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Relationship between the Gut Microbiome and Osteoarthritis Pain: Review of the Literature.
Sánchez Romero, EA, Meléndez Oliva, E, Alonso Pérez, JL, Martín Pérez, S, Turroni, S, Marchese, L, Villafañe, JH
Nutrients. 2021;(3)
Abstract
BACKGROUND Osteoarthritis (OA) is the most common form of chronic pain in Europe (34%), representing a great economic and social cost to society. There are studies that suggest an intestine-brain-articulation axis and hint at the existence of low-grade intestinal inflammation in OA, which would be related to an alteration of the microbiota and to the impairment of the epithelial barrier, with leakage of the microbial components. PURPOSE The purpose of this study was to review the association between gut microbiome and pain in the OA population through a review of the literature. METHODS A literature search was conducted to identify all available studies on the association between the gut microbiome and pain in the OA population, with no publication date limit until September 2020 and no language limit, in the MEDLINE, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials databases. RESULTS Only three of 2084 studies detected and analyzed by performing the proposed searches in the detailed databases, were finally selected for this review, of which one was with and two were without intervention. These studies only weakly support a relationship between the gut microbiome and OA, specifically a correlation between certain taxa or microbial products and the inflammatory landscape and severity of OA symptoms, including knee pain. Conclusions: Despite encouraging results, this review highlights the paucity of high-quality studies addressing the potential role of the gut microbiome in OA-related pain, along with the disparity of the techniques used so far, making it impossible to draw firm conclusions on the topic.
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Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift.
Deane, KD, Holers, VM
Arthritis & rheumatology (Hoboken, N.J.). 2021;(2):181-193
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Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA-like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the "pre-RA" stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre-RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
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Rheumatologic manifestations in celiac disease: what should we remember?
Dima, A, Jurcut, C, Jinga, M
Romanian journal of internal medicine = Revue roumaine de medecine interne. 2019;(1):3-5
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S-Adenosylmethionine for osteoarthritis of the knee or hip.
Rutjes, AW, Nüesch, E, Reichenbach, S, Jüni, P
The Cochrane database of systematic reviews. 2009;(4):CD007321
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Abstract
BACKGROUND Osteoarthritis is the most common form of joint disease and the leading cause of pain and disability in the elderly. S-Adenosylmethionine may be a viable treatment option but the evidence about its effectiveness and safety is equivocal. OBJECTIVES We set out to compare S-Adenosylmethionine (SAMe) with placebo or no specific intervention in terms of effects on pain and function and safety outcomes in patients with knee or hip osteoarthritis. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to 5 August 2008, checked conference proceedings and reference lists, and contacted authors. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that compared SAMe at any dosage and in any formulation with placebo or no intervention in patients with osteoarthritis of the knee or hip. DATA COLLECTION AND ANALYSIS Two independent authors extracted data using standardised forms. We contacted investigators to obtain missing outcome information. We calculated standardised mean differences (SMDs) for pain and function, and relative risks for safety outcomes. We combined trials using inverse-variance random-effects meta-analysis. MAIN RESULTS Four trials including 656 patients were included in the systematic review, all compared SAMe with placebo. The methodological quality and the quality of reporting were poor. For pain, the analysis indicated a small SMD of -0.17 (95% CI -0.34 to 0.01), corresponding to a difference in pain scores between SAMe and placebo of 0.4 cm on a 10 cm VAS, with no between trial heterogeneity (I(2) = 0). For function, the analysis suggested a SMD of 0.02 (95% CI -0.68 to 0.71) with a moderate degree of between-trial heterogeneity (I2 = 54%). The meta-analyses of the number of patients experiencing any adverse event, and withdrawals or drop-outs due to adverse events, resulted in relative risks of 1.27 (95% CI 0.94 to 1.71) and 0.94 (95% CI 0.48 to 1.86), respectively, but confidence intervals were wide and tests for overall effect were not significant. No trial provided information concerning the occurrence of serious adverse events. AUTHORS' CONCLUSIONS The current systematic review is inconclusive, hampered by the inclusion of mainly small trials of questionable quality. The effects of SAMe on both pain and function may be potentially clinically relevant and, although effects are expected to be small, deserve further clinical evaluation in adequately sized randomised, parallel-group trials in patients with knee or hip osteoarthritis. Meanwhile, routine use of SAMe should not be advised.
