Keywords
How to Cite
Abstract
Summary. Rheumatoid arthritis (RA) is an immunomodulated, chronic inflammatory disease, accompanied by the proliferation of the inflamed synovium and destruction of the articular cartilage, which leads to the formation of contracture of lower extremities joints and disability. Understanding the values of biomechanical loads on the articular surfaces with contracture of the joints of the lower extremities in patients with RA and the muscle forces (MF) participation in this process with the formation of adaptation and compensation mechanisms can contribute to the development of new views and approaches to the tactics of therapeutic measures specific to each stage of the disease.
Objective: to analyze the behavior of the musculoskeletal system of an RA patient in his walking pattern by calculating the forces acting in the main muscle groups and joints of the lower extremities.
Materials and Methods. Initial data were obtained from the examination of a female patient K., who was diagnosed with stage 2 phase 3 RA with a predominant lesion of the hip and knee joints and severe pain in the left hip joint. A video system of 6 cameras, reflective markers and a force platform were used for motion capture of the walking. A simulation musculoskeletal model of the gait of the RA patient using the AnyBody Modeling System 6.0 software (Denmark) was created. Joint reaction forces (JRF) and MF were calculated.
Results. Normal mode of loading of the lower extremities was altered to compensate for structural disorders in joints of RA patients. The peaks of vertical component of the ground reaction force (GRF) are lower compared to the normal population; the gait is static and asymmetric, sparing. MF increase in m. gluteus (maximus, medius, minimus) with increasing amplitude of movements in the frontal plane. JRF of both hips increase in all planes.
Conclusions. Walking of RA patients with limitation of active extensions in the hip and knee joints occurs due to an increase in the amplitude of the frontal plane compensatory movements. Postural muscle imbalance increases the m. gluteus, m. biceps femoris, m. semitendinosus and m. semimembranosus MF. Other lower extremities muscles decrease their MF. The MF redistribution is compensatory and aimed to keep the RA patient in the upright position and optimize the biomechanics of walking due to less painful movements. Biomechanical overloading of the hip and knee articular surfaces can serve as a factor in maintaining the inflammatory response, the development of degenerative processes, or the further progression of arthrosis and stiffness of the joints of the lower extremities in this category of patients.
References
Sigidin YA, Lukina GV. Rheumatoid arthritis; M: ANKO; 2001. 328 p.
Kovalenko VN. Rheumatoid arthritis: etiopathogenesis, clinical picture, diagnosis, treatment. Liki Ukrainy. 2005;3(92):18-20.
Sun HB. Mechanical loading, cartilage degradation, and arthritis. Ann NY Acad Sci. 2010;1211:37-50.http://dx.doi.org/10.1111/j.1749-6632.2010.05808.x
Jessome MA, Tomizza MA, Beattie KA., Bensen WG, Bobba RS, Cividino A, et al. Anatomical Patterns Suggest the Involvement of Biomechanical Stress in the Pathogenesis of Erosions in Rheumatoid Arthritis. ACR/ARHP 2016 Annual Meeting. American College of Rheumatology. 2016; Nov 11-16; Washington, US.
Guilak F. Biomechanical factors in osteoarthritis. Best Practice & Research. Clinical Rheumatology. 2011;25(6):815-23. http://dx.doi.org/10.1016/j.berh.2011.11.013
Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Mäkinen H, Sokka T. Muscle strength, pain and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis. 2006;65:30-4. http://dx.doi.org/10.1136/ard.2004.034769
Stucki G, Schönbächler J, Brühlman P, Mariacher S, Stoll T, Mechel BA. Does a muscle strength index provide complementary information to traditional disease activity variables in patients with rheumatoid arthritis? J Rheumatol. 1994;21:2200-5.
Uutela TI, Kautiainen HJ, Häkkinen AH Decreasing muscle performance associated with increasing disease activity in patients with rheumatoid arthritis. PLoS ONE. 2018;13(4). https://doi.org/10.1371/journal.pone.0194917
Baan H, Dubbeldam R, Nene AV, Laar М. Gait Analysis of the Lower Extremity in Patients with Rheumatoid Arthritis: A Systematic Review. Seminars in Arthritis and Rheumatism. 2012 June;6(41):768-88.
Isacson J, Broström LA. Gait in rheumatoid arthritis: an electrogoniometric investigation. J Biomech. 1988;21(6):451-7. http://dx.doi.org/10.1016/0021-9290(88)90237-0
Rasmussen J, Zee M, Damsgaard M, Christensen ST, Andersen MS. Musculoskeletal simulation of orthopedic surgical procedures. Poster presentation at the Workshop Proceedings of Computational Biomechanics for Medicine. MICCAI 2006, Copenhagen, Denmark, 2006
Damsgaar M, Rasmussen J, Christensen ST, Surma E, Zee M. Analysis of musculoskeletal systems in the AnyBody Modeling System. Simulation Modelling Practice and Theory. 2006;14(8):1100-11. https://doi.org/10.1016/j.simpat.2006.09.001
Konrath JM, Karatsidis A, Schepers HM, Bellusci G, Zee M, Andersen M.S. Estimation of the Knee Adduction Moment and Joint Contact Force during Daily Living Activities Using Inertial Motion Capture. Sensors. 2019;19(7):1681. https://doi.org/10.3390/s19071681/
This work is licensed under a Creative Commons Attribution 4.0 International License.