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Guillén-Astete CA, Revenga-Martínez M, Zea-Mendoza AC, Brito-Brito ME, Zurita-Prada P, Urrego-Laurín C, Villalobos-Sánchez L, García-Montes N, Vázquez-Díaz M. Subclinical synovitis impact on the progression of lupus joint disease: A 10-year longitudinal multicenter study. Lupus 2024; 33:638-643. [PMID: 38491423 DOI: 10.1177/09612033241240584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine the effect of subclinical synovitis on the progression of joint disease in a cohort of patients with systemic lupus erythematosus over a mean follow-up of 10 years. METHODS A longitudinal follow-up of 96 patients diagnosed with lupus was performed. All patients were considered clinically free of joint disease or with minimal joint impairment at baseline and were studied through ultrasound study of their dominant hand to assess the prevalence of subclinical synovitis. Now, over 10 years after we contacted them and reviewed their evolution to determine the impact of had or had not been diagnosed with subclinical synovitis in their current joint condition. RESULTS Thirty-one of the 91 reached patients developed clinical progression in their joint manifestations (at least one ordinal degree of worsening). Of these, 23 (74,9%) had demonstrated subclinical synovitis at baseline. In the group of patients who did not progress clinically, 46 (76,6%) did not have this finding at the start of follow-up (p < .01, OR 9,44 95%CI 3,46-25,74). The patients in whom clinical progression was demonstrated had worse combined ultrasound scores than the rest of the patients: 6,41 SD 1,45 vs. 1,15 SD 0,97 (p < .01). CONCLUSIONS The finding of subclinical synovitis in patients with systemic lupus erythematosus is associated with the development of joint disease progression both clinically and ultrasonographically.
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Affiliation(s)
- Carlos A Guillén-Astete
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
- Faculty of Biomedical Sciences and Health, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
- Rheumatology Unit, HLA Moncloa University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Nuria García-Montes
- Family and Community Medicine, Urgency & Emergency Department, Ramón y Cajal University Hospital, Madrid, Spain
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van Dijk BT, Boeren AMP, Khidir SJH, den Hollander NK, van der Helm-van Mil AHM. Work-related physical strain and development of joint inflammation in the trajectory of emerging inflammatory and rheumatoid arthritis: a prospective cohort study. RMD Open 2024; 10:e003895. [PMID: 38599648 PMCID: PMC11015171 DOI: 10.1136/rmdopen-2023-003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) mainly affects small joints. Despite the mechanical function of joints, the role of mechanical stress in the development of arthritis is insufficiently understood. We hypothesised that mechanical stress/physical strain is a risk factor for joint inflammation in RA. Therefore, we studied work-related physical strain in subjects with clinically suspected arthralgia (CSA) as a risk factor for the presence of imaging-detected subclinical joint inflammation and the development of clinical arthritis/RA. METHODS In 501 CSA patients and 155 symptom-free persons' occupation-related physical strain was quantified using the International Standard Classification of Occupations. Contrast-enhanced hand-MRIs were made and evaluated for joint inflammation (sum of synovitis/tenosynovitis/osteitis). CSA patients were followed on RA development. Age relationship was studied using an interaction term of physical strain with age. RESULTS The degree of physical strain in CSA is associated with the severity of joint inflammation, independent of educational-level/BMI/smoking (interaction physical strain-age p=0.007; indicating a stronger association with increasing age). Physical strain is associated with higher tenosynovitis scores, in particular. In symptom-free persons, physical strain was not associated with imaging-detected joint inflammation. Higher degrees of physical strain also associated with higher risks for RA development in an age-dependent manner (HR=1.20 (1.06-1.37)/10-year increase in age), independent of educational-level/BMI/smoking. This association was partly mediated by an effect via subclinical joint inflammation. CONCLUSIONS Work-related physical strain increases the risk of subclinical joint inflammation and of developing RA. The age relationship suggests an effect of long-term stress or that tenosynovium is more sensitive to stress at older age. Together, the data indicate that mechanical stress contributes to the development of arthritis in RA.
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Affiliation(s)
| | - Anna M P Boeren
- Rheumatology, LUMC, Leiden, The Netherlands
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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den Hollander NK, van der Helm-van Mil AHM, van Steenbergen HW. Improving our understanding of the paradoxical protective effect of obesity on radiographic damage: a large magnetic resonance imaging-study in early arthritis. Rheumatology (Oxford) 2024; 63:1007-1014. [PMID: 37389420 PMCID: PMC10986809 DOI: 10.1093/rheumatology/kead320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Obesity conveys a risk for RA development, while paradoxically, associating with less radiographic progression after RA diagnosis. Using MRI we can study this surprising association in detail from MRI-detected synovitis and osteitis to MRI-detected erosive progression, which precedes radiographic progression. Previous research suggested obesity associates with less osteitis and synovitis. We therefore aimed to (i) validate the previously suggested association between BMI and MRI-detected osteitis/synovitis; (ii) study whether this is specific for ACPA-positive or ACPA-negative RA or also present in other arthritides; (iii) study whether MRI-detected osteitis associates with MRI-detected erosive progression; and (iv) study whether obesity associates with MRI-detected erosive progression. METHODS We studied 1029 early arthritis patients (454 RA, 575 other arthritides), consecutively included in Leiden Early Arthritis Clinic. At baseline patients underwent hand-and-foot MRI that were RAMRIS-scored, and 149 RA patients underwent follow-up MRIs. We studied associations between baseline BMI and MRI-detected osteitis/synovitis (using linear regression), and erosive progression (using Poisson mixed models). RESULTS In RA, higher BMI associated with less osteitis at disease onset (β = 0.94; 95% CI: 0.93, 0.96) but not with synovitis. Higher BMI associated with less osteitis in ACPA-positive RA (β = 0.95; 95% CI: 0.93, 0.97), ACPA-negative RA (β = 0.97; 95% CI: 0.95, 0.99) and other arthritides (β = 0.98; 95% CI: 0.96, 0.99). Over 2 years, overweight and obesity associated with less MRI-detected erosive progression (P = 0.02 and 0.03, respectively). Osteitis also associated with erosive progression over 2 years (P < 0.001). CONCLUSIONS High BMI relates to less osteitis at disease onset, which is not confined to RA. Within RA, high BMI and less osteitis associated with less MRI-detected erosive progression. This suggests that the protective effect of obesity on radiographic progression is exerted via a path of less osteitis and subsequently fewer MRI-detected erosions.
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Affiliation(s)
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bakeer N, Saied W, Gavrilovski A, Bailey C. Haemophilic arthropathy: Diagnosis, management, and aging patient considerations. Haemophilia 2024; 30 Suppl 3:120-127. [PMID: 38578694 DOI: 10.1111/hae.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024]
Abstract
Gene therapy and universal use of safer, more effective, and personalised prophylactic regimens (factor, and nonfactor) are expected to prevent joint bleeding and promote joint health in persons with haemophilia (PwH). Growing evidence suggests that subclinical bleeding, with active and inactive synovial proliferation, continues and haemophilic arthropathy remains a major morbidity in PwH despite early institution of joint prophylaxis. Joint health assessment is evolving with physical examination scores complementing imaging scores. Point-of-care ultrasound is emerging as a safe, cost-effective, and readily available tool for acute determination of musculoskeletal abnormalities, serial evaluation of joints for sonographic markers of haemophilic arthropathy, and in providing objective insight into the efficacy of new therapies. In acute haemarthrosis, arthrocentesis expedites recovery and prevent the vicious cycle of bleed-synovitis-rebleed. When synovial proliferation develops, a multidisciplinary team approach is critical with haematology, orthopaedics, and physiotherapy involvement. Synovectomy is considered for patients with chronic synovitis that fail conservative management. Non-surgical and minimally invasive procedures should always be offered and considered first. Careful patient selection, screening and early intervention increase the success of these interventions in reducing bleeding, pain, and improving joint function and quality of life. Chemical synovectomy is practical in developing countries, but radioactive synovectomy appears to be more effective. When surgical synovectomy is considered, arthroscopic/minimally invasive approach should be attempted first. In advanced haemophilic arthropathy, joint replacement and arthrodesis can be considered. While excited about the future of haemophilia management, navigating musculoskeletal challenges in the aging haemophilia population is equally important.
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Affiliation(s)
- Nihal Bakeer
- Indiana Haemophilia and Thrombosis Centre, Indianapolis, Indiana, USA
- Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Walid Saied
- Department of Paediatric Orthopaedic Surgery, Children's Hospital "Bechir HAMZA", Medical School of Tunis, University Tunis-El Manar, Tunis, Tunisia
| | - Antonio Gavrilovski
- University Clinic for Orthopaedic Surgery-TOARILUC, Clinical Centre Mother Theresa Skopje, Skopje, North Macedonia
| | - Cindy Bailey
- Orthopaedic Haemophilia Treatment Centre at Orthopaedic Institute for Children Los Angeles, Los Angeles, California, USA
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Sande NK, Kirkhus E, Lilleby V, Tomterstad AH, Aga AB, Flatø B, Bøyesen P. Validity of an ultrasonographic joint-specific scoring system in juvenile idiopathic arthritis: a cross-sectional study comparing ultrasound findings of synovitis with whole-body magnetic resonance imaging and clinical assessment. RMD Open 2024; 10:e003965. [PMID: 38428979 PMCID: PMC10910647 DOI: 10.1136/rmdopen-2023-003965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE To assess the validity of an ultrasonographic scoring system in juvenile idiopathic arthritis (JIA) by comparing ultrasound detected synovitis with whole-body MRI and clinical assessment of disease activity. METHODS In a cross-sectional study, 27 patients with active JIA underwent clinical 71-joints examination, non-contrast enhanced whole-body MRI and ultrasound evaluation of 28 joints (elbow, radiocarpal, midcarpal, metacarpophalangeal 2-3, proximal interphalangeal 2-3, hip, knee, tibiotalar, talonavicular, subtalar and metatarsophalangeal 2-3). One rheumatologist, blinded to clinical findings, performed ultrasound and scored synovitis (B-mode and power Doppler) findings using a semiquantitative joint-specific scoring system for synovitis in JIA. A radiologist scored effusion/synovial thickening on whole-body MRI using a scoring system for whole-body MRI in JIA. At patient level, associations between ultrasound synovitis sum scores, whole-body MRI effusion/synovial thickening sum scores, clinical arthritis sum scores, and the 71-joints Juvenile Arthritis Disease Activity Score (JADAS71) were calculated using Spearman's correlation coefficients (rs). To explore associations at joint level, sensitivity and specificity were calculated for ultrasound using whole-body MRI or clinical joint examination as reference. RESULTS Ultrasound synovitis sum scores strongly correlated with whole-body MRI effusion/synovial thickening sum scores (rs=0.74,p<0.01) and the JADAS71 (rs=0.71,p<0.01), and moderately with clinical arthritis sum scores (rs=0.57,p<0.01). Sensitivity/specificity of ultrasound in detecting synovitis were 0.57/0.96 and 0.55/0.96 using whole-body MRI or clinical joint examination as reference, respectively. CONCLUSION Our findings suggest that ultrasound is a valid instrument to detect synovitis, and that ultrasound synovitis sum scores can reflect disease activity and may be an outcome measure in JIA.
