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PubMed1981

Corticosteroid and hyaluronic acid treatments in equine degenerative joint disease. A review.

Degenerative arthrosis is perhaps the most common debilitating disease of performance horses. Treatment should be based upon a knowledge of the anatomy and physiology of normal joints and upon an understanding of the processes of degeneration and repair. These topics are briefly reviewed. Although rest is probably, the most beneficial therapy, physical and pharmaceutical treatments are often employed in an effort to speed recovery. The effects and relative benefits of intrasynovial injections of corticosteroids, hyaluronica cid, and Arteparon are considered in detail. Although local corticosteroid therapy is inexpensive and is effective in reducing lameness caused by degenerative joint disease, it is rarely indicated. Septic arthritis and "steroid arthropathy" are two serious sequelae. Whereas the incidence of the former may be avoided through careful technique, the latter effect is inherent in the action of the drug. The accelerated rate of joint destruction observed in steroid arthropathy is due to suppression of chondrocyte metabolism and thus the processes of cartilage maintenance and repair. Hyaluronic acid is present in the synovial fluid and within the matrix of cartilage. The commercial preparation is no approved for use in the United States, but it is commonly obtained from other countries. Although hyaluronate apparently does not function in the lubrication of cartilage surfaces, it may improve lubrication of soft tissues thus decreasing resistance to joint movement and lessening pain. Reports substantiate the effectiveness of hyaluronic acid in treating early cases of degenerative arthrosis despite the fact that the drug does not significantly promote cartilage healing. Arteparon, a polysulfated glycosaminoglycan, has been used in Europe for two decades in the treatment of degeneration joint disease and is currently being tested in this country. The drug is deposited within diseased cartilage and improves the functional properties of the cartilage as well as stimulates cartilage metabolism.

Adrenal Cortex Hormones↗
PubMed1999

[Radiosynoviorthesis in the treatment plan of chronic inflammatory joint diseases].

UNLABELLED: The effectiveness of radiosynovirothesis in the local treatment of chronically inflammatory joint diseases, especially rheumatoid arthritis, was evaluated. SUBJECTS AND METHODS: Follow-up examinations of 415 joints in 115 patients up to 4.5 years after intraarticular application of beta-emitting yttrium-90, rhenium-186, and erbium-169 were evaluated. The examination protocol included estimation of joint circumference, range of active joint moving capability, fist-bending power, and radiological assessment of joint destruction. Subjective assessment of pain, swelling, and joint function by the patients was evaluated by means of a score with three levels. RESULTS: The mean range of active joint moving capability increased in all joint subgroups, compared with the initial examination, with exception of ankle joints examined more than 30 months after therapy. The mean joint circumference decreased in all joint subgroups. Good to excellent results were achieved in up to 66% of joints, satisfying results in up to 21%, and no improvement or further deterioration was noted in 13% according to subjective assessment by patients themselves. Treatment proved most effective in joints with poor or no alteration in X-ray examinations. CONCLUSIONS: In the local treatment of chronically inflammatory joint diseases--especially beyond systemic drug therapy and local corticoid therapy--, radiosynoviorthesis is a low-invasive method, which may provide long-term relief of pain and swelling as well as improvement of joint function.

Adult↗
PubMedDate not supplied

[Prostaglandin and leukotriene release of synovial tissue in various joint diseases].

Synovial tissue from 37 patients suffering from osteoarthritis, chondrocalcinosis, active and inactive rheumatoid arthritis was investigated. The tissue was obtained during knee surgery and immediately incubated in tyrode solution. PGE2, 6-keto-PGF1 alpha, LTB4 and LTC4 were measured by radioimmunoassay. Calcium ionophore A 23187 stimulated the eicosanoid release significantly. This effect was more pronounced with LT than with PG. In the four different joint diseases there was no significant difference in the PG release. The LTC4 release was significantly lower in inactive rheumatoid arthritis as compared to the other joint diseases. For LTB4 this effect was significant only when compared to osteoarthritis. Indomethacin 10(-5) and 10(-7)mol/l inhibited the PG release from synovial tissue in all joint diseases significantly (p less than 0.05), there was no significant effect on the LT release. LT as well as PG are pro-inflammatory mediators. Non-steroidal anti-inflammatory drugs inhibit only the PG release. The remaining LT synthesis might thus be partially responsible for the lack of efficacy of these drugs in some patients.

