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Li X, DuBois DC, Almon RR, Jusko WJ. Effect of Disease-Related Changes in Plasma Albumin on the Pharmacokinetics of Naproxen in Male and Female Arthritic Rats. Drug Metab Dispos 2017; 45:476-483. [PMID: 28246126 DOI: 10.1124/dmd.116.074500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/16/2017] [Indexed: 12/29/2022] Open
Abstract
Naproxen (NPX) is used in the treatment of rheumatoid arthritis (RA) for alleviation of pain and inflammation. In view of the extensive albumin binding of NPX, this study investigates whether chronic inflammation and sex influence the physiologic albumin concentrations, plasma protein binding, and pharmacokinetics (PK) of NPX. The PK of NPX was evaluated in a rat model of RA [collagen-induced arthritis (CIA) in Lewis rats] and in healthy controls. These PK studies included 1) NPX in female and male CIA rats that received 10, 25, or 50 mg/kg NPX i.p.; and 2) NPX in healthy female and male rats after i.p. dosing of NPX at 50 mg/kg. Plasma albumin concentrations were quantified by enzyme-linked immunosorbent assay, and protein binding was assessed using ultrafiltration. The NPX concentrations in plasma and filtrates were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma concentration-time data of NPX were first assessed by noncompartmental analysis (NCA). Nonlinear PK as indicated by dose-dependent NCA clearances and distribution volumes was observed. A two-compartment model with a first-order absorption process incorporating nonlinear protein binding in plasma and tissues jointly described the PK data of all groups. Saturable albumin binding accounts for the nonlinearity of NPX PK in all rats as well as part of the PK differences in arthritic rats. The CIA rats exhibited reduced albumin concentrations, reduced overall protein binding, and reduced clearances of unbound NPX, consistent with expectations during inflammation. The net effect of chronic inflammation was an elevation of the Cmax and area under the plasma concentration-time curve (AUC) of unbound drug.
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Affiliation(s)
- Xiaonan Li
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China (X.L.); Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences (X.L., D.C.D., R.R.A., W.J.J.), and Department of Biological Sciences (D.C.D., R.R.A.), State University of New York at Buffalo, Buffalo, New York
| | - Debra C DuBois
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China (X.L.); Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences (X.L., D.C.D., R.R.A., W.J.J.), and Department of Biological Sciences (D.C.D., R.R.A.), State University of New York at Buffalo, Buffalo, New York
| | - Richard R Almon
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China (X.L.); Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences (X.L., D.C.D., R.R.A., W.J.J.), and Department of Biological Sciences (D.C.D., R.R.A.), State University of New York at Buffalo, Buffalo, New York
| | - William J Jusko
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China (X.L.); Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences (X.L., D.C.D., R.R.A., W.J.J.), and Department of Biological Sciences (D.C.D., R.R.A.), State University of New York at Buffalo, Buffalo, New York
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Alawi KM, Russell FA, Aubdool AA, Srivastava S, Riffo-Vasquez Y, Baldissera L, Thakore P, Saleque N, Fernandes ES, Walsh DA, Brain SD. Transient receptor potential canonical 5 (TRPC5) protects against pain and vascular inflammation in arthritis and joint inflammation. Ann Rheum Dis 2016; 76:252-260. [PMID: 27165180 PMCID: PMC5264234 DOI: 10.1136/annrheumdis-2015-208886] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 02/06/2023]
Abstract
Objective Transient receptor potential canonical 5 (TRPC5) is functionally expressed on a range of cells including fibroblast-like synoviocytes, which play an important role in arthritis. A role for TRPC5 in inflammation has not been previously shown in vivo. We investigated the contribution of TRPC5 in arthritis. Methods Male wild-type and TRPC5 knockout (KO) mice were used in a complete Freund's adjuvant (CFA)-induced unilateral arthritis model, assessed over 14 days. Arthritis was determined by measurement of knee joint diameter, hindlimb weightbearing asymmetry and pain behaviour. Separate studies involved chronic pharmacological antagonism of TRPC5 channels. Synovium from human postmortem control and inflammatory arthritis samples were investigated for TRPC5 gene expression. Results At baseline, no differences were observed. CFA-induced arthritis resulted in increased synovitis in TRPC5 KO mice assessed by histology. Additionally, TRPC5 KO mice demonstrated reduced ispilateral weightbearing and nociceptive thresholds (thermal and mechanical) following CFA-induced arthritis. This was associated with increased mRNA expression of inflammatory mediators in the ipsilateral synovium and increased concentration of cytokines in synovial lavage fluid. Chronic treatment with ML204, a TRPC5 antagonist, augmented weightbearing asymmetry, secondary hyperalgesia and cytokine concentrations in the synovial lavage fluid. Synovia from human inflammatory arthritis demonstrated a reduction in TRPC5 mRNA expression. Conclusions Genetic deletion or pharmacological blockade of TRPC5 results in an enhancement in joint inflammation and hyperalgesia. Our results suggest that activation of TRPC5 may be associated with an endogenous anti-inflammatory/analgesic pathway in inflammatory joint conditions.
