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[Joint disease in idiopathic hemochromatosis].

This study concerns seven patients with idiopathic haemochromatosis. The most common joint lesion involved the 2nd and 3rd metacarpophalangeal joints (MCP) and the wrists. The most frequent sites of chondrocalcinosis were the knees, the hips and the triangular ligament of the wrist. The most common radiological sign is osteoporosis, but the most typical appearance is degenerative joint disease localized to the MCP (2nd and 3rd) and to the wrist. The authors observed an association with HLA A3-B7, but no cases of association with A3-B14. Only one patient had hypo-uricaemia. The authors compare this series with those of other authors.

Adult↗

The utility of measuring C-terminal telopeptides of collagen type II (CTX-II) in serum and synovial fluid samples for estimation of articular cartilage status in experimental models of destructive joint diseases.

OBJECTIVE: To characterize and validate a novel, enzyme-linked immunoassay for measuring cross-linked dimer forms of C-terminal telopeptides of type II collagen (CTX-II) in serum and synovial fluid of rodents, and investigate whether CTX-II measurements can reflect joint status in two established animal models of destructive joint diseases. METHODS: Firstly, the specificity, in vivo validity, antigen recovery, and reproducibility of the assay were investigated. Secondly, we induced arthritis in rats using either bovine collagen type II or mono-iodoacetate. CTX-II levels were measured in the serum and synovial fluid of the affected femoro-tibial joint and correlated with microscopic severity of joint lesions as determined by validated scoring systems. RESULTS: The F4601 monoclonal antibody (mAb) is highly specific for the EKGPDP sequence at the CTX-II. Strong CTX-II signals were detected during enzymatic degradation of articular cartilage explants by matrix metalloproteinase (MMP)-9 or MMP-13. The assay presented a good degree of precision and reproducibility (inter- and intra-assay CVs< 8.0%). In the collagen-induced arthritis (CIA) model, the assay indicated markedly increased levels of CTX-II in both the synovial fluid and the serum. Furthermore, CTX-II levels in both the synovial fluid (r = 0.76; P < 0.0001) and the serum (r = 0.85; P < 0.0001) showed strong correlations with the microscopic severity scores of joint lesions at Day 22. In the mono-iodoacetate-induced arthritis (MIA) model, CTX-II concentration in the synovial fluid (r = 0.53; P < 0.0001), but not in the serum, correlated with the microscopic severity score. CONCLUSIONS: The Preclinical CTX-II assay could provide a useful supplement to currently available methods for the non-invasive assessment of cartilage status. The utility of serum CTX-II to reflect joint status appeared to be limited to systemic forms of destructive joint diseases.

Animals↗

Comparative degenerative joint disease of the vertebral column in the medieval monastic cemetery of the Gilbertine priory of St. Andrew, Fishergate, York, England.

The pattern of degenerative joint disease (DJD) of the intervertebral and apophyseal joints of the vertebral column of 81 skeletons from the thirteenth to fourteenth century medieval priory cemetery of St. Andrew, Fishergate, York, was recorded in relation to their location of interment: eastern cemetery, southern cemetery, and intramurally (within the priory buildings). Archaeological context and ethnohistorical accounts support the interpretation that people of different social status were buried in these areas. Linear discriminant function analysis and paired Kolmogorov-Smirnov tests showed that the differences in vertebral column DJD pattern and severity among the three subgroups were not statistically significant. As the archaeological and historical evidence seems reliable, it is argued that the analysis of DJD of the vertebral column might not be ideal to study the effects of normal activity patterns, a conclusion which supports the results of recent bioarchaeological research. Further, high-low plots demonstrate that the differences in DJD pattern were located between intervertebral and apophyseal joints of individuals rather than between subgroups of the cemetery. It is thought that this difference was produced as a response to erect posture during bipedal locomotion, reflecting vertebral curvatures, rather than differing occupational stresses. Thus, due to biological constraints on its function, the vertebral column might not be an ideal structure to study markers of occupational stress.

Adult↗

Double-blind comparison of etodolac SR and diclofenac SR in the treatment of patients with degenerative joint disease of the knee.

