Day 1 :
Director Institute of Regenerative and Molecular Orthopedics
Dr. Purita is director of Institute of Regenerative and Molecular Orthopedics (www.stemcellorthopedic.com) in Boca Raton, Florida. The Institute specializes in the use of Stem Cells and Platelet Rich Plasma injections. Dr. Purita is a pioneer in the use of Stem Cells and Platelet Rich Plasma. The Institute has treated some of the most prominent professional athletes from all major sports in both the U.S.A. and abroad. He received a B.S. and MD degree from Georgetown Univ. Dr. Purita is board certified in Orthopedics by ABOS. He is a Fellow American College of Surgeons, Fellow American Academy Orthopedic Surgeons, and a Fellow American Academy of Pain Management. He is also certified in Age Management Medicine. He has lectured and taught extensively throughout the world on the use of Stem Cells and Platelet Rich Plasma. He has been instrumental in helping other countries in the world establish guidelines for the use of Stem Cells in their countries. He has been invited to lecture on these techniques throughout the world as a visiting professor.
The presentation concerns PRP and Stem Cell (both bone marrow and adipose) injections for musculoskeletal conditions in an office setting. Indications are given as to which type of cell and technique to use to accomplish repair. Stem cells, both bone marrow derived (BMAC) and adipose, are used for the more difficult problems. PRP injections are utilized for the less severe problems. Indications are given when to use Stem Cells verses PRP and when to use both. The newest concepts in stem cell science are presented. These concepts include the clinical use of MUSE cells, exosomes and Blastomere like stem cells. Basic science of both PRP and stem cells are discussed. This presentation defines what constitutes an effective PRP preparation. Myths concerning stem cells are dispelled. One myth is that mesenchymal stem cells are the most important stem cell. This was the initial interpretation of Dr. Arnold Caplan the father of mesenchymal stem cell science. Dr. Caplan now feels that MSCs have an immunomodulation capacity which may have a more profound and immediate effect on joint chemistry and biology. We now learn in the talk that the hematopoietic stem cells are the drivers of tissue regeneration. Also discussed are adjuncts used which enhance the results. These therapies include supplements, LED therapy, lasers, electrical stimulation and cytokine therapy. The scientific rationale is presented for each of these entities as to how they have a direct on stem cells.
National Institute of Rheumatic Disease, Piestany
Keynote: Alkaptonuria and Ochronosis
Time : 09:25 - 09:55
Prof. MD. Jozef Rovno, MD., FRCP since 1990, is director of the National Institute of Rheumatic Diseases in. It is extremely active publication, published in domestic and foreign journals with high citation index and has more than 120 citations in domestic and foreign magazines. He holds the Gold Medal revaluation of the Slovak Medical Association for his active work in the medical field. It is the President or no lenom in many organizations and a member of the editorial boards of journals: Newsletter LPRE SR Rheumatologia, medical monitor, Osteologický bulletin Scripta Medica 2000 Clinical Experimental Rheumatology.
Alkaptonuria is a rare inherited genetic disorder of phenylalanine and tyrosine metabolism. This is an autosomal recessive condition that is due to a defect in the enzyme homogentisate 1,2-dioxygenase, which participates in the degradation of tyrosine. As a result, homogentisic acid and its oxide, accumulate in the blood and are excreted in urine in large amounts. The polymer of homogentisc acid called alkapton, impregnates bradotrophic tissues. rnThe first signs of deposition of the ochronotic pigment can be detected accidentally during professional examination of the anterior segment of the eye. The ochronotic pigmentation of the ocular structures is present in approximately 70 % of patients. In addition to the sclera, lumps of the ochronotic pigment can be found in the conjunctiva and cornea. Since similar pigmentation of the cornea is not present in other medical conditions, this finding is regarded as pathognomic for alkaptonuric ochronosis. The diagnosis of alkaptonuria is based on the characteristic findings in urine. Alkaptonuria patients do not seek medical help due to difficulties with vision – they are without subjective complications. In parallel with the ocular manifestations, ochronotic changes can be found in the hearing organ. Color changes of the auricle are visible in the 10th to 15th year of life. Also typical for alkaptonuric ochronosis are changes in the skin, mainly brownish or bluish pigmentation of the skin under the arm, in the face, neck and hands, and rarely on the nails. Given their visibility they may be relevant for the early diagnosis alkaptonuric ochronosis. Ochronotic pigment is deposited also on the internal organs. In the field of cardiovascular organs it is the myocardium and blood vessels. From a clinical point of view, the most serious process takes place in the joints and is called ochronotic arthropathy. Therapy of alkaptonuria with Nitisinone is underway.
- Track 4:Osteoarthritis
Location: Terra Lucis
Laurence A. Bradley
University of Alabama at Birmingham USA
Yong Min Xiong
Xian Jiaotong University, China
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
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).
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 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.
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.
Director of the Endemic Institute of Xi'an Jiaotong University
Title: Selenoprotein gene polymorphism and oxidative stress signal transduction pathways in the kaschin-beck disease
Time : 10:35 - 10:55
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.
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.
Institute of Endemic Diseases
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
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.
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.
General Teaching Hospital Celje
Time : 11:35 - 11:55
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.
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.
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.
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.
Kurdistan University of Medical Sciences
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.
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
University of Alabama at Birmingham
Title: Ethnic differences in pain among persons with knee osteoarthritis: What are the mediating variables.
Time : 12:15 - 12:55
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.
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.
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
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.
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 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).
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
Pinar Physical Therapy and Rehabilitation Center Turkey
Pinar Physical Therapy and Rehabilitation Center
Time : 15:20 15:40
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.
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.
1st Hospital of China Medical University
Title: Retroperitoneal fibrosis：A clinical and outcome analysis of 81 cases and review of literature
Time : 15:40 - 16:00
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.
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.
The Tenth People’s Hospital, China
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.
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.
Title: Multiple versus single ultrasound guided Suprascapular Nerve block in treatment of frozen shoulder in diabetic patients.
Time : 16:20 - 16:40
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.
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.
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
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.
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.