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A methodic analysis of foot radiographs is valuable when evaluating for joint disease. The author presents a system that allows the interpreter to establish a list of expected differential diagnoses. This is especially useful when the arthritide does not present with its classic radiographic appearance.
A study was performed to evaluate the presence of degenerative joint disease (DJD) in idiopathic adolescent scoliosis (IAS) and correlate DJD with biomechanic factors. The average age of the subjects was 19 years (range, 12-30). Osteophytes reflecting the presence of degenerative joint disease occurred in apophyseal and/or intervertebral joints of 74% of 100 subjects. Osteophytes were correlated with curve angle and apical rotation. Compression forces are of pathogenic significance in the localization of osteophytes in IAS. IAS can serve as a naturally occurring prototype for the study of the influence of biomechanic factors on the pathogenesis of DJD.
The goal of this study was to look for correlations between the severity of chronic inflammatory joint disease and pharmacokinetic parameters of nonsteroidal antiinflammatory drugs. Disease severity data (pain severity and magnitude of abnormalities in laboratory tests for inflammation) and pharmacokinetic data (area under the curve in the morning (AUCm) and maximum plasma concentration (Cmax) were collected during a prospective, randomized, double-blind, parallel-group study. Two groups of nine and 11 patients, respectively, were given 300 mg etodolac b.i.d or 50 mg indomethacin b.i.d. by the oral route, for three days, after a 36-hour placebo washout. Univariate analyses demonstrated statistically significant negative correlations between pharmacokinetic parameters of both study drugs and a number of disease severity parameters. In the multivariate analysis of data for etodolac, the sigma erythrocyte sedimentation rate contributed significantly to variations in all pharmacokinetic parameters and explained 100% of the variations in free S-enantiomer AUCm and in total and free S-enantiomer Cmax. For indomethacin, pain contributed to variations in Cmax values of the total and free forms; the sigma erythrocyte sedimentation rate was also a factor in variations in total indomethacin. These negative correlations suggest that severity of chronic inflammatory joint disease may influence the pharmacokinetics of nonsteroidal antiinflammatory drugs.
Passive coxofemoral joint laxity of dogs, as quantitated by a distraction-stress radiographic method, may have important prognostic value in determining susceptibility to hip dysplasia. Data from 151 dogs, representing 13 breeds, were included in a logistic regression model to evaluate the contribution of factors such as age, breed, weight, sex, distraction index, and Norberg angle to the risk of developing degenerative joint disease (DJD) of the coxofemoral joint. Of the factors studied, the amount of passive hip laxity, as quantitated by the distraction index, was the most significant (P < 0.0001) determinant of the risk to develop DJD of the coxofemoral joint. In the longitudinal and cross-sectional components of the study, distraction index was a significant (P < 0.001) risk factor for DJD, irrespective of age at evaluation (4, 12, or 24 months). The strength of the hip laxity:DJD correlation increased with the age of dog. In contrast, the Norberg angle, a measure of hip laxity on the standard hip-extended radiograph, was not found to be a significant risk factor for DJD, either in the longitudinal or cross-sectional analyses. Breed-specific probability curves of DJD susceptibility indicated that German Shepherd Dogs had a significantly (P < 0.05) greater risk of developing DJD than did the pool of non-German Shepherd Dogs. The information derived from this statistical model will help to scientifically characterize the role of passive hip laxity as a component in the pathogenesis of DJD of the coxofemoral joint.
Although degenerative joint disease is a most common type of arthritis in persons past 40 years of age, and associated with an aging process, this case has been presented as an interesting finding because of the early occurrence. Clinical symptoms, radiographic changes, and microscopic alterations were demonstrated. Conservative therapy was unable to relieve the symptoms and slow the progressive degeneration, and resolution of the subjective complaints was achieved by surgical intervention.
The inflammatory activity of joints can be stated after intravenous administration of 99mTc-pertechnetate by demonstration of an enrichment of isotope. In 85 out of 111 patients (77%) a good accordance between profilogram and clinical finding could be seen. "False positive" results could be found in juvenile rheumatoid arthritis, ulcerative colitis, reactive arthritis and juvenile gout. In some cases of juvenile rheumatoid arthritis the clinical finding is later obvious than the demonstration by nuclear medicine. "False negative" results mainly can be seen at the wrists of patients with juvenile rheumatoid arthritis and tendosynovitis as well as in already existing radiological changes of the bones. Differential diagnostical evidences of profilography cannot be expected with the investigation technique used here. It, however, may contribute to assure the diagnosis in non-inflammatory joint diseases ("psychogenic rheumatism", lymphatic oedema).
