The Experts below are selected from a list of 2112 Experts worldwide ranked by ideXlab platform
Marcia Uchoa De Rezende - One of the best experts on this subject based on the ideXlab platform.
-
BRAZILIAN CONSENSUS STATEMENT ON Viscosupplementation OF THE KNEE (COBRAVI).
Acta ortopedica brasileira, 2019Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Eduardo Branco De Sousa, Paulo Cesar Hamdan, Cyro Scala De Almeida Júnior, Antonio Martins Tieppo, Adrieni Antunes Do Amaral Alchaar, Carlos Bruno Pinheiro, Eduardo De Melo Carvalho Rocha, Fabiano Gonçalves CunhaAbstract:Objective The aim of this consensus statement on Viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of Viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; Viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; Viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and Viscosupplementation is cost-effective. Conclusion This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
-
joint lavage followed by Viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy objective functional results
Haemophilia, 2017Co-Authors: Marcia Uchoa De Rezende, Gustavo Constantino De Campos, Alexandre Felicio Pailo, F R Andrusaitis, R T Silva, Erica Okazaki, J D A Carneiro, Thiago Pasqualin, Renato Frucchi, Paula Ribeiro VillacaAbstract:Introduction Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration. Aim To objectively assess whether Viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events. Methods Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G-F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom® force and balance platforms using the step-up-and-over task (STP), sit-to-stand test (STS), one-leg stance (UNI) and weight-bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed. Results Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift-up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04). Conclusion Joint lavage followed by injections of triamcinolone and Hylan G-F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.
-
adding triamcinolone to Viscosupplementation one year outcome of randomized trial
Medical Express, 2014Co-Authors: Gustavo Constantino De Campos, M I Hissadomi, Thiago Pasqualin, Renato Frucchi, Marcia Uchoa De RezendeAbstract:OBJECTIVE: This is an extended follow-up of a randomized controlled trial to evaluate if the addition of triamcinolone to Viscosupplementation could alter one-year pain and function of Viscosupplementation alone. This is a Level I Therapeutic study (See Guidelines for Authors for a complete description of levels of evidence). METHODS: In a previously reported study we prospectively enrolled 104 patients with knee osteoarthritis and randomized them to receive either a single intra-articular injection (6 mL) of hylan GF-20 (Group Viscosupplementation [Group VS]), or a single intra-articular injection of hylan GF-20 (6 mL) and 1 mL (20 mg) of triamcinolone hexacetonide (Group VS + T). Visual Analogue Scale, WOMACTM, and Lequesne questionnaires were completed at baseline, at weeks 1, 4, 12, 24. At the one-year follow-up point, all patients were recruited and reassessed. RESULTS: At one year, the effects of treatment observed in the previous periods were present, with no differences between groups; only the Group receiving hylan + triamcinolone hexacetonide still showed a difference from baseline in the Visual Analogue Scale questionnaire. CONCLUSIONS: The addition of triamcinolone hexacetonide improves first-week symptoms and functional scores of Viscosupplementation and does not alter its adverse effects. There might be benefits for the one-year pain results.
-
randomized prospective study evaluating addition of corticoid to Viscosupplementation three months of follow up
Revista Brasileira De Ortopedia, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Thiago Pasqualim, Renato Frucchi, Olavo Pires De CamargoAbstract:OBJECTIVE: To assess if the initial results of Viscosupplementation are improved by the addition of corticosteroid. DESIGN: We evaluated 104 patients receiving usual care for knee osteoarthritis at the Universidade de Sao Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6 mL of Hylan GF-20 (Group 1) or a single intra-articular injection of 6 mL of Hylan GF-20 plus 1 mL (20 mg) of Triamcinolone Hexacetonide (Group 2). VAS, WOMAC and Lequesne questionnaires were applied at weeks zero (prior the injection), and after one, four, and 12 weeks. RESULTS: The baseline measurements of the two groups with 52 patients each were not statistically different. At week one, WOMAC and VAS showed significantly better results for Group 2 compared to Group 1 (p < 0,05). At week four the scores did not show a statistically significant differences. The groups showed similar results at week 12. CONCLUSION: The addition of Triamcinolone Hexacetonide improves the short term symptom/functional scores of Viscosupplementation.
