Day :
- Track 5 Rheumatoid Arthritis
Track 9 : Pediatric Rheumatology
Track 10 :Therapies for Rheumatic Disorders
Track 12: Orthopedic trauma
Track 13 :Orthopedic Biomechanics
Location: Terra Lucis
Chair
Manuel Villanueva
Avanfi Institute, Spain
Co-Chair
Thomas Apostolou
Interbalkan Medical Center, Greece
Session Introduction
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound guided gastrocnemius recession: A new ultra-minimally invasive surgical technique
Time : 09:30 - 09:50
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Gastrocnemius equinus is defi ned as ankle dorsifl exion<10º with the knee extended. Th e equinus deformity alters foot biomechanics, predisposing to conditions such as Achilles tendinosis, fl atfoot, diabetic foot ulcer, metatarsalgia, plantar fasciitis, midfoot arthritis and nerve entrapment. In children, the deformity has been associated with equinus foot, spasticity and cerebral palsy. Th erefore, gastrocnemius recession has many well documented indications. We present an ultrasound guided ultra-minimally invasive technique for gastrocnemius recession. Materials & Methods: In 22 cadavers we checked the technique was eff ective and safe. Th en we performed gastrocnemius recession in 23 patients (25 cases), 18 males and 5 females on an outpatient regimen. Mean age was 42 years (13-61). In 11 cases the indication for the procedure was non-insertional Achilles tendinopathy. In 5 patients, the indication was gastrocnemius retraction in the presence of plantar fasciitis. US guided Achilles tenotomy, release of the paratenon or selective plantar fasciotomy were combined with gastrocnemius recession. Th e age range of patients with Achilles tendinopathy or plantar fasciitis was 37-51 years. In 3 patients (4 cases) the indication was equinus foot. Th e ages were 13, 14 and 15 years. Ultrasound guided plantar fasciotomy was performed at the same time. In 5 patients (50-61 years) the indication was metatarsalgia and forefoot overloading with no hammertoe or any other forefoot condition. All patients had at least 6 months of failed conservative management prior to surgery. Surgical Technique: Th e instrument set included long needles (a 16 gauge, 1.7 mm diameter Abbocath), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2, 3 mm) and an ultrasound device (Alpinion ECube15) with a 10-17 MHz linear transducer and the Needle Vision Plus™ soft ware package. Th e patient is placed prone, under local anesthesia plus sedation without lower limb ischemia. Recession is performed via one or two incisions (1-2–mm each) positioning the instruments beneath the sural nerve. No stitches are required, just adhesive strips and elastic bandage. Active dorsifl exion and plantar fl exion of the ankle are encouraged immediately aft er surgery. Partial weight bearing is allowed the day of surgery, aided with crutches. Results: In the clinical series, pain, function and ankle dorsifl exion increased signifi cantly for every patient in the study (mean, 14º; STD 3º). VAS score improved from 7 (6-9) to 0 (0-1) and AOFAS score improved from a mean of 30 (20-40) to 93 (85-100), at 6 months. All athletes returned to their previous sports aft er 6 months. Superfi cial hematomas were common in the series and some patients developed internal hematomas (observed by ultrasound) at the areas of the tendon and muscle surrounding the recession until the third month. Th ere were no instances of over lengthening or Achilles tendon rupture, infections, wound or nerve complications. Discussion: Open or endoscopic gastrocnemius lengthening require epidural anesthesia, lower limb ischemia and stitches. Ultrasound guided ultra-minimally invasive gastrocnemius recession allows continuous visualization of nerves and vessels without ischemia. It can be combined with other US guided ultra-minimally invasive techniques (plantar fasciotomy, Achilles tenotomies) to ensure minimal pain with excellent outcomes and no signifi cant morbidity.
Yelena Walters
University College London, UK
Title: Can task-orientated rehabilitation improve knee function in patients 12 months after knee replacement surgery for osteoarthritis?
Time : 09:50 - 10:10
Biography:
Yelena Walters obtained degrees in Civil Engineering and Economics from Vologda University in Russia before relocating to the UK to following her passion in healthcare and rehabilitation. She graduated from the London School of Osteopathy with Honors degree in Osteopathy in 2010 and went on to obtain MSc in Musculoskeletal Science and Sports Medicine, Exercise and Health from UCL and the Diploma in Orthopedic Medicine. She is a practicing Osteopath and is currently undertaking research towards her PhD in rehabilitation techniques at the Institute of Orthopedics and Musculoskeletal Science, UCL and Royal National Orthopedic Hospital, Stanmore.
Abstract:
Osteoarthritis (OA) of the knee is a common and debilitating disease, which at the end stage requires joint replacement surgery. Total knee arthroplasty (TKA) usually results in relief from knee pain. However, even though the surgical procedure may have been successful, the patient’s gait often does not return to a normal pattern and patients are disappointed with their mobility. The importance of physiotherapy immediately following TKA is well recognized although little consensus exists regarding appropriate rehabilitation programs for the longer term. Typically prescribed rehabilitation exercises have an internal focus on a specific muscle or joint. Movement is a complex process driven by coordinated interaction between different muscles and the peripheral and central nervous systems suggesting that practicing activities that form part of everyday life (task-orientated rehabilitation) maybe more effective. This study proposes that task-orientated rehabilitation (TOR) will enhance overall performance and satisfaction for those patients who are not content with their progress. In this study we investigate patients one year after TKA. We aim to determine the relationship between patient satisfaction using the Oxford Knee Score questionnaire (OKS) and gait characteristics using inertial movement units (IMU). We are selecting a subset of patients who demonstrate abnormal gait characteristics for a 4-week program of TOR. The program is based on the daily activities of walking and stair climbing with the aim of improving gait quality. Following this, patients are re-assessed using the OKS questionnaire and IMUs. Our preliminary results suggest a beneficial effect of TOR.
Renato A. Sernik
SÃrio Libanês Hospital
Brazil
Title: Update on the use of ultrasound in the diagnostic of Carpal Tunnel Syndrome.
Time : 10:10 - 10:30
Biography:
Renato A Sernik is a Doctor and obtained his PhD from the University of Sao Paulo. He is a Radiologist at the Medical School Hospital of the University of SaoPaulo for 16 years. He is the author of some books “Ultrasound of the Musculoskeletal System (1999) and Ultrasound of the Musculoskeletal System-Correlation with MRI (2009)”, translated into Spanish and Italian. He is working as a Radiologist at the Sirio Libanes Hospital from 14 years.
Abstract:
Ultrasonography has become one of the main complementary tests for the diagnosis of carpal tunnel syndrome, especially in patients with a history of diseases that may be associated with peripheral neuropathy, such as diabetes mellitus, or in cases where the electroneuromyography is doubtful. The method has also been useful in patients with unsatisfactory results after surgical treatment, where fibrosis, adhesions and neuromas can be identified, having the advantage compared to MRI to be dynamic examination and lower cost. However, the method is operator-dependent with a longer learning curve. Between 2006 and 2014 we analyzed about 120 wrists of patients with clinical suspicion of carpal tunnel syndrome, with electroneuromyographic correlation, being part of the results published in the journal Skeletal Radiology (2008). The increase in cross-sectional area associated with the change in echotexture of the median nerve are the main criteria used for the diagnosis of carpal tunnel syndrome.
Maosheng Xia
The First Hospital of China Medical University, China
Title: Leptin improves the locomotion recovery of spinal cord injury
Time : 10:30- 10:50
Biography:
Maosheng Xia has completed his PhD and MD from China Medical University and two-year Post-doctoral studies from Medical Center of Rochester University School. Currently, he works as the Associate Professor and Associate Chief Physician in the First Hospital of China Medical University. He has published 7 papers in the fi eld of spinal cord injury.
