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PubMed1975

Effect of the common bile acids on the fibrin/fibrinogen fragments in rheumatoid synovial fluid. A possible clue to the ameliorating effect of jaundice in rheumatoid arthritis.

Fibrin/fibrinogen degradation products observed in rheumatoid synovial fluid exhibit resistance to plasmin proteolysis. In the present study, the influence of the common bile acids on the plasmin digestion of these degradation products in 16 rheumatoid synovial fluids were quantitated immunologically by radial immunodiffusion, and qualitatively estimated by crossed immunoelectrophoresis. Addition of chenodeoxycholic acid, deoxycholic acid, and their taurine and glycine conjugates in concentrations of 3.33 mumole/ml of a mixture of rheumatoid synovial fluid and plasmin resulted in complete plasmin degradation. Cholic acid and its taurine and glycine conjugates were effective only in concentrations of 4.44 mumole/ml. A detergent, such as Triton X-100, had little or no effect on the plasmin digestion. Other proteins capable of influencing fibrinolytic activity, such as plasminogen and the inhibitors alpha1-antitrypsin and alpha2-macroglobulin, were not affected by the two detergents. The bile acids are thought to influence the fibrin/fibrinogen degradation products by unfolding the protein at a molecular level, by virtue of their properties as steroid detergents, leaving the fibrin/fibrinogen degradation products susceptible to plasmin digestion.

Alpha-Globulins↗

PubMed1994

Synovial fluid parameters in normal and osteochondritic hocks of horses with open physis.

An investigation was carried out on most common synovial fluid parameters of normal and osteochondritic hocks of horses less than 12 months old in order to confirm the presence of an inflammatory process. Furthermore, a spectroscopic study was performed on synovial fluid from both normal and diseased hocks. A depolymerization of hyaluronic acid was demonstrated in synovial fluid from diseases joints, similar to that reported in human rheumatoid arthritis. A one month rest seem to normalize all parameters considered and in one joint, a return to normal infrared spectrum was demonstrated.

Age Factors↗

PubMedDate not supplied

Study of IL-2, IL-6, TNF alpha, IFN gamma and beta in the serum and synovial fluid of patients with juvenile chronic arthritis.

In the last few years the important role played by various cytokines in the pathogenesis of chronic inflammatory diseases has emerged. In the present study, serum and synovial fluid levels of IL-2, IL-6, TNF alpha, IFN beta and IFN gamma were evaluated in a group of 66 patients with juvenile chronic arthritis (JCA). At the same time the ESR, CRP, hemoglobin, immunoglobulins, platelet count and Ritchie index were measured. In the serum of pauciarticular patients, IL-6 and TNF alpha levels were only slightly elevated compared with controls, but there was no correlation between these cytokines and clinical and other laboratory parameters. Serum IL-2 and IFN gamma were undetectable. In contrast, in the synovial fluid IL-6 levels were very high in all of the patients examined and there was a significant correlation between synovial fluid IL-6 levels and Ritchie's articular index. TNF alpha tended to be elevated but to a lesser extent, while synovial fluid IL-2 and IFN gamma were undetectable or very low, as in the serum. In polyarticular and systemic patients, on the other hand, serum IL-6 was elevated and statistically correlated with the majority of the laboratory parameters and with the Ritchie articular index. TNF alpha levels were only slightly elevated; on the other hand, IL-2 and IFN gamma were undetectable. There was an inverse correlation between IFN beta levels and the Ritchie articular index and a significant correlation with hemoglobin levels. In conclusion, our study demonstrates that not only IL-1 (as shown in other studies), but also IL-6 and to a lesser extent TNF alpha play a central role in the pathogenesis of JCA. IFN beta on the other hand, would seem to play an anti-inflammatory role.

Adolescent↗

PubMed1982

T lymphocyte subpopulations defined by monoclonal antibodies in synovial fluid of patients with rheumatic disease.

The proportion of T lymphocytes reacting with monoclonal antibodies to suppressor or helper T cell subsets and the proportion of T lymphocytes with Fc receptors for IgG or IgM were determined in synovial fluid and blood of 16 patients with rheumatic diseases including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis and juvenile rheumatoid arthritis. The percentage of T cells reacting with monoclonal antibodies (Leu 2a or OKT 8) directed at the suppressor/cytotoxic T cell subpopulation, was significantly higher in synovial fluid than in blood of patients or healthy donors. Monoclonal antibodies (Leu 3a or OKT 4) with specificity for the helper T cell subpopulation, reacted with a lower percentage of synovial T cells than of blood T cells of patients or controls. This distribution pattern was found in patients with RA as well as in the other patients with chronic arthritis. The percentage of T cells with Fc-IgG receptors (TG cells) was much lower in synovial fluid than in blood of patients or controls. Thus, in synovial fluid the percentage of T cells reacting with monoclonal antibody to the suppressor/cytotoxic cell subset was fairly high (mean 45%) whereas the proportion of TG cells, considered to represent suppressor cells, was low (mean 4%).