-
adding triamcinolone improves Viscosupplementation a randomized clinical trial
Clinical Orthopaedics and Related Research, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Renato Frucchi, Olavo Pires De CamargoAbstract:Background Intraarticular injections, mainly using long-lasting corticosteroid suspensions, have long been used to treat knee osteoarthritis. Viscosupplementation is a relatively new approach with injection of a variety of agents. When comparing Viscosupplementation with intraarticular injections of corticosteroids from baseline to the fourth week, steroids have been more effective for pain relief. By the fourth week they provide similar relief, but beyond that Viscosupplementation appears to provide greater pain reduction. The delayed onset of symptomatic improvement combined with reports of reactive synovitis may discourage physicians and patients.
Gustavo Constantino De Campos - One of the best experts on this subject based on the ideXlab platform.
-
BRAZILIAN CONSENSUS STATEMENT ON Viscosupplementation OF THE KNEE (COBRAVI).
Acta ortopedica brasileira, 2019Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Eduardo Branco De Sousa, Paulo Cesar Hamdan, Cyro Scala De Almeida Júnior, Antonio Martins Tieppo, Adrieni Antunes Do Amaral Alchaar, Carlos Bruno Pinheiro, Eduardo De Melo Carvalho Rocha, Fabiano Gonçalves CunhaAbstract:Objective The aim of this consensus statement on Viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of Viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; Viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; Viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and Viscosupplementation is cost-effective. Conclusion This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
-
joint lavage followed by Viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy objective functional results
Haemophilia, 2017Co-Authors: Marcia Uchoa De Rezende, Gustavo Constantino De Campos, Alexandre Felicio Pailo, F R Andrusaitis, R T Silva, Erica Okazaki, J D A Carneiro, Thiago Pasqualin, Renato Frucchi, Paula Ribeiro VillacaAbstract:Introduction Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration. Aim To objectively assess whether Viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events. Methods Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G-F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom® force and balance platforms using the step-up-and-over task (STP), sit-to-stand test (STS), one-leg stance (UNI) and weight-bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed. Results Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift-up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04). Conclusion Joint lavage followed by injections of triamcinolone and Hylan G-F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.
-
adding triamcinolone to Viscosupplementation one year outcome of randomized trial
Medical Express, 2014Co-Authors: Gustavo Constantino De Campos, M I Hissadomi, Thiago Pasqualin, Renato Frucchi, Marcia Uchoa De RezendeAbstract:OBJECTIVE: This is an extended follow-up of a randomized controlled trial to evaluate if the addition of triamcinolone to Viscosupplementation could alter one-year pain and function of Viscosupplementation alone. This is a Level I Therapeutic study (See Guidelines for Authors for a complete description of levels of evidence). METHODS: In a previously reported study we prospectively enrolled 104 patients with knee osteoarthritis and randomized them to receive either a single intra-articular injection (6 mL) of hylan GF-20 (Group Viscosupplementation [Group VS]), or a single intra-articular injection of hylan GF-20 (6 mL) and 1 mL (20 mg) of triamcinolone hexacetonide (Group VS + T). Visual Analogue Scale, WOMACTM, and Lequesne questionnaires were completed at baseline, at weeks 1, 4, 12, 24. At the one-year follow-up point, all patients were recruited and reassessed. RESULTS: At one year, the effects of treatment observed in the previous periods were present, with no differences between groups; only the Group receiving hylan + triamcinolone hexacetonide still showed a difference from baseline in the Visual Analogue Scale questionnaire. CONCLUSIONS: The addition of triamcinolone hexacetonide improves first-week symptoms and functional scores of Viscosupplementation and does not alter its adverse effects. There might be benefits for the one-year pain results.
-
randomized prospective study evaluating addition of corticoid to Viscosupplementation three months of follow up
Revista Brasileira De Ortopedia, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Thiago Pasqualim, Renato Frucchi, Olavo Pires De CamargoAbstract:OBJECTIVE: To assess if the initial results of Viscosupplementation are improved by the addition of corticosteroid. DESIGN: We evaluated 104 patients receiving usual care for knee osteoarthritis at the Universidade de Sao Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6 mL of Hylan GF-20 (Group 1) or a single intra-articular injection of 6 mL of Hylan GF-20 plus 1 mL (20 mg) of Triamcinolone Hexacetonide (Group 2). VAS, WOMAC and Lequesne questionnaires were applied at weeks zero (prior the injection), and after one, four, and 12 weeks. RESULTS: The baseline measurements of the two groups with 52 patients each were not statistically different. At week one, WOMAC and VAS showed significantly better results for Group 2 compared to Group 1 (p < 0,05). At week four the scores did not show a statistically significant differences. The groups showed similar results at week 12. CONCLUSION: The addition of Triamcinolone Hexacetonide improves the short term symptom/functional scores of Viscosupplementation.
