Abstract Background Changes in the body composition of the elderly can be quickly identified by health professionals in primary care, reducing the impact on health, nutritional status, and functional capacity. Objective To look for links between muscle mass and strength, nutritional status, and functional capacity in community-dwelling elderly. Method A cross-sectional study involving 323 elderly people was carried out. Body composition assessment was performed by absorptiometry (DEXA) and anthropometry. Functional capacity was assessed by Instrumental Activities of Daily Living and by gait speed (VM) and Time Up and Go (TUG). Results In this sample, the lean mass index (LMI) was associated with indicators of nutritional status (BMI, NC, and WC), in addition to having shown an important correlation with handgrip strength (HGS). HGS was associated with VM and TUG. Regression analysis identified an association between BMI and LMI (p < 0.001) and between GS and HGS (p = 0.003). Conclusion HGS was an important indicator of functional capacity and correlated with LMI. Consequently, the LMI is associated with indicators of nutritional status. Therefore, when it is impossible to assess the LMI, we recommend the assessment of HGS, NC and BMI as predictors of compromised nutritional status and functional disability in the elderly.

Resumo Introdução Alterações na composição corporal do idoso podem ser rapidamente identificadas por profissionais de saúde na Atenção Básica, reduzindo o impacto sobre a saúde, o estado nutricional e a capacidade funcional. Objetivo Identificar relações entre massa e força muscular com o estado nutricional e a capacidade funcional em idosos da comunidade. Método Estudo transversal, envolvendo 323 idosos. A avaliação da composição corporal foi realizada por absorciometria (DEXA) e antropometria. A capacidade funcional foi avaliada pelas Atividades Instrumentais de Vida Diária, pela velocidade da marcha (VM) e Time Up and Go (TUG). Resultados Nesta amostra, o índice de massa magra (IMM) se mostrou associado aos indicadores do estado nutricional (IMC, CP e CC), além de ter apresentado importante correlação com a força de preensão palmar (FPP). A FPP esteve relacionada à VM e ao TUG. A análise de regressão identificou associação entre o IMC e o IMM (p<0,001), bem como entre a VM e a FPP (p=0,003). Conclusão A FPP se apresentou como importante indicador da capacidade funcional e se mostrou correlacionada com o IMM. Consequentemente, o IMM está associado aos indicadores do estado nutricional. Logo, na impossibilidade de avaliação do IMM, recomendamos a avaliação da FPP, CP e IMC como preditores de comprometimento do estado nutricional e da incapacidade funcional do idoso.

Resumo Objetivo Este estudo teve o objetivo de analisar a associação entre a osteoartrite (OA) de joelho e a síndrome metabólica (SM) em pacientes idosos não institucionalizados. Métodos Pesquisa transversal, aleatorizada, extraída de um estudo probabilístico por conglomerado realizado com 416 idosos de uma Unidade de Saúde da Família do nosso município. A SM foi definida de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), e a OA de acordo com a escala KellgrLawrence (KL) (≥ 2). Resultados Para a análise estatística, foi realizada uma análise exploratória de dados, testes de Mann-Whitney ou Qui-quadrado e regressões logísticas uni e multivariadas, com nível de significância de p < 0,05; a concordância entre os avaliadores foi verificada através do coeficiente de Kappa. Verificou-se associação entre OA e índice de massa corpórea (IMC) (p = 0,0021) e entre OA e circunferência de cintura (CC) (p < 0,001; razão de chances [RC] = 3,524). Não foi encontrada associação significativa entre a OA e o número de componentes metabólicos nem com a SM em si. Conclusão Conclui-se que a OA de joelho associa-se à CC, independente do peso, e que o aumento em sua medida reflete em uma maior chance de SM em idosos não institucionalizados.

Abstract Objective This study aimed to analyze the association between knee osteoarthritis (OA) and metabolic syndrome (MS) in non-institutionalized elderly patients. Methods A cross-sectional, randomized study, drawn from a probabilistic cluster study conducted with 416 elderly people from a Family Health Unit (USF, in the Portuguese acronym) of our municipality. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), and OA according to the KellgrLawrence (KL) scale (≥ 2). Results For the statistical analysis, we performed an exploratory data analysis, Mann-Whitney or Chi-Squared tests and univariate and multivariate logistic regressions, with significance level of p < 0.05; the concordance between the evaluators was verified through the Kappa coefficient. There was an association between OA and body mass index (BMI) (p = 0.0021) and between OA and waist circumference (WC) (p < 0.001; odds ratio [OR] = 3.524). There was no significant association between OA and the number of metabolic components nor with SM itself. Conclusion We conclude that knee OA is associated with WC, regardless of weight, and that the increase in its measure reflects a greater chance of MS in non-institutionalized elderly patients.

