Name: Forfatter Spotlight: Behandling av kneartrose med Tuina - et nytt perspektiv
Uploaded: 2024-01-12T13:15:00
Description: Watch this Scientific Journal Video about Treating Knee Osteoarthritis with Tuina - A New Perspective at JoVE.com

Denne studien støttes av National Natural Science Foundation of China (NO.82105042, 82205302); Shanghai Postdoktor Excellence Program (NO.2020371); Kina Postdoktor Science Foundation (NO.2021M692156); Shanghai seilingsprogram (NO.20YF1450900); Science Foundation of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (NO.2021yygq03). Finansiørene hadde ingen rolle i utformingen, gjennomføringen eller skrivingen av studien.

Alle eksperimenter ble godkjent og overvåket av Animal Care and Use Committee ved Shanghai University of Traditional Chinese Medicine (godkjenningsnummer: SYXK2018-0040), som er i samsvar med bestemmelsene i World Medical Association Helsinki Declaration.
1. Dyr forberedelse
<ol><li>Hus 32 Sprague Dawley (SD) hannrotter i alderen 8 uker og veier 180-220 g i et spesifikt patogenfritt husapparat under 12 timer lys / 12 timer mørke sykluser ved 24 ± 2 ° C og 60% fuktighet m...

Terapeutisk potensial for Tuina-massasje for kneartrose

<ol>
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G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+knee+osteoarthritis+features+on+magnetic+resonance+imaging+in+asymptomatic+uninjured+adults:+a+systematic+review+and+meta-analysis.">Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.</a> Br J Sports Med. 53 (20), 1268-1278 (2019).</li><li>Safiri, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=regional+and+national+burden+of+osteoarthritis+1990-2017:+a+systematic+analysis+of+the+Global+Burden+of+Disease+Study+2017.">regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017.</a> Ann Rheum Dis. 79 (6), 819-828 (2020).</li><li>Kong, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traditional+Chinese+exercises+on+pain+and+disability+in+middle-aged+and+elderly+patients+with+neck+pain:+a+systematic+review+and+meta-analysis+of+randomized+controlled+trials.">Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with neck pain: a systematic review and meta-analysis of randomized controlled trials.</a> Front Aging Neurosci. 14, 912-945 (2022).</li><li>Nevitt, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Symptoms+of+knee+instability+as+risk+factors+for+recurrent+falls.">Symptoms of knee instability as risk factors for recurrent falls.</a> Arthritis Care Res (Hoboken). 68 (8), 1089-1097 (2016).</li><li>Hunter, D. J., March, L., Chew, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteoarthritis+in+2020+and+beyond:+a+Lancet+Commission).">Osteoarthritis in 2020 and beyond: a Lancet Commission).</a> Lancet. 396 (10264), 1711-1712 (2020).</li><li>Fan, Z. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interpretation+and+evaluation+of+the+Chinese+Osteoarthritis+Treatment+Guidelines+(2021+Edition).">Interpretation and evaluation of the Chinese Osteoarthritis Treatment Guidelines (2021 Edition).</a> Chinese Journal of Evidence-Based Medicine. 22 (06), 621-627 (2022).</li><li>Chen, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Design+of+an+epidemiological+survey+on+the+prevalence+of+osteoarthritis+of+the+knee+in+a+middle-aged+and+elderly+population+in+China.">Design of an epidemiological survey on the prevalence of osteoarthritis of the knee in a middle-aged and elderly population in China.</a> Journal of Hebei Medical University. 36 (04), 487-490 (2015).</li><li>Shao, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+on+the+mechanism+of+regulating+the+&amp;#34;balance+of+tendon+and+bone+force&amp;#34;+in+the+treatment+of+knee+osteoarthritis+by+Tui+Na+manipulation.">Study on the mechanism of regulating the &amp;#34;balance of tendon and bone force&amp;#34; in the treatment of knee osteoarthritis by Tui Na manipulation.</a> Shanghai University of Traditional Chinese Medicine. , 107-108 (2020).</li><li>Liu, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+and+mechanism+of+PD-1/PD-L1+pathway+in+osteoarthritis+in+mice.">Role and mechanism of PD-1/PD-L1 pathway in osteoarthritis in mice.</a> Shandong University. , 130-134 (2020).</li><li>Shoujian, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PD-1+promotes+the+repair+and+regeneration+of+contused+skeletal+muscle+by+regulating+Treg+cells+and+macrophages.">PD-1 promotes the repair and regeneration of contused skeletal muscle by regulating Treg cells and macrophages.</a> Shanghai Institute of Physical Education. , 54-58 (2020).