Gustavo Constantino de Campos

Conceitos atuais em osteoartrite

Osteoarthritis (OA), the most common form of joint disease, affects mainly the hips, knees, hands and feet, leading to severe disability and loss of quality of life, particularly in the elderly population. Its importance grows every year with the aging of the population, with a large increase in the elderly population compared to younger patients. The progressive understanding of the pathophysiology of OA, the perception that the process is not purely mechanical and / or aging, and clarification of the inflammatory pathways involved led recently to the clinical application of various drugs and other measures. This update aims to expose the current concepts on the pathophysiology and treatment of OA.Osteoarthritis (OA), the most common form of joint disease, affects mainly the hips, knees, hands and feet, leading to severe disability and loss of quality of life, particularly in the elderly population. Its importance grows every year with the aging of the population, with a large increase in the elderly population compared to younger patients. The progressive understanding of the pathophysiology of OA, the perception that the process is not purely mechanical and / or aging, and clarification of the inflammatory pathways involved led recently to the clinical application of various drugs and other measures. This update aims to expose the current concepts on the pathophysiology and treatment of OA.

Prevalence of osteoporosis in patients awaiting total hip arthroplasty

Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study.

PARQVE-Project Arthritis Recovering Quality of Life by Means of Education Short-term Outcome in a Randomized Clinical Trial

Objective: To evaluate the improvement in pain, function and quality of life of patients with knee osteoarthritis (OA) by means of an educational program. Methods: Two hundred and five patients with knee OA were evenly allocated in four groups. Three groups had two days of lectures on Osteoarthritis (OA). All groups received printed material to read and a video with all the lectures. Groups 1, 2, and 3, had lectures one, two and three months apart respectively. Group 4 received the educational material only. Half of the patients (subgroups A) received a telephone call two months after the final lecture. At enrollment and four months after the final lecture or after receiving the educational material, patients were asked to answer LEQUESNE, WOMAC, VAS, and SF-36 questionnaires, both physical (PCS) and mental (MCS). Results: Age wise all groups were similar. BMI was significantly higher in group 4. In general, all groups improved in pain, function and quality of life with no significant difference between groups for Lequesne, WOMAC, WOMAC pain, and SF36 PCS, or MCS. VAS showed significant difference favoring phone calls (p=0.021). Without telephone calls VAS scores trends (p=0.068) to be less in class attendants than in those that only retrieved the educational material. Conclusions: The educational program improved pain, function and quality of life (both physical and mental). Telephone calls improved pain and classroom programs seem to be superior to educational material alone.

Estudo anatômico do trajeto da artéria vertebral na coluna cervical inferior humana

SUMMARY The increasing use of new techniques and materials for surgical treatment of lower cervical spine conditions has come along with an increasing concern regarding potential complications that might occur. The transpedicular fixation technique, frequently used in other spine levels, is used on the cervical spine, while providing more stability than other techniques, it may cause serious complications such as vertebral artery injury, nervous root injury, or facet joint in- juries. However, the C7 vertebra is considered safer for performing this procedure, since, in the vast majority of people, according to available anatomical studies, does not have a vertebral artery passing through its cross-sectional foramen, because that vessel is inserted into such structure only on C6 vertebra. As there are only imaging studies available today for assessing the path of this artery and its anatomical variables, we conducted this anatomical study by dissecting 40 cadavers vertebral arteries in order to assess the incidence of anatomical variations. We found 3 cases where the vertebral artery penetrated into cross-sectional foramen at C7 (7.5%), a fact that enhances the risk of an undesired injury with a transpedicular technique at this level. The other remaining specimens showed a usual anatomy.

OBESITY, OSTEARTHRITIS AND CLINICAL TREATMENT

OBJECTIVE: To evaluate the relationship between BMI and pain and function in patients with OA undergoing medical treatment following OARSI recommendations. METHODS: Thirty-eight patients were classified according to their arthritis degree by X-ray and body mass index (BMI). All patients completed the WOMAC, Lequesne, and visual analogue pain scale (VAS) questionnaires at baseline and after six months treatment. All patients were treated with diacerhein and analgesics (according to pain), orthotics (when indicated), and an educational program on osteoarthritis. They were instructed on balanced diet and exercise at least three times a week. RESULTS: There was no significant BMI variation in this study. The higher the initial BMI, the lower the improvement in pain (p = 0.03). Pain did not improve significantly (p = 0.2). Function improved (p <0.001) in inverse ratio to the initial BMI. CONCLUSION: BMI determines how patients will improve pain and function.