-
adding triamcinolone improves Viscosupplementation a randomized clinical trial
Clinical Orthopaedics and Related Research, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Renato Frucchi, Olavo Pires De CamargoAbstract:Background Intraarticular injections, mainly using long-lasting corticosteroid suspensions, have long been used to treat knee osteoarthritis. Viscosupplementation is a relatively new approach with injection of a variety of agents. When comparing Viscosupplementation with intraarticular injections of corticosteroids from baseline to the fourth week, steroids have been more effective for pain relief. By the fourth week they provide similar relief, but beyond that Viscosupplementation appears to provide greater pain reduction. The delayed onset of symptomatic improvement combined with reports of reactive synovitis may discourage physicians and patients.
Lawrence J Bonassar - One of the best experts on this subject based on the ideXlab platform.
-
distinct tribological endotypes of pathological human synovial fluid reveal characteristic biomarkers and variation in efficacy of Viscosupplementation at reducing local strains in articular cartilage
Osteoarthritis and Cartilage, 2020Co-Authors: Rebecca M Irwin, Elizabeth Feeney, Cynthia Secchieri, D Galesso, Itai Cohen, Francesca Oliviero, Roberta Ramonda, Lawrence J BonassarAbstract:Summary Objective Viscosupplementation has been used for decades to treat mild to moderate osteoarthritis, yet it is unknown if the lubricating function of different pathological synovial fluids (SF) vary, or if they respond differentially to Viscosupplementation. The objectives of this study were to (i) evaluate the friction coefficients and induced shear strains in articular cartilage when lubricated with pathological SF, (ii) identify the effect of hyaluronic acid (HA) supplementation on friction coefficients and shear strains, and (iii) identify SF biomarkers that correlate with lubricating function. Method Human pathological SF was grouped by white blood cell count (inflammatory: >2000 cells/mm 3 , n = 6; non-inflammatory: 3 , n = 6). Compositional analyses for lubricin and cytokines were performed. Friction coefficients and local tissue shear strain measurements were coupled using new, microscale rheological analyses by lubricating neonatal bovine cartilage explants with SF alone and in a 1:1 ratio with HA (Hymovis®). Results Friction coefficients were not significantly different between the inflammatory and non-inflammatory pathologies (p = 0.09), and were poorly correlated with peak tissue strains at the cartilage articular surface (R 2 = 0.34). A subset of inflammatory SF samples induced higher tissue strains, and HA supplementation was most effective at lowering friction and tissue strains in this inflammatory subset. Across all pathologies there were clear relationships between polymorphonuclear neutrophil (PMN), IL-8, and lubricin concentrations with cartilage tissue strains. Conclusion These results suggest that pathological SF is characterized by distinct tribological endotypes where SF lubricating behaviors are differentially modified by Viscosupplementation and are identifiable by biomarkers.
Renato Frucchi - One of the best experts on this subject based on the ideXlab platform.
-
joint lavage followed by Viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy objective functional results
Haemophilia, 2017Co-Authors: Marcia Uchoa De Rezende, Gustavo Constantino De Campos, Alexandre Felicio Pailo, F R Andrusaitis, R T Silva, Erica Okazaki, J D A Carneiro, Thiago Pasqualin, Renato Frucchi, Paula Ribeiro VillacaAbstract:Introduction Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration. Aim To objectively assess whether Viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events. Methods Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G-F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom® force and balance platforms using the step-up-and-over task (STP), sit-to-stand test (STS), one-leg stance (UNI) and weight-bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed. Results Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift-up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04). Conclusion Joint lavage followed by injections of triamcinolone and Hylan G-F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.