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Affiliation(s)
- Nina Krafft Sande
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | | | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Bøyesen
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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du Toit C, Dima R, Papernick S, Jonnalagadda M, Tessier D, Fenster A, Lalone E. Three-dimensional ultrasound to investigate synovitis in first carpometacarpal osteoarthritis: A feasibility study. Med Phys 2024; 51:1092-1104. [PMID: 37493097 DOI: 10.1002/mp.16640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Synovitis is one of the defining characteristics of osteoarthritis (OA) in the carpometacarpal (CMC1) joint of the thumb. Quantitative characterization of synovial volume is important for furthering our understanding of CMC1 OA disease progression, treatment response, and monitoring strategies. In previous studies, three-dimensional ultrasound (3-D US) has demonstrated the feasibility of being a point-of-care system for monitoring knee OA. However, 3-D US has not been tested on the smaller joints of the hand, which presents unique physiological and imaging challenges. PURPOSE To develop and validate a novel application of 3-D US to monitor soft-tissue characteristics of OA in a CMC1 OA patient population compared to the current gold standard, magnetic resonance imaging (MRI). METHODS A motorized submerged transducer moving assembly was designed for this device specifically for imaging the joints of the hands and wrist. The device used a linear 3-D scanning approach, where a 14L5 2-D transducer was translated over the region of interest. Two imaging phantoms were used to test the linear and volumetric measurement accuracy of the 3-D US device. To evaluate the accuracy of the reconstructed 3-D US geometry, a multilayer monofilament string-grid phantom (10 mm square grid) was scanned. To validate the volumetric measurement capabilities of the system, a simulated synovial tissue phantom with an embedded synovial effusion was fabricated and imaged. Ten CMC1 OA patients were imaged by our 3-D US and a 3.0 T MRI system to compare synovial volumes. The synovial volumes were manually segmented by two raters on the 2D slices of the 3D US reconstruction and MR images, to assess the accuracy and precision of the device for determining synovial tissue volumes. The Standard Error of Measurement and Minimal Detectable Change was used to assess the precision and sensitivity of the volume measurements. Paired sample t-tests were used to assess statistical significance. Additionally, rater reliability was assessed using Intra-Class Correlation (ICC) coefficients. RESULTS The largest percent difference observed between the known physical volume of synovial extrusion in the phantom and the volume measured by our 3D US was 1.1% (p-value = 0.03). The mean volume difference between the 3-D US and the gold standard MRI was 1.78% (p-value = 0.48). The 3-D US synovial tissue volume measurements had a Standard Error Measurement (SEm ) of 11.21 mm3 and a Minimal Detectible Change (MDC) of 31.06 mm3 , while the MRI synovial tissue volume measurements had an SEM of 16.82 mm3 and an MDC of 46.63 mm3 . Excellent inter- and intra-rater reliability (ICCs = 0.94-0.99) observed across all imaging modalities and raters. CONCLUSION Our results indicate the feasibility of applying 3-D US technology to provide accurate and precise CMC1 synovial tissue volume measurements, similar to MRI volume measurements. Lower MDC and SEm values for 3-D US volume measurements indicate that it is a precise measurement tool to assess synovial volume and that it is sensitive to variation between volume segmentations. The application of this imaging technique to monitor OA pathogenesis and treatment response over time at the patient's bedside should be thoroughly investigated in future studies.
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Affiliation(s)
- Carla du Toit
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Robert Dima
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Samuel Papernick
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - David Tessier
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Emily Lalone
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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Protheroe D, Green R, Hayes M. Particulate synovitis granuloma complication following a first metatarsophalangeal joint silastic implant. BMJ Case Rep 2023; 16:e257031. [PMID: 38129094 DOI: 10.1136/bcr-2023-257031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This case presents a known complication of particulate synovitis granuloma associated with a first metatarsophalangeal joint silastic implant. However, the degree of soft tissue granuloma enlargement is quite unique in size and its proliferative effect-invading the medulla cavity and infiltrating the outer cortex of bone. This case study aims to demonstrate its clinical presentation, imaging investigations, surgical excision and histopathology findings. The learning points emphasised within this manuscript draw attention to the procedure selection for a silastic implant, as well as its proposed mode of action and various potential associated complications. Surgery was based on careful analysis of overall function, prior surgery conducted and patient expectations to achieve a shared decision-making process.
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Mostert JM, Dur NB, Li X, Ellermann JM, Hemke R, Hales L, Mazzoli V, Kogan F, Griffith JF, Oei EH, van der Heijden RA. Advanced Magnetic Resonance Imaging and Molecular Imaging of the Painful Knee. Semin Musculoskelet Radiol 2023; 27:618-631. [PMID: 37935208 PMCID: PMC10629992 DOI: 10.1055/s-0043-1775741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
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Affiliation(s)
- Jacob M. Mostert
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels B.J. Dur
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiufeng Li
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Jutta M. Ellermann
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, California
| | | | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California
| | - James F. Griffith
- Department of Imaging and Interventional Radiology Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Maerz T. Is synovitis inevitable after ACL injury? Osteoarthritis Cartilage 2023; 31:1531-1533. [PMID: 37597654 DOI: 10.1016/j.joca.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Ferracini R, Alessio-Mazzola M, Sonzogni B, Stambazzi C, Ursino C, Roato I, Mussano F, Bistolfi A, Furlan S, Godio L, Alotto D, Formica M. Age and synovitis affect the results of the treatment of knee osteoarthritis with Microfragmented Autologous Fat Tissue. Knee Surg Sports Traumatol Arthrosc 2023; 31:3655-3664. [PMID: 36087128 PMCID: PMC10435636 DOI: 10.1007/s00167-022-07139-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aims to assess the effectiveness of Microfragmented Autologous Fat Tissue (MFAT) treatment for knee osteoarthritis and to investigate whether patients' pre-treatment clinical condition, such as synovitis, correlates with clinical outcomes, to identify potential predicting factors for the success or failure of the treatment. METHODS In this prospective Cohort Study Level II multicentric trial, consecutive patients with a diagnosis of early/mild osteoarthritis and failure of previous conservative measures were enrolled to undergo diagnostic arthroscopy and a single MFAT injection. Patients were assessed with repeated scoring systems at baseline, 6 months, and 12 months after surgery. The demographic features, the arthroscopic findings, the immunophenotype of injected tissue and the histologic examination of synovia of failed patients were analyzed. RESULTS Data from 91 patients showed a significant improvement in Lysholm, WOMAC scores at 1-year follow-up (p < 0.001). A significant decrease in VAS score was observed, while a significant improvement of measured flexion angle was registered at 1 year (p < 0.001). No major complications were reported. Age and synovitis were identified as significant factors influencing the clinical outcome (p < 0.05). Body mass index, previous or concomitant procedures, and specific cartilage defects had no influence. The mean number of injected adipose tissue-derived mesenchymal stem cells seem not to correlate with the clinical outcome. CONCLUSION MFAT is effective in reducing pain when used with a single dose injection in early/mild OA of the knee, without major complications. Age over 60 and synovitis may be predictive for persistent pain at one year and should be considered before indications.
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Affiliation(s)
- R Ferracini
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy.
- Ospedale Koelliker, Corso Galileo Ferraris 247/255, 10134, Turin, Italy.
| | - M Alessio-Mazzola
- IRCCS Ospedale San Raffaele, Orthopaedic and Trauma Unit, Via Olgettina 60, 20132, Milan, Milano, Italy
| | - B Sonzogni
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy
| | - C Stambazzi
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy
| | - C Ursino
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy
| | - I Roato
- Department of Surgical Sciences, Bone and Dental Bioengineering Laboratory, CIR-Dental School, University of Turin, via Nizza 230, 10126, Turin, Italy
| | - F Mussano
- Department of Surgical Sciences, Bone and Dental Bioengineering Laboratory, CIR-Dental School, University of Turin, via Nizza 230, 10126, Turin, Italy
| | - A Bistolfi
- Orthopaedic and Traumatology, Cardinal Massaia Hospital, Corso Dante 202, 14100, Asti, Italy
| | - S Furlan
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy
| | - L Godio
- First University Service, Pathologic Anatomy, Azienda Ospedaliero-Universitaria Città Della Salute, Corso Bramante 88, 10126, Turin, Italy
| | - D Alotto
- Department of General Surgery and Special Surgery, Burns Center Unit, Unit of Skin Bank, Via Zuretti 29, 10126, Turin, Italy
| | - M Formica
- Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy
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Khan MJ, Asif N, Aziz MH, Shaikh SAH, Siddiqui FB, Moizuddin K, Nuhmani S. Arthroscopic debridement of the ankle in synovitis. J Med Life 2023; 16:1235-1239. [PMID: 38024814 PMCID: PMC10652676 DOI: 10.25122/jml-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/16/2023] [Indexed: 12/01/2023] Open
Abstract
Inflammation and hypertrophy of the ankle joint's synovial lining can occur due to various causes. Chronic pain and degenerative changes may be due to synovitis causing clinical manifestations through traction on the joint capsule. The failure of conservative treatment for at least six months indicates arthroscopic debridement, which can provide significant pain relief without the morbidity of extensive surgical exposures. This study was therefore conducted to establish the functional results of arthroscopic debridement of the ankle joint in synovitis. Fifteen patients with chronic ankle pain who had not responded to conservative treatment for approximately six months were included in the study. Arthroscopic debridement was performed using a shaver blade, followed by a postoperative ankle physiotherapy regimen. Patients were assessed preoperatively and postoperatively using the AOFAS, FADI, and VAS scores, with a mean follow-up period of 26 months. There was a significant improvement in the final clinical outcomes of the patients. The post-operative VAS score improved to 2.20±0.56 (2-4) (p-value=0.001), the AOFAS score was 86±8.25 (65-98) (p-value-0.001), and the FADI Score was 86.93±7.35(70-96) (p-value=0.001). Thirteen patients (86.67%) achieved outstanding or good results, while two had fair results, according to Meislin's criterion. One patient reported a superficial wound infection, which subsided with antibiotic therapy. The study findings indicate that arthroscopic ankle debridement is an efficient method to treat persistent ankle discomfort induced by synovitis, and it has a low postsurgical complications rate, quicker recovery, and less joint stiffness.