</li><li>Levinger, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+level+of+FoxO1+and+IL-15+in+skeletal+muscle,+serum+and+synovial+fluid+in+people+with+knee+osteoarthritis:+a+case+control+study.">The level of FoxO1 and IL-15 in skeletal muscle, serum and synovial fluid in people with knee osteoarthritis: a case control study.</a> Osteoporos Int. 27 (6), 2137-2143 (2016).</li><li>Niu, Q., Xie, C., Jiang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+in+Chinese+medicine+based+on+PI3K/AKT+signaling+pathway+for+the+treatment+of+knee+osteoarthritis.">Advances in Chinese medicine based on PI3K/AKT signaling pathway for the treatment of knee osteoarthritis.</a> Massage and Rehabilitation Medicine. , 1-5 (2022).</li><li>Liu, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blocking+of+checkpoint+receptor+PD-L1+aggravates+osteoarthritis+in+macrophage-dependent+manner+in+the+mice+model.">Blocking of checkpoint receptor PD-L1 aggravates osteoarthritis in macrophage-dependent manner in the mice model.</a> Int J Immunopathol Pharmacol. 33, 2058-2073 (2019).</li><li>Molanouri, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+effect+of+aerobic+interval+training+and+selenium+nanoparticles+on+expression+of+IL-15+and+IL-10/TNF-alpha+ratio+in+skeletal+muscle+of+4T1+breast+cancer+mice+with+cachexia.">Combined effect of aerobic interval training and selenium nanoparticles on expression of IL-15 and IL-10/TNF-alpha ratio in skeletal muscle of 4T1 breast cancer mice with cachexia.</a> Cytokine. 90, 100-108 (2017).</li><li>Mahmoudian, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early-stage+symptomatic+osteoarthritis+of+the+knee+-+time+for+action.">Early-stage symptomatic osteoarthritis of the knee - time for action.</a> Nat Rev Rheumatol. 17 (10), 621-632 (2021).</li><li>Nahin, R. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence-based+evaluation+of+complementary+health+approaches+for+pain+management+in+the+United+States.">Evidence-based evaluation of complementary health approaches for pain management in the United States.</a> Mayo Clin Proc. 91 (9), 1292-1306 (2016).</li><li>Bervoets, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Massage+therapy+has+short-term+benefits+for+people+with+common+musculoskeletal+disorders+compared+to+no+treatment:+a+systematic+review.">Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review.</a> J Physiother. 61 (3), 106-116 (2015).</li><li>Xu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+tui+na+in+treating+pain+after+total+knee+replacement+for+knee+osteoarthritis.">Effectiveness of tui na in treating pain after total knee replacement for knee osteoarthritis.</a> Chinese Tissue Engineering Research. 25 (18), 2840-2845 (2021).</li><li>Ali, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Massage+therapy+and+quality+of+life+in+osteoarthritis+of+the+knee:+a+qualitative+study.">Massage therapy and quality of life in osteoarthritis of the knee: a qualitative study.</a> Pain Med. 18 (6), 1168-1175 (2017).</li><li>Yoh, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+injection+of+monoiodoacetate+induces+diverse+hip+osteoarthritis+in+rats,+depending+on+its+dose.">Intra-articular injection of monoiodoacetate induces diverse hip osteoarthritis in rats, depending on its dose.</a> BMC Musculoskelet Disord. 23 (1), 494-487 (2022).</li><li>Lockwood, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterisation+of+peripheral+and+central+components+of+the+rat+monoiodoacetate+model+of+osteoarthritis.">Characterisation of peripheral and central components of the rat monoiodoacetate model of osteoarthritis.</a> Osteoarthritis Cartilage. 27 (4), 712-722 (2019).</li><li>McCoy, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+of+osteoarthritis:+Comparisons+and+key+considerations.">Animal models of osteoarthritis: Comparisons and key considerations.</a> Vet Pathol. 52 (5), 803-818 (2015).</li><li>Guo, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exploring+the+effect+of+pushing+on+cartilage+in+rats+with+knee+osteoarthritis+based+on+ROCK/LIMK1/Cofilin+signaling+pathway.">Exploring the effect of pushing on cartilage in rats with knee osteoarthritis based on ROCK/LIMK1/Cofilin signaling pathway.</a> Chongqing Medical University. , 42-44 (2022).</li><li>Liu, Z. 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Denne studien tar sikte på å vurdere forbedringen av KOA etter Tuina-intervensjon ved å bruke standardiserte atferdsindikatorer og undersøke mekanismene til Tuina for KOA og sammenhengen mellom skjelettmuskulatur og KOA. I motsetning til farmakologiske og kirurgiske terapier har Tuina en positiv regulerende effekt på motoriske, immun- og endokrine systemer. Tuina kan lindre betennelse og smerte forårsaket av sykdom ved å handle på forskjellige mål. For eksempel, ved å regulere TLR4-banen og miRNA, kan den hemme...