Abstract:
Spinal cord injury (SCI) causes long-term disability and has no eff ective clinically treatment. Th e initial trauma always results in permanent functional impairment and severe disability followed by secondary injury mechanism, which is characterized by increased infl ammation, glial scarring and neuronal cell death. Leptin (a glycoprotein) could induce the activation of Janus kinase (JAK2)/signal transducers and activators of transcription-3 (Stat3) pathway via leptin receptor. In vivo, we discovered the intraperitoneal injection of leptin improved the locomotion recovery of spinal cord injury. Th en, we researched the neuro-protective and anti-infl ammatory role of leptin on the spinal cord neurons and astrocytes. In the cultured neurons, we discovered leptin administration could enhance the expression of caveolin-1, block the composition of P2X7R-Panx1 complex and reduce the damage to neurons induced by ATP or by modeling operation of SCI. Even without injury operation, the pretreatment with leptin could suppress neuronal Ca2+ imaging triggered by ATP in spinal cord of live transgenic mice. In the cultured astrocytes, we discovered that: 1) the chronic administration of leptin could suppress the release of AA and PGE2 stimulated by ATP from the cultured spinal cord astrocytes; 2) leptin could elevate the expression of caveolin-1 through JAK2/Stat3 signaling pathway; 3) the increased caveolin-1 blocked the conjunction between Src and EGFR; 4) our results highlight leptin as a promising therapeutic agent for SCI.
Thomas Apostolou
Interbalkan Medical Center, Greece
Title: Surgical treatment of osteoarthritis of the hip: The AMIS procedure
Time : 11:10 - 11:30
Biography:
Thomas Apostolou is an Orthopedic Spine Surgeon and certifi ed surgeon in AMIS procedures. He has completed his PhD from Aristotle University of Thessaloniki, Greece and Post-doctoral studies from Aristotle University of Thessaloniki, School of Medicine. He is the Director of 3rd orthopedic department of Interbalkan Medical Center of Thessaloniki and Associate Professor of Department of Physiotherapy at Alexander Technological Educational Institute of Thessaloniki. He has published more than 25 papers in reputed journals and has served as Lecturer of Orthopedics, 1st Orthopedic Department, Aristotle University of Thessaloniki, from January 2014 to May 2015.
Abstract:
Total Hip Arthroplasty (THA) is the second most common joint replacement procedure performed in the United States, aft er primary Total Knee Replacement (TKR). In 2010, more than 300,000 THA procedures were performed. Complications and revision rates, associated with THA, have declined signifi cantly, despite an increasing number of patients at risk for these outcomes. Reasons for residual pain aft er total hip replacement include malalignment of the prosthesis, infection, joint instability, trochanteric bursitis, heterotopic bone formation, and prosthesis loosening. Th e large number of approaches for (THA) had increased signifi cantly the last decades. Transgluteal approach (Hardinge, anterolateral), posterior approach and, recently, anterior approach (AMIS procedure) are the most favorable among the surgeons. Disadvantages of the transgluteal approach are painful limp due to hip abductors damage, pain and stiff ness due to heterotopic ossifi cation, blood loss and prolonged hospitalization. Th e anterior access of the hip was described more than 50 years ago by Robert Judet. Th ese past ten years, several French surgeons, familiar with this technique, have attempted to reduce the size of skin incision, while preserving the muscles in the same manner. Th e benefi ts of AMIS technique are that no muscle or tendon is cut, there is no inter-nervous plane, and is mostly direct approach with small (5-6 cm) incision (real minimal invasive approach). Most comparative studies give a post-op functional advantage to anterior approach with the benefi t of no blood loss, shorter hospital stay and quicker recovery with 2nd post-op day of full weight bearing. Literature validated best functional results with very low dislocation rate for AMIS procedure.
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound-guided ultraminimally invasive carpal tunnel release
Time : 11:30 - 11:50
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Carpal tunnel syndrome is the most surgically treated entrapment neuropathy. It aff ects 1 million adults in the United States annually. Several studies suggest smaller incisions related to lower rates of scar tenderness, pillar pain rates and earlier return to work. Ultrasound-guided ultraminimally invasive release is performed with 1 mm incision, in an ambulant regimen, with local anesthesia, without the need for ischemia. Simultaneous bilateral release is possible even in patients with diseases considered contraindications for classic techniques. Material and methods: Th e instrument set included long needles (a 16-gauge, 1.7-mm diameter Abbocath, USA), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2,3 mm), and an ultrasound device (Alpinion ECube15) with a 10-17–MHz linear transducer and the Needle Vision Plus™ soft ware package. Th e patient is placed supine, with the hand on a table and the palm up. We do not use ischemia. We delineate the midpoint between the nerve and the ulnar vessels, trying to defi ne Nakamichi zone´s midpoint. At the selected midpoint at the forearm, we insert a large spinal needle with local anesthesia and check we pierce the deepest fi bers and are beneath the transverse carpal ligament. Color-doppler function may help us to safely determine the superfi cial palmar arch and guide the distal limit of our instruments. We insert the small and medium V-shaped straight curette guided by the needle. Th e release starts 2-3 mm proximal to the superfi cial palmar arch and proximally we extend the release proximal to the pisiform. We remove the hook knife following the curve of the blade so as not to enlarge the incision. Th e mobility of fi ngers is immediately checked. No stitches are required. We use adhesive-strips and a padded dressing. Th e procedure takes 10 minutes. Results: In 20 cadavers we have checked this procedure to be safe, preserving the nerve and vessels and eff ective. We have operated on 31 hands in 20 patients (11 bilateral cases), 16 women and 4 men. Th e age ranged from 39 to 74 years. One case was a recurrence of open surgery. Patients required “pain killers” for 1-2 days and returned to activities of daily living or work aft er 3 days (1-15 days). Th e Phalen test, Tinel test, reverse Phalen test, carpal compression test, and grip strength signifi catively improved. Quick DASH score improved from 57 pre-op (25-89) to 4post-op (0-9). Th ere were no infections nor nerve damage. Minor superfi cial hematomas were common. Two patients had residual numbness and thenar atrophy despite clinical improvement. Discussion: Better outcomes (in terms of pain, strength, function, and cosmetic aspects) have been reported as dissection was reduced from classic to endoscopic to mini or ultra-minimally invasive approaches. Ultrasound-guided surgery seems to be safe, helpful and successful for carpal tunnel release. It gives the surgeon direct control of the main structures. Since they can be performed on an outpatient basis under local anesthesia and without a tourniquet, complications and contraindications are minimized. As it causes minimal pain and swelling, recovery is quicker.