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Affiliation(s)
- Khadija M Alawi
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Fiona A Russell
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Aisah A Aubdool
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Salil Srivastava
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Yanira Riffo-Vasquez
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Lineu Baldissera
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Pratish Thakore
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK.,Institute of Pharmaceutical Science, King's College London, London, UK
| | - Nurjahan Saleque
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
| | - Elizabeth S Fernandes
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK.,Programa de Pós-Graduação, Universidade Ceuma, São Luís, Brazil
| | - David A Walsh
- Department of Academic Rheumatology, Arthritis Research UK Pain Centre, University of Nottingham, City Hospital, Nottingham, UK
| | - Susan D Brain
- Cardiovascular Division, BHF Cardiovascular Centre of Excellence and Centre of Integrative Biomedicine, King's College London, London, UK
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Simkin PA. The human knee: A window on the microvasculature. Tissue Barriers 2015; 3:e970465. [PMID: 25838977 DOI: 10.4161/21688362.2014.970465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022] Open
Abstract
In synovial joints, the lining cells do not have tight junctions with their neighboring cells and they have no underlying basement membrane. Therefore, the synovial fluid within the articular cavity is continuous with the interstitial fluid of the synovial intima. These features, combined with ready access to the space via arthrocentesis, permit quantitative studies of microvascular function in the knees of unanesthetized, volunteer, human subjects both with and without chronic arthritis. This brief article reviews the principal findings of such work over ∼40 years at the University of Washington. Examined variables include bidirectional fenestral diffusion of small solutes, effective blood flow, lymphatic drainage, and endothelial pore size and permeability. The latter work introduced a new method using gel filtration chromatography of paired synovial fluid (SF) and serum (S) to obtain essentially continuous SF/S ratios over a range of radii between 1 and 12 nanometers.