Adult↗

PubMed1992

T gamma delta cells and their subsets in blood and synovial fluid from patients with rheumatoid arthritis.

We have determined the distribution of T gamma delta cells in the peripheral blood of 44 patients with rheumatoid arthritis and in 36 healthy controls. In addition, paired blood and synovial fluid samples were obtained from seven patients with RA. The monoclonal antibodies A13, BB3 and Ti gamma A, which are specific for the V delta 1, V delta 2 and V gamma 9 gene products respectively, were used to define T gamma delta subsets. T gamma delta + cells expressed as a percentage of CD3+ lymphocytes were reduced in RA peripheral blood compared with the control group (3.9% +/- 0.5 versus 5.7% +/- 0.7; P less than 0.0001). There was a reduction in the V gamma 9/V delta 2+ subset (from 5.6% +/- 1.2 to 1.7% +/- 0.4) leading to a change in the mean ratio of V delta 2/V delta 1+ cells from 4.3 in normal subjects to 1.1 (P less than 0.002). No statistical difference was observed in T gamma delta cell numbers in synovial fluid compared with the paired blood samples (4.0% +/- 1.1 in blood and 4.4% +/- 1.4 in synovial fluid). Also the distribution of V delta 2+ and V delta 1+ cells was similar in the two compartments and a similar alteration in subset distribution was found in blood and synovial fluid. These findings do not indicate a selective accumulation of a specific T gamma delta subset in RA synovial effusions.

Antibodies, Monoclonal↗

PubMed1998

Elevated levels of synovial fluid PLA2, stromelysin (MMP-3) and TIMP in early osteoarthrosis after tibial valgus osteotomy in young beagle dogs.

We determined the concentration of markers in cartilage and synovium metabolism in the synovial fluid (SF) of the knee of young beagle dogs with slowly progressive osteoarthrosis. Osteoarthrosis (OA) was induced by a tibial 30 degrees valgus osteotomy to the right hindlimb of 16 dogs. The contralateral knee served as control. The animals were killed 7 (group I) and 18 months (group II) after operation. The levels in SF of chondroitin sulfate (CS), tissue inhibitor of metalloproteinases (TIMP-1), stromelysin (MMP-3), hyaluronan (HA), and the activity of phospholipase A2 enzyme (PLA2) were assayed. The first microscopic signs of cartilage degeneration were observed 7 months postoperatively and the lesions became more severe, including osteophyte formation during the following 11 months. The synovial fluid level of MMP-3 was higher (p = 0.04) at both time-points in the knee joint of the operated hindlimb than in the contralateral joint. On the operated side, 7 months postoperatively, synovial fluid PLA2 activity was higher (p = 0.02) than in the contralateral knee joint, but not 18 months postoperatively. The SF level of TIMP-1 was higher (p = 0.04) in the operated joint than in the contralateral joint 18 months after operation. The molar ratio of MMP-3 to TIMP-1 was higher (p = 0.001) in group II than in group I. The changes observed in the concentration of synovial fluid markers in this slowly progressive canine OA model suggest that activation of an inflammation-related process occurs at an early stage of the OA disease induced by unilateral tibial valgus osteotomy.

Animals↗

PubMed1991

Pharmacokinetics and synovial fluid concentrations of cephapirin in calves with suppurative arthritis.

Six calves with suppurative arthritis were given a single IM injection of sodium cephapirin at a dosage of 10 mg/kg of body weight. Cephapirin concentrations were serially measured in serum and in normal and suppurative synovial fluid over a 24-hour period. Mean peak serum concentration was 6.33 microliters/ml at 20 minutes after injection. The highest cephapirin concentrations in normal and suppurative synovial fluid were 1.68 and 1.96 micrograms/ml, respectively, 30 minutes after injection. Overall mean cephapirin concentration in normal synovial fluid for the first 4 hours (1.04 +/- 0.612 micrograms/ml) was not significantly different from that in suppurative synovial fluid (0.88 +/- 0.495 micrograms/ml; P greater than 0.05). Elimination half-life was 0.60 hours and clearance was 1,593 ml/h/kg.

Animals↗

PubMed1995

Synovial fluid from rheumatoid arthritis patients contains sufficient levels of IL-1 beta and IL-6 to promote production of serum amyloid A by Hep3B cells.