An on-going multi-centre, double-blind, parallel-group study is being carried out to compare the efficacy and tolerability of sustained-release (SR) formulations of etodolac and diclofenac in patients with degenerative joint disease (osteoarthritis) of the knee. An interim analysis of the findings has been made for 64 patients from two centres which have now completed their part in the study. Thirty-two patients were randomly assigned to receive 600 mg etodolac SR once daily for 4 weeks; the remaining 32 patients received 100 mg diclofenac SR. Primary efficacy assessments rated on a 5-point categorical scale were patient and physician overall assessments of the patient's condition, night pain and pain intensity. Secondary efficacy parameters included weight-bearing pain, stiffness duration, joint tenderness on pressure, degree of swelling and erythema, degree of knee flexion and time to walk 15 metres. The results showed that for both etodolac SR and diclofenac SR treatment groups there was an improvement from baseline in all efficacy parameters at the last visit and no statistically significant difference was observed between treatments. However, although not statistically significant, the improvement rate in the patient's condition at Week 2 was slightly greater in the etodolac SR treatment group, suggesting that improvement may occur more rapidly with etodolac SR than with diclofenac SR. With regard to tolerability, 5 patients in the etodolac SR treatment group and 3 in the diclofenac SR group withdrew from the study because of adverse reactions. Two events (dyspepsia and mouth ulceration) in the etodolac SR group and 4 events (headache, glossitis, depression and insomnia) in the diclofenac SR group were considered to be definitely drug-related. Dyspepsia was reported by 3 patients (1 withdrawal) treated with etodolac SR and by 4 patients (2 withdrawals) treated with diclofenac SR. A statistically significant decrease was observed in haemoglobin and haematocrit values after 4 weeks of treatment in the diclofenac SR group, but this was not considered to be clinically important. In addition, there were no clinically significant changes in blood chemistry and urinalysis for either treatments. In conclusion, the results of the present study indicate that 600 mg etodolac SR once daily for 4 weeks is effective in the treatment of patients with degenerative joint disease of the knee, as is 100 mg diclofenac SR. In addition, both drugs have comparable tolerability profiles.

Aged↗

Brachygnathia superior and degenerative joint disease: a new lethal syndrome in Angus calves.

Brachygnathia superior and generalized diarthrodial degenerative joint disease were seen in 17 related, purebred Angus calves ranging in age from 2 days to 4 months. Craniometrical studies revealed decreased maxillary and palatine bone lengths and increased cranial, skull, and facial indices. Radiological evaluation of major appendicular joints demonstrated lipping of the joint margins with osteophyte formation, sclerosis of subchondral bone, and narrowing of joint spaces. Synovial fluid evaluation indicated joint degeneration but no etiologic agent. Rheumatoid factor analysis of plasma was negative. Grossly, all major appendicular joints were defective including the atlanto-occipital articulation. Lesions ranged from loss of surface luster to erosions and deep ulcers with eburnation of the subchondral bone and secondary proliferative synovitis. Histological changes were degeneration of the articular cartilage matrix, chondrocyte necrosis, flaking and fibrillation, chondrone formation, erosions and ulcers of the articular cartilage with subchondral bone sclerosis, vascular invasion with fibrosis, and chronic, nonsuppurative, proliferative synovitis. Growth plates had defective chondrocyte proliferation and hypertrophy with aberrant ossification of calcified cartilaginous matrix. Histochemical analysis of cartilage and bone failed to incriminate which component was defective, glycosaminoglycan or collagen, but indicated different distribution or absence of one or the other. Genealogic studies revealed a genetic basis for the new defect.

Animals↗

Experimental production of cartilage necrosis by cold injury: failure to cause degenerative joint disease.

A cryoprobe (-20 to -80 C) was applied for 10-60 seconds to cause necrosis of metatarsal head cartilages of 11 rabbits. Segmental loss of nuclear staining was noted at 1 week and depletion of chondroitin sulfate (toluidine blue metachromasia and staining with safranin 0) a few days later. No degenerative joint disease was evident up to 6 months later. The latter finding suggests that, in addition to chondrocyte death, externally imposed stresses are necessary to disrupt the collagenous "skeleton" and initiate the changes of degenerative joint disease.

Animals↗

A metabolite of substance P, SP7-11 is involved in the pathogenesis of inflammatory joint disease.

The possibility that neuropeptides, in particular members of the tachykinin family are involved in inflammatory joint disease is widely disputed. Both clinical and experimental observations indicate that the tachykinin substance P (SP) may be involved in the pathogenesis of arthritis. We have studied the effects of tachykinins and the metabolites of SP on chondrocyte function. We have shown that the C-terminal pentapeptide sequence; H-Phe-Phe-Gly-Leu-Met-NH2 is biologically active in bovine chondrocyte cultures. The production of SP7-11 is limited by hydrolysis of the intact peptide by neutral endopeptidase (E.C. 3.4.24.11). The regulation of this enzyme would modulate the activity of substance P on articular cartilage chondrocytes.

