One-Year Outcomes of Intraarticular Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case Review of 99 Joints.
关节内脂肪移植治疗拇指腕掌关节骨关节炎的一年结果: 99 个关节的病例回顾。
- 作者列表："Haas EM","Eisele A","Arnoldi A","Paolini M","Ehrl D","Volkmer E","Giunta RE
BACKGROUND:This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery. METHODS:In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman's analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress. RESULTS:From 2 weeks on, there was pain relief, both under stress and at rest. Friedman's analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001]. CONCLUSION:The authors' preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
背景: 本研究旨在为拇指腕掌关节骨关节炎的治疗提供一种新的治疗选择。知道自体脂肪可能通过抗炎和软骨保护作用对骨关节炎有益，作者将自体脂肪脂肪移植到拇指腕掌关节，目的是推迟明确的切除关节成形术手术。 方法: 在这项初步研究中，作者对 99 个关节进行了手术。研究人群由症状和放射学证实的拇指腕掌关节骨关节炎患者组成。采集腹部脂肪组织后，将 1 ~ 2 ml未经物理或酶操作的脂肪移植到拇指腕掌关节。在 12 个月的随访咨询中，除了力量和疼痛测量外，还使用密歇根手结果问卷对手术结果进行量化。我们进行了Friedman的方差分析，以衡量密歇根手部结局问卷和压力下疼痛随时间的差异。 结果: 从 2 周开始，无论是在应激状态下还是在静息状态下，疼痛均有缓解。Friedman方差分析发现应激下疼痛有显著变化 [卡方 (5) = 68.5 2; p <0.001]。术后 12 个月密歇根手结局问卷评分显著改善 [卡方 (5) = 90.5 6; p <0.001]。 结论: 作者的初步研究结果表明，关节内自体脂肪移植是拇指腕掌关节骨关节炎的一种很有前途的替代治疗方法。 临床问题/证据水平: 治疗性，IV。
METHODS:OBJECTIVE:Patients with immune-mediated inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus are at increased risk of cardiovascular disease. However, the cardiovascular risk of patients with primary Sjögren's syndrome (SS) remains poorly studied. We aimed to investigate the association between primary SS and cardiovascular morbidity and mortality. METHODS:We performed a systematic review of articles in Medline and the Cochrane Library and recent abstracts from US and European meetings, searching for reports of randomized controlled studies of cardiovascular morbidity and cardiovascular mortality in primary SS. The relative risk (RR) values for cardiovascular morbidity and mortality associated with primary SS were collected and pooled in a meta-analysis with a random-effects model by using Review Manager (Cochrane collaboration). RESULTS:The literature search revealed 484 articles and abstracts of interest; 14 studies (67,124 patients with primary SS) were included in the meta-analysis. With primary SS versus control populations, the risk was significantly increased for coronary morbidity (RR 1.34 [95% confidence interval (95% CI) 1.06-1.38]; P = 0.01), cerebrovascular morbidity (RR 1.46 [95% CI 1.43-1.49]; P < 0.00001), heart failure rate (odds ratio 2.54 [95% CI 1.30-4.97]; P < 0.007), and thromboembolic morbidity (RR 1.78 [95% CI 1.41-2.25]; P < 0.00001), with no statistically significant increased risk of cardiovascular mortality (RR 1.48 [95% CI 0.77-2.85]; P = 0.24). CONCLUSION:This meta-analysis demonstrates that primary SS is associated with increased cardiovascular morbidity, which suggests that these patients should be screened for cardiovascular comorbidities and considered for preventive interventions, in a multidisciplinary approach with cardiologists.
METHODS:OBJECTIVE:We aimed to evaluate the comparative risk of hospitalized infection among patients with rheumatoid arthritis (RA) who initiated abatacept versus a tumor necrosis factor inhibitor (TNFi). METHODS:Using claims data from Truven MarketScan database (2006-2015), we identified patients with RA ages ≥18 years with ≥2 RA diagnoses who initiated treatment with abatacept or a TNFi. The primary outcome was a composite end point of any hospitalized infection. Secondary outcomes included bacterial infection, herpes zoster, and infections affecting different organ systems. We performed 1:1 propensity score (PS) matching between the groups in order to control for baseline confounders. We estimated incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) for hospitalized infection. RESULTS:We identified 11,248 PS-matched pairs of patients who initiated treatment with abatacept and TNFi with a median age of 56 years (83% were women). The IR per 1,000 person-years for any hospitalized infection was 37 among patients who initiated treatment with abatacept and 47 in those who initiated treatment with TNFi. The HR for the risk of any hospitalized infection associated with abatacept versus TNFi was 0.78 (95% CI 0.64-0.95) and remained lower when compared to infliximab (HR 0.63 [95% CI 0.47-0.85]), while no significant difference was seen when compared to adalimumab and etanercept. The risk of secondary outcomes was lower for abatacept for pulmonary infections, and similar to TNFi for the remaining outcomes. CONCLUSION:In this large cohort of patients with RA who initiated treatment with abatacept or TNFi as a first- or second-line biologic agent, we found a lower risk of hospitalized infection after initiating abatacept versus TNFi, which was driven mostly by infliximab.
METHODS:OBJECTIVE:Reducing pain is one of the main health priorities for children and young people with juvenile idiopathic arthritis (JIA); however, some studies indicate that pain is not routinely assessed in this patient group. The aim of this study was to explore health care professionals' (HCPs) beliefs about the role of pain and the prioritization of its assessment in children and young people with JIA. METHODS:Semi-structured interviews were conducted with HCPs who manage children and young people with JIA in the UK (including consultant and trainee pediatric rheumatologists, nurses, physical therapists, and occupational therapists). Data were analyzed qualitatively following a framework analysis approach. RESULTS:Twenty-one HCPs participated. Analyses of the data identified 6 themes, including lack of training and low confidence in pain assessment, reluctance to engage in pain discussions, low prioritization of pain assessment, specific beliefs about the nature of pain in JIA, treatment of pain in JIA, and undervaluing pain reports. Assessment of pain symptoms was regarded as a low priority and some HCPs actively avoided conversations about pain. CONCLUSION:These findings indicate that the assessment of pain in children and young people with JIA may be limited by knowledge, skills, and attitudinal factors. HCPs' accounts of their beliefs about pain in JIA and their low prioritization of pain in clinical practice suggest that a shift in perceptions about pain management may be helpful for professionals managing children and young people with this condition.