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Key Words
- BCP, Basic Calcium Phosphate
- C, Concentration
- Cl, Clearance
- IF, Interstitial Fluid
- NSAID, Non-steroidal Anti-inflammatory Drugs
- OA, Osteoarthritis
- P, Plasma
- RA, Rheumatoid Arthritis
- S, Serum
- SF, Synovial Fluid
- blood flow
- capillary
- fenestration
- glycocalyx
- lymph flow
- nm, nanometer
- permeability
- pore size
- rheumatoid
- synovium
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Affiliation(s)
- Peter A Simkin
- Division of Rheumatology; University of Washington ; Seattle, WA USA
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Nasui OC, Chan MW, Nathanael G, Crawley A, Miller E, Belik J, Cheng HL, Kassner A, Rayner T, Weiss R, Detzler G, Zhong A, Moineddin R, Jong R, Rogers M, Doria AS. Physiologic characterization of inflammatory arthritis in a rabbit model with BOLD and DCE MRI at 1.5 Tesla. Eur Radiol 2014; 24:2766-78. [PMID: 25187381 DOI: 10.1007/s00330-014-3331-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/17/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our aim was to test the feasibility of blood oxygen level dependent magnetic resonance imaging (BOLD MRI) and dynamic contrast-enhanced (DCE) MRI to monitor periarticular hypoxic/inflammatory changes over time in a juvenile rabbit model of arthritis. METHODS We examined arthritic and contralateral nonarthritic knees of 21 juvenile rabbits at baseline and days 1,14, and 28 after induction of arthritis by unilateral intra-articular injection of carrageenin with BOLD and DCE MRI at 1.5 Tesla (T). Nine noninjected rabbits served as controls. Associations between BOLD and DCE-MRI and corresponding intra-articular oxygen pressure (PO2) and blood flow [blood perfusion units (BPU)] (polarographic probes, reference standards) or clinical-histological data were measured by correlation coefficients. RESULTS Percentage BOLD MRI change obtained in contralateral knees correlated moderately with BPU on day 0 (r = -0.51, p = 0.02) and excellently on day 28 (r = -0.84, p = 0.03). A moderate correlation was observed between peak enhancement DCE MRI (day 1) and BPU measurements in arthritic knees (r = 0.49, p = 0.04). In acute arthritis, BOLD and DCE MRI highly correlated (r = 0.89, p = 0.04; r = 1.0, p < 0.0001) with histological scores in arthritic knees. CONCLUSION The proposed techniques are feasible to perform at 1.5 T, and they hold potential as surrogate measures to monitor hypoxic and inflammatory changes over time in arthritis at higher-strength MRI fields. KEY POINTS • BOLD and DCE MRI detect interval perisynovial changes in a rabbit knee • BOLD and DCE MRI act as surrogate markers of physiologic changes in arthritis • BOLD MRI signal represents oxygen extraction compared with intra-articular PO 2 • DCE MRI measurements estimate physiologic periarticular vascular properties • In rabbit knees with acute arthritis, BOLD/DCE MRI highly correlated with histological scores.
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Affiliation(s)
- Otilia C Nasui
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G1X8
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Dulin JA, Drost WT, Phelps MA, Santschi EM, Menendez MI, Bertone AL. Influence of exercise on the distribution of technetium Tc 99m medronate following intra-articular injection in horses. Am J Vet Res 2012; 73:418-25. [DOI: 10.2460/ajvr.73.3.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Egan CG, Lockhart JC, Ferrell WR. Pathophysiology of vascular dysfunction in a rat model of chronic joint inflammation. J Physiol 2004; 557:635-43. [PMID: 15064324 PMCID: PMC1665086 DOI: 10.1113/jphysiol.2004.062984] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 03/30/2004] [Indexed: 01/22/2023] Open
Abstract
The impact of chronic joint inflammation on articular vascular function in rats was investigated to address whether joint swelling and the associated vascular dysfunction are dependent upon a common prostanoid mechanism. Urinary nitrate/nitrite (NO(x)) and PGE(2) excretion, knee joint diameter and body weight were measured following induction of adjuvant-induced arthritis (AIA). Ten days postinduction of AIA, joint vascular reactivity was assessed by measuring the perfusion response using a laser Doppler imager (LDI) to topical application of acetylcholine (ACh) and sodium nitroprusside (SNP). Four groups were compared: a non-inflamed control group and three AIA groups treated i.p. with vehicle, indomethacin or SC-236 (at equimolar doses). The selective cyclooxygenase-2 (COX-2) inhibitor (SC-236) was used to differentiate between COX-1 and -2-derived prostaglandins. Urinary NO(x) and PGE(2) levels increased substantially during the early phase of AIA but decreased thereafter. Toxicity to indomethacin but not SC-236 was observed, as indicated by a marked decrease in body weight. Joint swelling was similarly attenuated by indomethacin and SC-236 (P= 0.0001 cf. vehicle-treated AIA; n= 5-6 per group), indicating that this is due to COX-2 and not COX-1 inhibition. The AIA-induced changes in urinary NO(x) and PGE(2) were corrected by both COX inhibitors. While vascular reactivity to ACh and SNP was significantly attenuated by AIA (P < 0.002; n= 5-10 per group), the perfusion responses to these vasodilating agents were similar in all three AIA groups, demonstrating that the vascular dysfunction was not corrected by inhibition of either COX-1 or COX-2 enzymes. Furthermore, the attenuation of both ACh and SNP-induced responses in AIA suggest that vascular dysfunction was not exclusively endothelial in nature. In conclusion, the joint swelling and vascular dysfunction associated with AIA appear to be mediated, at least in part, by independent mechanisms. While COX-1/COX-2 inhibition reduced joint swelling, vascular dysfunction in AIA is independent of constitutive or inducible prostanoid mechanisms, and appears not to be solely endothelial-derived, but to involve other components such as the vascular smooth muscle.
