The anatomical distribution of radiological abnormalities in Kashin-Beck disease in Tibet

Abstract

A radiological study of osteoarticular changes in Kashin-Beck Disease (KBD) was undertaken on the appendicular skeleton in 105 patients with KBD, in 31 healthy subjects living in an endemic area and in 30 healthy subjects living in a non-endemic area. The bone age was delayed in all three populations with no significant difference between the three studied Tibetan populations. Radiological changes occur in 56% of patients with KBD, and are usually bilateral. An analysis of the distribution of lesions shows a proximo-distal gradient. The changes are more common in the distal aspect of the limb and the lower limb is involved more commonly than the upper limb. The foot and ankle are involved in 89.5% of cases. The radiological changes and their distribution might be explained by the hypothesis of inhibition of angiogenesis by mycotoxins, exacerbated by chemical and physical environmental factors.Résumé Une étude radiographique des lésions ostéoarti-culaires produites par la maladie de Kashin-Beck (KBD) a été réalisée au Tibet sur le squelette appendiculaire de 105 patients atteints de KBD, de 31 sujets cliniquement sains vivant en région endémique et de 30 sujets en ré-gion non endémique. La détermination de l'âge osseux révèle un retard de la maturité osseuse dans les trois groupes. Les lésions radiologiques sont présentes dans 56% des cas cliniques de KBD et sont bilatérales dans presque tous les cas. Le nombre de lésions augmente vers la périphérie. Le membre inférieur est plus souvent atteint que le membre supérieur. Le pied et la cheville sont atteints dans 89.5% des cas présentant une lésion radiologique. Les lésions radiologiques observées et leur distribution pourraient être expliquées par une inhibition de l'angiogénèse aggravée par les facteurs environnementaux chimiques et physiques.

Total knee arthroplasty in elderly patients with severe Kashin-Beck disease of the knee

“…Clinically, KBD in the elderly usually exhibits symmetrical multi-joint enlargement, which is sometimes accompanied by muscular atrophy and severe joint distortion [2][3][4]. These observations were confirmed by the 50 % of KBD patients in our study who had no less than eight joints involved.…”

“…The primary clinical symptoms of KBD in the elderly include symmetrical multiple joint pain, enlarged and shortened fingers, and deformed, enlarged joints with limited motion in the extremities, along with a high rate of late-stage disability [2,3]. The degree of knee and elbow pain is relatively more serious than that of shoulders, hips, wrists and ankles, with the knee being the joint most seriously affected [4].…”

Efficacy of celecoxib, meloxicam and paracetamol in elderly Kashin-Beck Disease (KBD) patients

“…The secondary pathological findings, visible on radiographs, are repairing and remodelling around the necrotic foci of the cartilage of the metaphysis, bone end, epiphysis and carpal bones [2]. The most frequently affected sites are the distal limb joints [9][10][11], especially the hands [2]. Although its aetiology differs from osteoarthritis (OA) and rheumatoid arthritis (RA), the central pathological feature of KBD is still a degradation of cartilage, similar to OA.…”

Effects of physical environment on the evolution of Kashin-Beck disease in Tibet

“…The clinical manifestations and radiological lesions in Kashin-Beck disease in the Tibet Autonomous Region were described with their gravity scale in previous papers [7,8,11]. One of the most characteristic observations is the proximo-distal gradient along the apendicular skeleton in terms of frequency and severity of joint involvement [7].…”

“…One of the most characteristic observations is the proximo-distal gradient along the apendicular skeleton in terms of frequency and severity of joint involvement [7]. The most distal joints of the upper and lower limbs are the most often and most severely affected, especially noticeable in the lower limb (Fig.…”