Adult↗
PubMed1991

Evaluation of knee joint cartilages and menisci in patients with chronic inflammatory joint diseases. A prospective arthroscopic study before, six and twelve months after open synovectomy.

Destruction of joint cartilage is an important feature in chronic inflammatory joint diseases. This article considers the areas of the cartilages of the knee joint prone to destructive changes, pannus growth and marginal erosions, and the changes of pattern after open synovectomy. Twenty-eight patients with chronic inflammatory joint disease which gave indication for synovectomy of the knee joint had arthroscopy immediately before, 6 and 12 months after open synovectomy. A method of grading the changes of the cartilage, pannus growth, menisci and marginal erosions is described. There was an increase in cartilage pathology 12 months after synovectomy (p less than 0.001), particularly on the weight bearing areas of the femur and on the tibial condyles. No significant deterioration in areas with pathology at the time of synovectomy was found in the follow up. Pannus growth was particularly located to areas 2 and 4 on the femoral condyles. We conclude that cartilage destruction after synovectomy is more likely to be a result of osteoarthrosis than arthritic changes.

Arthritis↗
PubMed1978

[Clinical assessment of the activity and results of therapy in joint diseases through cytologic examination of puncture fluids (author's transl)].

Activity and results of therapy of joint diseases can be evaluated by means of cytological examinations of the synovia which is at the same time a prerequisite for differential diagnosis using the puncture fluid. Our cytological examinations of more than 700 puncture fluids stemming from different joint diseases were carried out immediately after the puncture on the fresh material, in order to prevent misinterpretation. This may occur through flaking out in stored material, which results in decrease in the cell count and a non-representative differential cell picture in the supernatant, as well as through degeneration of cells. In two thirds of our patients the local process activity, measured in terms of the cytological phase of activity, became evident in the total clinical activity. The synovia analysis furthermore permits objective assessment of the result of intra-articular injection treatment. Intractable activity, substantiated through synovia examination indicates synovectomy.

Diagnosis, Differential↗
PubMed2003

Prevalence of joint disease in patients with psoriasis: implications for therapy.

Joint diseases are common among patients with psoriasis. Psoriatic arthritis, the most important of these, can be defined as a rheumatoid factor-negative inflammatory arthritis associated with psoriasis and has emerged as a specific disease independent from rheumatoid arthritis. Psoriatic arthritis is divided into several clinical subsets, which is helpful in differentiating it from other types of inflammatory arthritis. The prevalence of arthritis in patients with psoriasis may be far higher than the previously accepted average of 7%. In a recent study of 5,795 members of the Nordic Psoriasis Associations, the prevalence was found to be 30%. Arthritis has a significant impact on quality of life in patients with psoriasis. These factors should be recognised as they have implications for therapy, since a number of drugs can delay or stop joint damage when given in time. This also applies to the new biologic agents, although at present these therapies are generally restricted to patients non-responsive to other available drugs. Alone or in combination, the new drugs may achieve higher response rates and have better safety profiles than older therapies. However, long-term experience is still lacking and, unfortunately, the new drugs will be far from affordable by all for some time to come.

Arthritis, Psoriatic↗
PubMed2005

Analysis of cartilage oligomeric matrix protein (COMP) degradation and synthesis in equine joint disease.