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Affiliation(s)
- Colin G Egan
- Biological Sciences, University of Paisley, Paisley PA1 2BE, UK
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Marcelino J, Carpten JD, Suwairi WM, Gutierrez OM, Schwartz S, Robbins C, Sood R, Makalowska I, Baxevanis A, Johnstone B, Laxer RM, Zemel L, Kim CA, Herd JK, Ihle J, Williams C, Johnson M, Raman V, Alonso LG, Brunoni D, Gerstein A, Papadopoulos N, Bahabri SA, Trent JM, Warman ML. CACP, encoding a secreted proteoglycan, is mutated in camptodactyly-arthropathy-coxa vara-pericarditis syndrome. Nat Genet 1999; 23:319-22. [PMID: 10545950 DOI: 10.1038/15496] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Altered growth and function of synoviocytes, the intimal cells which line joint cavities and tendon sheaths, occur in a number of skeletal diseases. Hyperplasia of synoviocytes is found in both rheumatoid arthritis and osteoarthritis, despite differences in the underlying aetiologies of the two disorders. We have studied the autosomal recessive disorder camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP; MIM 208250) to identify biological pathways that lead to synoviocyte hyperplasia, the principal pathological feature of this syndrome. Using a positional-candidate approach, we identified mutations in a gene (CACP) encoding a secreted proteoglycan as the cause of CACP. The CACP protein, which has previously been identified as both 'megakaryocyte stimulating factor precursor' and 'superficial zone protein', contains domains that have homology to somatomedin B, heparin-binding proteins, mucins and haemopexins. In addition to expression in joint synovium and cartilage, CACP is expressed in non-skeletal tissues including liver and pericardium. The similarity of CACP sequence to that of other protein families and the expression of CACP in non-skeletal tissues suggest it may have diverse biological activities.
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Affiliation(s)
- J Marcelino
- Department of Genetics and Center for Human Genetics, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
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Day RO, McLachlan AJ, Graham GG, Williams KM. Pharmacokinetics of nonsteroidal anti-inflammatory drugs in synovial fluid. Clin Pharmacokinet 1999; 36:191-210. [PMID: 10223168 DOI: 10.2165/00003088-199936030-00002] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The major site of action for nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatic diseases is probably within the synovial compartment. There has been little work on the disposition of NSAIDs in the synovium and most studies have involved the measurement of their concentrations in synovial fluid. The concentrations of NSAIDs are more sustained in synovial fluid than in plasma, the difference being particularly noted with NSAIDs with short elimination half-lives. The more sustained concentrations may contribute to the prolonged effect of the short half-life NSAIDs, which are usually administered at intervals longer than their half-lives in plasma. The most widely used method of kinetic analysis of NSAIDs in synovial fluid is a compartmental model in which synovial fluid is a peripheral compartment of distribution of the drug. Repeated samples of synovial fluid from individual patients are difficult to collect, but even 1 sample of synovial fluid and plasma from each patient can provide useful data when analysed using the population approach to pharmacokinetic analysis. According to the compartmental model, the mean half-lives of efflux of the NSAIDs from synovial fluid range from 1.5 to 7 hours. The mean partition coefficient of most NSAIDs between synovial fluid and plasma is approximately 0.6. The NSAIDs are highly protein-bound, and the lower mean concentrations in synovial fluid are largely because of the lower concentrations of the binding protein, albumin. The NSAIDs diffuse into and out of synovial fluid in their unbound forms, but there is some diffusion in the protein-bound forms, particularly out of synovial fluid. The mean rates of diffusion of NSAIDs into and out of skin blisters in humans are similar to the rates of influx and efflux in the synovial fluid of the knee, but there is considerable variation between the pharmacokinetics of transfer at the 2 sites in individual patients. NSAIDs decrease the synthesis of prostaglandins in synovial fluid, but there are few data on the relationship between the kinetics of NSAIDs in synovial fluid and the effects on prostaglandin synthesis.