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

OBJECTIVES: Articular cartilage is vulnerable to injuries and undergoes an irreversible degenerative process. The use of amniotic fluid mesenchymal stromal stem cells for the reconstruction of articular cartilage is a promising therapeutic alternative. The aim of this study was to investigate the chondrogenic potential of amniotic fluid mesenchymal stromal stem cells from human amniotic fluid from second trimester pregnant women in a micromass system (high-density cell culture) with TGF-β3 for 21 days. METHODS: Micromass was performed using amniotic fluid mesenchymal stromal stem cells previously cultured in a monolayer. Chondrocytes from adult human normal cartilage were used as controls. After 21 days, chondrogenic potential was determined by measuring the expression of genes, such as SOX-9, type II collagen and aggrecan, in newly differentiated cells by real-time PCR (qRT-PCR). The production of type II collagen protein was observed by western blotting. Immunohistochemistry analysis was also performed to detect collagen type II and aggrecan. This study was approved by the local ethics committee. RESULTS: SOX-9, aggrecan and type II collagen were expressed in newly differentiated chondrocytes. The expression of SOX-9 was significantly higher in newly differentiated chondrocytes than in adult cartilage. Collagen type II protein was also detected. CONCLUSION: We demonstrate that stem cells from human amniotic fluid are a suitable source for chondrogenesis when cultured in a micromass system. amniotic fluid mesenchymal stromal stem cells are an extremely viable source for clinical applications, and our results suggest the possibility of using human amniotic fluid as a source of mesenchymal stem cells.

OBJECTIVE: Hypoxia-inducible factor 1 alpha regulates genes related to cellular survival under hypoxia. This factor is present in osteroarthritic chondrocytes, and cytokines, such as interleukin-1 beta, participate in the pathogenesis of osteoarthritis, thereby increasing the activities of proteolytic enzymes, such as matrix metalloproteinases, and accelerating cartilage destruction. We hypothesize that Hypoxia Inducible Factor-1 alpha (HIF-1α) can regulate cytokines (catabolic action) and/or growth factors (anabolic action) in osteoarthritis. The purpose of this study was to investigate the modulation of HIF-1α in human osteoarthritic chondrocytes by interleukin-1 beta (IL-1β) and insulin-like growth factors I (IGF-I) and II (IGF-II) and to determine the involvement of the phosphatidylinositol-3kinase (PI-3K) pathway in this process. METHODS: Human osteroarthritic chondrocytes were stimulated with IL-1β, IGF-I and IGF-II and LY294002, a specific inhibitor of PI-3K. Nuclear protein levels and gene expression were analyzed by western blot and quantitative reverse transcription-polymerase chain reaction analyses, respectively. RESULTS: HIF-1α expression was upregulated by IL-1β at the protein level but not at the gene level. IGF-I treatment resulted in increases in both the protein and mRNA levels of HIF-1α , whereas IGF-II had no effect on its expression. However, all of these stimuli exploited the PI-3K pathway. CONCLUSION: IL-1β upregulated the levels of HIF-1α protein post-transcriptionally, whereas IGF-I increased HIF-1α at the transcript level. In contrast, IGF-II did not affect the protein or gene expression levels of HIF-1α . Furthermore, all of the tested stimuli exploited the PI-3K pathway to some degree. Based on these findings, we are able to suggest that Hypoxia inducible Factor-1 exhibits protective activity in chondrocytes during osteoarthritis.

INTRODUCTION: Numerous experimental efforts have been undertaken to induce the healing of lesions within articular cartilage by re-establishing competent repair tissue. Adult mesenchymal stem cells have attracted attention as a source of cells for cartilage tissue engineering. The purpose of this study was to investigate chondrogenesis employing periosteal mesenchymal cells. METHODS: Periosteum was harvested from patients who underwent orthopedic surgeries. Mesenchymal stem cells were characterized through flow cytometry using specific antibodies. The stem cells were divided into four groups. Two groups were stimulated with transforming growth factor β3 (TGF-β3), of which one group was cultivated in a monolayer culture and the other was cultured in a micromass culture. The remaining two groups were cultivated in monolayer or micromass cultures in the absence of TGF-β3. Cell differentiation was verified through quantitative reverse transcription-polymerase chain reaction (RT-PCR) and using western blot analysis. RESULT: In the groups cultured without TGF-β3, only the cells maintained in the micromass culture expressed type II collagen. Both the monolayer and the micromass groups that were stimulated with TGF-β3 expressed type II collagen, which was observed in both quantitative RT-PCR and western blot analysis. The expression of type II collagen was significantly greater in the micromass system than in the monolayer system. CONCLUSION: The results of this study demonstrate that the interactions between the cells in the micromass culture system can regulate the proliferation and differentiation of periosteal mesenchymal cells during chondrogenesis and that this effect is enhanced by TGF-β3.

