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The Relationship Between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine

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The Relationship Between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Yu-guo G, Hong J. The Relationship between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Syndrome Pattern of Osteoarthritis in the Knee. J Orthopedics & Orthopedic Surg. 2020;1(2):4-9 Research Article Open Access The Relationship between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Syndrome Pattern of Osteoarthritis in the Knee Gu Yu-guo, Jiang Hong* Department of Orthopaedics and Traumatology, Suzhou TCM Hospital, in affiliation with Nanjing University of Chinese Medicine, Suzhou, China Article Info Abstract Article Notes Purpose: The aim of this study was to guide the quantitative analysis Received: February 04, 2020 Accepted:June 19, 2020 of Traditional Chinese Medicine (TCM) syndromes by the measurement of magnetic resonance. *Correspondence: *Dr. Jiang Hong, Department of Orthopaedics and Traumatology, Methods: A total of 213 patients with knee osteoarthritis were selected Suzhou TCM Hospital, in affiliation with Nanjing University of Chinese for TCM dialectical classification, and their MRI images were scored on Whole- Medicine, Suzhou, China; Telephone No: + 86 138 6255 7621; Email: Organ Magnetic Resonance Imaging Score (WORMS) to evaluate the correlation [email protected]. between severity of synovitis and TCM syndrome types in the scores. ©2020 Hong J. This article is distributed under the terms of the Results: Among the 213 patients, 25 were Anemofrigid-damp arthralgia Creative Commons Attribution 4.0 International License. syndrome (accounting for 11.7%), 84 were Pyretic arthralgia syndrome (39.4%), 43 were Blood stasis syndrome (20.2%), and 61 were Liver and kidney Keywords: vitality deficiency syndrome (28.6%). In the WORMS score, 12 (5.6%) had a Knee joint Osteoarthritis synovitis score of 0, 60 (28.2%) had a synovitis score of 1, 50 (23.5%) had a Synovitis synovitis score of 2, and 91 (42.7%) had a synovitis score of 3. There was a TCM syndrome type statistically significant difference in the correlation analysis. The group with a WORMS score synovitis score of 3 in WORMS was more likely to occur in the Pyretic arthralgia syndrome (X2 = 194.424, P = 0.000). Conclusion: In this study, Pyretic arthralgia syndrome (39.4%) was found to be the main clinical manifestation in patients with knee osteoarthritis synovitis. This finding has certain guiding significance for relevant treatment. Introduction Traditional Chinese medicine (TCM) is an ancient and still very vital holistic system of health and healing, based on the notion of harmony and balance also employing the ideas of moderation and prevention. The philosophies and principles of traditional Chinese medicine explain how the body works as an integrated system. The concepts of Chinese medicine closely parallel the theories that Western medicine is now discovering. For example, there is an understanding that the acupuncture meridians are channels of communication that follow the fascia; the systems theory supports the principle of the body as a networked system. Chinese medicine recognizes that the accumulation and balance of the attributes within an individual (Yin–Yang, heat–cold, blood–Qi) determines their internal climate, and therefore their health or disease. entire joint. It not only affects the cartilage but also the structures andOsteoarthritis metabolic changes (OA) isof definedsubchondral as a bonedisease and which synovial involves tissue an1,2. Various reports have shown that synovitis is a key factor which associates with OA pain and symptoms, and even occurs in the Page 4 of 9 Yu-guo G, Hong J. The Relationship between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Syndrome Pattern of Osteoarthritis in the Knee. J Orthopedics & Journal of Orthopedics and Orthopedic Surgery Orthopedic Surg. 2020;1(2):4-9 early phase of osteoarthritis3-5. New imaging technologies (ultrasonic imaging and magnetic resonance imaging) to be the stagnation of vital energy circulation, blood stasis have proven that 70% of patients with osteoarthritis are andcause phlegm to be liver coagulation, and kidney the deficiency invading and and the attacking symptoms of infected by both OA and synovitis, 95% of which presents wind-cold damp pathogen, as well as the obstruction of synovitis accompanied by hydrarthrosis6. main and collateral channels. To summarize the ideas above, most of these skilled synovial thickening (hypertrophy and hyperplasia) and doctors agree that knee osteoarthritis with synovitis Synovial inflammation is a process characterized by7,8. The histological analysis of OA-infected synovium presented cellular infiltration (of lymphocytes and