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Affiliation(s)
- R O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, New South Wales, Australia.
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Nyberg P, Söderblom T, Pettersson T, Riska H, Klockars M, Linko L. Neurone-specific enolase levels in pleural effusions in patients with rheumatoid arthritis. Thorax 1996; 51:92-4. [PMID: 8658380 PMCID: PMC472809 DOI: 10.1136/thx.51.1.92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High pleural fluid levels of neurone-specific enolase (NSE) have been reported, not only in patients with small cell lung cancer but also in those with chronic inflammatory diseases. METHODS NSE concentrations were determined in pleural fluid and serum from 342 patients with pleural effusions including 17 with rheumatoid arthritis. RESULTS The median NSE concentration in pleural fluid was higher in rheumatoid effusions than in any other condition studied. The median pleural fluid:serum NSE ratio was highest in patients with rheumatoid arthritis (11.6) and about unity in all other diseases including small cell lung cancer (0.9). In patients with rheumatoid arthritis pleural fluid concentrations of NSE correlated inversely with pleural fluid glucose concentrations and the pH of the pleural fluid. CONCLUSIONS A high pleural fluid:serum NSE ratio was found consistently in pleural effusions from patients with rheumatoid disease.
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Abstract
Synovial perfusion was quantified in milliliters per minute per knee by two quite different clearance methods based on (1) counting tritiated water in serial aspirates of intraarticular saline, and (2) external counting of joints injected with free radioiodide. In each case, the serial counting data determine a rate constant that is multiplied by a distribution volume to provide the clearance in flow terms of milliliters per minute. This report updates and summarizes these data and compares the two methods to each other and to alternative assessments of synovial blood flow. Available methods such as laser Doppler flowmetry (with data output measured in volts) and solute clearance constant determinations (in min-1) are useful for selected purposes but cannot be used to quantify the articular flux (in milligrams per minute) of any solute. Radiolabeled microspheres provide data (in milliliters per minute per g of tissue) but are unsuitable for human use. The two clearance methods provide comparable results, but the free iodide technique seems most suitable for physiologic investigations. The latter potentially includes critical evaluations of synovial blood flow in relation to issues such as palpable warmth, visible erythema, articular ischemia, the permeability of synovial vessels, the genesis of effusions, the delivery and removal of therapeutic agents, and the concentration of every synovial fluid solute from micronutrients through cytokines, plasma proteins, and molecular markers of cartilagenous injury.
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195, USA
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195, USA
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Stevens CR, Blake DR, Merry P, Revell PA, Levick JR. A comparative study by morphometry of the microvasculature in normal and rheumatoid synovium. ARTHRITIS AND RHEUMATISM 1991; 34:1508-13. [PMID: 1747135 DOI: 10.1002/art.1780341206] [Citation(s) in RCA: 128] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Vascularity is said to be increased (subjectively) in rheumatoid arthritis, yet synovial fluid is hypoxic and acidotic. Morphometry by image analysis was used to quantify vascularity in normal and rheumatoid synovium from the knee joint. Capillaries were distributed more deeply in the rheumatoid synovium (93.3 microns, compared with 32.5 microns in normal synovium) and were significantly less densely arranged (80.2/mm2 rheumatoid, 241.5/mm2 normal). The blood volume fraction fell from 2.9% in normal knee synovium to 1.2% in rheumatoid synovium. These results imply that there is impairment of O2 transfer, which contributes to the intraarticular hypoxia, in rheumatoid arthritis.