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound guided ultra-minimally invasive plantar fascia release
Time : 11:50 - 12:10
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Plantar fasciitis is the most common cause of heel pain in active working adults between the ages of 25 and 65 years. It causes more than 1 million visits per year to health professionals in the USA. It accounts for about 10% of running related injuries. Th e classic indications for surgery are 6 months of unsuccessful conservative treatment and exclusion of other causes of heel pain. Current surgical options include open surgery, endoscopic surgery and fl uoroscopy assisted surgery. We present an ultrasound guided ultra-minimally invasive technique for plantar fascia release. Material & Methods: We performed a pilot study with 20 cadavers to ensure that the technique was accurate, reproducible and safe. In a second phase, we performed US guided plantar fascia release in 24 patients (26 cases) with chronic plantar fasciitis. Th e instrument set included long needles (a 16 gauge, 1.7 mm diameter Abbocath), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2, 3 mm), and an ultrasound device (Alpinion ECube15) with a 10-17 MHz linear transducer and the Needle Vision Plus™ soft ware package. Th is surgical technique does not require ischemia. Using the ultrasound, we can identify the posterior tibial nerve and inject3-5 cc of 2% mepivacaine. We make a 1-2 mm incision at the selected medial entry point and position the hook in the plane between the fat pad and the fascia before releasing it, thus minimizing damage to muscle tissue. Th e procedure takes 10 minutes and is performed under an outpatient regimen. No stitches are required, just adhesive strips and a padded dressing. Patients are encouraged to walk with crutches immediately aft er surgery without orthotics. Results: We achieved the desired partial plantar fascia release in all the cadavers with no damage to the muscle, nerve or vessels. Th e clinical study population comprised 15 males and 9 females. Th ere were two bilateral cases. Mean age was 39 years (37-59). Patients had received multiple previous conservative treatments for 1-3 years. However, their symptoms failed to resolve. Preoperative plantar fascia thickness ranged 0.7-1.2 cm. Preoperative VAS averaged 9 (8-10), AOSFAS averaged 30 points. Postoperative VAS averaged 1 (0-2) and AOSFAS 91 points (74-100). Patients returned to previous daily activities or sports. Some patients developed superfi cial hematomas that resolved in 2-3 weeks. Discussion: Endoscopic release of plantar fascia have shown excellent results although some drawbacks remain including the need for ischemia, greater dissection and wound healing problems in patients with diabetes or vascular insuffi ciency. Fluoroscopy guided release does not allow us to visualize the muscle nor the fascia. Ultrasound guided ultra-minimally invasive release allows us to prevent damage to the plantar muscles and visualize the width and depth of the fascia. It is performin outpatient regimen, it does not require ischemia or stitches and allows for immediate weight bearing, thus reducing wound healing problems and classic contraindications in patients with diabetes or vascular insuffi ciency. We think that ultrasound guided plantar fascia release may be the technique of choice in the future.
Kathy Kane
Director of Business Development
PharmaLegacy, China
Title: Preclinical development of animal models for Rheumatoid Arthritis that are more clinically relevant and more focused on targeted therapeutics.
Time : 12:10 - 12:30
Biography:
Kathy Kane is the Director of Business Development for PharmaLegacy. She is a Management Executive with over 14 years’ experience in the Biotech Industry in Sales Management and Business Development.
Abstract:
In the past two decades, antibody drugs have achieved great success in the treatment of many human diseases, due to their superior efficacies and pharmacokinetic characteristics. Antibody drugs bind to human disease target molecules with great specificity, and do not cross-react with most rodent targets. This has posted a big challenge to the traditional preclinical efficacy evaluation systems, which are mainly based on rodent models. However, antibody drugs can cross-react with most target molecules in Non-human Primate (NHP) models due to the high homology of these NHP targets with their human counterparts. This makes NHP models an ideal system for preclinical efficacy evaluation of antibody therapies. Since 2009, PharmaLegacy has been dedicated to developing a preclinical evaluation system for antibody therapies based on NHP. Now, PharmaLegacy has established a range of NHP models in inflammation/autoimmune and bone disease areas and has successfully evaluated many candidate mAb drugs binding to important disease targets like TNFα/IL-6/IL-1β and RANKL/Sclerostin. Our experiences have fully demonstrated that NHP models form an ideal preclinical efficacy evaluation system for antibody drugs.
Mohamed Albarouni
Bonn University
Germany
Title: Predictors of response to methotrexate in juvenile idiopathic arthritis
Time : 13:35 - 13:55
Biography:
Dr. Mohamed Albarouni works as a pediatrician since 2007, he has completed his MBBCh from Tripoli University in Libya, he earned his MD degree from University of Bonn in Germany. 2010-2014 he worked in the Centre of Pediatric Rheumatology in Asklepios Clinic Sankt Augustin, Germany. In 2014 he has won the Poster Award of the German Society for Pediatric Rheumatology. Since 2015 he works in the Department of Pediatrics in St. Elisabeth Hospital in Wittlich, Germany.
Abstract:
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic illness in children and it is responsible for short and long-term disability. In the recent years an increased number of disease-modifying anti-rheumatic drugs (DMARDs) have been developed for treatment of juvenile idiopathic arthritis, but methotrexate still the most common second line therapeutic agent used in treatment of JIA worldwide, either as mono-therapy or in combination with biologic agents. However, there is variation in the clinical response to methotrexate among the patients. The main goal of juvenile idiopathic arthritis treatment is the achievement of wellbeing with minimal risk of side effects. Prediction of response can prevent further exposing of patients to side effects of methotrexate and also saving the time by progressing to the treatment with an alternative therapy (e.g. biological drugs) as soon as possible to prevent irreversible complications. Identification of predictors of response might also be helpful to develop recommendations for methotrexate use, especially starting of methotrexate as well as further continuation or early discontinuation and starting use of an alternative therapy. The aim of this study is to determine whether demographic, clinical, articular and laboratory variables at baseline predict methotrexate response in patients with juvenile idiopathic arthritis.
Khalid Masood
Combined Military Hospital Lahore, Pakistan
Title: An easy technique of corrective osteotomy for distal radial deformities
Time : 13:55 - 14:15
Biography:
Khalid Masood obtained his MBBS from Nishtar Medical College Multan, Pakistan in 1988. He initially obtained his fellowship in General Surgery from College of Physicians and Surgeons Pakistan, followed by completion of training in Orthopedic Surgery from Armed forces Post Graduate Medical Institute, Rawalpindi in 2001. He completed his Fellowship in Hand surgery from UK in 2010. Since then, he is practicing exclusively in upper extremity and currently serving as head of department in hand and upper limb surgery centre, Lahore, Pakistan.
Abstract:
Distal radial malunion is being treated by traditional techniques with unpredictable results. Purpose is to report our experience of special technique of corrective osteotomy followed by fixation with locking volar plate to restore best possible anatomy. 34 patients with different types of malunion were operated during last two years. Preoperative evaluation required clinical, radiological or CT-scan assessment followed by preparation of preoperative template. Under C-arm control, open wedge osteotomy was performed by directing the oscillating saw under guidance of two K-wires passed parallel to the articulating surface through two different planes (sagittal and horizontal). Additionally, cortico-cancellous iliac bone graft was used and fixed with 2.7 mm titanium fixed angle locking volar plate. Post-operative results were evaluated by radiological and clinical parameters. This technique significantly improved radiological parameters. Radial height, Radial inclination and Volar tilt improved from 7.9 mm (SD ±2.4), 17.63º (SD±3.5), -1.42º (SD±7.50) to 10.33 mm (SD±1.7), 20.39º (SD±3.7) and 10.53º (SD ±10.53) respectively. Clinically there was eminent improvement in wrist and forearm function, finger movements and grip strength. Anatomical restitution is the hall mark of this surgery which can be achieved by correct way of osteotomy. Rigid peculiarities of volar plates provide the best fixation allowing early post-operative motion with credible outcome.
Bita Anvari
Imam Khomeini Hospital-Kermanshah University of Medical Science, Iran
Title: Methotrexate hepatotoxicity in rheumatoid arthritis - An analysis of the physician's policy
Time : 14:15 - 14:35
Biography:
Anvari B did her Medical education and Internship, from Shiraz University of medical science, in the year 1990-1997, and in 2004-2008, Internal medicine residency and Board (2008), from Tehran University of Medical science. Her previous related work experiences include: from 1997-2004, she worked as a emergency, primary care, and trustworthy physician, from 2008-2009, she worked as a Internist of Internal medicine ward of GHods Hospital, Paveh, Kermanshah, and from 2009 to present, she is working as an Assistant Professor, in Internal medicine department, at Imam Khomeini Hospital, Kermanshah.