macrophages) dystrophyis fundamentally of muscles caused and bybones. gradual The deficiencypain is stimulated of liver number, of which the majority were macrophages7,9 while and kidneys, insufficiency of vital energy and blood, and onlyan increase an extremely of synovial small lining proportion cells and were infiltrating B and T cellscells 10in. organs and meridians. In addition, wind-cold damp The symptom of synovitis has been now recognized as a pathogensby loss of the attack five joints key elements at the weak and point, dystrophy or falling of internal occurs key characteristic of OA symptoms and progression11. which results in joint spraining, or long-term strain takes place on joints, all leading to obstruction of main and Traditionally, osteoarthritis (OA) is categorized within collateral channels, blood stasis, stagnation of bone arteries and veins, while obstruction triggers pain. understanding of the persistent immune response process ofnon-inflammatory OA-infected joints arthritis. and synovium, However, the with differentiation increased The TCM syndrome differentiation was conducted by reference to the Diagnosis and Treatment of Knee Paralysis Disease (Knee Osteoarthritis) by ‘the 11th Five-Year Plan’ between inflammatory arthritis and degenerative arthritis Key Specialty Cooperative Team of the State Administration becomes more and more blurred. Synovitis is defined as of Traditional Chinese Medicine14. Thus, knee osteoarthritis awaresynovial of inflammation,the fact that a whichconsiderable is a characteristic part of patients of classic with was differentiated into four syndrome types: primaryinflammatory OA show arthritis. synovitis. Increasingly, In light scholars of this are observation, becoming (1) Anemofrigid-damp arthralgia syndrome: the knee further research has found the presence of arthritis and joint presents the feeling of heaviness, souring and synovitis in the pathogenesis of OA. Knee osteoarthritis with synovitis is categorized in “knee paralysis diseases” in traditional Chinese medicine. pain, or swelling, and even difficulty in extension and It develops from degenerative changes of articular duringflexion. cold The or painful rainy days.sites Theare skinmore does stationary, not turn redbut cartilage, with synovial injury of articular capsule, orsometimes hot; the tonguemigrate. presents The symptoms a layer of arethin intensified and white fur; and the pulse is wiry and tense. major pathological changes. In clinical, degenerative synovial hyperemia, and inflammatory exudation as its (2) Pyretic arthralgia syndrome: the knee joint shows pain, redness and hotness, with severe swelling and pain. If treated with cold therapy, the knee joint isosteoarthropathy most often diagnosed with swelling, in middle-aged pain and and difficult elderly extension people. and flexion of the knee joint (as the main manifestations) becomes less painful. The muscles and vessels around In modern medicine, phlegm is the thick viscous the area are spastic. The symptoms are mild during substance secreted by the mucous membranes of the day-time hours but severe at night, accompanied respiratory passages but in traditional Chinese medicine, with fever, thirst, worrying, restlessness, red tongue, the cause of phlegm is a special concept caused by a special slimy yellow fur or dried yellow fur on the tongue, as kind of pathogenic factors. It is different from wind, cold, well as a rolling and rapid pulse pattern. (3) Blood stasis syndrome: the knee joint is in pain and It is also different from seven emotions, diet, overwork sensitive to pressure when pressed on, present’s internalheat, dampness, injuries drynesspathogenic and factors,fire, the butpathogenic also is factors.closely uncomfortable swelling and can be described as related to the etiology. being as painful as being stabbed by an awl or other It is formed by these pathogenic factors acting on the sharp pointy objects. The symptoms are mild during human body after a pathological product. Deng Jinfeng12 the day but turn severe at night or can persist without liver and kidney as well as the motor impairment syndrome motion, preventing internal or external rotation. ofconsiders the knee the rootjoint, cause which of the is diseasemanifested to be theas deficiencyobstruction of Patientsshowing insigns this of TCM relief. syndrome The joint type has oftendifficulty exhibit with a syndrome of bone and joint. The disease is characterized darker complexion and whitening of the lips. Their with “motor impairment as the root cause and rheumatism tongues turn green or grow ecchymosis. Their pulses 13 suggested the root are more are tense and erratic, or thread and rapid. as the symptom”. Similarly, He Xian Page 5 of 9 Yu-guo G, Hong J. The Relationship between Synovial Inflammation in
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