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Affiliation(s)
- C R Stevens
- Bone and Joint Research Unit, London Hospital Medical College, Whitechapel, United Kingdom
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Abstract
Because the synovial lining is a major target organ of rheumatic diseases, it seems logical to seek understanding of those conditions through study of the normal and abnormal physiology of this specialized organ system. This brief review covers some basic principles and recent progress in this area with emphasis on our evolving knowledge of microvascular function.
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195
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Stevens CR, Williams RB, Farrell AJ, Blake DR. Hypoxia and inflammatory synovitis: observations and speculation. Ann Rheum Dis 1991; 50:124-32. [PMID: 1705416 PMCID: PMC1004353 DOI: 10.1136/ard.50.2.124] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C R Stevens
- ARC Bone and Joint Research Unit, London Hospital Medical College
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Gamma-glutamyl transpeptidase in synovial fluid, serum, and urine of patients with rheumatoid arthritis. BIOCHEMICAL MEDICINE AND METABOLIC BIOLOGY 1990; 43:183-92. [PMID: 1974451 DOI: 10.1016/0885-4505(90)90024-u] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The changes in the levels of GGT activity in various body fluids, ESR, SF-protein concentration, and SF-WBC count were determined in 59 RA patients and 18 control subjects. The SF-GGT and UGGT were markedly elevated in all RA patients investigated. The increase of SF-GGT is more pronounced than UGGT. The observation of comparable levels of SGGT in RA patients and control subjects indicates that SGGT does not gain entry into synovial fluid or urine. No differences were noticed in SF-protein concentration whereas ESR levels and SF-WBC counts were significantly higher in RA patients than in control subjects. Statistically significant correlations were observed between SF-GGT versus UGGT, SF-WBC, and ESR in females, and between SF-GGT and SF-protein and SGGT in male RA patients. The correlation coefficient values between UGGT versus SF-protein, SF-WBC, and ESR were found to be significant in male RA patients. UGGT levels correlated strongly with SGGT in all RA patients. These findings suggest that the measurement of SF-GGT and UGGT might be useful in understanding the pathogenesis of rheumatoid arthritis.
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Gardner GC, Weisman MH. Pyarthrosis in patients with rheumatoid arthritis: a report of 13 cases and a review of the literature from the past 40 years. Am J Med 1990; 88:503-11. [PMID: 2186625 DOI: 10.1016/0002-9343(90)90430-l] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study is to report 13 cases and review the literature for pyarthrosis occurring in the setting of rheumatoid arthritis (RA). Special emphasis is placed on evaluating both the changing, as well as the constant, features of this complication and on assessing diagnostic and therapeutic aspects that have a bearing upon outcome. PATIENTS AND METHODS A retrospective review of records from our institution revealed 13 cases of pyarthrosis in patients with RA over the past 14 years. Information obtained included patient demographics, RA history, concomitant illnesses and medications, length of symptoms prior to the diagnosis of pyarthrosis, peri-articular manifestations, probable source of infection, joint(s) involved, relevant laboratory data, and information on treatment and outcome based on initial surgical therapy versus closed needle drainage. In addition, 213 cases from 45 citations were reviewed for similar information. RESULTS Our series was notable for a high percentage of associated serious medical illnesses and peri-articular manifestations of the pyarthrosis (i.e., sinus tract formation, concomitant septic bursitis, or infected synovial cyst). The erythrocyte sedimentation rate was a useful monitor of adequate therapy and was often a signal of recurrent infection. In all patients, the skin was the major source of infection. The mortality from pyarthrosis has declined over the past 40 years but is still unacceptably high, especially in patients with polyarticular involvement. Preliminary observations suggest that an initial surgical approach to joint drainage may be preferable to closed needle drainage in order to improve joint outcome in patients with RA and pyarthrosis. CONCLUSION Pyarthrosis occurring in patients with RA continues to produce unacceptable morbidity and mortality despite 40 years' experience. Earlier recognition (which may include peri-articular features) and perhaps an aggressive surgical approach to drainage may improve the prognosis.