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Affiliation(s)
- Mohammad Jesan Khan
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Naiyer Asif
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohd Hadi Aziz
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Siraj Ahmed Hasham Shaikh
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Faiza Banu Siddiqui
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Khwaja Moizuddin
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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12
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Rodriguez-Merchan EC. Hemophilic arthropathy: how to diagnose subclinical bleeding early and how to orthopedically treat a damaged joint. Expert Rev Hematol 2023; 16:651-658. [PMID: 37392151 DOI: 10.1080/17474086.2023.2232547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION It is important to know the current status of hemophilic arthropathy diagnoses, treatments, complications, and outcomes in developed countries. AREAS COVERED A bibliographic search in PubMed for articles published from 1 January 2019 through 12 June 2023 was performed. EXPERT OPINION In developed countries with specialized hemophilia treatment centers, primary hematological prophylaxis (started before the age of 2 years and after no more than one joint bleed) has almost completely eliminated the joint-related problems of the disease. The ideal goal of zero hemarthroses can be achieved only with intense and well-dosed prophylaxis: intravenous infusion of coagulation factor - standard half-life or extended half-life; periodic or subcutaneous injections of nonfactor products (emicizumab or fitusiran). However, hemophilic arthropathy continues to occur due to subclinical joint hemorrhages. In one study, 16% of the joints without reported hemarthroses showed signs of previous subclinical bleeding (hemosiderin deposits with/without synovial hypertrophy on magnetic resonance imaging were deemed signs of previous subclinical bleeding), rendering evidence for subclinical bleeding in people with severe hemophilia with lifelong prophylaxis treatment. Subclinical joint hemorrhages can be averted only by employing accurate and tailored prophylaxis.
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Boeren AMP, Niemantsverdriet E, Verstappen M, Wouters F, Bloem JL, Reijnierse M, van der Helm-van Mil AHM. Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences. Skeletal Radiol 2023; 52:1193-1202. [PMID: 36441238 PMCID: PMC7615876 DOI: 10.1007/s00256-022-04238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE MRI of small joints plays an important role in the early detection and early treatment of rheumatoid arthritis. Despite its sensitivity to demonstrate inflammation, clinical use is hampered by accessibility, long scan time, intravenous contrast, and consequent high costs. To improve the feasibility of MRI implementation in clinical practice, we introduce a modified Dixon sequence, which does not require contrast and reduces total acquisition time to 6 min. Because the reliability in relation to conventional MRI sequences is unknown, we determined this. METHODS In 29 consecutive early arthritis patients, coronal and axial T2-weighted modified Dixon acquisitions on 3.0 T MRI scanner were acquired from metacarpophalangeal 2-5 to the wrist, followed by the standard contrast-enhanced protocol on 1.5 T extremity MRI. Two readers scored osteitis, synovitis and tenosynovitis (summed as total MRI-inflammation), and erosions (all summed as total Rheumatoid Arthritis MRI Score (RAMRIS)). Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined. RESULTS Performance between readers was good/excellent. Comparing modified Dixon and conventional sequences revealed good/excellent reliability: ICC for total MRI-inflammation score was 0.84 (95% CI:0.70-0.92), for erosions 0.90 (95% CI:0.79-0.96), and for the total RAMRIS score 0.88 (95% CI:0.77-0.94). The scores of total MRI-inflammation, total erosions, and total RAMRIS were highly correlated (ρ = 0.80, ρ = 0.81, ρ = 0.82, respectively). CONCLUSION The modified Dixon protocol is reliable compared to the conventional MRI protocol, suggesting it is accurate to detect MRI inflammation. The good correlation may be the first step towards a patient-friendly, short and affordable MRI protocol, which can facilitate the implementation of MRI for early detection of inflammation in rheumatology practice.
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Affiliation(s)
- Anna M P Boeren
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | - Marloes Verstappen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fenne Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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14
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Shim JW, Chae SH, Kim IS, Park MJ. Clinical course in patients with chronic undifferentiated arthritis of the elbow after arthroscopic synovectomy. J Shoulder Elbow Surg 2022; 31:2514-2520. [PMID: 36007866 DOI: 10.1016/j.jse.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical treatment can be considered for patients with undifferentiated arthritis (UA) limited to the elbow joint. The purpose of this study was to analyze the clinical outcomes of arthroscopic synovectomy. METHODS Nineteen patients who underwent arthroscopic synovectomy for chronic UA of the elbow between 2006 and 2019 were enrolled in this study. One patient was excluded because of evidence of tuberculosis in the biopsy. Chronic UA of the elbow was defined as (1) localized synovitis diagnosed by magnetic resonance imaging, (2) no specific cause, and (3) no response to conservative treatment for >3 months. We compared baseline characteristics and clinical outcomes between the remission and disease progression groups. RESULTS Postoperatively, synovitis was controlled in 13 patients. In 5 patients, the symptoms disappeared after surgery without any medical treatment. Four patients discontinued disease-modifying antirheumatic drugs. Nine patients were classified as in remission. The disease progression group had a longer symptom duration, elevated rheumatoid markers, and higher Larsen grading. However, the difference was not statistically significant. CONCLUSIONS Arthroscopic synovectomy achieved remission in approximately 47% of patients with chronic UA of the elbow. Although arthroscopic synovectomy did not prevent RA, it can be considered for rapid resolution of synovitis and diagnostic purposes.
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Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Chae
- Lee's Bon Spine & Joint Hospital, Busan, Republic of Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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15
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den Hollander NK, Verstappen M, Sidhu N, van Mulligen E, Reijnierse M, van der Helm-van Mil AHM. Hand and foot MRI in contemporary undifferentiated arthritis: in which patients is MRI valuable to detect rheumatoid arthritis early? A large prospective study. Rheumatology (Oxford) 2022; 61:3963-3973. [PMID: 35022703 PMCID: PMC9536782 DOI: 10.1093/rheumatology/keac017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Identifying patients that will develop RA among those presenting with undifferentiated arthritis (UA) remains a clinical dilemma. Although MRI is helpful according to EULAR recommendations, this has only been determined in UA patients not fulfilling 1987 RA criteria, while some of these patients are currently considered as RA because they fulfil the 2010 criteria. Therefore, we studied the predictive value of MRI for progression to RA in the current UA population, i.e. not fulfilling RA classification criteria (either 1987 or 2010 criteria) and not having an alternate diagnosis. Additionally, the value of MRI was studied in patients with a clinical diagnosis of UA, regardless of the classification criteria. METHODS Two UA populations were studied: criteria-based UA as described above (n = 405) and expert-opinion-based UA (n = 564), i.e. UA indicated by treating rheumatologists. These patients were retrieved from a large cohort of consecutively included early arthritis patients that underwent contrast-enhanced MRI scans of hand and foot at baseline. MRIs were scored for osteitis, synovitis and tenosynovitis. Patients were followed for RA development during the course of 1 year. Test characteristics of MRI were determined separately for subgroups based on joint involvement and autoantibody status. RESULTS Among criteria-based UA patients (n = 405), 21% developed RA. MRI-detected synovitis and MRI-detected tenosynovitis were predictive for progression to RA. MRI-detected tenosynovitis was independently associated with RA progression (odds ratio (OR) 2.79; 95% CI 1.40, 5.58), especially within ACPA-negative UA patients (OR 2.91; 95% CI 1.42, 5.96). Prior risks of RA development for UA patients with mono-, oligo- and polyarthritis were 3%, 19% and 46%, respectively. MRI results changed this risk most within the oligoarthritis subgroup: positive predictive value was 27% and negative predictive value 93%. Similar results were found in expert-opinion-based UA (n = 564). CONCLUSION This large cohort study showed that MRI is most valuable in ACPA-negative UA patients with oligoarthritis; a negative MRI could aid in preventing overtreatment.
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Affiliation(s)
| | | | - Navkiran Sidhu
- Department of Rheumatology, Leiden University Medical Center, Leiden
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden
- Department of Rheumatology, Erasmus Medical Center, Rotterdam
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16
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Abstract
BACKGROUND Inflammatory arthritis is the most common late manifestation of untreated Lyme disease in the United States. While antimicrobial therapy is effective in resolving swelling and pain for 90% of patients, many patients have persistent inflammation, termed postinfectious Lyme arthritis (PILA). Current outcome measures for Lyme arthritis have several limitations, as improvement is considered a dichotomous outcome based solely on physical examination. There is growing interest in the use of ultrasonography to better define outcomes in inflammatory arthritis, and this is particularly relevant for conditions such as late Lyme arthritis and PILA, which are monoarticular or oligoarticular. We describe results from a series of 5 patients who underwent ultrasound evaluations leading to a diagnosis of PILA. METHODS This is a case series describing 5 patients with PILA who were referred for evaluation and treatment of symptomatic joints. RESULTS Musculoskeletal ultrasound showed significant joint pathology, even in cases with minimal clinical findings. Synovitis, effusions, enthesitis/tendinopathy, and bone erosions were seen and helped confirm the presence of ongoing inflammatory arthritis. CONCLUSIONS Marked inflammatory change-with synovitis, enthesitis and erosions-can be seen in selected patients with PILA. Systematic sonographic evaluation of patients with PILA is needed to further evaluate pathology and treatment response.