Abstract:
Background: Rheumatoid Arthritis is a common chronic disease and concern about the adverse eff ect of methotrexate especially hepatotoxicity could be a reason for discontinuation or reducing dose but the result of multiple policy in this situation is unclear and the physicians need to know what would be happened aft er each decision. Aim of the work: To demonstrate the result of multiple approaches to transaminitis in patients with Rheumatoid Arthritis who received methotrexate. Patients & Methods: Th e data has been collected from the previous work (since 2006) on 295 patients with Rheumatoid Arthritis who received at least 7.5 mg methotrexate for one month in a referral rheumatology clinic. Th e patients who developed transaminitis at least one time were selected for this study (N=102). At this point, physicians’ decision on discontinuing, decreasing, increasing or fi xed dose of methotrexate in approach to patients was collected and the result of the next liver enzyme was evaluated. Results: Decreased dose or discontinuation was happened among 32 patients (31.4%) and fi xed dose or rising dose in 53.9% and 8.8% respectively. Th e result of next enzyme in each group was normal in 93%, 65% and 67% respectively. Among 30 patients who had two consecutive elevated liver enzymes, 30% discontinued or decreased MTX dose. Th e next enzyme became normal in all of them however it was seen in 67% of the others with fi xed or rising dose. Conclusion: Obvious improvement in liver enzymes aft er decreased dose or discontinuation of methotrexate could be seen that makes this policy the best of action in approach to transaminitis of methotrexate, however trend to improvement despite of physicians’ decision were observed. If this natural course may be due to adjustment of hepatocyte activity or renal clearance, it needs to be further investigated.
Cesare Chemello
Asiago Hospital, Italy
Title: PSI: new instruments for a new generation of knee arthroplasty
Biography:
Cesare Chemello has completed his PhD from Padua University (Italy) and Post-doctoral studies from Padua University School of Medicine. From 2009 to 2010, he was a fellow of PhD Confalonieri Roberto in the Teaching Center of Milan where he improved his technique about computer assisted surgery and Total Knee replacement. In 2012, he was a fellow of PhD Alecci where he learned anterior approach and minimally surgery of total hip replacement. From 2013 he is consultant for Microport about Total Knee Replacement. He has published more than 10 papers in reputed journals. He is the winner of the Caos Scholarship in 2010 and SICOT Lester Lowe Award in 2012.
Abstract:
Introduction: Custom Made Surgery seems to be the future of total knee replacement (TKR). “Patients specific instrument” (PSI) helps the surgeon to perform a real tissue sparing surgery (TSS) and it allows to customize the technique and to standardize the results. Usually rheumatologic knees have important axial deviation and important bone loss, for this reason it is difficult to use a traditional prosthesis. The aim of our study was to illustrate the advantages and disadvantages of PSI in a prospective study of 100 pre-navigated total knee replacements.
Materials & Methods: 100 patients, affected by knee advance osteoarthritis and by axial deviation exceeding 3°, underwent to TKR (Advance Prophecy Wright). In the pre-operative examination, a TC was performed following strict protocols. We used a strict radiological protocol Post operative axes were compared to the planed ones and the following angles were examined: between anatomical and mechanical femoral axis (α-AAM), femoral flexion shield (FSF), tibial slope (ST) and frontal angle of the tibial component (α-CT). Negative outcome was considered as axial deviations ± 2 for FSF, ST and ±3 for α-CT e α-AAM.
Results: All patients achieved an excellent clinical and functional result according to KSS. Unplanned gender prosthesis was implanted in two patients. In only 1 case we changed the component size (femoral). In two cases, a 17 mm insert was necessary. Final knee flexion was necessary always more than 105°. Only 2 errors of the final α-AAM
Conclusion: This technique allows performing a TSS surgery, to reduce surgical time, to obtain optimal alignments. This technique also allows converting a challenging knee in a normal knee.
Sameer Naranje
Helena Regional Medical Center, USA
Title: An update on lower limb joint replacement in rheumatoid arthritis
Biography:
Sameer Naranje has completed his fellowship in joint replacement and adult reconstructive surgery from University of Minnesota after completing his M.R.C.S from Royal College of Physicians and Surgeons, Glasgow and Orthopaedic Residency from prestigious All India Institute of Medical Sciences, New Delhi, India. He is currently Chief of Surgery and Orthopaedics at Helena Regional Medical Center, AR, USA and Consultant Orthopaedic Surgeon at East Arkansas Orthopaedic Associates, AR, USA. He has extensive research background, numerous conference presentations, has published more than 30 papers in reputed journals and has been serving as an editorial board member and reviewer of number of reputed Orthopaedic journals.
Abstract:
More than 2/3rd of patients of Rheumatoid arthritis (RA) become disabled 20 years from primary diagnosis. RA is one of the most common indications for lower limb joint replacement in Northern Europe and North America. Though improved medical treatment of RA over last 2 decades have decreased the rate of hip and knee surgery, over a third of patients will need a major joint replacement, of which the majority will receive a total hip or knee replacement (THR and TKR). This paper summarizes an update on the major lower limb arthroplasty surgery for patients with RA. A multidisciplinary approach is needed for preoperative optimization. RA patients may need joint replacement at relatively younger age when compared to the patients with osteoarthritis and may need mutilple revision surgeries over their lifespan. Patients should be made aware of this and increased risk of infection and periprosthetic fracture rates associated with their disease. Biologic agents should be stopped pre-operatively due the increased infection rate. However, continued use of methotrexate does not increase infection risk, and may infact be helpful in recovery. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. Achieving ligamentous balance may be challenging in knee replacements in these patients and more constrained implants may be needed in patients with poor ligaments and severe deformities. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. The results of total ankle replacement remain inferior to THR and TKR though the science of ankle replacement continues to evolve. RA patients achieve equivalent pain relief after joint replacement, but their rehabilitation is slower and their functional outcome may not be optimum due to continued presence or worsening of the disease. Again, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimize their outcome.
Kimihiko Okazaki
Okazaki Medical Clinic, Japan
Title: A case report of Atopic Dermatitis that healed completely
Biography:
Dr. Kimihiko Okazaki was born in Osaka on March 23, 1933. Graduated from Kyoto University Faculty of Medicine in March, 1959. Engaged in medical chemical research work from April, 1960 through July, 1981. Started working as an internist in July, 1981. Started running a private medical clinic in September, 1989.
Abstract:
It has long been taken for granted that every antibody molecule rigidly adheres to its receptor on cell surfaces. Needless to say, to take something for granted is not very scientific. Indeed, another concept that an equilibrium state exists among antibody molecules in the vicinity of their receptors has been established since a half century ago. These two concepts obviously disagree with each other. Needless to say, again, the latter concept is more scientific and relevant than the former. It follows that every receptor of antibodies keeps changing antibodies. It still follows that the ratio of certain kind of antibody occupying receptors equals the ratio of that kind of antibody existing in the vicinity of the receptors. Accordingly, antibodies’ substitution should take place immediately after a new type of antibody appears. Hence, pathogenic antibodies could be detached from their receptors by producing non-pathogenic antibodies in the patients’ bodies. In order to let the patients produce non-pathogenic antibodies, the patients need to receive intra-dermal injections with non-pathogenic antigens. In conclusion, sufficient time of repetition of intra-dermal injections with non-pathogenic antigens should bring about complete cures of all of immunological diseases, i.e. diseases which are caused by pathogenic antibodies.