REASONS FOR PERFORMING STUDY: Cartilage oligomeric matrix protein (COMP) is abundant within cartilage; its turnover and/or degradation have been investigated in various equine joint diseases and it has been suggested that COMP fragmentation might be useful for monitoring such conditions. OBJECTIVES: To determine whether COMP metabolism is compromised in equine osteoarthritis (OA) and whether COMP degradation is a useful joint marker representing cartilage destruction. HYPOTHESIS: A monoclonal antibody (mAb) with a higher affinity for degraded COMP allows discrimination of diseased joints by quantifying COMP levels and fragmentation. METHODS: A mAb (clone14G4) was generated against equine cartilage COMP. The NH2-terminal sequence of enzyme-cut COMP fragments recognised by 14G4 was determined, as was the efficiency of binding to COMP (using a generated COMP peptide). COMP concentration and fragmentation were analysed in synovial fluid (SF) from normal horses and those with OA. RESULTS: The mAb 14G4 had a higher affinity for the smaller fragments of equine COMP, compared with a mAb (clone 12C4) generated against human COMP. The 14G4 epitope was identified as between C134 and F147. The COMP values in OA (mean +/- s.d. 205.8 +/- 90.9 microg/ml) were significantly higher than in the normal (133.1 +/- 31.5 microg/ml) SF. On the immunoblots of OA sample, the proportions of intact COMP were significantly lower, while smaller fragments ranging from 75 to 290 kDa were higher compared with the normal SF. CONCLUSIONS AND POTENTIAL RELEVANCE: The mAb 14G4 reliably detects COMP degradation as well as synthesis, and fragmentation analysis combined with quantification in SF could be useful to study equine OA.

Animals↗
PubMed1995

[Are degenerative joint diseases chronic compartment syndromes?].

An increase of the intraosseous pressure is observed in the epiphyses of bones involved in degenerative joint disease. The increase of pressure may be caused by an accumulation of osmotically active substances in the interstitium as it has been described in case of the Compartment Syndrome. Based on the postulated pathophysiological mechanism a causative therapy of the degenerative joint disease is proposed.

Animals↗
PubMed2006

Cartilage tissue engineering for degenerative joint disease.

Pain in the joint is often due to cartilage degeneration and represents a serious medical problem affecting people of all ages. Although many, mostly surgical techniques, are currently employed to treat cartilage lesions, none has given satisfactory results in the long term. Recent advances in biology and material science have brought tissue engineering to the forefront of new cartilage repair techniques. The combination of autologous cells, specifically designed scaffolds, bioreactors, mechanical stimulations and growth factors together with the knowledge that underlies the principles of cell biology offers promising avenues for cartilage tissue regeneration. The present review explores basic biology mechanisms for cartilage reconstruction and summarizes the advances in the tissue engineering approaches. Furthermore, the limits of the new methods and their potential application in the osteoarthritic conditions are discussed.

Animals↗
PubMed1983

Fourier analysis of ground reaction forces in normals and patients with knee joint disease.

Fourier analysis was performed on the ground reaction force patterns during gait in 26 normals and 10 patients with knee joint disease prior to total knee replacement. A method was developed to determine the essential number of harmonics for each force component, based on data sampling rate and the level of accuracy required in reconstructing the original patterns. The criteria used to select the level of accuracy depend upon the type of analysis to be performed. Only the first two to four harmonics, plus the constant term, were found to be the dominating coefficients in describing each of the reaction force patterns, and they are subsequently used as the key parameters in differentiating normals and patients with knee joint disease. The advantages of this method and its implication to objective gait analysis in biomechanics are discussed.

Adult↗
PubMed2000

Degenerative joint disease in African great apes: an evolutionary perspective.

Degenerative joint disease is investigated in the spine and major peripheral joints (shoulder, elbow, hip and knee) in samples of chimpanzees (Pan troglodytes schweinfurthii; P. troglodytes troglodytes), lowland gorillas (Gorilla gorilla gorilla), and bonobos (P. paniscus). The P. troglodytes schweinfurthii sample comes from Gombe National Park, Tanzania, while the other samples are derived from museum materials originally collected in west/central Africa. Total data for African ape samples include 5807 surfaces for ascertainment of vertebral osteophytosis, 12,479 surfaces for determination of spinal osteoarthritis, and 1211 joints for evaluation of peripheral joint osteoarthritis. All apes display significantly less spinal disease than in a comparable human sample, and these differences are most likely a consequence of human biomechanical adaptations for bipedal locomotion. Apes are also generally less involved in the major peripheral joints than are humans, but human groups are themselves highly variable in prevalence of peripheral osteoarthritis. These data agree with other findings of low prevalence of degenerative joint prevalence in free-ranging apes, but contrast markedly with evidence derived from colony-reared Old World monkeys.