Knet artrose (KOA) er en vanlig degenerativ slitasjegikt, preget av kroniske smerter og funksjonshemming, og relativt alvorlig KOA vil føre til irreversibel strukturell skade på leddet1. Den høye globale forekomsten av KOA har blitt en stor global folkehelseutfordring 2,3, noe som alvorlig svekker livskvaliteten til pasienter 4,5. Studier har vist at KOA påvirker mer enn 260 millioner mennesker over hele verden6. Med aldring av befolkningen er den totale prevalensen av KOA i Kina så høy som 17,0% over 40 år, noe som legger en tung byrde på familiene til de berørte 7,8.
Ifølge kinesisk medisin tilhører KOA kategorien "lammelse"9, og Den gule keiserens klassiker i indremedisin forbinder sener, bein og kjøtt med lammelse. Derfor må vi være oppmerksom på sammenhengen mellom brusk, muskel, synovium, samt andre vev rundt kneleddet i KOA. I moderne medisin driver både muskel- og beinbetennelse, som er hovedkomponenter i immunhomeostasen av leddgikt, utviklingen av KOA-smerte. De fleste studier fokuserer imidlertid på bruskbetennelse og synovialbetennelse i beinledd, og det er mangel på artikler som undersøker betennelsesfenomener i skjelettmuskulatur. Derfor er det behov for mer forskning på skjelettmuskulaturens rolle i betennelse for å få en mer omfattende forståelse av KOA og gi ideer til mer effektive behandlingsmodaliteter. I en litteraturgjennomgang fant vi at hemming av immunrelatert faktor programmert dødsligand 1 (PD-L1) forverret progresjonen av KOA10,11 og at det var differensialuttrykk av IL-15 og FOXO1 i skjelettmuskulaturen hos pasienter med KOA 12, samt signifikant skjelettmuskulaturbetennelse hos pasienter med KOA i sluttstadiet, som også var forbundet med endringer i gangart. Det er vist at skjelettmuskulaturen også kan skille ut faktorer som er nært beslektet med inflammatorisk immunitet som IL-6, og at TNF-α også er nært beslektet med PD-L1-banen og KOA13,14,15.
For tiden inkluderer tilgjengelige behandlinger for KOA vektkontroll, trening, medisinering og kirurgi, som vanligvis inkluderer intraartikulære injeksjoner, smertestillende medisiner, artroskopisk kirurgi og periprostetisk osteotomi i kneet16. For tiden kan KOA sykdomsprogresjon ikke stoppes helt eller reverseres, og uten en klar forståelse av de komplekse mekanismene som ligger til grunn for KOA-smerte, er KOA-pasienter i fare for overforbruk av smertestillende medisiner og høy forekomst av bivirkninger8. De fleste behandlingsstrategier er effektive bare i korte perioder og fokuserer bare på midlertidig lindring av symptomer i stedet for på patogenesen av sykdommen. Derfor er KOA-smerte fortsatt en prioritet og en utfordring for behandling, og utgjør en alvorlig klinisk utfordring. Imidlertid kan Tuina direkte stimulere skjelettmuskulaturen rundt det berørte leddet i KOA-behandling og kan gi noen fordeler. Kombinert med den forrige beskrivelsen er det den ideelle terapien for å studere rollen til skjelettmuskulaturvev i KOA, og avklaring av skjelettmuskulaturvevets rolle i betennelse kan også gi bedre teoretisk støtte til Tuina av KOA.
Studier har vist at massasjeterapi, osteopatisk manipulativ terapi og spinal manipulasjon kan bidra til å lindre smerte og gjenopprette kroppsfunksjon17,18. Disse manipulasjonene kan virke på lokal betennelse og lindre spasmer og smertestillende gjennom ekstern mekanisk virkning. De kan lindre smerte etter total kne artroplastikk, redusere bruken av smertestillende legemidler, fremme postoperativ utvinning og forbedre biomekanisk balanse19. Svensk massasje er mulig i behandlingen av slitasjegikt og kan redusere stress og forbedre livskvaliteten20. Den terapeutiske effekten av Tuina på KOA har blitt foretatt av visse studier.
I dette eksperimentet vil teamet vårt undersøke om uttrykket av PD-L1 og relaterte inflammatoriske faktorer i skjelettmuskulaturen kan indusere KOA og fremme utviklingen basert på MIA-indusert KOA-modell hos rotter. Tuina vil også bli implementert for å se om det kan lindre KOA-symptomer forårsaket av økt inflammatorisk faktoruttrykk. Tuina vil bli kombinert med PD-L1-hemming for å demonstrere sammenhengen mellom Tuina-mediert PD-1-vei i skjelettmuskulaturbetennelse som påvirker KOA-utvikling og smerte, og legge grunnlaget for videre flernivåstudier på de terapeutiske mekanismene til Tuina-intervensjon i KOA.
Oppsummert beskriver dette papiret undersøkelsen og utarbeidelsen av mekanismene for skjelettmuskulaturbetennelse i utviklingen av KOA og dens smerte, samt de terapeutiske effektene av Tuina på KOA, fra perspektivet til immuninflammatorisk faktoruttrykk, kombinert med atferdsrelaterte indikatorer, for å gi moderne forskningsbevis for "ubalanse av sene og bein" teori i tradisjonell kinesisk medisin.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Anti-PD-L1</td>
			<td>Abcam, Cambridge, MA, USA</td>
			<td>ab80276</td>
			<td></td>
		</tr>
		<tr>
			<td>electric von Frey esthesiometer&#160;</td>
			<td>IITC/Life Science, Woodland Hills, CA, USA</td>
			<td>ALMEMO 2450</td>
			<td></td>
		</tr>
		<tr>
			<td>GraphPad Prism 9.0</td>
			<td>GraphPad Software</td>
			<td></td>
			<td>Software for stastistical analysis</td>
		</tr>
		<tr>
			<td>monosodium iodoacetate</td>
			<td>Sigma-Aldrich Inc</td>
			<td>I9148</td>
			<td>Resolved into normal saline for injection</td>
		</tr>
		<tr>
			<td>pentasorbital sodium</td>
			<td>Sigma-Aldrich Inc</td>
			<td>P3761</td>
			<td></td>
		</tr>
		<tr>
			<td>Sprague Dawley (SD) male rats</td>
			<td>Shanghai Jihui Experimental Animal Breeding Co., Ltd</td>
			<td>No. SCXK (Hu) 2017-0012</td>
			<td></td>
		</tr>
		<tr>
			<td>thermal analgesia tester</td>
			<td>IITC/Life Science</td>
			<td>Model 390</td>
			<td></td>
		</tr>
	</tbody>
</table>

