ESKOA. The focus groups identified 46 items, among risk factors, signs, and symptoms, which could reflect a pre-radiographic stage of knee OA. After the first expert meeting, these items were reduced to 15, then two Delphi rounds, by the weighting of items, led to the ranking of the criteria. A further evaluation led to a final definition of an algorithm for the identification of patients affected by ESKOA (Figure 1).ConclusionsThe diagnosis of ESKOA is today possible and opens a relevant problem that is the identification of the therapeutic regimens needed to slow down disease progression. The early identification of ESKOA patients might allow a better quality of life significantly reducing the social and health systems costs. A validation study aimed to confirm the appropriateness of these criteria is warranted.Disclosure of InterestNone declared
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