Mseleni joint disease (MJD) is an unusual form of progressive and widespread degenerative osteoarthropathy that has been identified in several hundred people in the remote Mseleni region of northern Zululand. Affected individuals experience articular discomfort in childhood and may be seriously handicapped as adults, often requiring prosthetic hip joint replacement. Although the condition clusters in families, there is no evidence of Mendelian inheritance and assessment of affected kindreds has not shown any evidence of genomic imprinting. To date our molecular work-up has entailed the study of 47 affected individuals from MJD kindreds to investigate familial predisposition based on the inheritance of a subset of markers and/or genes on the human genome, particularly those associated with the cartilage matrix. In addition, we have collected blood specimens form 111 unaffected but unrelated individuals from the same population group in order to determine whether any relationship exists between genetic components of the human leucocyte antigen (HLA) system and the MJD phenotype. Our investigations show the following: (i) there is no association between MJD and the HLA system which has previously been associated with non-Mendelian genetic conditions; (ii) COL2A1, which has been implicated in some forms of spondylo-epiphyseal dysplasia, may be involved in at least a subset of MJD patients; and (iii) type VI collagen is overabundant in degenerated hip joint cartilage.
Degenerative joint disease, primarily in the form of osteoarthrosis, affects the temporomandibular joints (TMJs) with symptoms similar to those found in other body joints. These symptoms include stiffness, pain, restriction of movement, inflammation, crepitus and radiographic changes. Symptoms can occur in both males and females at any age, starting with pre-adolescent, but most often occur in females age 30 and over. Most symptoms will last nine to 18 months (followed by remission) and are managed using anti-inflammatory medications, physical therapy, occlusal splints and dietary changes. Major areas for consideration in this article include epidemiology, signs and symptoms, radiography, etiopathology and symptom management.
The collagen in the degenerated articular cartilage from dysplastic canine hip joints was characterized as to type by examining cartilage directly and also after labeling cartilage slices with 14C-proline in vitro. Collagen analysis was by sodium dodecylsulfate-polyacrylamide gel electrophoresis of 14C-labeled collagen, and of 14C-peptides which had been cleaved by cyanogen bromide. Amino acid analysis was done on hydrolysates of whole cartilage and of purified collagens to quantify the ratio of hydroxyproline to hydroxylysine. Data revealed that type II collagen was the radiolabeled product synthesized in all samples of degenerated cartilage and was the only collagen detected in biochemical tests in the cartilage of joints with degenerative joint disease as well as in disease free hip joints. Results suggested that chondrocytes in degenerated cartilage of canine joints did not switch their collagen phenotype, but continued to synthesize type II collagen. Cartilage degeneration in joints of dogs with hip dysplasia proceeded without a change in collagen phenotype.
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Synovial fluid of patients with different inflammatory and metabolic joint diseases contains low-molecular CPIs (stefins and cystatins) and high-molecular CPIs (kininogens). An additional inhibitory fragment with a molecular mass of about 20 kDa, which is a part of the kininogen molecule, has been detected. Cathepsin B and cystatin C were determined by ELISA test in 47 patients with rheumatoid arthritis, seronegative spondylarthritis, osteoarthritis, undifferentiated arthritis and gout. A significantly higher amount of cathepsin B was found in patients with rheumatoid arthritis. The elevation of cathepsin B was accompanied by an increased amount of cystatin C.
OBJECTIVE: To estimate the annual incidence of inflammatory joint diseases in a population based prospective referral study in an adult population in Kronoberg County in southern Sweden. METHODS: The patients were referred from primary healthcare centres to the rheumatology department in Växjö Central Hospital or to the one private rheumatologist in Växjö participating in the study. Additionally, the hospital records for patients with joint aspirates during the inclusion period were checked. The patients were registered as incident cases if the onset of the joint inflammation was between 1 May 1999 and 1 May 2000. A systematic follow up of incoming referrals was conducted up to 31 January 2001. Children under the age of 16 and patients with septic arthritis, crystal arthropathies, and osteoarthritis were excluded from the study. RESULTS: A total of 151 new cases with inflammatory joint diseases were identified during one year, corresponding to a total annual incidence of 115/100 000. Of these, 31 patients (21%) had rheumatoid arthritis, the annual incidence being 24/100 000 (for women 29/100 000, and for men 18/100 000). Reactive arthritis was diagnosed in 37 patients (24%, annual incidence 28/100 000) and 54 patients had undifferentiated arthritis (36%, annual incidence 41/100 000). Eleven patients presented with psoriatic arthritis (7%, annual incidence 8/100 000). The incidence of Lyme arthritis was small in this non-endemic area, and the incidence of sarcoid arthritis corresponded to that in earlier studies. CONCLUSION: This is the first prospective population based annual incidence study of early arthritis in Sweden. In this population, 36% of the incident cases had undifferentiated arthritis, whereas rheumatoid arthritis and reactive arthritis accounted for 45% of the cases. The incidence figures compare well with figures reported from other countries.