tuina intervention in sodium monoiodoacetate injection-induced rat model of knee osteoarthritis

Knet artrose (KOA), en vanlig degenerativ leddsykdom, er preget av kronisk smerte og funksjonshemming, som kan utvikle seg til uopprettelig strukturell skade på leddet. Undersøkelser av sammenhengen mellom leddbrusk, muskler, synovium og annet vev rundt kneleddet i KOA er av stor betydning. For tiden inkluderer administrerende KOA livsstilsendringer, trening, medisinering og kirurgiske inngrep; Imidlertid mangler fortsatt belysningen av de intrikate mekanismene som ligger til grunn for KOA-relatert smerte. Følgelig forblir KOA-smerte en viktig klinisk utfordring og en terapeutisk prioritet. Tuina har vist seg å ha en regulatorisk effekt på motoriske, immun- og endokrine systemer, noe som fører til utforskning av om Tuina kan lindre KOA-symptomer, forårsaket av oppregulering av inflammatoriske faktorer, og videre hvis de inflammatoriske faktorene i skjelettmuskulaturen kan øke utviklingen av KOA.
Vi randomiserte 32 mannlige Sprague Dawley (SD) rotter (180-220 g) i fire grupper på åtte dyr hver: antiPD-L1 + Tuina (gruppe A), modell (gruppe B), Tuina (gruppe C) og sham kirurgi (gruppe D). For gruppe A, B og C injiserte vi 25 μL natriummonoiodoacetat (MIA) oppløsning (4 mg MIA fortynnet i 25 μL steril saltoppløsning) i høyre kneleddhule, og for gruppe D ble det injisert samme mengde sterilt fysiologisk saltvann. Alle gruppene ble evaluert ved hjelp av de minst til mest stressende testene (potemekanisk tilbaketrekningsterskel, poteuttak, termisk latens, hevelse i høyre kneledd, Lequesne MG score, hudtemperatur) før injeksjon og 2, 9 og 16 dager etter injeksjon.