- Track 4:Osteoarthritis
Location: Terra Lucis
Chair
Laurence A. Bradley
University of Alabama at Birmingham USA
Co-Chair
Yong Min Xiong
Xian Jiaotong University, China
Session Introduction
Julie Winand
Bone Therapeutics, Belgium
Title: A novel injectable visco-antalgic (JTA-004®) with prolonged lubrication effects and anti-inflammatory properties for knee osteoarthritis
Time : 09:55 - 10:15
Biography:
Julie Winand has completed her PhD at the Université Catholique de Louvain in 2013. Since 2014, she is Project Manager at Bone Therapeutics, a bone and joint regenerative company developing innovative products for the treatment of osteoarthritis (OA).
Abstract:
Bone Therapeutics has developed an injectable visco-antalgic product (JTA-004®) intended to restore the natural composition of synovial fluid of osteoarthritic knees. The specific composition of JTA-004® is intended to reduce local inflammation and to prolong the lubrication effect. The anti-inflammatory properties of JTA-004® were assessed in vitro in an activated peripheral blood mononuclear cells model (PBMCs; from healthy donors) where activated PBMCs were contacted with JTA-004®, Ostenil® Plus (a reference visco-supplement) or positive controls (methotrexate and dexamethasone) for 3 days. In presence of JTA-004®, the proliferation of activated PBMCs was reduced by 52 ± 2% compared to activate PBMCs alone. The positive control methotrexate decreased the proliferation of activated PBMCs by 73 ± 8%. Moreover, JTA-004® reduced TNF-α secretion of activated PBMCs by 41 ± 14% compared to activated PBMCs alone, whereas the positive control dexamethasone decreased its secretion by 54 ± 6%. Ostenil® Plus did not impact activated PBMCs proliferation and TNF-α secretion. In vivo, the “lubrication” efficacy of JTA-004® and of Synvisc-One® (a reference visco-supplement) in a rat model of surgically induced knee OA (resection of the medial meniscus) was assessed by measuring the synovial fluid viscosity at different time points, up to 10 days after the intra-articular administration. At each time point, the synovial fluid viscosity of OA-knees treated with JTA-004® was higher than that of control knees. At ten days after injection, the synovial fluid viscosity of OA-knees treated with JTA-004® was still 67% higher than the viscosity of control knees while that of OA-knees treated with Synvisc-One® it was only 11% higher. Altogether, these in vitro and in vivo results demonstrated the superiority of JTA-004® compared to commercially available visco-supplements for OA treatment.
Diana Hodgins
Managing Director
European Technology for Business
UK
Title: Knee Osteoarthritis – Early detection
Time : 10:15 - 10:35
Biography:
Diana obtained her degree in Mechanical Engineering and her PhD in solid state gyroscopes from the University of Hertfordshire (UH). Diana has 30 patents granted on solid state sensors and more recently on medical applications relating to the use of these sensors. In 2000 Diana was awarded an MBE for services to SMEs in the region and in 2002 she won the Women Inventor of the Year Award for Industry. In 2005 Diana was awarded an Honorary doctorate from the UH for services to innovation. In 1995 Diana and her husband established their own business, ETB and in 2009 ETB launched their sensor based gait monitoring product, GaitSmart. This is now a world leading product used in wide range of medical and sports applications around the world. One of the sectors where it is applied is orthopaedics and a number of papers have been published on this topic. Diana is currently a visiting professor at the UH and helped to establish a new MEng course in Biomedical Engineering and in 2014 was awarded Alumni of the year at the UH.
Abstract:
Knee osteoarthritis is the primary reason why people undergo a knee replacement. This is because there is currently no effective treatment, even if it is detected early. A major EU initiative, funded by IMI, has been set up to qualify methods for patient stratification and ultimately support the selection of patients for clinical trials with new disease modifying osteoarthritis drugs. One of the monitoring tools used to help classify patients is a new sensor based tool (Gait-Smart), which has already been shown to be an effective tool to detect early and late stage knee osteoarthritis. In addition a range of existing imaging techniques will be used. This paper will present the protocol to be used in the patient classification prior to treatment.
YongMin Xiong
Director of the Endemic Institute of Xi'an Jiaotong University
China
Title: Selenoprotein gene polymorphism and oxidative stress signal transduction pathways in the kaschin-beck disease
Time : 10:35 - 10:55
Biography:
Yong Min Xiong holds the positions of Director of the Endemic Institute of Xi'an Jiaotong University, Deputy Director of the Key Laboratory of Trace Element and Endemic Diseases of National Health and Family Planning Commission, China. Her qualifications include a Bachelor of Medicine, PhD of Medicine. She is currently the Committee member of Society of Endemic Diseases of Chinese Medical Association and Chairman of Trace Elements Branch in Shaanxi Province Medical Association. She has a particular interest in the Environment and gene interactions in the molecular mechanism of endemic osteoarthritis diseases. She has published more than 30 articles in reputed journals.
Abstract:
Kashin-Beck disease (KBD) is an endemic, disabling and deforming osteoarthropathy that mainly affects children or teenagers in growth and development period. The mainly pathological changes in KBD are degeneration and necrosis in joint cartilage and epiphyseal plate cartilage. The disease has been found over 160 years, but, its etiology remains unclear. Epidemiological investigation of environmental risks has shown that selenium deficiency may contribute to the etiopathogenesis of KBD and Se supplementation could significantly decrease the incidence of KBD. Thus, it is considered that Se deficiency is a main environmental factor of KBD. Selenoprotein gene transcription level, protein expression level and enzymatic activity in KBD and normal blood and cartilage samples were detected by using qRT-PCR, ELISA and Western blot and selenoprotein single nucleotide polymorphisms (SNPs) were detected by using PCR-RFLP and ARMS-PCR in this study. The chondrocyte oxidative damage model was established using hydrogen peroxide tert butyl alcohol (tBHP) and the oxidative damage effects on apoptosis and oxidative stress, inflammation signaling pathways in chondrocyte were observed in the model. The results indicated that some important SNPs of selenoprotein are associated with the risk of development of KBD, including GPX1Pro198Leu, GPx4 (rs713041, rs4807542), SEPS1G-105A, sep15rs5859, which might influence inflammation or oxidative stress signal pathways in KBD patients. Furthermore, chondrocyte apoptosis induced by oxidative stress might be mediated via up-regulation of PI3K/Akt, JNK, NFκB and AP1 signaling pathways related to inflammation and oxidative stress, and Na2SeO3 has an effect of anti-apoptosis by down-regulating the signaling pathways.
Jinghong Chen
Institute of Endemic Diseases
China
Title: KBD pathogenesis from Kashin-Beck disease and a rat model of Kashin–Beck disease using T-2 toxin and selenium deficiency conditions
Time : 11:15 - 11:35
Biography:
Jinghong Chen completed her PhD from Xi'an Jiaotong University in China and Post-doctoral studies from Hospital for Special Surgery, Cornell University School of Medicine. She is the Vice-Director of Institute of Endemic Diseases, Xi’an Jiaotong University College of Medicine, a premier Kashin-Beck disease research organization in China. She has published more than 50 papers in international journals and Chinese journals.
Abstract:
Kashin-Beck disease (KBD) is a chronic, deforming endemic osteoarticular disease. Its etiology and pathogenesis remains unclear. This study compares pathogenic lesions and death of joint cartilages, sulfate glycosaminoglycan (GAG), oxidant damage, cytokines levels and MMPs/TIMPs ratio between KBD children and a novel model, in which rats were administered a selenium-deficient diet for 4 weeks prior to their exposure to T-2 toxin for 4 weeks. Chondronecrosis in deep zone of articular cartilage of knee joints was seen in T-2 toxin plus selenium-deficient diet groups, which were very similar to chondronecrosis observed in human KBD and decreased anabolic enzymes of GAG metabolism, PAPSS2, PAPST1 and CHST15, and increased catabolic enzymes ARSB and GALNS in cartilage were seen in KBD and in the novel rat model. Further, the levels of MDA, and IL-6, IL-1β, TNF-α in serum and cartilage were increased in KBD and in the novel rat model. And MMP-1 and -13 levels increased, while TIMP-1 levels decreased in KBD and in the novel rat model. Those results indicate that the rat by employing T-2 toxin treatment under selenium deficient conditions can be used as a suitable animal model for studying etiological factors contributing to the chondro-necrosis observed in human KBD. This pathological change which results from oxidative stress/ cytokines/ MMPs pathways by T-2 toxin and selenium deficiency may result in progressive chondrocyte cell death, and ECM degradation and destruction in the deep zone of cartilage in KBD. Alterations of enzymes involved in cartilage CS GAG metabolism on PGs play an important role in the onset and pathogenesis of KBD.