Amino Acid Sequence↗

Temporomandibular degenerative joint disease. Part I. Anatomy, pathophysiology, and clinical description.

The anatomy and function of the temporomandibular joint (TMJ) are described in the detail needed to evaluate and treat temporomandibular degenerative joint disease (TDJD). Innervation of the joint and the mechanism of arthralgia are described and related to TDJD. The clinical course of TDJD, radiographic evaluation of it, histopathologic description, and etiology are presented.

Age Factors↗

Characterisation of blood and synovial fluid lymphocytes from patients with rheumatoid arthritis and other joint diseases by monoclonal antibodies (OKT series) and acid alpha-naphthyl esterase staining.

Mononuclear cell preparations from peripheral blood (PBL) and synovial fluid (SFL) of 27 Patients with rheumatoid diseases (15 patients with definite rheumatoid arthritis (RA), 10 with other inflammatory joint diseases (OJD), 1 with sarcoid arthritis (SA) and 1 with traumatic arthritis (TA) were examined for lymphocyte subpopulations determined by monoclonal antibodies of the OKT series and by the dot-like, acid alpha-naphthyl esterase staining (ANAE) activity. In patients with classic, active RA, blood T cells carrying the OKT8+ (suppressor/killer) phenotype were significantly reduced leading to an elevated OKT4/OKT8 ratio of 4.1 +/- 0.4 compared with 2.1 +/- 0.1 in healthy controls. In 10 patients with OJD this diminution of OKT8+ cells in peripheral blood was less pronounced or absent. As regards SFL subpopulations, patients with RA and OJD exhibited a similar distribution pattern with an elevation of OKT8+, Ia+ and ANAE negative cells and a similar OKT4/OKT8 ratio of 1.5 +/- 0.3 and 1.6 +/- 0.4, respectively. Similar results were also obtained in the only patient with TA, whereas the patient with SA and one RA patient with relapse after surgical synovectomy exhibited high OKT4/OKT8 ratios, both in synovial fluid and peripheral blood. Neither the OKT markers nor the dot-like ANAE staining pattern were significantly correlated to parameters of systemic or local disease activity as estimated by erythrocyte sedimentation rate and a local disease activity index.

Adolescent↗

[The Temporomandibular Joint Diseases Unit of the Villeneuve-Saint-Georges Hospital Center].

A disease as complex as that of temporomandibular joint dysfunction can only be managed by a multidisciplinary team. The authors describe the temporomandibular joint diseases unit of the Centre Hospitalier de Villeneuve-Saint-Georges which consists of Stomatologists, Radiologists, Psychiatrists and Psychologists and a Rehabilitation Medicine doctor specialised in electrodiagnosis. The hospital's Department of Stomatology and Maxillofacial Surgery (Doctor Pierre Scheffer) coordinates this unit which holds committee meetings one a month to evaluate each case. The therapeutic decisions reflect the multiplicity of the aetiologies, none of which are mutually exclusive, which explains the necessity for a multidisciplinary approach.

France↗

Patient self-assessment of health status and function in glenohumeral degenerative joint disease.

One hundred three consecutive patients with primary glenohumeral degenerative joint disease completed standard questionnaires regarding their general health status (Short Form-36) and the function of their shoulder (Simple Shoulder Test). These patients' self-assessed health status indicated overall bodily pain, physical functioning, and physical role fulfillment scores that were significantly below those of population-based control groups. Self-assessed shoulder functions were likewise consistently below those of patients with normal shoulders. These deficits clearly indicated the problems that the patients desired to have resolved by treatment. The use of self-assessment questionnaires to routinely characterize patients with shoulder conditions is practical in the context of a busy practice. These data enable surgeons to understand the condition from the patient's perspective. This understanding should be central to the planning of treatment and to the evaluation of treatment effectiveness.

Female↗

Pathogenesis of degenerative joint disease.

Proteoglycan degradation is central to the development of degenerative joint disease. Proteoglycans may be degraded by lysosomal enzymes from chondrocytes, synoviocytes or leucocytes. Collagen and matrix degradation occurs either by direct damage or due to degrading enzymes released into synovial fluid. Once the pathological sequence has begun it continues in a cyclic manner unless arrested by the ability of chondrocytes to synthesise sufficient matrix components. Treatment should ideally be directed to this end.

Animals↗

[Microbiologic aspects of inflammatory joint diseases].