PARQVE: PROJECT ARTHRITIS RECOVERING QUALITY OF LIFE THROUGH EDUCATION: TWO-YEAR RESULTS

ABSTRACT Objective: To evaluate the effects of a multi-professional educational program in patients with knee osteoarthritis (KOA). Methods: Prospective randomized controlled trial with 195 KOA patients. One group was submitted to two-day lectures and received educational material about KOA (Class group), and the control group received the educational material only. Patients were evaluated at baseline, twelve and 24 months. At evaluation, patients answered pain and functional questionnaires (WOMAC, Lequesne, VAS and SF-36); reported the intensity of exercise per week; measured the body fat percentage, weight and height to estimate body mass index (BMI); and performed Timed Up & Go (TUG) and Five-Times-Sit-to-Stand (FTSST) tests. Results: The groups presented similar results in all time points with respect to pain (VAS and WOMAC pain), WOMAC, BMI and body fat percentage (p>0.05). The Class group exhibited improved function according to the Lequesne questionnaire, whereas the control group worsened (p=0.02) during follow-up (p<0.02). TUG (p=0.01) and FTSST (p<0.001) improved in the Class group. A higher percentage of patients in the Class group performed regular physical activity (p=0.045). Conclusions: The educational program with classes improved the consistency of physical activity and the subjective and objective function of patients with KOA.Level of evidence IA, Prospective Randomized Controlled Trial.

Randomized prospective study evaluating addition of corticoid to viscosupplementation: three months of follow-up

Objective To assess if the initial results of viscosupplementation are improved by the addition of corticosteroid. Design We evaluated 104 patients receiving usual care for knee osteoarthritis at the Universidade de São Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6 mL of Hylan GF-20 (Group 1) or a single intra-articular injection of 6 mL of Hylan GF-20 plus 1 mL (20 mg) of Triamcinolone Hexacetonide (Group 2). VAS, WOMAC and Lequesne questionnaires were applied at weeks zero (prior the injection), and after one, four, and 12 weeks. Results The baseline measurements of the two groups with 52 patients each were not statistically different. At week one, WOMAC and VAS showed significantly better results for Group 2 compared to Group 1 (p < 0,05). At week four the scores did not show a statistically significant differences. The groups showed similar results at week 12. Conclusion The addition of Triamcinolone Hexacetonide improves the short term symptom/functional scores of viscosupplementation.

Schooling of the patients and clinical application of questionnaires in osteoarthitis

Objective: To evaluate the consistency of the questionnaires (WOMAC, Lequesne, VAS, SF 36-PCS and SF 36-MCS) when applied in patients with osteoarthritis of the knees (KOA) verifying if age and level of education interfere with the completion of the questionnaires. Method: One hundred and two patients with KOA answered WOMAC, LESQUESNE, VAS and SF-36 questionnaires and provided data correlated with age and education. The internal consistency of the WOMAC questionnaire was verified with Cronbachs alpha. Pearsons correlations between the questionnaires, age and educational level was performed. Results: Mean age was 65 years old. Schooling averaged 7.94 years; WOMAC 47.95; VAS 63.57; Lequesne 12.29; PCS and MCS 31.91 43.68. Cronbachs alpha for WOMAC 0.9. Education did not affect WOMAC response (r=-0.182, p = 0.067) and MCS (r=0.021 / p=0.835), but showed weak but significant correlation with VAS (r=-0.264 / p=0.007), Lequesne (r=0.277, p=0.005) and PCS (r=0.309/ p=0.002). Age showed significant direct correlation only with PCS (r=0.205, p=0.039). Conclusion: The level of education does not interfere with the completion of WOMAC but may interfere with completing VAS, Lequesne and physical component of SF-36. Level of Evidence II, Retrospective Study.

Is osteoarthritis a mechanical or inflammatory disease

Traditionally considered “wear and tear” disease, the pathogenic mechanisms of osteoarthritis have not yet been elucidated. The increasing number of articles demonstrating the influence of inflammatory factors in the onset and progression of the disease currently raises great debate in the literature about the importance of each of the factors involved in the disease. Even the choice between the terms “Osteoarthritis” and “Osteoarthrosis” generates controversy, since the first term implies the presence of inflammation as the key generator of the disease, and the latter denotes a degenerative/mechanical causal factor. The aim of this revision article is to promote a debate on the influence of inflammatory factors and mechanical factors in the pathogenesis of OA.

Evaluation of the effect of adding corticosteroid to viscosupplementation: a prospective and randomized study

Purpose: The aim of this study is to assess if we can improve the initial results of viscosupplementation by the addition of corticosteroids to the procedure, watching for any interference on the long-term results. Methods:We evaluated 104 patients with knee osteoarthritis (OA), treated at the group for the treatment of osteometabolic diseases of IOT-FMUSP, Sao Paulo. All patients were receiving usual care for OA, and those who underwent to any kind of intraarticular injection or knee surgery in the last 6 months, or presented post-traumatic or rheumatoid arthritis were not Abstracts / Osteoarthritis an