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Affiliation(s)
- G C Gardner
- Department of Medicine, University of California, San Diego 92103
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Simkin PA, Benedict RS. Iodide and albumin kinetics in normal canine wrists and knees. ARTHRITIS AND RHEUMATISM 1990; 33:73-9. [PMID: 2302270 DOI: 10.1002/art.1780330109] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The clearance rates of free iodide and of radioiodinated serum albumin were measured in the knee and wrist joints of 9 normal adult dogs. Iodide clearance from the knee was 3 times greater than that from the wrist. In contrast, radioiodinated serum albumin clearance from the knee was only slightly greater than that from the wrist. Interpreted as respective indices of effective synovial plasma flow and lymphatic drainage, these values indicate that the filtration fraction is normally greater in microvessels of the wrist than in those of the knee. These findings complement the results of companion studies of Starling forces that indicate a higher pressure microvascular bed in the wrist than in the knee.
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195
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Geborek P, Forslind K, Wollheim FA. Direct assessment of synovial blood flow and its relation to induced hydrostatic pressure changes. Ann Rheum Dis 1989; 48:281-6. [PMID: 2653243 PMCID: PMC1003742 DOI: 10.1136/ard.48.4.281] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A method for measuring synovial blood flow changes using the laser Doppler technique is described. Mean blood flow and mean pulse amplitude decreased by 50-70% in relation to the reference level when the intra-articular hydrostatic pressure in effusive knee joints of patients with rheumatoid arthritis was increased. As an increase of intra-articular pressure of as little as 20 mmHg decreased synovial blood flow significantly it is suggested that hypoxia may occur in vivo during joint use in the presence of an effusion. This may be of aetiopathogenetic importance for tissue destruction and the persistence of chronic synovitis.
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Affiliation(s)
- P Geborek
- Department of Rheumatology, University Hospital of Lund, Sweden
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Furst DE. The basis for variability of response to anti-rheumatic drugs. BAILLIERE'S CLINICAL RHEUMATOLOGY 1988; 2:395-424. [PMID: 3066500 DOI: 10.1016/s0950-3579(88)80020-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The reasons for variability of response to anti-rheumatic drugs are myriad. All the factors that contribute to kinetic variability, for example, contribute to differences in response between individuals. Thus, differences in drug formulation, protein binding, drug metabolism and excretion, all contribute to variable responses. Further, factors which contribute to differential clinical response/toxicity must be considered. Here, age, gender, genetic background, weight, concomitant diseases and numerous environmental factors come into play. Among the environmental factors are such diverse elements as smoking, activity and diet. Finally our ability to measure change, be it in response or toxicity, is limited, introducing apparent variability (as much as real variability) into the equation. While we cannot, at present, delineate the contribution of each factor to individual variability, it is hoped that systematic, persistent effort will help us understand and then control these elements, leading to improved ability to individualize therapy and decrease the variability of response to anti-rheumatic drugs.
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Wallis WJ, Simkin PA, Nelp WB. Protein traffic in human synovial effusions. ARTHRITIS AND RHEUMATISM 1987; 30:57-63. [PMID: 3814198 DOI: 10.1002/art.1780300108] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Concentrations of 5 marker proteins were measured in synovial fluid and serum samples from knee effusions of 11 patients with rheumatoid arthritis and 9 with osteoarthritis. Indirect determinations of synovial plasma flow and lymphatic drainage were obtained by measuring iodide clearance (ml/minute) and radio-albumin clearance (ml/minute). Together with protein concentrations, these determinations allowed us to calculate: the flux of each marker protein through synovial tissues (mg/minute); the volume of plasma cleared by synovium per unit time (ml/minute); and the fractional extraction per passage through the synovial microcirculation (protein permeance). These measures differed substantially between rheumatoid arthritis and osteoarthritis patient populations and quantified the severity of the microvascular lesion in rheumatoid synovitis.
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