The article presents the results of determining the levels of markers of cartilage remodeling of type II collagen (CTX II) in urine and oligomeric matrix protein of cartilage (COMP) in blood plasma in patients of the main group with 0-1 radiological stages of osteoarthritis of the knee joint and the control group, which are compared with clinical data, results of MRI and ultrasound studies. The authors evaluated the effectiveness of various treatment regimens for osteoarthritis in groups with different levels of cartilage metabolism. In patients with a high level of cartilage tissue degradation, monotherapy was accompanied by a statistically significant increase in "MRT-WORMS, sum", while in patients on combination therapy, stabilization of the process (assessed by "MRT-WORMS, sum") was noted.
Background:Osteoarthritis (OA) is the leading cause of disability among all RMDs. Early diagnosis of OA is complicated. So, there is an absence of clear markers of the diagnosis of OA, and this issue is now being discussed.Objectives:The aim of this study is to examine relatively healthy individuals without symptoms in order to evaluate MR-markers of early OA of the knee.Methods:We included 29 relatively healthy individuals. 55,17% (n=16) were women. Median age was 35 (32-41) years. They didn’t have any complaints, according to the preliminary criteria of early OA, symptoms of OA (1), didn’t have any significant concomitant diseases and elevated ESR, CRP. The exclusion criteria were previous trauma, orthopedic surgery, X-Ray signs of OA. MRI was performed on 1,5 Tl Siemens Magnetom Essenza. WORMS-scale was used to evaluate the knee joint structures.Results:In all examined joints we observed small changes characteristic of symptomatic OA (osteophytes, cartilage damage etc.). In 4 knees we found undamaged cartilage (0 points). In 5 knees we observed cartilage damage >=4 points with marrow abnormality. In the Table 1 we present the frequency of any abnomaly (>=1 points) in each parameter present in examined joints. The most commonly asymptomatic changes were observed in the patellofemoral joint. Small osteophytes were the most common changes.Table 1.Number of examined knee joints with different anomalies according to WORMS (>=1 point).ParameterMFTJ (percent, total)LFTJ, (percent, total)PFJ (percent, total)S-region, (percent, total)Total, (percent, total)Cartilage19,44% (n=7)19,44% (n=7)75,00% (n=27)-83,33% (n=30)Marrow abnormality0,00%2,78% (n=1)0,00%13,89% (n=5)16,67%(n=6)Bone cysts0,00%0,00%0,00%0,00%0,00%Bone attrition66,67% (n=24)0,00%--66,67% (n=24)Osteophytes88,89% (n=32)86,11% (n=31)97,22% (n=35)-100,00% (n=36)Menisci0,00%2,78% (n=1)--2,78% (n=1)Ligaments----0,00%Synovitis----33,33% (n=12)Total––––100,00% (n=36)Besides, we calculated mean points in each parameter in the scale and compared it with the maximum score in this parameter (in percent). Table 2 shows the results. The most severe change was bone attrition.Table 2.Mean points of different WORMS parameters in examined knee joints.ParameterMFTJ (percent, total)LFTJ, (percent, total)PFJ (percent, total)S-region, (percent, total)Total, (percent, total)Cartilage1,30%1,02%7,64%-2,91%Marrow abnormality0,00%0,37%0,00%4,63%0,31%Bone cysts0,00%0,00%0,00%0,00%0,00%Bone attrition15,37%0,00%0,00%-1,75%Osteophytes6,59%5,48%8,33%-6,69%Menisci0,00%0,93%--0,46%Ligaments----0,00%Synovitis----12,04%Total----3,61%We didn’t observe asymptomatic lesions in the medial meniscus, marrow abnormality in MFTJ and LFTJ, subchondral cysts in any location, ligament lesions. Despite minimal osteophytes almost in all individuals, they didn’t have any clinical features of knee OA.Conclusion:MRI of the knee joints in the cohort of young relatively healthy individuals without clinical features of OA revealed irreversible structural changes characteristic of symptomatic OA. There is no association between symptoms and structural damage. Based on these, we can make an assumption about asymptomatic stage of OA. In order to distinguish between definitions of early asymptomatic OA as a disease onset and asymptomatic structural changes as reflection of metabolic disorders it is necessary to follow up and to perform an in-depth examination of these individuals.References:[1]Migliore, A., Scirè, C.A., Carmona, L.et al.The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology.Rheumatol Int37, 1227–1236 (2017).Disclosure of Interests:Natalia Martusevich Shareholder of: k, Svetlana Duben: None declared, Alexander Aleshkevich: None declared, Alena Dmitrieva: None declared, Tatsiana Bondar: None declared, Katsiarina Gudkevich: 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
The article describes an ultrasound method for a comprehensive study of the shoulder, wrist joints and small joints of the hands, hip, knee, ankle and foot joints in patients with osteoarthritis of the knee joint. The authors proposed the optimal sequence of diagnostic methods of research, taking into account the use of various ultrasonic sensors, changes in the settings of the device, the need to change the position of the patient when examining various joints. The results of the study of pathological changes in all joints and their degree of severity are presented in accordance with a single study protocol.
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