La artrosis como enfermedad genética

J.R. Prieto-Montañaa and J.A. Rianchob, ,

La artrosis es un ejemplo de enfermedad compleja, que se origina por la interacción de factores genéticos y ambientales. En este trabajo revisamos los diferentes tipos de estudios que permiten analizar la contribución de los factores genéticos a la patogenia de las enfermedades complejas y los genes cuyos polimorfismos se han relacionado con el riesgo de desarrollar artrosis.

Dado el importante beneficio que aporta la cirugía a los pacientes con artrosisavanzada, cabría plantearse si estos estudios genéticos tienen realmente alguna utilidad. La respuesta es claramente afirmativa. Por un lado, el conocimiento de los factores genéticos implicados en la aparición y el desarrollo de la artrosis puede permitir identificar y controlar subgrupos de individuos de mayor riesgo en fases precoces. Por otro lado, la identificación de los genes involucrados puede llevar a determinar nuevas dianas terapéuticas que permitan frenar de manera eficaz el desarrollo del proceso, algo que no podemos ofrecer a nuestros pacientes en la actualidad.

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Can We Explain Heterogeneity Among Randomized Clinical Trials of Exercise for Chronic Back Pain? A Meta-Regression Analysis of Randomized Controlled Trials

Manuela L. Ferreira (manuela.ferreira@sydney.edu.au), Rob J.E.M. Smeets, Steven J. Kamper, Paulo H. Ferreira and Luciana A.C. Machado

Abstract

Background Exercise programs may vary in terms of duration, frequency, and dosage; whether they are supervised; and whether they include a home-based program. Uncritical pooling of heterogeneous exercise trials may result in misleading conclusions regarding the effects of exercise on chronic low back pain (CLBP).

Purpose The purpose of this study was to establish the effect of exercise on pain and disability in patients with CLBP, with a major aim of explaining between-trial heterogeneity.

Data Sources Six databases were searched up to August 2008 using a computerized search strategy.

Study Selection Eligible studies needed to be randomized clinical trials evaluating the effects of exercise for nonspecific CLBP. Outcomes of interest were pain and disability measured on a continuous scale.

Data Extraction Baseline demographic data, exercise features, and outcome data were extracted from all included trials.

Data Synthesis Univariate meta-regressions were conducted to assess the associations between exercise effect sizes and 8 study-level variables: baseline severity of symptoms, number of exercise hours and sessions, supervision, individual tailoring, cognitive-behavioral component, intention-to-treat analysis, and concealment of allocation.

Limitations Only study-level characteristics were included in the meta-regression analyses. Therefore, the implications of the findings should not be used to differentiate the likelihood of the effect of exercise based on patient characteristics.

Conclusions The results show that, in general, when all types of exercise are analyzed, small but significant reductions in pain and disability are observed compared with minimal care or no treatment. Despite many possible sources of heterogeneity in exercise trials, only dosage was found to be significantly associated with effect sizes.

Sonographically guided percutaneous first annular pulley release: cadaveric safety study of needle and knife techniques.

Smith J, Rizzo M, Lai JK.

OBJECTIVE: The purpose of this study was to assess the safety of sonographically guided percutaneous finger and thumb first annular (A1) pulley releases performed using needle and hook knife techniques in an unembalmed cadaveric model.

METHODS: A single operator completed 50 (40 fingers and 10 thumbs) sonographically guided percutaneous A1 pulley releases in unembalmed cadavers using previously described needle and hook knife techniques and simulated local anesthesia. Half of the fingers and thumbs were completed with each technique. An experienced observer blinded to the technique dissected each specimen and assessed for neurovascular, flexor tendon, and A2 pulley injury. Completeness of release was also recorded as a secondary outcome.

RESULTS: No neurovascular or A2 pulley injury occurred in any digit, regardless of technique. No significant flexor tendon injury was seen in any digit, although minor surface scratches were visualized in 3 cases (6%; 2 knife and 1 needle). The hook knife technique was significantly more likely to result in a complete pulley release compared to the needle technique (22 of 25 [88%] versus 8 of 25 [32%]; P < .001).

CONCLUSIONS: Sonographically guided percutaneous A1 pulley releases can be performed safely using previously described needle and hook knife techniques. The safety margin for thumb releases is less than that for finger releases, particularly with respect to the radial digital nerve. These cadaveric data support recently published clinical investigations recommending consideration of sonographically guided percutaneous A1 pulley release in the management of patients with a disabling trigger finger.

The Efficacy of Lumbar Epidural Steroid Injections: Transforaminal, Interlaminar, and Caudal Approaches

Monica E. Rho MD and Chi-Tsai Tang MD

Conservative management of low back pain includes the use of lumbar epidural steroid injections, which have become increasingly more popular in the last 20 years. The body of literature regarding the efficacy of these injections is vast, conflicting, and difficult to summarize. This article reviews the updated evidence for efficacy and the indications for these injections.

Keywords: Low back pain; Epidural steroid injection; Efficacy; Transforaminal; Interlaminar; Caudal