Africa↗
PubMed1996

Synovial fluid and serum concentrations of aminoterminal propeptide of type III procollagen in healthy volunteers and patients with joint disease.

OBJECTIVES: To analyse synovial fluid and serum concentrations of the amino-propeptide of the type III procollagen (PIIINP) in normal individuals and patients with joint disease, and to explore the relationship between synovial fluid PIIINP concentrations and the rheumatological diagnosis, local inflammation, and joint disease. METHODS: A radioimmunoassay was used to measure the PIIINP concentrations in serum and knee joint synovial fluid from 16 healthy volunteers and patients with osteoarthritis (OA) (n = 40), rheumatoid arthritis (RA) (n = 30), and psoriatic arthritis (PsA) (n = 12). The PIIINP measurements were related to demographic data, synovial fluid leucocyte counts, and radiographic changes at the knee. RESULTS: Serum PIIINP concentrations were greater in each of the disease groups than in control subjects, but there were no differences between the disease groups. Synovial fluid concentrations of PIIINP were much greater than those in serum, indicating local production, and were significantly greater in RA than in other disease groups (p < 0.001). There was only a weak positive correlation between synovial fluid leucocyte counts, some radiographic changes, and synovial fluid PIIINP concentrations. CONCLUSIONS: These data suggest that synovial fluid PIIINP concentrations may reflect local synovial proliferative processes in joint disease, and that they could be of diagnostic and prognostic value in inflammatory arthropathies.

Adult↗
PubMed1985

Audit of closed synovial biopsy in the diagnosis of inflammatory joint disease.

In a prospective study, the clinical features and synovial histopathology of 78 patients with joint disease were compared. Nineteen patients had early rheumatoid disease, 19 chronic rheumatoid, 17 chondrocalcinosis or osteoarthritis, 10 persistent monoarthritis and 14 other miscellaneous arthropathies. After semiquantitative assessment of the degree of inflammatory infiltration, increase in vascularity, synovial hypertrophy and ulceration and fibrin deposition biopsies were categorized as either normal, or slightly or severely abnormal. The highest incidence of severely abnormal biopsy was in patients with chronic rheumatoid disease and miscellaneous forms of arthritis. Major histological abnormalities were uncommon in osteoarthritis, chondrocalcinosis and persistent monoarthritis. Generally, histology was of little help in differential diagnosis, but in early rheumatoid disease there was a relationship between the clinical degree of knee joint disease and the category of histological change. In these patients, general disease activity was reassessed at least 18 months after biopsy. All those with severely abnormal biopsies had persistent or severe persistent rheumatoid disease, whereas 3 of the 4 patients with normal biopsies had no evidence of active synovitis.

Arthritis↗
PubMed1990

Proteoglycans of articular cartilage: changes in aging and in joint disease.

In human osteoarthritis and animal models of degenerative joint disease, damage to the structure of cartilage proteoglycan is a central event. Loss of proteoglycan from the matrix alters the physicochemical properties of the tissue, but the pathological process and biochemical mechanisms that lead to this loss are poorly understood. This review examines the present state of knowledge regarding proteoglycan structure and the changes that occur in aging and osteoarthritis. It also discusses how these studies will influence the development of new methods for measuring cartilage breakdown.

Aging↗
PubMed2002

Evaluation of a cranial arthroscopic approach to the stifle joint for the treatment of femorotibial joint disease in horses: 23 cases (1998-1999).