During necropsy of cetaceans stranded or accidentally net-captured along the western coast of the Gulf of Mexico from 1991 to 1996, we found 13 of 59 (22%) animals had abnormalities of the atlanto-occipital and/or humeroscapular joints, the synovial joints. A few cases demonstrated mild roughening of the articular cartilage, while the majority exhibited complete erosion with thickened synovium and bony proliferation. The lesions resulted in ankylosis of both joints in one animal. In humans and terrestrial mammals, synovial joint diseases are known to be debilitating. Cetaceans depend on neck and flipper movement for locomotion, feeding, avoiding danger, and reaching the water's surface for breathing. Therefore, synovial joint disease may be significant mortality factor in these marine animals.
The radiographic evaluation of joint diseases in the adult hand and wrist is described in this chapter. The main focus is on the interpretation of plain radiographs of the hands and wrists in patients with joint symptoms. After considering the general approach to the analysis of the radiographs, the findings of the common forms of arthritis are illustrated and the differential diagnoses are discussed.
The failure of meniscal regeneration via a fibrous semilunar mold can be correlated with an increased incidence of degenerative joint disease. Experiments on rabbits revealed a statistically significant relationship between the failure of meniscal regeneration and the development of degenerative joint disease, characterized by osteophyte formation, cartilage pitting and erosions, and loss of carbilage proteoglycan. Similar results in limited studies utilizing adult fox hounds supported this observation. In dogs, variation in the extent of tissues resected about the meniscus, including synovectomy, did not inhibit the reformation of a fibrous semilunar mold. No specific "zone of regeneration" responsible for meniscal regeneration was identified.
Twenty-nine consecutive patients who met strict criteria for a diagnosis of primary glenohumeral degenerative joint disease completed standardized questionnaires regarding general health status as well as function of the shoulder before I performed a total glenohumeral arthroplasty. The patients completed the forms again at an average of ten months after the operation. Comparison of the preoperative and postoperative responses to the questions regarding health status demonstrated highly significant improvement in the patients' assessments of over-all bodily pain (p < 0.0001) and physical function (p < 0.0005) as well as significant improvement in role function (p < 0.05) and the anticipated change in general health status (p < 0.05). Concurrently, comparison of the responses to the questions regarding function of the shoulder indicated highly significant improvement in the ability of the patients to sleep on the side, to tuck in the back of a shirt, to place the hand behind the head, to toss overhand (p < 0.0001 for all), and to place one pound (0.5 kilogram) (p < 0.005) or eight pounds (3.6 kilograms) (p < 0.0001) on a shelf at shoulder level. The comparison also revealed significant (p < 0.05) improvement in the ability of the patients to place a coin on a shelf, to carry twenty pounds (9.1 kilograms) at the side, to wash the back of the contralateral shoulder, and to do their usual work.
OBJECTIVE: To determine serum amyloid A (SAA) concentrations in serum and synovial fluid from healthy horses and horses with joint disease and assess the effect of repeated arthrocentesis on SAA concentrations in synovial fluid. Animals-10 healthy horses and 21 horses with various types of joint disease. PROCEDURES: Serum and synovial fluid samples were obtained from each horse. In 5 of the 10 healthy horses, arthrocentesis was repeated 9 times. Concentrations of SAA were determined via immunoturbidometry. RESULTS: Serum and synovial fluid SAA concentrations were less than the assay detection limit in healthy horses and did not change in response to repeated arthrocentesis. Synovial fluid SAA concentrations were significantly higher in horses with suspected bacterial joint contamination or infectious arthritis, or tenovaginitis than in healthy controls, and serum concentrations were significantly higher in horses with infectious conditions than in the other groups. Neither serum nor synovial fluid SAA concentrations in horses with low-inflammation joint conditions differed significantly from those in healthy controls. Concentrations of SAA and total protein in synovial fluid were significantly correlated. CONCLUSIONS AND CLINICAL RELEVANCE: Synovial fluid SAA concentration was a good marker of infectious arthritis and tenovaginitis and appeared to reflect changes in inflammatory activity. The advantages of use of SAA as a marker include the ease and speed of measurement and the fact that concentrations in synovial fluid were not influenced by repeated arthrocentesis in healthy horses. Further study of the SAA response in osteoarthritic joints to assess its usefulness in diagnosis and monitoring of osteoarthritis is warranted.
Targeting chemokines and/or chemokine receptors appears to be an intriguing new approach to treating chronic inflammatory disorders like rheumatoid arthritis, inflammatory bowel diseases, multiple sclerosis, and transplant rejections. The involvement of chemokines and chemokine receptors in inflammatory joint diseases, the in vitro and in vivo characteristics of the chemokine family in inflammatory joint disease, and initial clinical data on chemokine blockade in patients with rheumatoid arthritis suggest that targeting the chemokine and chemokine receptor family might provide a new, promising antirheumatic strategy.