Knee osteoarthritis (KOA) is a common degenerative osteoarthritis, characterized by chronic pain and disability, and relatively severe KOA will lead to irreversible structural damage to the joint1. The high global prevalence of KOA has become a major global public health challenge2,3, which seriously impairs the quality of life of patients4,5. Studies have shown that KOA affects more than 260 million people worldwide6. With the aging of the population, the total prevalence rate of KOA in China is as high as 17.0% over the age of 40, which puts a heavy burden on the families of those affected7,8.
According to Chinese medicine, KOA belongs to the category of &#34;paralysis&#34;9, and the Yellow Emperor&#39;s Classic of Internal Medicine associates tendons, bones, and flesh with paralysis. Hence, we need to pay attention to the connection between the cartilage, muscle, synovium, as well as other tissues around the knee joint in KOA. In modern medicine, both muscle and bone inflammation, which are major components of the immune homeostasis of arthritis, drive the progression of KOA pain. However, most studies focus on cartilage inflammation and synovial inflammation in bone joints, and there is a paucity of articles examining inflammatory phenomena in skeletal muscles. Therefore, more research on the role of skeletal muscle in inflammation is needed to gain a more comprehensive understanding of KOA and provide ideas for more effective treatment modalities. In a review of the literature, we found that inhibition of the immune-related factor programmed death ligand 1 (PD-L1) exacerbated the progression of KOA10,11 and that there was differential expression of IL-15 and FOXO1 in the skeletal muscle of patients with KOA12, as well as significant skeletal muscle inflammation in patients with end-stage KOA, which was also associated with changes in gait. It has been shown that the skeletal muscle can also secrete factors closely related to inflammatory immunity such as IL-6, and that TNF-&#945; is also closely related to the PD-L1 pathway and KOA13,14,15.
Currently, available treatments for KOA include weight control, exercise, medication, and surgery, which usually include intra-articular injections, analgesic medication, arthroscopic surgery, and periprosthetic osteotomy of the knee16. Currently, KOA disease progression cannot be completely stopped or reversed, and without a clear understanding of the complex mechanisms underlying KOA pain, KOA patients are at risk for overuse of analgesic medications and a high incidence of side effects8. Most treatment strategies are effective only for short periods and focus only on the temporary relief of symptoms rather than on the pathogenesis of the disease. Therefore, KOA pain remains a priority and a challenge for treatment, posing a serious clinical challenge. However, Tuina can directly stimulate the skeletal muscles around the affected joint in KOA treatment and can provide some benefits. Combined with the previous description, it is the ideal therapy to study the role of skeletal muscle tissue in KOA, and clarifying the role of skeletal muscle tissue in inflammation can also provide better theoretical support for Tuina of KOA.
Studies have shown that massage therapy, osteopathic manipulative therapy, and spinal manipulation can help relieve pain and restore body function17,18. These manipulations can act on local inflammation and relieve spasms and analgesia through external mechanical action. They can relieve pain after total knee arthroplasty, reduce the use of analgesic drugs, promote postoperative recovery, and improve biomechanical balance19. Swedish massage is feasible in the treatment of osteoarthritis and can reduce stress and improve quality of life20. The therapeutic effect of Tuina on KOA has been preceded by certain studies.
In this experiment, our team will explore whether the expression of PD-L1 and related inflammatory factors in skeletal muscle can induce KOA and promote its development based on the MIA-induced KOA model in rats. Tuina will also be implemented to see whether it can alleviate KOA symptoms caused by increased inflammatory factor expression. Tuina will be combined with PD-L1 inhibition to demonstrate the association between Tuina-mediated PD-1 pathway in skeletal muscle inflammation affecting KOA development and pain, laying the foundation for further multi-level studies on the therapeutic mechanisms of Tuina intervention in KOA.
In summary, this paper describes the investigation and elaboration of the mechanisms of skeletal muscle inflammation in the development of KOA and its pain, as well as the therapeutic effects of Tuina on KOA, from the perspective of immune-inflammatory factor expression, combined with behavioral related indicators, to provide modern research evidence for the &#34;imbalance of tendon and bone&#34; theory in traditional Chinese medicine.