Matjaz Sajovic
General Teaching Hospital Celje
Slovenia
Title: An Algoritem for the management of Knee Osteoarthritis
Time : 11:35 - 11:55
Biography:
Sajovic Matjaz MD, PhD is an Associate Professor of Medicine Faculty at University of Maribor, Slovenia. He completed medical school at Ljubljana University Medicine Faculty. He is a Consultant Orthopedic Surgeon and Deputy Head of Orthopedic and Sports trauma surgery department at General Teaching Hospital Celje, Slovenia.
Abstract:
A clinical diagnosis of Osteoarthritis can be made by focusing on the following six clinical symptoms and signs: persistent knee pain, limited knee stiffness (<30 minutes), reduced function, crepitus, restricted movement and bony enlargement. The majority of patients can be managed adequately by following treatment algorithm recommended by the European League against Rheumatism (EULAR) and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESECEO). Basic principles consist of the need for a combined pharmacological and non-pharmacological treatment with a core set of initial measures, including information access/ education, weight loss if overweight and an appropriate exercise program. Four multimodal steps were then established. Step 1 consists of background therapy, either non-pharmacological (physical therapy) or pharmacological treatment. The latter consists of chronic Symptomatic Slow-Acting Drugs for OA (SYSADOA) with paracetamol at-need; topical NSAIDs are added in the still symptomatic patient. In patients with varus deformity and medial compartment knee disease, open high tibial osteotomy is recommended. Step 2 consists of the advanced pharmacological management in the persistent symptomatic patient and is centered on the use of oral COX-2 selective or non-selective NSAIDs, chosen based on concomitant risk factors, with intra-articular corticosteroids or hyaluronate for further symptom relief if insufficient. In Step 3, the last pharmacological attempts before uni-compartmental or total knee replacement are represented by short-term weak opioids and other central analgesics. Finally, Step 4 consists of end-stage disease management and surgery, with classical opioids as a difficult-to-manage alternative when surgery is contraindicated.
Biography:
Apurba Ganguly has completed his PhD and DSc from Open University of Alternative Medicine (accredited with WAUC, USA). He is Founder Chairman of OPTM Health Care (P) Ltd, a premier health care organisation in India, Nanophyto Pharmacy, a manufacturing Unit of specialised Phytomedicine for ‘Varicose Vein’ and ‘Urinary Incontinence’ and Head Researcher of OPTM Research Institute. He has awarded many National and International awards for his excellence treatment protocol. He has written 6 papers out of which 4 papers have been published in International Journals and 2 papers are under review. He is a supervisor to PhD students of Techno India University.
Abstract:
Osteoarthritic disorders (OAD) namely osteoarthritis, rheumatoid arthritis, lumbar and cervical spondylosis, etc., are major health concern worldwide. Th ere are many causative factors such as age, obesity, injury aff ecting muscles and bones, etc. Th e objective is to develop the tools for pain diagnosis for OAD and treatment thereon by topical phytotherapeutic protocol with specialised technique. Th e study was conducted on 108 patients ( male: 27 and female: 81) aged ≥50 years old for diagnosis of pain and complete recovery of OAD with the help of topical application of phytoconstituents (aqueous extracts) from Indian medicinal plants such as Cissus quadrangularis, Heliotropium indicum, Rosmarinus offi cinalis and Calotropis gigantea preserving with sesame oil and beeswax. Th e development of diagnostic tools for abnormalities of OAD were studied through anatomical measurements (bilateral knee gaps between the short head of bicep femories and level of the bed, bilateral knee fl exions and extensions in supine, prone and standing positions), biochemical parameters (muscle creatinine phosphokinase, C-reactive protein and aldolase A) and radiological images (AP and lateral views) at the baseline. In order to justify the complete recovery, the same parameters were studied at the end of 42 sittings and compared with the data at the baseline (0 sitting). Th e present results reveal a novel study for new pain diagnostic protocol and complete recovery of abnormalities due to OAD and prevention thereon as evidenced by anatomical measurements, biochemical parameters and radiological images by specialised phytotherapeutic treatment programme 0 sitting and aft er 42 sittings of treatment.
Biography:
Cedo M Bagi, MD, PhD is a Senior Research Fellow at Worldwide Science & Technology group at Pfizer Inc., (Groton, CT) with over 25 years of research experience in academic and pharmaceutical research organizations. Current research focuses on the metabolic diseases, immunological disorders and bone cancers. His responsibilities include implementation of translational disease animal models and diverse technologies to provide preclinical efficacy and safety data and enable rapid translation of novel medicines to clinic, and ultimately to patients. His accomplishments of past work include patents, numerous publications, book chapters, presentations and memberships in professional organizations.
Abstract:
Osteoarthritis (OA) is a leading cause of disability, but despite the high unmet clinical need and extensive research seeking dependable therapeutic interventions, no proven disease-modifying treatment for OA is currently available. Due to the close interaction and interplay between the articular cartilage and the sub-chondral bone plate, it has been hypothesized that antiresorptive drugs can also reduce cartilage degradation, inhibit excessive turnover of the subchondral bone plate and prevent osteophyte formation and or that bone anabolic drugs might also stimulate cartilage synthesis by chondrocytes and preserve cartilage integrity. The benefit of intensive zoledronate (Zol) and parathyroid hormone (PTH) therapy for bone and cartilage metabolism and bone strength was evaluated in a rat model of OA. The results of this study highlight the complex changes in bone metabolism in different bone compartments influenced by local factors, including inflammation, pain and mechanical loads. Surgery caused severe and extensive deterioration of the articular cartilage at the medial tibial plateau, as evidenced by contrast-enhanced µCT and histology. The study results showed the negative impact of MM surgery on the weight-bearing capacity of the operated limb, which was not corrected by treatment. Although both Zol and PTH improved subchondral bone mass and Zol reduced serum CTX-II level, both treatments failed to prevent or correct cartilage deterioration, osteophyte formation and mechanical incapacity.
Hadi Abdollahzad
Kurdistan University of Medical Sciences
Iran
Title: Coenzyme Q10 supplementation and health status of rheumatoid arthritis patients.
Biography:
Hadi Abdollahzad has completed his PhD from Tabriz University of Medical Sciences. He is the Assistance Professor of Kurdistan University of Medical Sciences, Iran. He has published more than 5 papers in reputed journals and has been serving as an Editorial Board Member of Austin Arthritis.