-
adding triamcinolone to Viscosupplementation one year outcome of randomized trial
Medical Express, 2014Co-Authors: Gustavo Constantino De Campos, M I Hissadomi, Thiago Pasqualin, Renato Frucchi, Marcia Uchoa De RezendeAbstract:OBJECTIVE: This is an extended follow-up of a randomized controlled trial to evaluate if the addition of triamcinolone to Viscosupplementation could alter one-year pain and function of Viscosupplementation alone. This is a Level I Therapeutic study (See Guidelines for Authors for a complete description of levels of evidence). METHODS: In a previously reported study we prospectively enrolled 104 patients with knee osteoarthritis and randomized them to receive either a single intra-articular injection (6 mL) of hylan GF-20 (Group Viscosupplementation [Group VS]), or a single intra-articular injection of hylan GF-20 (6 mL) and 1 mL (20 mg) of triamcinolone hexacetonide (Group VS + T). Visual Analogue Scale, WOMACTM, and Lequesne questionnaires were completed at baseline, at weeks 1, 4, 12, 24. At the one-year follow-up point, all patients were recruited and reassessed. RESULTS: At one year, the effects of treatment observed in the previous periods were present, with no differences between groups; only the Group receiving hylan + triamcinolone hexacetonide still showed a difference from baseline in the Visual Analogue Scale questionnaire. CONCLUSIONS: The addition of triamcinolone hexacetonide improves first-week symptoms and functional scores of Viscosupplementation and does not alter its adverse effects. There might be benefits for the one-year pain results.
-
randomized prospective study evaluating addition of corticoid to Viscosupplementation three months of follow up
Revista Brasileira De Ortopedia, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Thiago Pasqualim, Renato Frucchi, Olavo Pires De CamargoAbstract:OBJECTIVE: To assess if the initial results of Viscosupplementation are improved by the addition of corticosteroid. DESIGN: We evaluated 104 patients receiving usual care for knee osteoarthritis at the Universidade de Sao Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6 mL of Hylan GF-20 (Group 1) or a single intra-articular injection of 6 mL of Hylan GF-20 plus 1 mL (20 mg) of Triamcinolone Hexacetonide (Group 2). VAS, WOMAC and Lequesne questionnaires were applied at weeks zero (prior the injection), and after one, four, and 12 weeks. RESULTS: The baseline measurements of the two groups with 52 patients each were not statistically different. At week one, WOMAC and VAS showed significantly better results for Group 2 compared to Group 1 (p < 0,05). At week four the scores did not show a statistically significant differences. The groups showed similar results at week 12. CONCLUSION: The addition of Triamcinolone Hexacetonide improves the short term symptom/functional scores of Viscosupplementation.
-
adding triamcinolone improves Viscosupplementation a randomized clinical trial
Clinical Orthopaedics and Related Research, 2013Co-Authors: Gustavo Constantino De Campos, Marcia Uchoa De Rezende, Alexandre Felicio Pailo, Renato Frucchi, Olavo Pires De CamargoAbstract:Background Intraarticular injections, mainly using long-lasting corticosteroid suspensions, have long been used to treat knee osteoarthritis. Viscosupplementation is a relatively new approach with injection of a variety of agents. When comparing Viscosupplementation with intraarticular injections of corticosteroids from baseline to the fourth week, steroids have been more effective for pain relief. By the fourth week they provide similar relief, but beyond that Viscosupplementation appears to provide greater pain reduction. The delayed onset of symptomatic improvement combined with reports of reactive synovitis may discourage physicians and patients.
Raveendhara R Bannuru - One of the best experts on this subject based on the ideXlab platform.
-
osteoarthritis is Viscosupplementation really so unsafe for knee oa
Nature Reviews Rheumatology, 2012Co-Authors: Timothy E Mcalindon, Raveendhara R BannuruAbstract:The latest in a series of meta-analyses of trials assessing Viscosupplementation for knee osteoarthritis is the first to raise concerns about its safety. Questions remain, however, regarding the methodological rigour with which the serious adverse events were analyzed, and the biological plausibility of the events reported.
-
Osteoarthritis: Is Viscosupplementation really so unsafe for knee OA?
Nature Reviews Rheumatology, 2012Co-Authors: Timothy E Mcalindon, Raveendhara R BannuruAbstract:The latest in a series of meta-analyses of trials assessing Viscosupplementation for knee osteoarthritis is the first to raise concerns about its safety. Questions remain, however, regarding the methodological rigour with which the serious adverse events were analyzed, and the biological plausibility of the events reported.