Forfatter Spotlight: Behandling av kneartrose med Tuina - et nytt perspektiv 

Tuina-intervensjon i natriummonoiodoacetat injeksjon-indusert rottemodell av knet artrose

We are trying to broaden the views on the research of knee osteoarthritis by introducing the perspective of refocusing on muscle inflammation during the pathological process of the KOA. There is a recent trend in non-pharmacological therapy treating the knee osteoarthritis. Therapy measures of traditional Chinese medicine, such as TNA and acupuncture, are receiving more and more recognition.There is a calling for detailed mechanism in the treatment. Our experiments indicates the possibility of chronic muscle inflammation in the process of knee osteoarthritis. It also points out the possibility of non-pharmacological therapy such as TNA to treat and control it.

Den beskrevne protokollen ble implementert i en klinisk setting ved Yueyang Hospital of Integrated Traditional Chinese and Western Medicine. Figur 1 viser den nøyaktige plasseringen av akupunktene som presses inn hos rotter, og tabell 1 illustrerer de vanlige fordelene ved å stimulere disse punktene. Tabell 2 og tabell 3 gir overbevisende bevis på bemerkelsesverdig smertelindring oppnådd gjennom Tuina-terapi, selv i fravær av PD-1-baneh...

Watch this Scientific Journal Video about Treating Knee Osteoarthritis with Tuina - A New Perspective at JoVE.com

Denne protokollen beskriver metodene for Tuina-intervensjon i natriummonoiodoacetat injeksjonsindusert rottemodell av knet artrose (KOA), som gir en referanse for anvendelse av Tuina i KOA dyremodeller. Denne protokollen studerer også den effektive mekanismen til Tuina for KOA, og resultatene vil bidra til å fremme anvendelsen.

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable ...

Vi prøver å utvide synspunktene på forskningen av knet artrose ved å introdusere perspektivet på å fokusere på muskelbetennelse under den patologiske prosessen med KOA. Det er en ny trend i ikke-farmakologisk terapi som behandler kneartrose. Terapi tiltak av tradisjonell kinesisk medisin, som TNA og akupunktur, mottar mer og mer anerkjennelse.Det etterlyses en detaljert mekanisme i behandlingen. Våre eksperimenter indikerer muligheten for kronisk muskelbetennelse i prosessen med knet artrose. Det peker også på muligheten for ikke-farmakologisk terapi som TNA for å behandle og kontrollere det.

tuina-intervention-sodium-monoiodoacetate-injection-induced-rat-model

Research

JoVE Journal

Medicine

Tuina Intervention in Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable structural damage of the joint. Investigations into the link between articular cartilage, muscles, synovium, and other tissues surrounding the knee joint in KOA are of great importance. Currently, managing KOA includes lifestyle modifications, exercise, medication, and surgical interventions; however, the elucidation of the intricate mechanisms underlying KOA-related pain is still lacking. Consequently, KOA pain remains a key clinical challenge and a therapeutic priority. Tuina has been found to have a regulatory effect on the motor, immune, and endocrine systems, prompting the exploration of whether Tuina could alleviate KOA symptoms, caused by the upregulation of inflammatory factors, and further, if the inflammatory factors in skeletal muscle can augment the progression of KOA.
We randomized 32 male Sprague Dawley (SD) rats (180-220 g) into four groups of eight animals each: antiPD-L1+Tuina (group A), model (group B), Tuina (group C), and sham surgery (group D). For groups A, B, and C, we injected 25 &#181;L of sodium monoiodoacetate (MIA) solution (4 mg MIA diluted in 25 &#181;L of sterile saline solution) into the right knee joint cavity, and for group D, the same amount of sterile physiological saline was injected. All the groups were evaluated using the least to most stressful tests (paw mechanical withdrawal threshold, paw withdrawal thermal latency, swelling of the right knee joint, Lequesne MG score, skin temperature) before injection and 2, 9, and 16 days after injection.

This protocol describes the methods of Tuina intervention in sodium monoiodoacetate injection-induced rat model of knee osteoarthritis (KOA), which provides a reference for the application of Tuina in KOA animal models. This protocol also studies the effective mechanism of Tuina for KOA, and the results will help promote its application.