Abstract:
Progressive cartilage and bone destruction culminates to physical disability and deteriorates health status in rheumatoid arthritis (RA). In addition to adverse effects and high costs, current therapies sometimes fail or produce only partial responses. Recently, trends toward nutritional supplements as adjunct therapies have been extended. Anti-inflammatory and anti-nociceptive effects of coenzyme Q10 (CoQ10) in the arthritis animal model have been characterized. The current study was carried out to investigate the effects of CoQ10 supplementation on health status in rheumatoid arthritis patients. In this double-blind, randomized placebo-controlled clinical trial 54 RA patients with moderate and sever disease activity score (DAS28>3.2) were selected from those referred to specialized clinics of Urmia University of Medical Sciences. Eligible participants randomly allocated to supplement or placebo groups. In addition to usual pharmacologic therapies, each patient received a 100 mg/day capsule of CoQ10 in supplemented group (n=27) or placebo in control group (n=27) for two months. Patients’ demographic data were recorded at the baseline. Before and after the intervention dietary food intakes and health assessment questionnaire (HAQ) were completed through respective questionnaires. Data were analyzed using SPSS. Energy and macronutrients intake showed no significant differences within and between groups. CoQ10 significantly lowered HAQ score and led to a significant difference between two groups. It appears that oral CoQ10 supplement can be applied as an adjuvant treatment in combination with anti-rheumatic drugs. Longer clinical trials with higher doses of CoQ10 may be necessary to confirm the results of our study.
- Symposium on Advances in Osteoarthritis Pain Research
Location: Terra Lucis
Session Introduction
Laurence A. Bradley
University of Alabama at Birmingham
USA
Title: Ethnic differences in pain among persons with knee osteoarthritis: What are the mediating variables.
Time : 12:15 - 12:55
Biography:
Laurence A. Bradley, PhD is Professor of Medicine in the Division of Clinical Immunology and Rheumatology at UAB School of Medicine. He has established a strong research program (143 papers, 55 chapters, 3 books) over the past 40 years concerning the interplay between biological and behavioral factors that influence persistent pain in persons with rheumatologic illnesses. With continuous support by the National Institutes of Health since 1989, Dr. Bradley’s goal is to use clinical and basic science methods to enhance understanding of individual differences in persistent pain and lead to improved management of pain and related health outcomes.
Abstract:
There are large differences between non-Hispanic white (NHW) and African American (AA) persons with knee OA in reports of clinical pain intensity. However, little is known concerning biological or psychosocial variables that may mediate these ethnic differences. I will review cross-sectional study findings reported by my colleagues at UAB and the University of Florida during the past 6 years of ethnic differences in both clinical pain and pain induced by standardized pressure, heat, and cold stimuli in the laboratory (i.e., quantitative sensory testing or QST). Specifically, we found that AA persons with knee OA, relative to their NHW counterparts, report higher levels of clinical pain intensity and higher intensity of pain in response to QST. We also found that AA persons, compared to NHW counterparts, show greater increases in pain intensity in response to repetitive heat and pressure stimuli that reflect alterations in central processing of noxious stimuli among AA individuals. I also will describe a new longitudinal study with which we aim to identify the mechanisms underlying ethnic differences in knee OA pain over a 2-year period. We are now assessing the progression and predictors of clinical pain and disability as well as altered central pain processing among AA and NHW persons with and without knee OA. Potential mediating variables include sleep disturbance, MRI imaging of brain structure and brain response to QST and new biomarkers of pain inhibition. Our findings should provide novel and important information regarding the mechanisms underlying ethnic group differences in pain.
Jasvinder A. Singh
University of Alabama at Birmingham (UAB) USA
Title: Persisting Pain and Poor Function after Knee or Hip Joint Arthroplasty: What can learn about this epidemic?
Time : 13:40 - 14:20
Biography:
Jasvinder A. Singh, PhD is Professor of Medicine in the Division of Clinical Immunology and Rheumatology at UAB School of Medicine in Birmingham, Alabama, USA. He leads a strong research program studying patient outcomes in rheumatic conditions. His team has made new observations about the comparative risks of biologics by performing systematic reviews and network meta-analyses, and helped to understand the predictors and correlates of pain and function outcomes in patients with gout and this undergoing joint replacement. His research program has had continuous federal support by federal funding since 2004. Dr. Singh’s goal is to use epidemiological tools to enhance the understanding of patient reported outcomes in rheumatic diseases that can lead to improved outcomes in arthritis and related conditions.
Abstract:
Knee and hip joint arthroplasty are among the most successful surgical procedures preformed for the relief of refractory knee or hip joint pain due to end-stage arthritis and other causes. Close to 1 million procedures are done in the US and the utilization rates are projected to increase 8-fold for knee and 2-fold for hip joint replacement by 2025, compared to 2005. A small, but significant proportion of patients, do not achieve acceptable improvement in pain and function after joint replacement surgery. What leads to this state is not clear, however, with the increasing volume of these procedures being performed, this group of patients is growing quickly. No acceptable treatment is available to these patients in the absence of a mechanical failure of the implant. We have been studying the characteristics of patients who have persisting pain and poor function after joint replacement and have found that certain patient characteristics (gender, age), comorbidity, body mass index, as well as economic factors are associated with these outcomes. Some of our recent findings indicate that some factors are potentially modifiable. In this symposium, I will summarize the work that we and others have done in the area, highlighting key studies and findings that provide insight in this problem.
Anthony Jones
University of Manchester, UK
Title: Mechanisms of pain resilience and vulnerability
Time : 14:20 - 15:00
Biography:
Anthony Jones is Professor of Neuro-rheumatology at Manchester University and leads the Human Pain Research Group. Whilst at the Hammersmith Hospital, he pioneered the development of techniques to image neuro-chemical and metabolic brain responses to pain using Positron Emission Tomography. Over the last twenty years, he has used a number of functional brain imaging techniques to understand the normal and abnormal mechanisms of pain perception. He also leads the International Association for the Study of Pain Musculoskeletal Pain Taskforce and has led the development of National and International Guidelines on the Integrated Management of Musculoskeletal Pain (jointly sponsored by the BSR and the IASP).
Abstract:
Pain is one of the main drivers of long term disability in patients with chronic musculoskeletal pain. The matrix of brain structures responsible for the perception of pain has been shown to have both high specificity and sensitivity for pain. Subtle sex differences in cortical processing have also been described. There is increasing evidence for central sensitization resulting from abnormal processing within this matrix being a key driver in the maintenance of chronic pain. Common candidate mechanisms related to abnormal processing of expectation and attention to pain have been identified in the brains of patients with osteoarthritis (OA) and fibromyalgia (FM). Increased summation and abnormalities of descending inhibition have also been identified in these populations. In addition changes in brain opioid receptor binding have been related to increased vulnerability and vulnerability to pain. These findings taken together suggest a range of physiological phenotypes in patients with different types of chronic pain that does not respect traditional medical models and classifications of pain.
- Track 1: Rheumatic Disorders
Track 3 Arthritis
Track 6 Soft Tissue Rheumattism
Location: Terra Lucis
Chair
Yesim Garip
Pinar Physical Therapy and Rehabilitation Center Turkey
Session Introduction
Yesim Garip
Pinar Physical Therapy and Rehabilitation Center
Turkey
Title: Use of biologic agents for rheumatic diseases in pregnancy
Time : 15:20 15:40
Biography:
Yesim Garip has completed her MD at Gazi University School of Medicine, Ankara, Turkey (2003) and completed training in the medical specialty of physical medicine and rehabilitation at Numune Training and Research Hospital, Ankara, Turkey (2009). She is the director of a physical therapy and rehabilitation center. She has published about 30 papers in journals and 2 of her papers were awarded in international congresses. She has been serving as an editorial board member of Journal of Orthopedics, Rheumatology and Sports Medicine and World Journal of Rheumatology.