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Affiliation(s)
- John B Miller
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
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17
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Koff MF, Gao MA, Neri JP, Chiu YF, Lin BQ, Burge AJ, Su E, Padgett DE, Potter HG. Adverse Local Tissue Reactions are Common in Asymptomatic Individuals After Hip Resurfacing Arthroplasty: Interim Report from a Prospective Longitudinal Study. Clin Orthop Relat Res 2021; 479:2633-2650. [PMID: 34232144 PMCID: PMC8726542 DOI: 10.1097/corr.0000000000001882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evaluation of the natural history prevalence of adverse local tissue reactions (ALTRs) using MRI has focused only on metal-on-metal (MoM) bearing surfaces without comparison to nonMoM bearing surfaces. QUESTIONS/PURPOSES To determine (1) the longitudinal changes and differences in blood metal ion levels in patients with hip resurfacing arthroplasty (HRA), ceramic-on-ceramic (CoC) THA, and metal-on-polyethylene (MoP) THA compared with those undergoing ceramic-on-polyethylene (CoP) THA; (2) how the longitudinal change of synovial reaction classification in patients with HRA, CoC THA, and MoP THA compares with those undergoing CoP THA, and whether there is an association between the presence of an ALTR or metallosis on MRI with corresponding patient-reported outcomes, or the presence of capsular dehiscence; and (3) differences in blood metal ion levels between patients undergoing HRA with an ALTR or metallosis on MRI and those with HRA without these conditions. METHODS Between March 2014 and February 2019, 22,723 patients underwent primary HRA and THA at one center. Patients received an HRA based on their desired athletic level after surgery and the presence of normal acetabular and proximal femoral bone morphology without osteopenia or osteoporosis. Two percent (342 of 22,723) of patients were contacted to participate, and 71% (243 of 342 hips in 206 patients) were enrolled for analysis at baseline. The patients underwent arthroplasty for degenerative joint disease, and 25 patients withdrew over the course of the study. We included patients who were more than 1 year postarthroplasty. All participants had an MRI examination and blood serum ion testing and completed a Hip Disability and Osteoarthritis Outcome Score survey annually for four years (baseline, year 1, year 2, year 3). Morphologic and susceptibility-reduced MR images were evaluated by a single radiologist not involved in the care of patients for the presence and classification of synovitis (Gwet AC1: 0.65 to 0.97), synovial thickness, and volume (coefficient of repeatability: 1.8 cm3). Linear mixed-effects models were used to compare the mean synovial thickness, synovial volume, and Hip Disability and Osteoarthritis Outcome Score subscales between bearing surfaces at each timepoint and within each bearing surface over time. Marginal Cox proportional hazards models were used to compare the time to and the risk of developing ALTR only, metallosis only, and ALTR or metallosis between bearing surfaces. All models were adjusted for age, sex, BMI, and length of implantation based on known confounders for hip arthroplasty. Adjustment for multiple comparisons was performed using the Dunnett-Hsu method. RESULTS Patients with unilateral HRA had higher cobalt and chromium serum ion levels (baseline: 1.8 ± 0.8 ppb, year 1: 2.0 ± 1.5 ppb, year 2: 2.1 ± 1.2 ppb, year 3: 1.6 ± 0.7 ppb) than those with unilateral CoP bearings (baseline: 0.0 ± 0.1 ppb, year 1: 0.1 ± 0.3 ppb, year 2: 0.0 ± 0.2 ppb, year 3: 0.0 ± 0.0 ppb) at all timepoints (p < 0.001 for each time point). More patients who received an HRA developed ALTR or metallosis on MRI than did patients with CoP bearings (hazard ratio 4.8 [95% confidence interval 1.2 to 18.4]; p = 0.02). There was no association between the longitudinal change of synovial reaction to ALTR or metallosis on MRI with patient-reported outcomes. In addition, there was no association between the presence of dehiscence at baseline and the subsequent development of ALTR or metallosis, as seen on MRI. There were elevated cobalt (4.7 ± 3.5 ppb) and chromium (4.7 ± 2.6 ppb) serum levels in patients with unilateral HRA who had an ALTR or metallosis present on MRI at year 1 compared with patients without an ALTR or metallosis on MRI (cobalt: 1.8 ± 1.0 ppb, mean difference 4.7 ppb [95% CI 3.3 to 6.0]; p < 0.001; chromium: 2.3 ± 0.5 ppb, mean difference 3.6 ppb [95% CI 2.2 to 5.0]; p < 0.001) as well as for chromium at year 3 (3.9 ± 2.4 ppb versus 2.2 ± 1.1 ppb, mean difference 1.3 ppb [95% CI 0.3 to 2.4]; p = 0.01). CONCLUSION We found a higher proportion of ALTR or metallosis on MRI in patients with HRA compared with patients with CoP, even when patient self-assessed symptomatology of those with an ALTR or metallosis on MRI was not different than the absence of these features. MRI detected ALTRs in high-function patients, emphasizing that an annual clinical assessment dependent on survey or blood ion testing alone may not detect soft tissue complications. The results of this study are in line with prior consensus recommendations of using MRI as part of a routine follow-up protocol for this patient population. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Matthew F. Koff
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Madeleine A. Gao
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - John P. Neri
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Yu-fen Chiu
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Bin Q. Lin
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J. Burge
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Edwin Su
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Douglas E. Padgett
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
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Wang Y, Xiang Y, Cao Y, Zhang W, Li C. Tonsillectomy Leads to Remission of Bone Marrow Edema and Palmoplantar Pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. J Clin Rheumatol 2021; 27:S719-S720. [PMID: 32897988 DOI: 10.1097/rhu.0000000000001546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yutong Wang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yirong Xiang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yihan Cao
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Wen Zhang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Chen Li
- Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Mahmoud K, Zayat AS, Yusof MYM, Dutton K, Teh LS, Yee CS, D’Cruz D, Ng N, Isenberg D, Ciurtin C, Conaghan PG, Emery P, Edwards CJ, Hensor EMA, Vital EM. Ultrasound to identify systemic lupus erythematosus patients with musculoskeletal symptoms who respond best to therapy: the US Evaluation For mUsculoskeletal Lupus longitudinal multicentre study. Rheumatology (Oxford) 2021; 60:5194-5204. [PMID: 33792659 PMCID: PMC8566203 DOI: 10.1093/rheumatology/keab288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine whether SLE patients with inflammatory joint symptoms and US synovitis/tenosyovitis achieve better clinical responses to glucocorticoids compared with patients with normal scans. Secondary objectives included identification of clinical features predicting US synovitis/tenosynovitis. METHODS In a longitudinal multicentre study, SLE patients with physician-diagnosed inflammatory joint pain received intramuscular methylprednisolone 120 mg once. Clinical assessments, patient-reported outcomes and bilateral hand/wrist USs were collected at 0, 2 and 6 weeks. The primary outcome (determined via internal pilot) was the early morning stiffness visual analogue scale (EMS-VAS) at 2 weeks, adjusted for baseline, comparing patients with positive (greyscale ≥2 and/or power Doppler ≥1) and negative US. Post hoc analyses excluded FM. RESULTS Of 133 patients, 78 had a positive US. Only 53 (68%) of these had one or more swollen joint. Of 66 patients with one or more swollen joint, 20% had a negative US. A positive US was associated with joint swelling, symmetrical small joint distribution and serology. The primary endpoint was not met: in the full analysis set (N = 133) there was no difference in baseline-adjusted EMS-VAS at week 2 [-7.7 mm (95% CI -19.0, 3.5); P = 0.178]. After excluding 32 patients with FM, response was significantly better in patients with a positive US at baseline [baseline-adjusted EMS-VAS at 2 weeks -12.1 mm (95% CI -22.2, -0.1); P = 0.049]. This difference was greater when adjusted for treatment [-12.8 mm (95% CI -22, -3); P = 0.007]. BILAG and SLEDAI responses were higher in US-positive patients. CONCLUSION In SLE patients without FM, those with a positive US had a better clinical response to therapy. Imaging-detected synovitis/tenosynovitis may be considered to decide on therapy and enrich clinical trials.
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Affiliation(s)
- Khaled Mahmoud
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Ahmed S Zayat
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford
| | - Md Yuzaiful Md Yusof
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Katherine Dutton
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Lee Suan Teh
- Royal Blackburn Teaching Hospital, Blackburn and University of Central Lancashire, Preston
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust, Doncaster
| | | | | | | | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | - Philip G Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Paul Emery
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Elizabeth M A Hensor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Edward M Vital
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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Takahashi I, Takeda K, Matsuzaki T, Kuroki H, Hoso M. Reduction of knee joint load suppresses cartilage degeneration, osteophyte formation, and synovitis in early-stage osteoarthritis using a post-traumatic rat model. PLoS One 2021; 16:e0254383. [PMID: 34270585 PMCID: PMC8284605 DOI: 10.1371/journal.pone.0254383] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to clarify the histological effect of reducing the loading to knee on cartilage degeneration, osteophyte formation, and synovitis in early-stage osteoarthritis (OA) using a post-traumatic rat model. Ten male rats were randomly allocated into two experimental groups: OA induction by surgical destabilization of medial meniscus (DMM, OA group) and hindlimb suspension after OA induction by DMM (OAHS group). The articular cartilage, osteophyte formation, and synovial membrane in the medial tibiofemoral joint were analyzed histologically and histomorphometrically at 2 and 4 weeks after surgery. The histological scores and changes in articular cartilage and osteophyte formation were significantly milder and slower in the OAHS group than in the OA group. At 2 and 4 weeks, there were no significant differences in cartilage thickness and matrix staining intensity between both the groups, but chondrocytes density was significantly lower in the OA group. Synovitis was milder in OAHS group than in OA group at 2 weeks. Reducing knee joint loading inhibited histological OA changes in articular cartilage, osteophyte formation, and synovial inflammation. This result supports the latest clinical guidelines for OA treatment. Further studies using biochemical and mechanical analyses are necessary to elucidate the mechanism underlying delayed OA progression caused by joint-load reduction.
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Affiliation(s)
- Ikufumi Takahashi
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keisuke Takeda
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Taro Matsuzaki
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Hoso
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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21
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Law J, Nauka PC, Nguyen A, LeFrancois D. Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Associated with DPP-4 Inhibitor. Am J Med 2021; 134:e412-e414. [PMID: 33621536 DOI: 10.1016/j.amjmed.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jammie Law
- Department of Medicine, Montefiore Medical Center, Bronx, NY.
| | - Peter C Nauka
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Andy Nguyen
- Department of Medicine, Montefiore Medical Center, Bronx, NY
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22
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Zhang W, Zhao D, Wu M, Chen W, Jin Z, Zhang H. Ultrasound Evaluation of Three Outcome Domains in the Follow-up of Urate-Lowering Therapy in Gout: An Observational Study. Ultrasound Med Biol 2021; 47:1495-1505. [PMID: 33785225 DOI: 10.1016/j.ultrasmedbio.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
This prospective study was aimed at observing the changes in three ultrasound (US) outcome domains (urate deposition, joint inflammation and bone erosion) in gout patients within the 1 y on urate-lowering therapy. The elementary lesions, including tophus, double-contour (DC) sign, aggregates, synovitis and bone erosion of the bilateral knee, ankle and first metatarsophalangeal joints, were evaluated repeatedly by US before and after 3, 6 and 12 mo of treatment, and the effective rates of clearance of tophus, DC sign and aggregates in different time groups were compared. A Global OMERACT-EULAR Synovitis Score (GLOESS) was calculated for these three paired joints to observe the inflammation. Bone erosion was also scored. The correlation between serum uric acid levels and tophus size changes was analyzed. Our results indicated that the decrease in serum uric acid levels was not completely parallel to the decrease in tophus size. For tophus, there was no significant difference in the clearance rate between different time groups (χ2 = 1.76, p = 0.392), while for DC sign and aggregates, there were significant differences (χ2 = 21.48, p < 0.001, χ2 = 7.75, p = 0.018). Meanwhile, GLOESS was significantly lower after 6 mo of therapy (χ2 = 32.316, p < 0.001). Additionally, bone erosion had not improved after 1 y of treatment (Z = -1.633, p = 0.102). Thus, US is crucial for assessing response to urate-lowering therapy in gout.
