STRUCTURAL AND FUNCTIONAL CONDITION OF THE KNEE JOINT IN PATIENTS WITH MONOGONARTHROSIS IN THE STAGE OF EXACERBATION
The goal is to study the structural changes of the elements of the knee joint and their functional consequences in patients with monogonarthrosis of the 1st-2nd grade in the stage of exacerbation according to the data of a complex clinical and arthroscopic study.
Materials and Methods. Materials - protocols of clinical, radiological and arthroscopic examination of 125 patients (54 (43.2%) men; 71 (57.8%) women), aged 18 - 79 years, with a previous diagnosis: Monoarthrosis of the knee joint in the stage of exacerbation. Research methods: questionnaire, orthopedic examination, X-ray diagnostics, arthroscopy, laboratory diagnostics of blood (determination of C-reactive protein (CRP) as a serological marker of inflammation), synovial fluid (analyses of physical properties, biochemical, cytological, bacteriological), statistical.
Results and Discussion. According to the results of the comprehensive examination, the presence of primary monoarthrosis was confirmed in 118 (94.4%) patients (group A). Based on the definition of CRP, subgroups were distinguished: A1 (n=71; 56.8%) with a normal level and A2 (n=47; 37.6%) with elevated CRP. In 7 (5.6%) patients diagnosed seropositive unspecified rheumatoid monoarthritis with hypertrophic synovitis (group B). A significant predominance of women compared to men insubgroup A2 was revealed (p<0.05). It was investigated that the features of complaints, nature of pain sensations and indicators of orthopedic status in patients from subgroups A1 and A2 did not reliably differ in groups of patients with different levels of CRP. A significant predominance of normal contours of the affected knee joint was found in subgroups A1 (p<0.001) and A2 (p<0.01). Structural changes in knee joint elements according to X-ray and arthroscopic examination have no significant differences in subgroups of patients A1 and A2.
Conclusions. The structural and functional state of the knee joints in patients with monogonarthrosis of the 1st-2nd grade according to the Kellgren-Lawrence classification is characterized by degenerative changes in almost all elements of the knee joint with moderate pain syndrome and functional disorders.
Abraham S, Patel S. Monoarticular Arthritis. [Updated 2021 Aug 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542164/
Ayral, X.; Pickering, E.H.; Woodworth, T.G.; Mackillop, N.; Dougados, M. Synovitis: A potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis - Results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthr. Cartil. 2005, 13, 361-367.
Baker, K.; Grainger, A.; Niu, J.; Clancy, M.; Guermazi, A.; Crema, M.; Hughes, L.; Buckwalter, J.; Wooley, A.; Nevitt, M.; et al. Relation of synovitis to knee pain using contrast-enhanced MRIs. Ann. Rheum. Dis. 2010, 69, 1779-1783.
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019;27(11):1578-89.
Becker JA, Daily JP, Pohlgeers KM. Acute Monoarthritis: Diagnosis in Adults. Am Fam Physician. 2016 Nov 15;94(10):810-816.
Berruto M, Murgo A, Ferrua P, Uboldi F, Tradati D, Pasqualotto S, Marelli B (2016) Synovitis of the knee. In: Arthroscopy. Berlin, Heidelberg, Springer, pp. 373-386.
Deveza LA, Kraus VB, Collins JE, Guermazi A, Roemer FW, Nevitt MC, Hunter DJ. Is synovitis detected on non-contrast-enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion? Data from the Osteoarthritis Initiative. Scand J Rheumat 2018;47(3):235-242 https://doi.org/10.1080/03009742.2017.1340511
Emery, C.A.; Whittaker, J.L.; Mahmoudian, A.; Lohmander, L.S.; Roos, E.M.; Bennell, K.L.; Toomey, C.M.; Reimer, R.A.; Thompson, D.; Ronsky, J.L.; et al. Establishing outcome measures in early knee osteoarthritis. Nat. Rev. Rheumatol. 2019, 15, 438-448.
Fusco, M.; Skaper, S.D.; Coaccioli, S.; Varrassi, G.; Paladini, A. Degenerative Joint Diseases and Neuroinflammation. Pain. Pract. 2017, 17, 522-532
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1545-1602.
Goyal T, Paul S, Choudhury AK, Kalonia T. Monoarticular synovitis of knee: dealing with the dilemma. SICOT-J 2020;48(6):8 https://doi.org/10.1051/sicotj/2020044
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759.
Ilas, D.C.; Churchman, S.M.; McGonagle, D.; Jones, E. Targeting subchondral bone mesenchymal stem cell activities for intrinsic joint repair in osteoarthritis. Futur. Sci. OA 2017, 3, FSO228.
Litman K. A rational approach to the diagnosis of arthritis. Am Fam Physician. 1996 Mar;53(4):1295-300, 1305-6, 1309-10.
Loeuille, D.; Chary-Valckenaere, I.; Champigneulle, J.; Rat, A.C.; Toussaint, F.; Pinzano-Watrin, A.; Goebel, J.C.; Mainard, D.; Blum, A.; Pourel, J.; et al. Macroscopic and microscopic features of synovial membrane inflammation in the osteoarthritic knee: Correlating magnetic resonance imaging findings with disease severity. Arthritis Rheum. 2005, 52, 3492-3501.
Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: what is the cause of my patient's painful swollen joint? CMAJ. 2009 Jan 6;180(1):59-65. doi: 10.1503/cmaj.080183
Madhuchandra P, Sunil Santhosh G, Raju K P (2019) Efficacy of synovial fluid analysis and synovial biopsy in diagnosing joint pathologies. IP Int J Orthop Rheumatol 4(2), 61-67.
Pathak SK, Agnihotri M (2017) Efficacy of synovial fluid analysis in diagnosing various types of arthritis, with special reference to percutaneous synovial biopsy as a diagnostic tool. Vol. 4, International Journal of Contemporary Medical Research.
Primorac D, Molnar V, Rod E, Jelec Z, Cukelj F, Matisic V, Vrdoljak T, Hudetz D, Hajsok H, Boric I. Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes 2020;11:854 doi:10.3390/genes11080854
Sellam, J.; Berenbaum, F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat. Rev. Rheumatol. 2010, 6, 625-635
Singhal O, Kaur V, Singhal M, Machave Y, Gupta A, Kalhan S (2013) Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision. Int J Appl Basic Med Res 2(2), 102.
Swingler, T.E.; Niu, L.; Smith, P.; Paddy, P.; Le, L.; Barter, M.J.; Young, D.A.; Clark, I.M. The function of microRNAs in cartilage and osteoarthritis. Clin. Exp. Rheumatol. 2019, 37, 40-47.
Thabah MM, Chaturvedi V. An approach to monoarthritis. Jo Mahatma Gandhi Inst Med Scie 2014;19(1):122-18 DOI:10.4103/0971-9903.126229
Tennant F. Erythrocyte Sedimentation Rate and C-Reactive Protein: Old But Useful Biomarkers for Pain Treatment. Pract Pain Manag (PPM) 2021;13(2):11.
Treutlein, C., B?uerle, T., Nagel, A.M. et al. Comprehensive assessment of knee joint synovitis at 7?T MRI using contrast-enhanced and non-enhanced sequences. BMC Musculoskelet Disord 21, 116 (2020). https://doi.org/10.1186/s12891-020-3122-y
Vincent, Tonia L.. Peripheral pain mechanisms in osteoarthritis. PAIN: September 2020 - Volume 161 - Issue p S138-S146 doi: 10.1097/j.pain.0000000000001923
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