Regarding of microbiological aspects of arthritis three forms of joint diseases are under investigation: the septic arthritis, the reactive arthritis and the Rheumatoid Arthritis. In 95% of patients with septic arthritis microorganisms as causative agents responsible for the disease are described: Staphylococci, Streptococci, some gram-negative bacteria. By an haematogenic route of infection predominantly patients with immunosuppressive therapy are altered. In newborns and children septic arthritis is to observe more rarely. A reactive arthritis is a postinfectious sterile process in dependence on an infection occurred at an earlier time. As etiologic agents Yersinia, Enterobacteriaceae and Campylobacter have been discovered. 80% of the patients suffering such a reactive arthritis are carrier of the HLA-B27 system. The etiology of the Rheumatoid Arthritis is an open, unanswered problem. Of importance are: immunogenetic conditions, autoimmune phenomena, endocrinologic, dietetic and psychologic factors as well as bacteria and viruses as causative agents: cocci, bacilli, Diphteroids, endoparasitic bacteria (Listeria, L-forms, Mycoplasma, Chlamydiae), viruses (Adeno-, Mumps-, Measles-, ECHO-, Coxsackie-A- and B-, Hepatitis-, Cytomegalo-, Para-influenza-, Retro-, Parvo- and Rubella viruses). In the last years the EBV is of interest covering the question of a distinct virus persistence in tissues and the adequate limiting factors. Perhaps a defect of the hu-IFN-gamma-system might be of immunopathological and clinical significance.

Arthritis, Infectious↗

125Iodinated fibrinogen uptake in inflammatory joint disease as a complicating factor in the detection of deep vein thrombosis.

An enhanced uptake of 125I-fibrinogen observed in the arthritic knee joint of a patient suspected of deep vein thrombosis was confirmed in a number of patients with inflammatory joint disease in the absence of thrombosis. Whilst this is a potentially serious source of false positive diagnoses, the possibility also exists that this phenomenon could be used to evaluate the degree to which active disease is present in the joints of patients suffering from inflammatory disease.

Adult↗

Functional and phenotypical characterization of activated T cells from intra-articular sites in inflammatory joint diseases. Possible modulation of the CD3 antigen.

The presence of activated T lymphocytes bearing interleukin 2 (IL-2) receptors and HLA class II (Ia) antigens accompanied by impaired T cell functions such as a decreased mitogenic responsiveness are characteristic findings, especially in intra-articular sites in chronic inflammatory joint diseases. The objective of the present study was to further characterize these in vivo activated T cells by the investigation of IL-2 production and a possible T cell receptor modulation. IL-2 receptors were found to be expressed primarily in the CD4+ subset. The Ia+ subset expressing both DR and DQ antigens showed a weaker mitogen-induced response as compared to the Ia- fraction. A decreased mitogen-induced IL-2 production and a lower response to anti-CD3 monoclonal antibodies was observed with synovial T lymphocytes as compared to peripheral blood T cells. The density of the CD3 molecule, known to be closely associated with the T cell receptor, was significantly lower in intra-articular sites, while other T cell-specific surface molecules were expressed to a similar extent in both compartments. The decreased synovial T cell mitogenesis was not restored by the addition of lymphokines (IL-1 and IL-2) or blood monocytes, nor by removing CD8+ T cells. These data present further evidence for a significant T cell activation in intra-articular sites in chronic inflammatory joint diseases. The decreased expression of the CD3 glycoprotein suggests a modulation by so far unidentified antigen(s), which could also be responsible for the weak T cell response elicited by polyclonal mitogens.

Antibodies, Monoclonal↗

Degenerative joint disease in hunter-gatherers and agriculturalists from the Southeastern United States.

This study examines degenerative joint disease of the major appendicular joints in hunter-gatherers and agriculturalists from northwestern Alabama. Arthritis is highest at the shoulder, elbow, and knee and lower at the hip and ankle. There are virtually no sex differences in the hunter-gatherer group, but in the agriculturalists, males have more severe osteoarthritis than females. The hunters-gatherers have a somewhat greater prevalence of arthritis than the agriculturalists, but the differences are rarely significant. The similarity in osteoarthritis levels over time conflicts with biomechanical evidence, which indicates an increase in usual activities in the agricultural period. Several possible reasons for this are explored, including the suggestion that arthritis is a response to intensive or infrequent activities. Whatever the cause, it is clear that biomechanical data and osteoarthritis are responding to different factors and do not equally represent the level of usual activities.

Adult↗