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Affiliation(s)
- Weijing Zhang
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Di Zhao
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Min Wu
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weiyu Chen
- College of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Zhibin Jin
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Huayong Zhang
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Scotece M, Rego-Pérez I, Lechuga-Vieco AV, Cortés AC, Jiménez-Gómez MC, Filgueira-Fernández P, Vaamonde-García C, Enríquez JA, Blanco FJ. Mitochondrial DNA impact on joint damaged process in a conplastic mouse model after being surgically induced with osteoarthritis. Sci Rep 2021; 11:9112. [PMID: 33907208 PMCID: PMC8079696 DOI: 10.1038/s41598-021-88083-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
It has been suggested that mitochondrial dysfunction and mtDNA variations may contribute to osteoarthritis (OA) pathogenesis. However, the causative link to support this claim is lacking. Here, we surgically-induced OA in conplastic mice in order to evaluate the functional consequences of mtDNA haplotypes in their joint degeneration. BL/6NZB strain was developed with C57BL/6JOlaHsd nuclear genome and NZB/OlaHsdmtDNA while BL/6C57, which is the original, was developed with C57BL/6JOlaHsd nuclear genome and C57/OlaHsdmtDNA for comparison. The surgical DMM OA model was induced in both strains. Their knees were processed and examined for histopathological changes. Cartilage expression of markers of autophagy, apoptosis, oxidative stress and senescence were also analyzed by immunohistochemistry. The joints of BL/6NZB mice that were operated presented more cellularity together with a reduced OARSI histopathology score, subchondral bone, menisci score and synovitis compared to those of BL/6C57 mice. This was accompanied with higher autophagy and a lower apoptosis in the cartilage of BL/6NZB mice that were operated. Therefore, the study demonstrates the functional impact of non-pathological variants of mtDNA on OA process using a surgically-induced OA model. Conplastic (BL/6NZB ) mice develop less severe OA compared to the BL/6C57original strain. These findings demonstrate that mitochondria and mtDNA are critical targets for potential novel therapeutic approaches to treat osteoarthritis.
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Affiliation(s)
- Morena Scotece
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Ignacio Rego-Pérez
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Ana Victoria Lechuga-Vieco
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- CIBERES, C/Melchor Fernández-Almagro 3, 28029, Madrid, Spain
- Kennedy Institute of Rheumatology, University of Oxford, Headington, Oxford, UK
| | - Alberto Centeno Cortés
- Centro Tecnológico de Formación Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
| | | | - Purificación Filgueira-Fernández
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Carlos Vaamonde-García
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - José Antonio Enríquez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- CIBERFES, C/Melchor Fernández-Almagro 3, 28029, Madrid, Spain
| | - Francisco J Blanco
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain.
- Universidade da Coruña (UDC), Grupo de Investigación de Reumatología y Salud (GIR-S), Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Facultad de Fisioterapia, Campus de Oza, A Coruña, Spain.
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Venerito V, Cazzato G, Lopalco G, Fornaro M, Righetti G, Urso L, Cimmino A, Iannone F. Histopathologic Features of Fibrotic Knee Synovitis in a Young Adult With Seronegative Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:e73-e74. [PMID: 31876841 DOI: 10.1097/rhu.0000000000001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Gerardo Cazzato
- Pathology Unit, Department of Emergency and Organ Transpantations, University of Bari, Bari, Italy
| | | | | | | | | | - Antonietta Cimmino
- Pathology Unit, Department of Emergency and Organ Transpantations, University of Bari, Bari, Italy
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a framework to distinguish Blau syndrome/Early Onset Sarcoidosis and Sarcoidosis clinically. We also discuss relevant differences in genetics, pathogenesis, and management of these diseases. RECENT FINDINGS Blau syndrome and Sarcoidosis share the characteristic histologic finding of noncaseating granulomas as well as some similar clinical characteristics; nevertheless, they are distinct entities with important differences between them. Blau syndrome and Early Onset Sarcoidosis are due to one of numerous possible gain-of-function mutations in NOD2, commonly presenting before age 5 with a triad of skin rash, arthritis, and uveitis. However, as more cases are reported, expanded clinical manifestations have been described. In systemic Sarcoidosis, there are numerous susceptibility genes that have been identified, and disease is thought to result from an environmental exposure in a genetically susceptible host. It most often presents with constitutional symptoms and pulmonary involvement and typically affects adolescents and adults. This paper reviews the similarities and differences between Blau syndrome and Sarcoidosis. We also discuss the importance of distinguishing between them, particularly with regard to prognosis and outcomes.
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Affiliation(s)
- Katherine P Kaufman
- Department of Pediatrics, Division of Rheumatology and Nephrology, Duke University Medical Center, Durham, NC, USA.
- CarolinaEast Internal Medicine, Pollocksville, NC, USA.
| | - Mara L Becker
- Department of Pediatrics, Division of Rheumatology and Nephrology, Duke University Medical Center, Durham, NC, USA
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Abstract
INTRODUCTION After knee replacement, therapy resistant, persistent synovitis is a common issue, which causes effusion and pain, and leads to loosing. It has been hypothesized that radiosynovectomy (RSO) is useful in these patients. MATERIALS AND METHODS A cohort of 55 patients with 57 knee replacements and persistent synovitis underwent RSO using 4.9 ± 0.24 mCi (182 ± 9 MBq) of Y-citrate. The number of RSOs ranged from 1 to 4. Bone scans before and 3 months after every RSO were performed. Long-term follow-up ranged from 0.8 to 7.6 years with a mean of 23.2 months. For qualitative analysis, an established 4 steps scoring was used. For quantification, the uptake was determined within the Tc-MDP scintigraphy blood pool phase before and after therapy. RESULTS Long-term response was in 27% with excellent, 24% good, 30% weak, and 20% no response. The duration of response was 12.0 ± 12.0 months (maximum, 54 months). In patients with repeated treatment, the effect after the first therapy was lesser than in patients who received a single treatment in total. However, 3 months after the last RSO, patients with repeated treatment showed a similar effectiveness than single treated patients. At the end of long-term follow-up, patients with repeated RSOs had a higher effectiveness at similar duration response. In bone scan, 65% of patients showed a reduction of uptake. When comparing subjective and objective response, 78% of patients showed a concordance in both symptoms and scintigraphy. Pilot histological analysis revealed that the synovitis is triggered by small plastic particles. CONCLUSIONS We concluded that RSO is an effective therapy in patients with knee replacement and persistent synovitis with high long-term response. Repeated treatment leads to a stronger long-time response.
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Affiliation(s)
- Knut Liepe
- From the Department of Nuclear Medicine, GH Hospital Frankfurt (Oder), Frankfurt (Oder), Germany
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Gowler PRW, Mapp PI, Burston JJ, Shahtaheri M, Walsh DA, Chapman V. Refining surgical models of osteoarthritis in mice and rats alters pain phenotype but not joint pathology. PLoS One 2020; 15:e0239663. [PMID: 32991618 PMCID: PMC7523978 DOI: 10.1371/journal.pone.0239663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022] Open
Abstract
The relationship between osteoarthritis (OA) structural change and pain is complex. Surgical models of OA in rodents are often rapid in onset, limiting mechanistic utility and translational validity. We aimed to investigate the effect of refining surgical small rodent models of OA on both joint pathology and pain behaviour. Adult male C57BL/6 mice (n = 76, 10-11 weeks of age at time of surgery) underwent either traditional (transection of the medial meniscotibial ligament [MMTL]) or modified (MMTL left intact, transection of the coronary ligaments) DMM surgery, or sham surgery. Adult male Sprague Dawley rats (n = 76, weight 175-199g) underwent either modified meniscal transection (MMNX) surgery (transection of the medial meniscus whilst the medial collateral ligament is left intact) or sham surgery. Pain behaviours (weight bearing asymmetry [in mice and rats] and paw withdrawal thresholds [in rats]) were measured pre-surgery and weekly up to 16 weeks post-surgery. Post-mortem knee joints were scored for cartilage damage, synovitis, and osteophyte size. There was a significant increase in weight bearing asymmetry from 13 weeks following traditional, but not modified, DMM surgery when compared to sham operated mice. Both traditional and modified DMM surgery led to similar joint pathology. There was significant pain behaviour from 6 weeks following MMNX model compared to sham operated control rats. Synovitis was significant 4 weeks after MMNX surgery, whereas significant chondropathy was first evident 8 weeks post-surgery, compared to sham controls. Pain behaviour is not always present despite significant changes in medial tibial plateau cartilage damage and synovitis, reflecting the heterogeneity seen in human OA. The development of a slowly progressing surgical model of OA pain in the rat suggests that synovitis precedes pain behaviour and that chondropathy is evident later, providing the foundations for future mechanistic studies into the disease.
