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Individuals With Patellofemoral Pain Have Less Hip Flexibility Than Controls Regardless of Treatment Outcome.
Hamstra-Wright, KL, Earl-Boehm, J, Bolgla, L, Emery, C, Ferber, R
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. 2017;(2):97-103
Abstract
OBJECTIVE To examine differences in hip flexibility before and after a 6-week muscle strengthening program between those with patellofemoral pain (PFP) and healthy controls. DESIGN Single-blind, multicentered, randomized controlled trial. SETTING Four clinical research laboratories. SUBJECTS Physically active individuals (199 PFP and 38 controls). INTERVENTIONS Patellofemoral pain and control subjects were randomized into either a hip-focused or a knee-focused muscle strengthening treatment program. MAIN OUTCOME MEASURES Pain-visual analog scale (centimeter), function-Anterior Knee Pain Scale (points), flexibility-passive goniometry (degrees): hip adduction (HADD), hip external rotation (HER), hip internal rotation (HIR), total hip rotation (HROT), hip extension (HEXT) were measured before and after the muscle strengthening treatment program. RESULTS Subjects with patellofemoral pain who successfully completed the treatment program (n = 153) had 65%, 25%, 18%, and 12% less HADD, HER, HROT, and HIR ranges of motion (ROMs), respectively, than controls (P < 0.05). Patellofemoral pain subjects who did not successfully complete the program (n = 41) had 134%, 31%, 22%, and 13% less HADD, HER, HROT, and HIR ROMs, respectively, than controls (P < 0.05). All subjects increased their HIR, HROT, and HEXT ROMs pretest to posttest (P < 0.05), but by less than 2 degree. CONCLUSIONS Individuals with PFP had less hip flexibility than controls regardless of treatment outcome or time. After the 6-week muscle strengthening program, and regardless of treatment success, PFP and control subjects experienced a small but clinically insignificant improvement in hip flexibility. CLINICAL RELEVANCE Hip ROM should be considered as a targeted area of focus in a rehabilitation program for physically active individuals with PFP.
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[Effect of External Applying Compound Tripterygium wilfordii Hook F. on Joint Pain of Rheumatoid Arthritis Patients].
Jiao, J, Tang, XP, Yuan, J, Liu, X, Liu, H, Zhang, CY, Wang, LY, Jiang, Q
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. 2016;(1):29-34
Abstract
OBJECTIVE To observe the effectiveness and safety of external applying Compound Tripterygium wilfordii Hook F. (TwHF) in relieving joint pain in rheumatoid arthritis (RA) patients. METHODS In this double-blinded, randomized multicenter trial, a total of 174 moderately active RA patients were enrolled and randomly assigned to the treatment group (treated with Compound TwHF, 87 cases) and the placebo control group (87 cases). Compound TwHF or placebo was externally applied in painful joints, 20 g each time, once per day for 8 weeks. Self-reported joint pain relief was taken as a primary effective indicator. Visual analogue scale for pain (VAS), disease activity score of 28 joints (DAS28), VAS for general health (GH) were evaluated before treatment, at week 4 and after treatment. Erythrocyte sedimentation rate (ESR) and hypersensitive C reactive protein (hs-CRP) were tested before and after treatment. Menstrual changes in females were observed during treatment. Skin irritation occurred during the recording process was assessed using skin irritation strength. Intention to treat (ITT) was statistically analyzed. RESULTS The joint pain relief rate in the treatment group was 90.8% (79/87 cases), higher than that in the placebo control group (69.0%, 60/87 cases; P = 0.001). VAS pain score, DAS28, VAS for GH score were significantly improved in the two groups at week 4 of treatment and after treatment, as compared with before treatment (P < 0.01). ESR and hs-CRP levels significantly decreased in the treatment group after treatment (P < 0.05, P < 0.01). No difference was found in post-treatment VAS pain score, DAS28, VAS for GH score, ESR, or hs-CRP between the two groups (P > 0.05). Eight adverse events occurred in the treatment group (5 skin allergy, 1 intolerance of medical odor, and 2 mild liver injury), while 3 adverse events occurred in the placebo control group (2 skin allergy, 1 mild liver injury). There was no statistical difference in adverse event between the two groups (P > 0.05). No menstrual change occurred in the treatment group. CONCLUSION External applying Compound TwHF was an effective and safe way to relieve-joint pain of RA patients, which could be taken as an adjuvant therapy.
