Shoulder Cartilage Biochemically Weaker Than Knee or Ankle Cartilage
Shoulder, knee, and ankle cartilage…which is more resistant to damage and degeneration? Well, it’s not the shoulder, says new research from Midwest Orthopaedics at Rush. Brian Cole, M.D., who directs the Rush Cartilage Restoration Center, told OTW, “Years ago we became a go-to facility for patients with chondrolysis of the shoulder; often these were people who had undergone a previous shoulder surgery and on occasion, had a pain pump placed for post-operative pain management. Every once in awhile, we would see a young patient who had undergone an arthroscopic shoulder surgery whose cartilage would rapidly degenerate in an uncharacteristic way. For this study, we hypothesized that there was something implicitly vulnerable about the articular cartilage in the glenohumeral joint (GHJ)…a scenario where a minor insult led to the rapid demise of the articular cartilage.
“For this study, we took articular cartilage from the GHJ, knee, and ankle from the same donors—eight individuals with no history of joint disease. Our goals were to describe the histological and morphological appearance of normal GHJ cartilage, and to assess the cellular responses of GHJ cartilage to interleukin-1β (IL-1β) compared to knee and ankle cartilage from the same donors. GHJ cartilage did indeed seem to be more vulnerable to damage than cartilage in the knee or ankle. We believe that the shoulder is biochemically different than other joints, but do not as of yet understand why this is.
“Our next steps are to better understand these differences and to determine a way to prevent this demise. This could involve high-level sensitivity analysis of cartilage (maybe proteomics). Then we will try to decide if anything we do surgically (like temperature, length of the procedure, etc.) is a modifiable variable that can prevent downstream degeneration.”
Additional authors and contributors to this work include: Susan Chubinskaya, Maximilian A. Meyer, Atsushi Urita, Arnavaz A. Hakimiyan, Lev Rappoport, Arkady Margulis, Adam Yanke, Nikhil Verma, and Anthony Romeo.
Wrist Fractures in Elderly Could Portend Falls
In new work from Washington University School of Medicine in St. Louis, Missouri, researchers found that elderly patients who experience a wrist fracture have more balance difficulties, placing them in a vulnerable position when it comes to falling.
The team, led by Craig Louer, M.D., an orthopedic surgery resident, focused on low energy fractures. They assessed 23 patients who had suffered a wrist fracture and 23 age and sex-matched controls who had not had a fracture. The result? Those in the fracture group had a higher dual x-ray absorptiometry scan (DMA) score, indicating balance issues.
Dr. Louer told OTW, “My co-authors and I found it very rewarding to work with this population of patients. Older adults commonly suffer from wrist fractures. Even if they have eluded the injury, they likely know friends and family who have not been so lucky. These injuries are painful and negatively affect quality of life, but they also seem to be an indicator that an individual is at higher risk for falls and further injury. Falls are the most common cause of non-fatal injury and hospital admission in the U.S. with estimated medical costs approaching $30 billion. On the broader scale, a study like this has the potential to impact a significant portion of our society. Within the scope of the individual patient, we were struck at how much interest each study participant had in their individual balance performance. All of them, whether they had a prior fracture or not, wanted to know if their balance was compromised and what they could do to improve it.
“Unfortunately, there is not a ‘magic pill’ for balance and its unlikely there ever will be. Balance is just one factor that contributes to increased likelihood of falls. In general, maintaining physical health and staying physically fit can help to improve muscle strength and body coordination. There is some evidence that specific exercise programs that combine balance training and muscle strengthening may decrease the rate of falls, so one should inquire with a local physical therapist about balance training programs. However, it should be recognized that increased walking speed and physical activity may increase exposure to potential falls, as these factors have been shown to increase fracture risk in certain studies when taken to the extreme. The take-away is that physical activity is generally good, but older patients should slow down and watch their step!
“Patients can also reduce their fall risk by addressing other contributing factors: multiple medications, poor eyesight, unrecognized or undertreated chronic medical conditions, external hazards in the home, and lack of handrails or safety measures. If you’ve had a wrist fracture and are over the age of 65, even if you feel your physical health is excellent, speak with your physician about your risk of falls and whether balance training should be considered along with bone density assessment and treatment.”
Immunotherapy Drugs for RA Reduces CV Events
New research from Russia has found that using immunotherapy drugs with rheumatoid arthritis (RA) patients can reduce the risk of cardiovascular (CV) events. The study included 68 patients who either received the combination of anti-TNFα and anti-IFN γ plus standard disease-modifying therapy (38 patients) or placebo plus standard therapy (30 patients).
This work was led by Professor Aida Babaeva, head of the Department of Internal Medicine, Volgograd State Medical University. Dr. Babaeva told OTW, “Our findings suggest that the decreased rheumatoid arthritis disease activity with the combination of anticytokines translates into decreased cardiovascular risk.
“Our previous research showed that treatment with extra-low dose anti-TNF-α significantly reduce the severity of clinical manifestations and activity of RA. In addition, prolonged treatment leads to reduction of pro-inflammatory mediators and cytokines including CRP, RF, TNF-α, IL-1, IL-6 in patients’ blood.
“IFN-γ plays an important role in the activation of cytokine cascade. Therefore, usage of agents that inactivate endogenous IFN-γ is one of possible pro-inflammatory mediators locking mechanisms.
“Extra-low dose anti-IFN-γ has immunomodulatory properties, which are implemented in the restoration of the physiological ratio of lymphocyte subpopulations and mediators of cell-mediated immunity. The possibility of its use in the treatment of a number of diseases associated with immune regulation disorders is discussed. RA is one such process, in which there are significant qualitative and quantitative changes of cell-mediated immunity. The impact on IFN-γ natural production may affect the level of endogenous TNF-α, as the synthesis of TNF-α by macrophages and monocytes is regulated by IFN-γ.
“On the basis of these data usage of anti-TNF-α and anti-IFN-γ combination in treatment of RA can be considered pathogenetically and clinically reasonable.
“The above was the basis for the combined use of two anticytokine drugs affecting the key mediators of immune inflammation—TNF-α and IFN-γ.
“Combined use of TNF-α and IFN-γ antibodies in extra-low doses appears promising due to the fact that their simultaneous introduction can contribute to more rapid development of clinical effect.”