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Affiliation(s)
- Peter R. W. Gowler
- Pain Centre Versus Arthritis, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Paul I. Mapp
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - James J. Burston
- Pain Centre Versus Arthritis, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Mohsen Shahtaheri
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - David A. Walsh
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Victoria Chapman
- Pain Centre Versus Arthritis, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
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28
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Stergiou IE, Christoforou P, Sypsa G, Skoufias S, Mitropoulos D, Tzioufas AG, Voulgarelis M. Extraordinary extrahaematological manifestations of chronic myelomonocytic leukaemia. Lancet 2020; 396:853. [PMID: 32950091 DOI: 10.1016/s0140-6736(20)31905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/09/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022]
MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Aged
- Antineoplastic Agents, Alkylating/therapeutic use
- Biopsy, Needle/methods
- Bone Marrow/pathology
- Cyclophosphamide/therapeutic use
- Facial Paralysis/diagnosis
- Facial Paralysis/etiology
- Female
- Hematoma/etiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Kidney/blood supply
- Kidney/diagnostic imaging
- Kidney/pathology
- Knee Joint/pathology
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Nephrectomy/methods
- Polyarteritis Nodosa/drug therapy
- Polyarteritis Nodosa/pathology
- Stomatitis, Aphthous/etiology
- Synovitis/etiology
- Tongue Diseases/pathology
- Wrist Joint/pathology
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Affiliation(s)
- Ioanna E Stergiou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
| | - Panagiotis Christoforou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Georgia Sypsa
- Radiology Department, Laikon Hospital, Athens, Greece
| | - Spyridon Skoufias
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios G Tzioufas
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Michael Voulgarelis
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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Oo WM, Linklater JM, Bennell KL, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Superb Microvascular Imaging in Low-Grade Inflammation of Knee Osteoarthritis Compared With Power Doppler: Clinical, Radiographic and MRI Relationship. Ultrasound Med Biol 2020; 46:566-574. [PMID: 31917042 DOI: 10.1016/j.ultrasmedbio.2019.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
We compared the assessment of active synovitis in knee osteoarthritis (OA) by utilising superb microvascular imaging (SMI) and conventional power Doppler (cPD) techniques, and then correlated each technique with paients' symptoms, radiographic features and magnetic resonance imaging (MRI)-detected synovitis. A subgroup of participants with symptomatic knee OA underwent dynamic ultrasound assessment for semi-quantitative scores for SMI and cPD in the suprapatellar, medial and lateral parapatellar knee recesses. Knee pain and other symptoms were evaluated with the knee injury and osteoarthritis outcome score (KOOS). OA severity was assessed using the Kellgren and Lawrence grade (KLG) on radiograph and effusion-synovitis and Hoffa's synovitis score of MRI osteoarthritis knee score on non-contrast-enhanced MRI sequences. The χ2 test and κ statistics were conducted to compare detectability of SMI and cPD for low-grade inflammation, and the Spearman's correlation and Fisher's r to z transformation were conducted to compare correlations of both techniques with symptoms and imaging severity. A total of 89 participants were included in the analyses. SMI increased the detection rate by 25.5% for grade 0 cPD, by 35.4% for grade 1 cPD and by 9% for grade 2 cPD. SMI showed significant correlations with KOOS symptoms, KLG, MRI effusion-synovitis and Hoffa's synovitis scores (r = -0.24 [-0.45, -0.01]; r = 0.31 [0.10, 0.50]; r = 0.49 [0.33, 0.63]; and r = 0.54 [0.37, 0.68]). The cPD was significantly correlated with KOOS pain, other symptoms, MRI effusion-synovitis and Hoffa's synovitis (r = -0.23 [-0.44, -0.01]; r = -0.29 [-0.49, -0.06]; r = 0.46 [0.28, 61], r = 0.46 [0.25, 0.63]). However, no significant differences were detected in their extent of correlations. SMI can detect low-grade inflammation implicated in OA disease better than cPD and reveal a significant correlation with symptoms, radiographic features and MRI synovitis. The added clinical value of SMI over cPD is still not clear.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia.
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St. Leonards, Sydney, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Shirley Yu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
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Bordes SJ, Murray IVJ, Sylvester JA. Atypical presentation of acute rheumatic fever (ARF) in a 25-year-old woman in the Caribbean: a challenging diagnosis. BMJ Case Rep 2020; 13:e231888. [PMID: 32041756 PMCID: PMC7021172 DOI: 10.1136/bcr-2019-231888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old woman presented a challenging diagnosis of acute rheumatic fever (ARF). Initial symptoms included dry cough and three minor Jones criteria (unabating fever (38.4°C, 0d), elevated acute phase reactants (C-reactive protein, 13d) and joint pain (monoarthralgia) in her neck (0d)). ARF was diagnosed only after presentation of two major Jones criteria (polyarthritis/polyarthralgia (16d) and erythema marginatum (41d)) and positive antistreptolysin O titre (44d). Parotid swelling, peripheral oedema, elevated liver enzymes and diffuse lymphadenopathy complicated the diagnosis. Throat swab, chorea and carditis were negative or absent. Atypical ARF is challenging to recognise. There is no diagnostic test and its presentation is similar to that of other diseases. While the 2015 Jones criteria modification increased specificity of ARF diagnosis, atypical cases may still be missed, especially by physicians in developed countries. Suspicion of atypical ARF, especially after travel to high incidence regions, would allow for earlier treatment and prevention of rheumatic heart disease.
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Affiliation(s)
- Stephen John Bordes
- Department of Anatomical Sciences, Medical Student Research Institute, St. George's University School of Medicine, St. George's, Grenada
| | - Ian Victor Joseph Murray
- Department of Medical Physiology Physiology, Engineering Medicine, Texas A&M University, Houston, Texas, USA
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Larios-Forte MDC, García-Coronado JM, Skinner-Taylor CM, Esquivel-Valerio JA, Vega-Morales D, Vilchez-Cavazos F, Quiroga-Garza A, Elizondo-Omaña RE. The very early inflammatory triquetral lesion by MRI - is this the first sign in Rheumatoid Arthritis? Acta Reumatol Port 2019; 44:218-224. [PMID: 31300634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION/AIM Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before. METHODS We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist. RESULTS Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15). CONCLUSION Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.
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Affiliation(s)
| | | | | | | | - David Vega-Morales
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González"
| | - Felix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González"
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Wang S, Wang X, Liu Y, Sun X, Tang Y. Ultrasound-guided intra-articular triamcinolone acetonide injection for treating refractory small joints arthritis of rheumatoid arthritis patients. Medicine (Baltimore) 2019; 98:e16714. [PMID: 31415364 PMCID: PMC6831351 DOI: 10.1097/md.0000000000016714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the efficiency and clinical safety of intra-articular triamcinolone acetonide (TA) injection under the guide of ultrasonography combined with standard treatment for treating refractory small joints arthritis in rheumatoid arthritis (RA) patients.TA was injected upon confirmation of the needle inserting into the articular cavity. The dose was 40 mg for the wrist, 20 mg for the metacarpophalangeal (MCP) joint and 20 mg for the proximal interphalangeal (PIP) joint, respectively. Visual analogue scale (VAS) for joint pain, swelling, tenderness, synovial hyperplasia and power Doppler signal scores were evaluated at pretreatment, and post-treatment 24 hours, 1 week, 4 weeks as well as 12 weeks.The VAS for pain and tenderness scores showed gradual improvement at 24 hours, 1 week, 4 weeks and 12 weeks after treatment compared with the baseline levels (P' < .005). The swelling showed no changes at 24 hours after treatment compared with the baseline, and showed gradual improvement at 1 week, 4 weeks and 12 weeks after treatment (P' < .005). Significant decrease was noticed in the synovial hyperplasia score at 4 weeks and 12 weeks compared with the baseline level. Power Doppler signal score showed significant decrease at post-treatment 24 hours, which showed further decrease at 1 week and 4 weeks.Ultrasound-guided intra-articular TA injection is effective for treating RA patients with refractory small joints arthritis without changing the original treatment plan.
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Mallon S, Bussis K, Beswick Z, North WT, Soliman SB. Ultrasonographic and radiographic findings of polyethylene component displacement with severe metallosis and metal-induced synovitis following total knee arthroplasty. Knee 2019; 26:941-950. [PMID: 31255527 DOI: 10.1016/j.knee.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/07/2019] [Accepted: 06/01/2019] [Indexed: 02/02/2023]
Abstract
Aseptic loosening and wear is second to only infection as the most common cause of arthroplasty failure. Degeneration of the polyethylene and metal arthroplasty components can lead to metallosis, which can cause a combination of direct cytotoxic effects and an inflammatory response within the synovial and periarticular tissues. This can result in bone resorption and secondary arthroplasty component loosening as well as a metal containing joint effusion and metal-induced synovitis. Little literature exists as to the ultrasonographic findings of metal-induced synovitis and polyethylene component displacement. As the use of musculoskeletal ultrasound significantly increases, being aware of these findings is important. The most important ultrasonographic findings include differentiating a joint effusion from synovitis utilizing dynamic compression, identifying areas of echogenic shadowing related to metal deposition and visualizing displaced arthroplasty components. The following is a case report that demonstrates the ultrasonographic imaging findings of metallosis, metal-induced synovitis and polyethylene component displacement. We will also demonstrate the ultrasound-guided aspiration findings as well as radiographic and gross pathologic correlations.
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Affiliation(s)
- Shane Mallon
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA
| | - Kyle Bussis
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA
| | - Zachary Beswick
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA
| | - W Trevor North
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
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Lee KA, Min SH, Kim TH, Lee SH, Kim HR. Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med 2019; 34:651-659. [PMID: 29166759 PMCID: PMC6506727 DOI: 10.3904/kjim.2016.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/22/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Magnetic resonance imaging (MRI) is a sensitive and useful method for the detection of synovitis and joint destruction in rheumatoid arthritis (RA) patients. However, the patterns of MRI-detected bone erosion, bone marrow edema (BME), synovitis, and tenosynovitis have received insufficient attention. Therefore, this study evaluated the patterns of bone erosion, BME, synovitis, and tenosynovitis, and calculated the RA-MRI score (RAMRIS) of patients with RA at the carpal and metacarpophalangeal (MCP) joints using MRI. METHODS MRI datasets from 43 RA patients were analyzed. All patients had undergone MRI of one wrist. In addition, 36 patients had MCP joint images taken, and three had also received MRI of the contralateral wrist and MCP joints. The MR images were evaluated for bone erosion, BME, and synovitis in consensus by two blinded readers according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RAMRIS. The MRI-detected tenosynovitis was evaluated based on Haavardsholm's tenosynovitis score. RESULTS The capitate, lunate, triquetrum, and hamate bones were the most common sites of erosion and BME and showed the highest RAMRIS erosion and BME scores. Moreover, MRI-detected tenosynovitis was present in 78.3% of all patients with RA, and the extensor compartment 4 and flexor digitorum profundus and superficialis were frequently affected. CONCLUSION This study identified the distribution and prevalence of MRI-detected bone erosion, BME, synovitis, and tenosynovitis of the wrist and MCP joints in RA patients. The patterns of the MRI-detected abnormalities may help to select sites for the application of MRI protocols in clinical trials and practice.
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Affiliation(s)
- Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Ho Min
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
- Correspondence to Hae-Rim Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: + 82-2-2030-7542 Fax: + 82-2-2030-7748 E-mail:
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Xiao L, Lin S, Zhan F. The association between serum uric acid level and changes of MRI findings in knee osteoarthritis: A retrospective study (A STROBE-compliant article). Medicine (Baltimore) 2019; 98:e15819. [PMID: 31124983 PMCID: PMC6571402 DOI: 10.1097/md.0000000000015819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to examine whether Magnetic resonance imaging (MRI) features of knee osteoarthritis (OA) had an association with the level of serum uric acid (SUA). The MRI of the OA patients from June 2015 to July 2017 were studied. The patients fulfilled the following inclusion criteria: 1) meet American College of Rheumatology (ACR) radiological and clinical criteria for OA of the knee, 2) age ≤ 65years old, 3) Body mass index (BMI) < 25 kg/m. Patients with OA were categorized into two groups based on the level of SUA. Patients with SUA level lower than 360 umol/L were recruited into the first group and the others were the second group. Odds ratios (OR) and 95% confidence intervals (CI) for SUA level and different MRI patterns were estimated with multivariable logistic regression.71 patients were included in this research. The mean age of the first group was 54.5 ± 8.4 and the second group was 55.6 ± 6.4. The Body Mass Index (BMI) of two groups was 22.7 ± 1.3 and 23.23 ± 1.9 separately. The mean SUA and creatinine (CR) level of the second group were 433.8 ± 70.6 umol/L and 80.1 ± 23.9 umol/L. There were statistically more focal erosions, osteophytes, bone marrow lesions and synovitis in the MRIs of the second group. A positive association between SUA level and synovitis as well as soft tissue swelling in MRIs was observed in patients with knee OA (OR = 1.017; 1.008, 95% CI: 1.007-1.028; 1.000-1.016). In conclusion, subjects with higher SUA level were more likely to have MRI abnormalities. OA patients need to lower their SUA level in order to keep the disease from progressing.