OBJECTIVE: To describe a single-portal cranial arthroscopic approach to the stifle joint in horses and to determine the clinical outcome in horses with femorotibial joint disease in which this approach was used. DESIGN: Retrospective study. ANIMALS: 23 adult horses. PROCEDURE: Medical records were reviewed to obtain information on clinical outcome in horses in which the single-portal cranial arthroscopic approach was used. RESULTS: Twenty-nine stifle joints of 23 horses were examined arthroscopically, using the described approach. Subchondral bone cysts were treated in 19 medial femoral condyles of 12 horses. Unilateral cruciate ligament desmitis (4 horses), meniscal tearing (3), or both (2) were identified in 9 horses. Evidence of degenerative joint disease without cystic lesions or soft tissue trauma was found in 2 horses. Information on clinical outcome was obtained for 21 of 23 horses. A successful outcome was obtained in 15 of 21 horses and was defined as return to sound performance at a degree equal to or better than that prior to injury and lameness. Eight of 12 horses treated for medial femoral condylar cysts had a successful outcome. Four show horses treated for cruciate ligament lesions alone successfully returned to showing activity. None of the 3 horses with meniscal tearing were able to perform successfully. CONCLUSIONS AND CLINICAL RELEVANCE: The femorotibial joint was evaluated through a single-portal cranial arthroscopic approach, using the femoropatellar joint as the point of access. This approach was easy to perform, allowed controlled access to the femorotibial joint, avoided accidental damage to articular structures, and required fewer access portals.

Animals↗
PubMed1998

Tibiofemoral contact pressures in degenerative joint disease.

Using tibiofemoral joints from older (age, 53-80 years) human cadavers with articular cartilage degeneration, contact pressures and contact areas were measured in the extended knee in four conditions: (1) neutral alignment; (2) 5 degrees varus (simulating single limb stance of gait); (3) 5 degrees valgus; and (4) after a 5 degrees proximal tibial closing wedge valgus osteotomy. In degenerated cartilage, contact pressures were reduced at the lesion sites and were high on the borders of the lesions. No statistically significant changes occurred in contact pressures and areas when values from neutral loading were compared with values during loading in each of the other three conditions. Lateral average and maximum contact pressures were less in varus loading than in valgus loading. Equal medial and lateral contact pressures during varus loading, in contrast to lower medial than lateral contact pressures in the other three loading, supports the theory that the varus moment imposed on the knee in single limb stance could be a mechanism causing medial tibiofemoral osteoarthritis. The 5 degrees valgus osteotomy resulted in contact pressures similar to those in neutral loading. These experiments do not support the value of the 5 degrees valgus osteotomy in reducing contact pressures on the medial tibial plateau.

Aged↗
PubMed1994

[Are degenerative joint diseases chronic compartment syndromes?].

An increase of the intraosseous pressure is observed in the epiphyses of bones involved in degenerative joint disease. The increase of pressure may be caused by an accumulation of osmotically active substances in the interstitium, as it has been described in case of the compartment syndrome. Based on the postulated pathophysiological mechanism, a causative therapy of degenerative joint disease is proposed.

Algorithms↗
PubMed1999

Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients.

We examined 320 patients with MRI and arthroscopy after an acute trauma to evaluate MRI in diagnosis of degenerative joint disease of the knee in relation to sports activity and clinical data. Lesions of cartilage and menisci on MRI were registered by two radiologists in consensus without knowledge of arthroscopy. Arthroscopy demonstrated grade-1 to grade-4 lesions of cartilage on 729 of 1920 joint surfaces of 320 knees, and MRI diagnosed 14% of grade-1, 32% of grade-2, 94% of grade-3, and 100% of grade-4 lesions. Arthroscopy explored 1280 meniscal areas and showed degenerations in 10%, tears in 11.4%, and complex lesions in 9.2%. Magnetic resonance imaging was in agreement with arthroscopy in 81% showing more degenerations but less tears of menisci than arthroscopy. Using a global system for grading the total damage of the knee joint into none, mild, moderate, or severe changes, agreement between arthroscopy and MRI was found in 82%. Magnetic resonance imaging and arthroscopy showed coherently that degree of degenerative joint changes was significantly correlated to patient age or previous knee trauma. Patients over 40 years had moderate to severe changes on MRI in 45% and patients under 30 years in only 22%. Knee joints with a history of trauma without complete structural or functional reconstitution showed marked changes on MRI in 57%, whereas stable joints without such alterations had degenerative changes in only 26%. There was no correlation of degenerative disease to gender, weight, type, frequency, and intensity of sports activity. Therefore, MRI is an effective non-invasive imaging method for exact localization and quantification of chronic joint changes of cartilage and menisci that recommends MRI for monitoring in sports medicine.

Adolescent↗