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Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial.
Jin, X, Jones, G, Cicuttini, F, Wluka, A, Zhu, Z, Han, W, Antony, B, Wang, X, Winzenberg, T, Blizzard, L, et al
JAMA. 2016;(10):1005-13
Abstract
IMPORTANCE Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current trial evidence is contradictory. OBJECTIVE To compare the effects of vitamin D supplementation vs placebo on knee pain and knee cartilage volume in patients with symptomatic knee osteoarthritis and low vitamin D levels. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized, double-blind, placebo-controlled clinical trial in Tasmania and Victoria, Australia. Participants with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D (12.5-60 nmol/L) were enrolled from June 2010 to December 2011. The trial was completed in December 2013. INTERVENTIONS Participants were randomly assigned to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years. MAIN OUTCOMES AND MEASURES Primary outcomes were change in tibial cartilage volume (assessed using magnetic resonance imaging [MRI]) and change in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (0 [no pain] to 500 [worst pain]) from baseline to month 24. Secondary outcomes were cartilage defects and bone marrow lesions (assessed using MRI). RESULTS Of 413 enrolled participants (mean age, 63.2 years; 50% women), 340 (82.3%) completed the study. The level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/L) than in the placebo group (6.7 nmol/L) (P < .001) over 2 years. There were no significant differences in annual change of tibial cartilage volume or WOMAC pain score. There were no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Adverse events (≥ 1 per patient) occurred in 56 participants in the vitamin D group and in 37 participants in the placebo group (P = .04). [table: see text]. CONCLUSIONS AND RELEVANCE Among patients with symptomatic knee osteoarthritis and low serum 25-hydroxyvitamin D levels, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or WOMAC knee pain score over 2 years. These findings do not support the use of vitamin D supplementation for preventing tibial cartilage loss or improving WOMAC knee pain in patients with knee osteoarthritis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01176344; anzctr.org.au Identifier: ACTRN12610000495022.
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Effect of baseline serum vitamin D levels on aromatase inhibitors induced musculoskeletal symptoms: results from the IBIS-II, chemoprevention study using anastrozole.
Singh, S, Cuzick, J, Mesher, D, Richmond, B, Howell, A
Breast cancer research and treatment. 2012;(2):625-9
Abstract
Severe deficiency of vitamin D in adults can cause musculoskeletal pain, stiffness, and joint discomfort. Musculoskeletal symptoms similar to those associated with vitamin D deficiency are frequently seen in breast cancer patients receiving adjuvant aromatase inhibitors (AIs). This is presumably due to oestrogen deficiency caused by AIs. However, no data are available on serum levels of vitamin D and their relation to developing musculoskeletal symptoms/arthralgia in women receiving an AI. IBIS-II is a multicentre randomized placebo controlled trial of the AI, anastrozole, in postmenopausal women aged 40-70 years, who are at increased risk of breast cancer. Serum vitamin D levels were measured for 416 participants. The samples were sent for assays in three batches: the first two batches (n = 250) included paired serum samples and the third batch (n = 166) included paired samples and samples from women who had arthralgia within the first year of follow-up. At entry, 56 (13%) women had adequate (≥ 30 ng/ml), 173 (41%) had inadequate (≥ 20-< 30 ng/mL), 167 (40%) were deficient (> 10-< 20 ng/mL), and 24 (6%) were severely deficient (< 10 ng/mL). At the time of analysis, 225 out of 834 (27%) women had reported arthralgia within the first year of follow-up. Baseline serum vitamin D levels did not significantly predict arthralgia within the first year of follow-up either in the overall group (OR 0.87 (95% CI: 0.67, 1.13; P = 0.30) or separately in the anastrozole (P = 0.60) or placebo groups (P = 0.38). Absolute serum levels of vitamin D increased significantly at one year in the anastrozole group (2.88 ng/ml, [1.71, 4.06; P < 0.0001]) but not in the placebo group (0.75 ng/ml [-0.35, 1.85; P = 0.18]). Only a small and a nonsignificant effect of baseline vitamin D levels were seen on the risk of musculoskeletal symptoms. This does not appear to be a major determinant of risk for these symptoms.