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Abstract
Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.
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Affiliation(s)
- Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital
| | | | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Abstract
Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].
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Powell B, Szleifer I, Dhaher YY. In silico study of principal sex hormone effects on post-injury synovial inflammatory response. PLoS One 2018; 13:e0209582. [PMID: 30596697 PMCID: PMC6312367 DOI: 10.1371/journal.pone.0209582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
Abstract
Following an anterior cruciate ligament injury, premenopausal females tend to experience poorer outcomes than males, and sex hormones are thought to contribute to the disparity. Evidence seems to suggest that the sex hormones estrogen, progesterone, and testosterone may regulate the inflammation caused by macrophages, which invade the knee after an injury. While the individual effects of hormones on macrophage inflammation have been studied in vitro, their combined effects on post-injury inflammation in the knee have not been examined, even though both males and females have detectable levels of both estrogen and testosterone. In the present work, we developed an in silico kinetic model of the post-injury inflammatory response in the human knee joint and the hormonal influences that may shape that response. Our results indicate that post-injury, sex hormone concentrations observed in females may lead to a more pro-inflammatory, catabolic environment, while the sex hormone concentrations observed in males may lead to a more anti-inflammatory environment. These findings suggest that the female hormonal milieu may lead to increased catabolism, potentially worsening post-injury damage to the cartilage for females compared to males. The model developed herein may inform future in vitro and in vivo studies that seek to uncover the origins of sex differences in outcomes and may ultimately serve as a starting point for developing targeted therapies to prevent or reduce the cartilage damage that results from post-injury inflammation, particularly for females.
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Affiliation(s)
- Bethany Powell
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
- Department of Mechanical Engineering and Bioengineering, Valparaiso University, Valparaiso, IN, United States of America
| | - Igal Szleifer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
- Department of Chemistry, Northwestern University, Evanston, IL, United States of America
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, United States of America
| | - Yasin Y. Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Sigaux J, Abdelkefi I, Bardin T, Laredo JD, Ea HK, UreñaTorres P, Cohen-Solal M. Tendon thickening in dialysis-related joint arthritis is due to amyloid deposits at the surface of the tendon. Joint Bone Spine 2018; 86:233-238. [PMID: 30243785 DOI: 10.1016/j.jbspin.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Beta-2-microglobulin (β2M) dialysis-related amyloidosis (DRA), a disabiliting joint disease, has been initially reported in patients under long-term dialysis. The incidence and prevalence has significantly decreased with the improvement in dialysis techniques. Here, we attempted to clarify the clinical and MRI features to improve the diagnosis. METHODS We retrospectively reviewed the files of 19 patients under dialysis treatment referred for suspicion of β2M DRA. The diagnosis was based on MRI criteria (low signal intensity on both T1- and T2-weighted MR sequences). MRI analysis included a scoring of the several joint lesions. Scores were quantified according to a severity scale (0 to 3). RESULTS Patients had a mean age of 66.0 ± 10.5 years and mean dialysis duration of 23.7 ± 10.5 years. DRA affected mainly large joints (shoulder in 73.7%, hip in 47.3%) and spine (36.8%). MRI images for 8 shoulders, 8 hips, and 3 spines were analysed. Amyloid synovitis was present in all cases, with high mean scores in the three sites. In all joints, the most common lesions were tendon thickening (68.4%) and bone erosions (68.4%). The mean tendon thickening score was high, particularly at the shoulders and also at the spine. Bone erosions were most frequent in the shoulder and pelvis. CONCLUSION In patients under long-term dialysis, β2M DRA involves large joints but also the spine. Special awareness should be drawn by the thickening of the tendon. MRI is required to characterize the pattern of the lesions and to achieve the diagnosis.
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Affiliation(s)
- Johanna Sigaux
- Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France
| | - Imen Abdelkefi
- Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France
| | - Thomas Bardin
- Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France
| | - Jean-Denis Laredo
- Department of bone and joint imaging, hôpital Lariboisière and university, 75010 Paris, France
| | - Hang-Korng Ea
- Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France
| | - Pablo UreñaTorres
- Ramsay-Générale de santé, clinique du Landy, 93400 Saint Ouen, France; Department of nephrology and dialysis and department of renal physiology, necker hospital, 75015 Paris, France; University of Paris Descartes, 75006 Paris, France
| | - Martine Cohen-Solal
- Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France.
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Jeka S, Dura M, Zuchowski P, Zwierko B, Waszczak-Jeka M. The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy. ADV CLIN EXP MED 2018; 27:1303-1307. [PMID: 30016010 DOI: 10.17219/acem/69133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue. It is characterized by symmetrical multiple joint involvement and extra-articular symptoms. Modern RA treatment methods place a particular emphasis on the earliest possible diagnosis and initiation of appropriate treatment. Currently, ultrasonography (US) is the key imaging test performed in RA patients. However, despite the general acknowledgement of its role in the assessment of disease activity, US was not included in the applicable ACR/EULAR criteria. This is due to the lack of strictly defined criteria for US evaluation and the interpretation of test results. In addition, the absence of a correlation between the common DAS/DAS28 disease activity score and ultrasound assessment of joints makes developing new diagnostic criteria difficult. The objective of this article is to review recent scientific reports on the use of ultrasonography in the diagnosis and monitoring of RA and to indicate current problems associated with the interpretation of test results and the comparison with applicable scores of disease activity.
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Affiliation(s)
- Sławomir Jeka
- Clinic of Rheumatology and Systemic Connective Tissue Disorders, Jan Biziel University Hospital No. 2, Ludwik Rydygier Collegium Medicum in Bydgoszcz, UMK in Toruń, Poland
| | - Marta Dura
- Department of Radiology, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Zuchowski
- Clinic of Rheumatology and Systemic Connective Tissue Disorders, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
| | - Beata Zwierko
- Department of Radiology, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
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Ahsan T, Erum U, Dahani A, Khowaja D. Clinical and immunological profile in patients with mixed connective tissue disease. J PAK MED ASSOC 2018; 68:959-962. [PMID: 30323370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis.
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Affiliation(s)
- Tasnim Ahsan
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
| | - Uzma Erum
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
| | | | - Danish Khowaja
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
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Wu H, Wu H, He Y, Gan Z, Xu Z, Zhou M, Liu S, Liu H. Synovitis in mice with inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced NIR fluorescence imaging using iRGD-targeted liposomes as fluorescence probes. Int J Nanomedicine 2018; 13:1841-1850. [PMID: 29615837 PMCID: PMC5870656 DOI: 10.2147/ijn.s155475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a common inflammatory disorder characterized primarily by synovitis and pannus formation in multiple joints, causing joints destruction and irreversible disability in most cases. Early diagnosis and effective therapy monitoring of RA are of importance for achieving the favorable prognosis. METHODS We first prepared the targeted fluorescence probes, and then explored the feasibility of near-infrared (NIR) fluorescence molecular imaging to detect and evaluate the RA via the targeted fluorescence probes by quantitative analysis in this study. RESULTS The targeted fluorescence probes (indocyanine green-liposomes decorated with iRGD peptide [iLPs]) was successfully prepared. The quantitative analysis found that strong fluorescence signal was detected in inflamed paws and the fluorescence signal in iLPs group was 3.03-fold higher than that in non-targeted (indocyanine green-liposomes decorated without iRGD peptide [LPs]) group (P<0.01) at 15 min after injection, whereas the fluorescence signal from iLPs signal can almost not be observed in the non-inflamed paws, showing the high sensitivity and accuracy for arthritis by the NIR fluorescence imaging based on iLPs. CONCLUSION The NIR fluorescence imaging by iLPs may facilitate improved arthritis diagnosis and early assessment of the disease progression by providing an in vivo characterization of angiogenesis in inflammatory joint diseases.
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Affiliation(s)
- Hao Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haohan Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Zhen Gan
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhili Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Meijun Zhou
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Sai Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
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Kempers AC, Nejadnik MR, Rombouts Y, Ioan-Facsinay A, van Oosterhout M, Jiskoot W, Huizinga TWJ, Toes REM, Scherer HU. Fc gamma receptor binding profile of anti-citrullinated protein antibodies in immune complexes suggests a role for FcγRI in the pathogenesis of synovial inflammation. Clin Exp Rheumatol 2018; 36:284-293. [PMID: 29352854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Anti-citrullinated protein antibodies (ACPA) are highly specific for rheumatoid arthritis (RA). Here, we studied binding of ACPA-IgG immune complexes (IC) to individual Fc gamma receptors (FcγR) to identify potential effector mechanisms by which ACPA could contribute to RA pathogenesis. METHODS ACPA-IgG1 and control IgG1(IgG1 depleted of ACPA-IgG1) were isolated from plasma and synovial fluid (SF) of RA patients by affinity chromatography using CCP2 peptides. Subsequently, IC were generated using fluorescently labelled F(ab')2 fragments against the F(ab')2 region of IgG, or by using citrullinated fibrinogen. IC were incubated with FcγR-transfected CHO cell lines or neutrophils from healthy donors. FcγR binding of IC was analysed by flow cytometry in the presence or absence of specific blocking antibodies. RESULTS ACPA-IgG1 IC predominantly bound to FcγRI and FcγRIIIA on FcγR-transfected CHO cell lines, while much lower binding was observed to FcγRIIA and FcγRIIB. ACPA-IgG1 IC showed reduced binding to FcγRIIIA compared to control IgG1 IC, in line with enhanced ACPA-IgG1 Fc core-fucosylation. Neutrophils activated in vitro to induce de novo expression of FcγRI showed binding of ACPA-IgG IC, and blocking studies revealed that almost 30% of ACPA-IgG IC binding to activated neutrophils was mediated by FcγRI. CONCLUSIONS Our studies show that ACPA-IgG1 IC bind predominately to activating FcγRI and FcγRIIIA, and highlight FcγRI expressed by activated neutrophils as relevant receptor for these IC. As neutrophils isolated from SF exhibit an activated state and express FcγRI in the synovial compartment, this IC-binding could contribute to driving disease pathogenesis in RA.
