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Fulltext A pilot study of the primary care management of knee osteoarthritis in the Northern States of Malaysia.

Arshad, A., Rashid, R.

International Medical Journal Malaysia, 2008;7(2):31-36.
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Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.

Matched MeSH terms: Osteoarthritis, Knee
Fulltext Early Experience of Reverse Total Shoulder Arthroplasty in a Public Hospital in Malaysia

Sam CX, Anwar AZ, Ahmad AR, Solayar GN

Malays Orthop J, 2021 Mar;15(1):119-123.
PMID: 33880158 DOI: 10.5704/MOJ.2103.018

Introduction: Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of cuff tear arthropathy, arthritis and fracture sequelae. This study aimed to assess the short-term outcomes following reverse total shoulder arthroplasty for patients in a large public hospital in Malaysia.
Materials and Methods: We identified and performed five primary reverse total shoulder arthroplasties between 1 May 2019 and 1 June 2020. All patients were contactable and available for analysis. Assessment of functional outcomes was performed using the Constant-Murley score, the patient satisfaction score (PSS), and imaging studies. The mean follow-up from operation to the time of reporting was 9.6 months (range, 3 to 14 months).
Results: The median age for our patients was 58 years (±11.91). The most common indication for surgery was post-traumatic arthritis, followed by rotator cuff arthropathy and osteoarthritis. The mean Constant score improved from 9.0 pre-operatively to 52.3 post-operatively at a mean of 9.6 months. The majority of the patients were satisfied with the surgery as the post-operative range of motion, especially anterior elevation and abduction, improved in four of our patients and there were no short-term complications, for example, of infection or revisions, reported at the last follow-up.
Conclusion: This study has shown that reverse total shoulder arthroplasty can yield good short-term outcomes for the treatment of complex shoulder problems in addition to cuff tear arthropathy. It should be considered a treatment for rotator cuff tears, severe arthritis and ≥ 3 parts proximal humeral fractures.

Matched MeSH terms: Osteoarthritis
Septic arthritis of temporomandibular joint

Azmi NS, Mohamad N, Razali NA, Zamli AKT, Sapiai NA

Med J Malaysia, 2021 03;76(2):264-266.
PMID: 33742643

Septic arthritis (SA) occurrence for temporomandibular joint (TMJ) is rare. Pain, fever, swelling or loss of TMJ function are the typical presentation. The more common diagnosis for these presentations is internal derangement, osteoarthritis and rheumatoid arthritis. Therefore, TMJ septic arthritis is a challenging diagnosis and at risk of delayed diagnosis. We present a case of TMJ septic arthritis in a 46 year old Malay female with underlying hypertension and hypercholestrolemia, which was diagnosed as internal derangement in the initial presentation. The initial radiograph was normal. Arthrocentesis procedure had temporarily relieved the symptoms before progressive facial swelling developed after a week. Contrast enhanced computed tomography (CECT) brain revealed left TMJ abscess formation with left condylar erosion. Patient subsequently improved after wound debridement, left condylectomy and antimicrobial therapy.

Matched MeSH terms: Osteoarthritis
Fulltext Ultrastructural changes of the articular cartilage in some arthropathies with special reference to chondrocyte cell death

Kapitonova MY, Mansor O

Malays J Pathol, 2003 Jun;25(1):15-27.
PMID: 16196374

OBJECTIVE: To determine in situ using TEM the balance of apoptosis and necrosis in the articular cartilage of patients with inflammatory (rheumatoid arthritis and seronegative spondyloarthritis) and degenerative (osteoarthritis) joint diseases and to establish possible correlation between the cell death rate and the matrix vesicles formation.
METHODS: Cartilage samples of the knee joint were obtained from patients with rheumatoid arthritis (RA, 18 cases), osteoarthritis (OA, 22 cases), Reiter's disease (RD, 9 cases), peripheral form of the ankylosing spondyloarthritis (AS, 6 cases) and psoriatic arthritis (PA, 6 cases) during arthroscopy or knee surgery. Normal samples taken from autopsy cases without a history of joint diseases were used as control. Samples were processed for TEM with subsequent semi-quantitative estimation of the cell death rate in the superficial, middle and deep zone of non-calcified articular cartilage, and computer-aided ultramorphometric evaluation of the matrix vesicles of different types.
RESULTS: Both apoptotic and necrotic cell death could be identified in the cartilage of patients with inflammatory joint diseases, including seronegative spondyloarthritides and degenerative arthropathies. Apoptosis dominated over necrosis in all examined arthritides, including RA patients in which necrosis of the chondrocyte was the most frequent among arthropathies, while the highest apoptotic cell death rate was discovered in OA in which it correlated with the volume and numeric density of the matrix vesicles. These data provide evidence that apoptosis may contribute to the cartilage breakdown not only in RA and OA but also in the seronegative spondyloarthritides, which had a significantly higher apoptotic rate than the normal cartilage.

Matched MeSH terms: Osteoarthritis
Vernonia amygdalina inhibited osteoarthritis development by anti-inflammatory and anticollagenase pathways in cartilage explant and osteoarthritis-induced rat model

Madzuki IN, Lau SF, Abdullah R, Mohd Ishak NI, Mohamed S

Phytother Res, 2019 Jul;33(7):1784-1793.
PMID: 31033070 DOI: 10.1002/ptr.6366

Vernonia amygdalina (VA) is a medicinal tropical herb for diabetes and malaria and believed to be beneficial for joint pains. The antiosteorthritis effects of VA leaf in cartilage explant assays and on postmenopausal osteoarthritis (OA) rat model were investigated. The VA reduced the proteoglycan and nitric oxide release from the cartilage explants with interleukin 1β (IL-1β) stimulation. For the preclinical investigation, ovariectomized (OVX) female rats were grouped (n = 8) into nontreated OA, OA + diclofenac (5 mg/kg), OA + VA extract (150 and 300 mg/kg), and healthy sham control. Monosodium iodoacetate was injected into the knee joints to accelerate OA development. After 8 weeks, the macroscopic, microscopic, and histological images showed that the OA rats treated with VA 300 mg/kg and diclofenac had significantly reduced cartilage erosions and osteophytes unlike the control OA rats. The extract significantly down-regulated the inflammatory prostaglandin E2, nuclear factor κβ, IL-1β, ADAMTS-5, collagen type 10α1, and caspase3 in the OVX-OA rats. It up-regulated the anti-inflammatory IL-10 and collagen type 2α1 mRNA expressions, besides reducing serum collagenases (MMP-3 and MMP-13) and collagen type II degradation biomarker (CTX-II) levels in these rats. The VA (containing various caffeoyl-quinic acids, flavanone-O-rutinoside, luteolin, apigenin derivative and vernonioside D) suppressed inflammation, pain, collagenases as well as cartilage degradation, and improved cartilage matrix synthesis to prevent OA.

Matched MeSH terms: Osteoarthritis