Abstract:
Use of biologic agents in the late 1990s have inaugurated a new era in the treatment of inflammatory rheumatic diseases. In recent years, several biologic agents have been approved by Food and Drug Administration (FDA) and have offered an alternative treatment for the patients failing conventional therapy. Although there is a tendency for clinical remission during pregnancy, in some cases, continuing with treatment throughout pregnancy may be necessary. Since important antirheumatic agents such as methotrexate and leflunomide have teratogenic effects, biologic therapy may be an option for pregnant women with high disease activity. Safety of these agents during pregnancy is still a matter of debate due to absence of drug trials conducted in pregnant women and their use during pregnancy is not recommended. However, cumulative data suggest that rate of birth defects following prenatal exposure to biologic agents appear to be comparable with that expected in the general population. The decision to use biologic agents during pregnancy is difficult. The benefits of biologic agents must outweigh the risks to the fetus/embryo or mother. This review provides published data on use of biologic agents including etanercept, infliximab, adalimumab, certolizumab pegol, golimumab, tocilizumab, rituximab, anakinra and abatacept for rheumatic diseases during pregnancy.
Hang Liu
1st Hospital of China Medical University
China
Title: Retroperitoneal fibrosis：A clinical and outcome analysis of 81 cases and review of literature
Time : 15:40 - 16:00
Biography:
Hang Liu has completed her MD at the age of 26 years from China Medical University and now is pursuing her Doctorial Degree in China Medical University. She embarked on the basic experiment in her college years and won prizes in the national experiment design contest. During her graduate study, she participated in her professor’s National Science Foundation Projects and paid a visit to Tohoku University to strength the cooperation and collaboration with the accomplished professors in Japan. She participated in national conferences and presented as a speaker. Her research now focuses on interleukin-17 and IgG4-related disease.
Abstract:
Objective To investigate the clinical features and outcomes of retroperitoneal fibrosis (RPF). Methods 81 RPF treatment cases in the First Affiliated Hospital of China Medical University were retrospectively analyzed, including clinical characteristics and laboratory data. Results RPF was found predominantly in elderly men with atypical clinical manifestations of back pain, abdominal pain and lower limb edemas. In laboratory examinations, the acute-phase reactants such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels increased significantly. Renal function failure was frequently found in patients with urethral obstruction. All patients had retroperitoneal soft tissue shadows or urethral obstructions on computed tomography or magnetic resonance imaging, 8 of which had histological diagnosis of idiopathic RPF. 46 patients received surgical interventions; 50 patients received medication treatment alone including corticosteroids, immunosuppressants, and tamoxifen; 21 patients received corticosteroids after surgical intervention. Surgery followed by medication was most effective for RPF. Conclusion Computed tomography and magnetic resonance imaging helps to exclude secondary causes, but biopsy remains the gold standard for diagnosis. Long-term low dose corticosteroids and immunosuppressants may prevent relapse of RPF.
Pengfei Zan
The Tenth People’s Hospital, China
Title: The effect of patella eversion on clinical outcome measures in simultaneous bilateral total knee arthroplasty, a prospective randomized controlled trial
Biography:
Pengfei Zan is a Medical PhD student in Tongji University, one of the most famous colleges in China. He received the national scholarship, published 5 SCI papers and achieved three patents until now. He is about to be an attending doctor in Shanghai Tenth People’s Hospital.
Abstract:
Background: During total knee arthroplasty (TKA), surgical exposure requires mobilization technique of the patella. With this trial, we intended to investigate the eff ect of patella eversion on clinical outcome measures in simultaneous bilateral TKA. Methods: We prospectively enrolled 44 patients (88 knees) from April 2008 to June 20l4. One knee was operated with patella eversion (group A) and the other with patella lateral retraction (group B) randomly. Follow-up results, including the operation time, complications, the time of achieving strait leg raise (SLR) and 90° knee fl exion, were recorded. Th e data of range of motion (ROM) and Visual Analogue Scale (VAS) score were collected separately at seven days, three months, six months and one year postoperatively. Results: Th e time of achieving SLR was (2.7±0.8) days in Group A and (2.1±0.7) days in Group B, which were signifi cantly diff erent (P=0.032). Signifi cant diff erence was found on active and passive ROM during the follow-up times between Group A and B, except the passive ROM at 6 month postoperatively. No signifi cant diff erence was found on operation time, complications, patella baja or tilt, time of achieving 90° knee fl exion and VAS score during the follow-up times. Conclusions: Patellar eversion was adverse to the early knee function recovery aft er TKA, it would delay the time of achieving SLR, decrease the passive and active ROM. Additionally, more carefully and scientifi cally designed randomized controlled trials are still required to further prove the claim.
Mohamed A Mortada
Zagazig Universty.Egypt
Title: Multiple versus single ultrasound guided Suprascapular Nerve block in treatment of frozen shoulder in diabetic patients.
Time : 16:20 - 16:40
Biography:
Mohamed A Mortada is a Lecturer of Rheumatology, Faculty in Medicine, Zagazig University. He completed his MD in 2011and published many papers in the field of musculoskeletal ultra-sonography in rheumatology practice.
Abstract:
Background: Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder.
Objective: To compare between single and multiple (nine) SSNB in the treatment of diabetic frozen shoulder.
Patients & Methods: Type 2 diabetic patients with frozen shoulder divided into 2 equal groups. Patients in group1 were subjected to single SSNB. Patients in group 2 were subjected to multiple (nine) SSNB 3 times per week. Participants will be assessed clinically and by ultrasound at baseline and after 3 weeks and 4 months.
Results: At assessment points (3weeks & 4months), there was a significant improvement of all clinical & ultrasound parameters in both groups in comparison with the base line parameters (p≤0.001). But the improvement in the multiple injection protocol was significantly better than the improvement in the single injection protocol was used.
Mohammed el sayed zaky
Cairo University
Egypt
Title: Impact of self-management techniques on self-efficacy among patients with rheumatoid arthritis at a university hospital in Cairo
Time : 16:40 - 17:00
Biography:
Mohammed El Sayed Zaky is an Assistant Lecturer, Faculty of Nursing, at Cairo University in Medical Surgical Nursing department. He received his master degree in April 2016 in rheumatoid arthritis.
Abstract:
Background: Self-management techniques of rheumatoid arthritis patients are designed to minimize the potential long-term disabilities. Th ese patients are liable to decreased fl exibility, muscle atrophy, diminished muscle strength. Self-management techniques were provided to the study subjects using hand out of instructional booklet containing all the needed knowledge that help patients to perform self-management techniques. Th is was preceded by instructional sessions and self-effi cacy assessment. Objectives & Aims: Aim was to evaluate the impact of self-management techniques on self-effi cacy among patients with rheumatoid arthritis at a university hospital in Cairo. Subject & Methods: Sample: A random sample of 30 adult RA patients. Setting: Outpatient rheumatology clinics at El Kasr El Eini Hospital. Design: One-group Pre-Assessment/Post-Assessment research design (pre-experiments). Tools of data collection: a- Structured interview questionnaire b- Arthritis Self-Effi cacy Tool. Results: Th e majority of the studied sample (80%) was females. Th e mostly reported signs and symptoms by RA subjects were (Arthralgia, continuous fatigue, joint hotness, stiff ness, inability to perform ADLS and joint swelling) were (87%, 81%, 81%, 75%, 72% and 69 %) respectively. Th e self-effi cacy of studied sample in 1st Assessment, 2nd Assessment and 3rd Assessment were (125.37±29.93, 130.23±32.45 and 137.06±29.23) respectively indicating improved self-effi cacy. Finally, there is relation between age and 3rd selfeffi cacy assessment (127.06±32.32) T=2.05, P=0.05. However, gender, level of education and practicing exercise didn't play a role in relation to self-effi cacy. Conclusion: Patients who received self-management techniques showed high self-effi cacy levels.. Recommendation: Self-management techniques should become an integrated part of the total management of rheumatoid arthritis patient. Self-effi cacy should be enhanced to help patients limit the impact of their signs and symptoms on their living activities.