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Affiliation(s)
- Ayla C Kempers
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - M Reza Nejadnik
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Yoann Rombouts
- Department of Rheumatology, Leiden University Medical Center; Center for Proteomics and Metabolomics, Leiden University Medical Center; and Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, France
| | | | | | - Wim Jiskoot
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Hans Ulrich Scherer
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.
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Abstract
Nine patients had attacks of joint pain and sometimes swelling precipitated by certain foods or associated with allergic manifestations. All were atopic subjects--three having strong evidence of Type I (immediate) allergy and three 'urticarial arthralgia', in which attacks of severe urticaria and joint pain occurred coincidentally. Food allergy appeared to be responsible for the joint symptoms in three patients and in one it was possible to precipitate swelling of a knee due to synovitis with effusion by drinking milk a few hours beforehand, the synovial fluid having mildly inflammatory features and a relatively high eosinophil count. It seems that allergy is an occasional cause of episodic rheumatic pain or synovitis in certain atopic patients, whether or not they have an underlying arthritis. These are usually Type I hypersensitivity reactions, though it is thought that some food-allergic reactions are immune complex-mediated.
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Affiliation(s)
- D N Golding
- Rheumatology Unit, Princess Alexandra Hospital, Harlow, Essex
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45
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Sarkar R, Paul R, Roy D, Thakur I, Lahiri G, Sau TJ, Ghosh R. Remitting Seronegative Symmetrical Synovitis with Pitting Edema Associated with Gastric Carcinoma. J Assoc Physicians India 2018; 66:106-107. [PMID: 30341859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | | | | | | | - Tanmay Jyoti Sau
- Professor, Dept. of Medicine, Medical College, Kolkata, West Bengal
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Hassan EA, Lambrechts NE, Weng HY, Snyder PW, Breur GJ. Effects of denervation of the hip joint on results of clinical observations and instrumented gait analysis in dogs with sodium urate crystal-induced synovitis. Am J Vet Res 2016; 77:1200-1210. [PMID: 27805445 DOI: 10.2460/ajvr.77.11.1200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of selective hip joint denervation on gait abnormalities and signs of hip joint pain in dogs. ANIMALS 6 healthy adult hound-type dogs. PROCEDURES Minimally invasive denervation was performed on the right hip joint of each dog. Two weeks later, sodium urate was injected into the right hip joint to induce synovitis. Dogs were evaluated clinically and by use of instrumented gait analysis before and 2 weeks after minimally invasive denervation and 4, 8, and 24 hours after induction of synovitis. Dogs were euthanized, and necropsy and histologic examination were performed. RESULTS No kinetic or kinematic gait modifications were detected 2 weeks after minimally invasive denervation. Denervation did not eliminate signs of pain and lameness associated with sodium urate-induced synovitis. Results of histologic examination confirmed that denervation was an effective method for transecting the innervation of the craniolateral and caudolateral aspects of the hip joint capsule. CONCLUSIONS AND CLINICAL RELEVANCE In this study, minimally invasive denervation did not result in gait modifications in dogs. Denervation did not abolish the signs of pain and lameness associated with generalized induced synovitis of the hip joint. Further studies are required before conclusions can be drawn regarding the clinical usefulness of hip joint denervation for dogs with hip dysplasia.
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Resnick CM, Vakilian PM, Kaban LB, Peacock ZS. Quantifying the Effect of Temporomandibular Joint Intra-Articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2016; 74:2363-2369. [PMID: 27474460 DOI: 10.1016/j.joms.2016.06.189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To quantify the effect of intra-articular steroid injections (IASIs) on temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA) using gadolinium-enhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS The present study was a retrospective study of children with JIA who had undergone TMJ IASIs at Boston Children's Hospital. The patients were included if they had undergone contrast-enhanced MRI both before and after IASI and if the pre-IASI MRI had demonstrated synovitis (enhancement ratio [ER] >1.55). Patients with TMJ pathology or pain unrelated to JIA or a history of facial trauma were excluded. The predictor variables were age, gender, JIA subtype, exposure to medications for arthritis, and a family history of autoimmune disease. The primary outcome variable was the ER. Additional outcome variables included patient-reported pain and the maximal incisal opening (MIO). RESULTS Twenty-nine subjects (83% female) with a total of 50 injected TMJs were included. The average age at JIA diagnosis and at IASI was 6.8 ± 1.7 years and 12.1 ± 1.9 years, respectively. The mean follow-up period was 22.9 ± 4.3 months (range 5 to 48). The ER decreased in all injected joints, with a mean reduction of 1.05 ± 1.01 (P < .001). The post-IASI ER was less than the normal threshold (1.55) in 18% of the injected TMJs. IASI was associated with an elimination of pain in 89% of the subjects (P < .001) and in augmentation of the MIO by 5.8 ± 2.6 mm (P < .001). CONCLUSIONS In children with JIA and TMJ synovitis, TMJ IASI was associated with a reduction in synovial enhancement, decreased pain, and an increased MIO. Only 18% of injected joints, however, experienced complete resolution of synovitis. These results support the use of IASI in the management of the pain and dysfunction associated with TMJ synovitis. Further study is required to determine the efficacy of IASI in limiting inflammation and future joint destruction.
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Affiliation(s)
- Cory M Resnick
- Attending Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital; Instructor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
| | | | - Leonard B Kaban
- Visiting Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Walter C. Guralnick Distinguished Professor, Harvard School of Dental Medicine, Boston, MA
| | - Zachary S Peacock
- Associate Visiting Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Assistant Professor, Harvard School of Dental Medicine, Boston, MA
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Abrams GD, Luria A, Carr RA, Rhodes C, Robinson WH, Sokolove J. Association of synovial inflammation and inflammatory mediators with glenohumeral rotator cuff pathology. J Shoulder Elbow Surg 2016; 25:989-97. [PMID: 26775747 DOI: 10.1016/j.jse.2015.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/06/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that patients with full-thickness rotator cuff tears would have greater synovial inflammation compared with those without rotator cuff tear pathology, with gene expression relating to histologic findings. METHODS Synovial sampling was performed in 19 patients with full-thickness rotator cuff tears (RTC group) and in 11 patients without rotator cuff pathology (control group). Cryosections were stained and examined under light microscopy and confocal fluorescent microscopy for anti-cluster CD45 (common leukocyte antigen), anti-CD31 (endothelial), and anti-CD68 (macrophage) cell surface markers. A grading system was used to quantitate synovitis under light microscopy, and digital image analysis was used to quantify the immunofluorescence staining area. Quantitative polymerase chain reaction was performed for validated inflammatory markers. Data were analyzed with analysis of covariance, Mann-Whitney U, and Spearman rank order testing, with significance set at α = .05. RESULTS The synovitis score was significantly increased in the RTC group compared with controls. Immunofluorescence demonstrated significantly increased staining for CD31, CD45, and CD68 in the RTC vs control group. CD45+/68- cells were found perivascularly, with CD45+/68+ cells toward the joint lining edge of the synovium. Levels of matrix metalloproteinase-3 (MMP-3) and interleukin-6 were significantly increased in the RTC group, with a positive correlation between the synovitis score and MMP-3 expression. CONCLUSIONS Patients with full-thickness rotator cuff tears have greater levels of synovial inflammation, angiogenesis, and MMP-3 upregulation compared with controls. Gene expression of MMP-3 correlates with the degree of synovitis.
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Affiliation(s)
- Geoffrey D Abrams
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA; VA Palo Alto Healthcare System, Palo Alto, CA, USA.
| | - Ayala Luria
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | | | | | - William H Robinson
- VA Palo Alto Healthcare System, Palo Alto, CA, USA; Division of Immunology/Rheumatology, Stanford University, Stanford, CA, USA
| | - Jeremy Sokolove
- VA Palo Alto Healthcare System, Palo Alto, CA, USA; Division of Immunology/Rheumatology, Stanford University, Stanford, CA, USA
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Merolli A, Rocchi L, De Spirito M, Federico F, Morini A, Mingarelli L, Fanfani F. Debris of carbon-fibers originated from a CFRP (pEEK) wrist-plate triggered a destruent synovitis in human. J Mater Sci Mater Med 2016; 27:50. [PMID: 26758897 DOI: 10.1007/s10856-015-5664-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/29/2015] [Indexed: 06/05/2023]
Abstract
Application of carbon-fiber-reinforced-polymer (CFRP) artifacts in humans has been promoted in Orthopedic and Trauma Surgery. Literature documents the biocompatibility of materials used, namely carbon fibers (CF) and poly-ether thermoplastics, like poly-ether-ether-ketone (PEEK). A properly designed and accurately implanted composite artifact should not expose its fibers during or after surgery: however this may happen. A white Caucasian woman came to our attention 11 months after surgery for a wrist fracture. She had a severe impairment, being unable to flex the thumb; index finger and distal phalanx of third finger. We retrieved a correctly positioned plate and documented an aggressive erosive flexor tendons synovitis with eroded stumps of flexor tendons. The plate and soft tissues were analyzed by Visible Light and Scanning Electron Microscopy. Histopathology showed granulomatous fibrogenic process with CF engulfed inside multinucleated giant cells. Fibers were unmasked and disrupted inside the holes where screws were tightened and corrugation of the polymer coating led to further unmasking. The mechanism of foreign-body reaction to CF has not been studied in depth yet, particularly at the ultrastructural level and in Humans. This case documents a damage occurred in a clinical application and which was theoretically possible. Our opinion is that a proper way to promote the use of CRFP in the Clinic in the short term is to direct Research towards finding a better way to prevent CF debris to be exposed and released. In the longer term, the biological response to CF deserves a deeper understanding.
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Affiliation(s)
- Antonio Merolli
- Orthopedic and Trauma Surgery, Policlinico Gemelli, Clinica Ortopedica, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy.
| | - Lorenzo Rocchi
- Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Central Laboratory for Microscopy, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Federico
- Service for Histopathology, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Morini
- Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Mingarelli
- Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
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Abstract
In the United States, Lyme arthritis is the most common feature of late-stage Borrelia burgdorferi infection, usually beginning months after the initial bite. In some, earlier phases are asymptomatic and arthritis is the presenting manifestation. Patients with Lyme arthritis have intermittent or persistent attacks of joint swelling and pain in 1 or a few large joints. Serologic testing is the mainstay of diagnosis. Synovial fluid polymerase chain reaction for B burgdorferi DNA is often positive before treatment, but is not a reliable marker of spirochetal eradication after therapy. This article reviews the clinical manifestations, diagnosis, and management of Lyme arthritis.
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Affiliation(s)
- Sheila L Arvikar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Allen C Steere
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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