Este estudo tem como objetivo identificar os fatores sociodemográficos, clínico-funcionais e psicocognitivos associados ao histórico de quedas de idosos saudáveis. A amostra foi constituída por 96 idosos divididos igualmente em três grupos de acordo com o histórico de quedas ocorrido no último ano (sem queda, uma queda e quedas recorrentes). Não houve diferença entre os grupos quanto aos dados sociodemográficos. Os idosos do grupo sem quedas apresentaram menor queixa de dor (p = 0,012) e de tontura (p = 0,003), melhor mobilidade (p < 0,001), capacidade funcional (p < 0,001) e menor relato de quase quedas (p = 0,003) quando comparados aos idosos dos grupos com histórico de quedas. Na avaliação psicocognitiva os idosos com quedas recorrentes revelaram maior escore para humor deprimido (p = 0,009) e maior déficit cognitivo (p = 0,040) do que os sem quedas. As quedas interferem de forma negativa na vida do idoso, motivo da importância de identificação dos fatores protetores e potencializadores deste evento. Com o reconhecimento desses fatores é possível que os profissionais possam prevenir as quedas ou as consequências debilitantes causadas por sua ocorrência.

This study aims at identifying the sociodemographic, clinical-functional and psycho-cognitive factors associated with the history of falls of community-dwelling elderly individuals assisted by Programa Saúde da Família (PSF - Family Health Program). The sample comprised 96 elderly subjects equally divided into three groups according to the report of falls that occurred during the past year, as follows: without falls, one fall or recurrent falls. There were no significant differences between groups in relation to sociodemographic data. The non-faller group presented less complaints about pain (p=0.012) and dizziness (p=0.003), and less near-falls reports (p=0.003) when compared to the faller groups. Besides, it presented better mobility (p<0.001) and functional capacity (p<0.001) in comparison with the same groups. In the psycho-cognitive assessment, recurrent fallers showed higher depressed mood score (p=0.009) and higher cognitive impairment score (p=0.040) compared to non-fallers. The occurrence of falls must be considered a significant agent that negatively affects elders' life. This is why its causative as well as impeditive factors must be accurately identified, so that professionals can effectively prevent falls or their debilitating consequences.

Este estudo tem como objetivo identificar os fatores sociodemográficos, clínico-funcionais e psicocognitivos associados ao histórico de quedas de idosos saudáveis. A amostra foi constituída por 96 idosos divididos igualmente em três grupos de acordo com o histórico de quedas ocorrido no último ano (sem queda, uma queda e quedas recorrentes). Não houve diferença entre os grupos quanto aos dados sociodemográficos. Os idosos do grupo sem quedas apresentaram menor queixa de dor (p = 0,012) e de tontura (p = 0,003), melhor mobilidade (p < 0,001), capacidade funcional (p < 0,001) e menor relato de quase quedas (p = 0,003) quando comparados aos idosos dos grupos com histórico de quedas. Na avaliação psicocognitiva os idosos com quedas recorrentes revelaram maior escore para humor deprimido (p = 0,009) e maior déficit cognitivo (p = 0,040) do que os sem quedas. As quedas interferem de forma negativa na vida do idoso, motivo da importância de identificação dos fatores protetores e potencializadores deste evento. Com o reconhecimento desses fatores é possível que os profissionais possam prevenir as quedas ou as consequências debilitantes causadas por sua ocorrência.

This study aims at identifying the sociodemographic, clinical-functional and psycho-cognitive factors associated with the history of falls of community-dwelling elderly individuals assisted by Programa Saúde da Família (PSF - Family Health Program). The sample comprised 96 elderly subjects equally divided into three groups according to the report of falls that occurred during the past year, as follows: without falls, one fall or recurrent falls. There were no significant differences between groups in relation to sociodemographic data. The non-faller group presented less complaints about pain (p=0.012) and dizziness (p=0.003), and less near-falls reports (p=0.003) when compared to the faller groups. Besides, it presented better mobility (p<0.001) and functional capacity (p<0.001) in comparison with the same groups. In the psycho-cognitive assessment, recurrent fallers showed higher depressed mood score (p=0.009) and higher cognitive impairment score (p=0.040) compared to non-fallers. The occurrence of falls must be considered a significant agent that negatively affects elders' life. This is why its causative as well as impeditive factors must be accurately identified, so that professionals can effectively prevent falls or their debilitating consequences.

