Radiological Assessment of Osteo-Arthrosis

Kellgren, Jan; Lawrence, John S.

doi:10.1136/ard.16.4.494

Cited by 10,308 publications

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“…Patients inclusion criteria were: Male and female patients between 40 and 80 years with osteoarthritis of the knee according to ACR criteria (American College of Rheumatology) [15], X-ray classification: Kellgren-Lawrence Grading Scale: 2 – 4 [16,17], and subjective pain intensity at baseline > 40 mm on the visual analogue scale and no other OA therapy except NSAID in the previous 4 weeks. Patients were excluded if they fulfilled one or more of the following criteria: current use of anticoagulants (e.g., Phenprocoumon, Heparin), coagulopathy, or any form of cupping therapy in the previous 12 months; intra-articular injection of corticosteroids or NSAID into the knee joint in the previous 4 months; arthroscopy of the knee joint in the previous 12 months, use of systemic corticosteroids in the previous 4 weeks; physical therapy, leeches or acupuncture in the previous 4 months or other CAM therapies for osteoarthritis in the previous 4 weeks.…”

Section: Methodsmentioning

confidence: 99%

Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

Teut

Kaiser

Ortiz

et al. 2012

BMC Complement Altern Med

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IntroductionCupping is used in various traditional medicine forms to relieve pain in musculoskeletal diseases. The aim of this study was to investigate the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA).MethodsIn a two-group, randomized controlled exploratory pilot study patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity > 40 mm on a 100 mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4 weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0 mm = no pain to 100 mm = maximum intensity) and Quality of Life (SF-36) 4 and 12 weeks after randomization. Use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome.Results21 patients were allocated to the cupping group (5 male; mean age 68 ± SD 7.2) and 19 to the control group (8 male; 69 ± 6.8). After 4 weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p = 0.001). After 12 weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p = 0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12 weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets between both groups (mean 9.1, SD ± 20.0 vs. 11.5 ± 15.9).ConclusionIn this exploratory study dry cupping with a pulsatile cupping device relieved symptoms of knee OA compared to no intervention. Further studies comparing cupping with active treatments are needed.Trial registrationClinicaltrials.gov Identifier: NCT01057043

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Section: Methodsmentioning

confidence: 99%

Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

Teut

Kaiser

Ortiz

et al. 2012

BMC Complement Altern Med

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“…All specimens were radiographed in the posterior‐anterior position with an Axiom Luminos Siemens ® apparatus to define the Kellgren Lawrence (KL) scoring 3. Knees with KL = 0 were considered as normal, KL = 1 as early OA, KL = 2 as moderate OA, and KL > 2 as late OA.…”

Section: Methodsmentioning

confidence: 99%

“…The JS volume (JS_Vol, mm3) was calculated by counting all the voxels inside the segmented VOI. From the 3D map, the following morphometric parameters were calculated: mean (JS_mean, mm), median (JS_median, mm), minimum (JS_min, mm), maximum (JS_max, mm), and standard deviation (JS_SD, mm).…”

Section: Methodsmentioning

confidence: 99%

“…The main characteristics are the narrowing of the joint space width (JSW), the sclerosis of the subchondral bone, and the presence of osteophytes 2. In order to follow the natural history of OA or the effect of new drugs, a common grading system is used to assess the severity of knee OA using five grades from normal to severe 3. It is also possible to make an indirect measurement of the cartilage thinning on posterior‐anterior standing X‐rays by measuring the JSW between the articular cortices of the femur and the tibial plateau.…”

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confidence: 99%

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Three‐dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications

Mezlini-Gharsallah

Youssef

et al. 2018

Journal Orthopaedic Research

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One of the most important characteristic of knee osteoarthritis (OA) is the joint space (JS) width narrowing. Measurements are usually performed on two dimensional (2D) X‐rays. We propose and validate a new method to assess the 3D joint space at the medial knee compartment using high resolution peripheral computed tomography images. A semi‐automated method was developed to obtain a distance 3D map between femur an tibia with the following parameters: volume, minimum, maximum, mean, standard deviation, median, asymmetry, and entropy. We analyzed 71 knee specimens (mean age: 85 years), radiographs were performed for the Kellgren Lawrence (KL) score grading. In a subgroup of 41 specimens, the histopathological Outerbridge and meniscal classifications were performed and then cores were harvested from the tibial plateau in three different positions (posterior, central, and peripheral) and imaged at 10 µm of resolution to measure the cartilage thickness. Minimum, maximum, mean, and median were statistically lower and entropy higher between knee specimens classified as KL = 0 and KL = 3–4. Gr1 and 2 were statistically different from Gr3‐4 for minimum, asymmetry, entropy using the Outerbridge classification and Gr1 was statistically different from Gr3–4 using the meniscal classification. Asymmetry, minimum, mean, median and entropy were significantly correlated with cartilage thickness. Parameters extracted from a 3D map of the medial joint space indicate local variations of JS and are related to local measurements of tibial cartilage thickness, and could be consequently useful to identify early OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2380–2391, 2018.

