PURPOSE: Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids. MATERIALS AND METHODS: Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated. RESULTS: Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group. CONCLUSION: Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.
Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects/therapeutic use ; Disease Progression ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/*drug therapy/radiography ; Osteoarthritis, Knee/*drug therapy/radiography ; Pain/drug therapy

OBJECTIVETo observe and assess the effect of manipulation on knee cartilaginous recovery with knee osteoarthritis (OA) by using magnetic resonance (MR).

METHODSFifty cases which were suffering from knee OA involved this retrospective study. They were matched-pairs into 2 groups according to their gender, age and severity. Treated with manipulation once a week in one year for manipulation group patients, compared with those orally use with 500 mg glucosamine sulfate (GS) three times per day. Knee cartilage MR were performed before treatment and on 3, 6, 12 months after treatment, the maximum defect diameter and volume of knee cartilage were assessed with Noyes Score.

RESULTBoth Noyes Score declined in the two groups. But Noyes Score of the manipulation group significantly decreased 6 months after treatment, the same tendency was observed just 12 months after treatment in another group. The maximum defect diameter of knee cartilage began to diminish at 3 months after treatment in the manipulation group, grew significantly at 6 and 12 months after treatment compared with before treatment. In the GS group, there was no significantly deference in the maximum defect diameter of knee cartilage between after and before treatment. The volume of knee cartilage in manipulation group was greater than the GS group at 3, 6, 12 months after treatment and significantly increased at 6 months after treatment and grew 58 percent 12 months after treatment. The volume of knee cartilage in GS group had no significantly change, though had a tendency to increase.

CONCLUSIONManipulation is effective to treatment of knee osteoarthritis by decreasing the maximum defect diameter and increasing the volume of knee cartilage.

Aged ; Cartilage ; diagnostic imaging ; injuries ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Musculoskeletal Manipulations ; methods ; Osteoarthritis, Knee ; diagnostic imaging ; drug therapy ; therapy ; Radiography ; Retrospective Studies ; Treatment Outcome

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1beta, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.
Aged ; Bone Density Conservation Agents/*therapeutic use ; Calcitonin/*therapeutic use ; Collagen Type II/urine ; Exercise Therapy ; Female ; Humans ; Interleukin-1beta/blood ; Magnetic Resonance Imaging ; Matrix Metalloproteinase 3/blood ; Middle Aged ; Nitric Oxide/blood ; Osteoarthritis, Knee/*drug therapy/radiography ; Peptide Fragments/urine ; Respiratory Therapy ; Severity of Illness Index ; Treatment Outcome ; Walking

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1beta, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.
Aged ; Bone Density Conservation Agents/*therapeutic use ; Calcitonin/*therapeutic use ; Collagen Type II/urine ; Exercise Therapy ; Female ; Humans ; Interleukin-1beta/blood ; Magnetic Resonance Imaging ; Matrix Metalloproteinase 3/blood ; Middle Aged ; Nitric Oxide/blood ; Osteoarthritis, Knee/*drug therapy/radiography ; Peptide Fragments/urine ; Respiratory Therapy ; Severity of Illness Index ; Treatment Outcome ; Walking