As funções do quadril são cruciais para a independência funcional de um indivíduo, motivo da grande repercussão da osteoartrite (OA) sobre as alterações nessa articulação. A OA de quadril é uma doença crônico-degenerativa e o tratamento atual detém-se em combater sua sintomatologia. Dentre os possíveis tratamentos conservadores, os exercícios têm sido indicados para a redução da dor e melhora funcional. O objetivo desta revisão sistemática é elucidar a função e efetividade dos exercícios físicos no tratamento conservador da OA de quadril. Para a realização do levantamento bibliográfico foram consultadas as bases de dados PUBMED, LILACS e MEDLINE referentes às publicações de artigos de ensaio clínico aleatório controlado dos últimos dez anos (julho/2005 - julho/1995), utilizando-se a relação entre as palavras-chave osteoarthritis, hip, exercise. Resultaram da busca, 18 artigos. Desses, dez continham os critérios para revisão na íntegra. Após análise do conteúdo dos dez estudos, foram identificadas três categorias: a) exercícios específicos para OA de quadril (n=3); b) exercícios para OA de quadril e joelho (n=4) e c) exercícios para pré e pós-cirurgia de artroplastia decorrente de OA (n=3). Dos dez estudos analisados, três revelaram limitações dos benefícios dos exercícios nas amostras. Embora, a maioria dos estudos tenha demonstrado bons resultados com a prática de exercícios no tratamento da OA de quadril, ainda não é possível determinar o alcance deste tipo de terapêutica no quadro geral da doença e para sua progressão, tendo em vista a escassez de estudos e falta de especificidade das intervenções propostas.

Functions of the hip are crucial for the functional independence of an individual, being the reason of great repercussion of Osteoarthritis (OA) on the alterations in this joint. Hip OA is a chronic degenerative disease and the available treatment aims to alleviate its symptoms. Exercises, one of the conservative treatment possibilities, have been indicated for the reduction of pain and function improvement. The purpose of this systematic review is to clarify the function and effectiveness of physical exercises in the conservative treatment of hip OA. The review of the literature was based on PUBMED, LILACS and MEDLINE database consultation, searching for article publications of randomized clinical trials for the last ten years (July/2005 - July/1995), using the combination of the following keywords: osteoarthritis, hip, exercise. The search resulted in eighteen articles; ten of each followed given criteria and underwent complete revision. After analysis of the ten selected studies, three categories were identified: a) specific exercises for OA of hip (n=3); b) exercises for OA of hip and knee (n=4) and c) exercises for pre and post-surgery of total hip (n=3). Three studies have encountered limitations with the practice of exercises. Although, the majority of the articles have demonstrated good results of exercises in the hip OA treatment, it is still not possible to determine their actual extension in the clinical picture of the illness and on its progression, mainly due to the scarcity of researches and to the lack of specificity of the proposed interventions.

OBJETIVO: avaliar a incidência de osteoartrite de mãos nos pacientes encaminhados aos ambulatórios de reumatologia do Hospital das Clínicas da Universidade Estadual de Campinas e analisar a possível associação entre osteoartrite (OA) de mãos e o índice de massa corpórea (IMC). MÉTODOS: foram analisados 515 pacientes, calculando-se o IMC e também a idade no momento do diagnóstico (20-80 anos), sexo, cor e o diagnóstico através de regressão logística. RESULTADOS: OA de mãos esteve presente em 15,8% dos diagnósticos reumatológicos, incluindo-se, entre outras, as doenças do tecido conjuntivo e as doenças auto-imunes. Não houve relação estatisticamente significativa entre IMC e OA de mãos na regressão univariada. Entretanto, quando realizado estudo de regressão logística multivariada, verificou-se que a cada 1 kg/m² de aumento do IMC, o risco de OA de mãos aumenta em 5,4%. Observou-se, ainda, que pacientes com sobrepeso apresentam 2,16 vezes mais risco de ter OA de mãos que os com peso considerado normal. Os obesos apresentam esse risco 2,04 vezes maior. CONCLUSÕES: a despeito de a associação entre o IMC e a prevalência da OA de mãos não ter sido significativa, pacientes com IMC > 25 apresentam maior risco de desenvolverem OA de mãos.

OBJECTIVE: To evaluate the incidence of hand osteoarthritis (OA) among patients that were referred to the Rheumatology Unit at State University of Campinas and to verify the association between hand OA and bone mass index (BMI). METHODS: We evaluated 515 outpatients, calculating the BMI and registering the age at diagnosis, sex, ethnicity and diagnosis. Logistic regression was also performed. RESULTS: Hands OA was present in 15.8%. There was no relation between BMI and hands OA in the univariated analysis. However, when multivariated logistic regression was performed, we observed 5.4% increase in the risk to develop hands OA per each 1 kg/m² of enhance in the BMI. We also observed that overweight patients showed 2,16 fold more risk than normal subjects to present hands OA. The obese patients showed 2.04 fold more risk than the normal ones. CONCLUSIONS: We concluded that despite the lack of direct association between BMI and the hands OA prevalence, patients with BMI > 25 kg/m² are at higher risk to develop hands OA.