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“…Tissue samples of articular cartilage were obtained with consent from 5 patients with RA (mean Ϯ SD age 60.8 Ϯ 7.6 years) and 3 patients with OA (mean Ϯ SD age 73.6 Ϯ 9.1 years) who underwent total knee arthroplasty. All the OA samples we examined were grade 4 (severe) according to the Kellgren/Lawrence radiographic grading system (26). Cartilage from the femoral head, which was used as the normal control, was obtained from 2 patients (ages 76 years and 82 years, respectively) who underwent replacement of the femoral head following femoral neck fracture.…”

Section: Methodsmentioning

confidence: 99%

CCAAT/ENHANCER binding protein β mediates expression of matrix metalloproteinase 13 in human articular chondrocytes in inflammatory arthritis

Hayashida¹,

Okazaki²,

Fukushi³

et al. 2009

Arthritis & Rheumatism

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Objective. To determine the function of CCAAT/ enhancer binding protein ␤ (C/EBP␤) in the expression of matrix metalloproteinase 13 (MMP-13) in chondrocytes in inflammatory arthritis.Methods. Cartilage obtained from patients with rheumatoid arthritis and osteoarthritis was immunostained for expression of C/EBP␤ or MMP-13. Interleukin-1␤-or tumor necrosis factor ␣ (TNF␣)-stimulated chondrocytes were subjected to Western blotting and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). MMP-13 promoter assays were conducted, and the C/EBP␤ response element was characterized by deletion and mutation analysis. C-28/I2 cells were treated with TNF␣ and subjected to chromatin immunoprecipitation (ChIP) assays. Finally, C/EBP␤-liver-enriched activator protein (LAP) was overexpressed in C-28/I2 cells or cartilage tissues, and MMP-13 expression was analyzed.Results. C/EBP␤ and MMP-13 expression was colocalized in chondrocytes in arthritic cartilage. MMP-13 promoter activity was stimulated by C/EBP␤ overexpression in a dose-dependent manner. Luciferase assays revealed that a -981-bp promoter had the greatest activity, while deletion to -936 bp strongly diminished promoter activity. Luciferase activity was repressed to basal levels by mutations in potential C/EBP binding sites. The stimulatory effects of C/EBP␤ overexpression were diminished by mutation. ChIP assays revealed that TNF␣ treatment enhanced the binding of C/EBP␤ to the MMP-13 promoter. When C/EBP␤-LAP was overexpressed in C-28/I2 cells, endogenous MMP-13 expression was stimulated up to 32-fold as detected by real-time RT-PCR. Furthermore, following adenoviral overexpression of C/EBP␤-LAP in organ culture of articular cartilage, stimulation of MMP-13 was also detected by immunohistochemistry. Conclusion. C/EBP␤ directly binds to the MMP-13 promoter region and stimulates the expression of MMP-13 in chondrocytes in inflammatory arthritis.Degeneration of articular cartilage is the principal process causing disability in patients with inflammatory arthritis, including those with rheumatoid arthritis (RA) (1,2) and osteoarthritis (OA) (3,4). Normally, maintenance of the cartilage extracellular matrix (ECM) is strictly regulated by the balance of anabolic and catabolic factors secreted by synovial cells or by chondrocytes themselves. Arthritic cartilage is characterized by excessive production of proteinases, such as matrix metalloproteinases (MMPs) and aggrecanases, and reduced synthesis of new matrix by chondrocytes, which disturbs the balance of anabolic and catabolic factors. Among the proteinases, MMP-13 cleaves a broad range of substrates, including fibrillar type II collagen and type II procollagen as well as gelatin, types I, III, IV, IX, X, and XIV collagen, tenascin, fibronectin, fibronectin fragments, and aggrecan (5-8). It has been reported that MMP-13 has the highest degradation activity for type II collagen (5,9). A recent study showed that up-regulated transgenic expression of MMP-13 in mouse articular cartilage resulted in pathologic chan...

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Radiological Assessment of Osteo-Arthrosis

Abstract: In survey work only a limited number of films can be taken, partly for financial reasons and partly 494 copyright.

Cited by 10,308 publications

References 1 publication

Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

Three‐dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications

CCAAT/ENHANCER binding protein β mediates expression of matrix metalloproteinase 13 in human articular chondrocytes in inflammatory arthritis

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