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The evidence for clinical efficacy of rose hip and seed: a systematic review.
Chrubasik, C, Duke, RK, Chrubasik, S
Phytotherapy research : PTR. 2006;(1):1-3
Abstract
BACKGROUND The objective of this review is to evaluate whether clinical research has gained any evidence of effectiveness of Rosa canina preparations. METHODS Several databases and other sources were searched to identify randomized controlled trials of Rosa canina preparations. RESULTS Trials were described in a narrative way, taking into consideration methodological quality scores. Four trials were included in this review and two were identified as subgroup analyses. CONCLUSIONS Moderate evidence exists for the use of a powder of the seeds and husks of a Rosa canina subspecies in patients suffering from osteoarthritis.
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Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review.
Gagnier, JJ, Chrubasik, S, Manheimer, E
BMC complementary and alternative medicine. 2004;:13
Abstract
BACKGROUND The objective of this review is to determine the effectiveness of Harpagophytum procumbens preparations in the treatment of various forms of musculoskeletal pain. METHODS Several databases and other sources were searched to identify randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials testing Harpagophytum preparations in adults suffering from pain due to osteoarthritis or low back pain. RESULTS Given the clinical heterogeneity and insufficient data for statistical pooling, trials were described in a narrative way, taking into consideration methodological quality scores. Twelve trials were included with six investigating osteoarthritis (two were identical trials), four low back pain, and three mixed-pain conditions. CONCLUSIONS There is limited evidence for an ethanolic Harpagophytum extract containing less than <30 mg harpagoside per day in the treatment of knee and hip osteoarthritis. There is moderate evidence of effectiveness for (1) the use of a Harpagophytum powder at 60 mg harpagoside in the treatment of osteoarthritis of the spine, hip and knee; (2) the use of an aqueous Harpagophytum extract at a daily dose of 100 mg harpagoside in the treatment of acute exacerbations of chronic non-specific low back pain; and (3) the use of an aqueous extract of Harpagophytum procumbens at 60 mg harpagoside being non-inferior to 12.5 mg rofecoxib per day for chronic non-specific low-back pain (NSLBP) in the short term. Strong evidence exists for the use of an aqueous Harpagophytum extract at a daily dose equivalent of 50 mg harpagoside in the treatment of acute exacerbations of chronic NSLBP.
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Unusual manifestations of gastric inflammatory fibroid polyp in a child.
Chongsrisawat, V, Yimyeam, P, Wisedopas, N, Viravaidya, D, Poovorawan, Y
World journal of gastroenterology. 2004;(3):460-2
Abstract
AIM: Inflammatory fibroid polyp (IFP) is a rare benign lesion that may occur throughout the digestive tract. IFP is more commonly found in the antrum of the stomach in particular. It mostly affects adults at the average age of 60 years. These polyps are able to cause abdominal pain, gastrointestinal bleeding, intestinal obstruction or intussusception. In this paper we report a case of gastric IFP with unusual presenting features. METHODS A child with gastric IFP was described and the literature was reviewed. RESULTS A 4-year-old girl presented with fever for 2 months, arthralgia of knees and ankles, iron deficiency anemia, and hypoalbuminemia. Her stool examination was positive for occult blood. The upper gastrointestinal study demonstrated a large lobulated mass at the upper part of gastric body. Partial gastrectomy en bloc with this 5 cm x 8 cm mass was subsequently performed. Pathological examination was consistent with IFP. Following the mass excision, her fever abruptly declined and disappeared together with anemia and arthralgia. She remained asymptomatic and the abdominal ultrasonography performed at the 24-month follow-up demonstrated no recurrence of the tumor. CONCLUSION The etiopathogenesis of IFP still remains unclear. The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose. The inflammatory symptoms found in this patient support the hypothesis of inflammatory benign lesions of IFP.