The presence of positive acute phase proteins within the circulation of rheumatoid arthritis patients suggests that elevated cytokine production associated with this chronic inflammatory disorder initiates the hepatic acute phase response. Cytokines produced at inflammatory lesions are believed to travel via the circulation to the liver where they induce acute phase protein production by hepatocytes. To test whether serum from rheumatoid arthritis patients contained sufficient levels of cytokines to promote an acute phase response in vitro, a bioassay was developed that employed the human hepatoma cell line Hep3B. These cells produced the acute phase protein serum amyloid A (SAA) in response to a combination of recombinant IL-1 beta and IL-6 or to monocyte conditioned medium. Serum (or plasma) from normal individuals or from rheumatoid arthritis patients did not induce SAA production by Hep3B cells. Moreover, these serum samples did not prevent SAA production induced by monocyte conditioned medium, indicating that they did not contain inhibitors of cytokine activity. Despite the inactivity of serum samples, synovial fluid samples obtained from rheumatoid arthritis patients were active in the hepatocyte bioassay and promoted SAA synthesis. One synovial fluid sample was analysed in detail to identify cytokines responsible for the SAA-inducing activity. Neutralizing antisera against IL-6 and IL-1 beta blocked this activity by > 90% whereas anti-IL1 alpha and anti-TNF-alpha sera were without effect. Absolute cytokine levels within the synovial fluid sample were determined by ELISA; IL-6, IL-beta and TNF-alpha, but not IL-1 alpha, were confirmed to be present. Moreover, the synovial fluid sample contained a large amount of the IL-1 receptor antagonist. These data indicate, therefore, that synovial fluid recovered from an inflamed joint contains all the necessary cytokines in balance with inhibitors to promote SAA production by Hep3B cells. The steady state levels of these factors within the plasma compartment, however, were insufficient to induce the acute phase response by cultured Hep3B cells, suggesting that this system does not mimic the relationship between the circulation and the liver that likely exists in rheumatoid arthritis patients.

Arthritis, Rheumatoid↗

PubMed1996

Synovial fluid levels of lactate dehydrogenase in patients with total knee arthroplasty.

Synovial fluid lactate dehydrogenase determination may offer a valuable preoperative assessment of polyethylene wear in aseptic total joint arthroplasty. Particulate ultrahigh-molecular-weight polyethylene may result in cell lysis and release of intracellular enzymes. This study tests the possible relationship between lactate dehydrogenase levels and particle wear in synovial fluid. The lactate dehydrogenase level may be used as a marker of joint inflammation from polyethylene wear.

Biocompatible Materials↗

PubMed1991

Oxidative damage to hyaluronate and glucose in synovial fluid during exercise of the inflamed rheumatoid joint. Detection of abnormal low-molecular-mass metabolites by proton-n.m.r. spectroscopy.

Proton Hahn spin-echo n.m.r. spectroscopy was employed to detect abnormal metabolites present in rheumatoid synovial fluid that are derived from the deleterious generation of reactive oxygen radical species during exercise of the inflamed rheumatoid joint. A resonance attributable to a low-molecular-mass N-acetylglucosamine-containing oligosaccharide formed by the oxygen-radical-mediated depolymerization of synovial-fluid hyaluronate was clearly demonstrable when subjects with inflammatory joint disease were exercised. Moreover, formate, which may be derived from the attack of OH.radical on synovial-fluid carbohydrates, was also readily detectable in these samples. gamma-Radiolysis of rheumatoid synovial fluid samples and aqueous solutions of hyaluronate also gave rise to the production of the low-molecular-mass hyaluronate-derived oligosaccharide species and markedly elevated concentrations of (non-protein-bound) formate in the biological fluids. As expected, corresponding spectra of gamma-irradiated blood serum samples obtained from normal volunteers did not contain the signal attributable to the low-molecular-mass oligosaccharide species, but the formate resonance (barely detectable in non-irradiated normal serum samples) became clearly visible. Additionally, a curious increase in the effective concentration of non-protein-bound low-molecular-mass metabolites such as acetate, citrate, lactate and glutamine was observed after gamma-radiolysis of all biological fluids studied. The hyaluronate-derived low-molecular-mass oligosaccharide species and formate are suggested as novel markers of reactive oxygen radical activity in the inflamed rheumatoid joint during exercise-induced hypoxic/reperfusion injury.

Adult↗

PubMed2000

Isolation of Kingella kingae from synovial fluids using four commercial blood culture bottles.

According to the literature, Kingella kingae may be an underdiagnosed cause of joint and bone infections in children. The use of the Bactec blood culture system for culture of joint fluids has dramatically improved the isolation of this fastidious bacterium. The aim of this study was to test the recovery rate and detection time of four commercial blood culture systems: three different BacT/Alert (Organon Teknika, USA) bottles and one Bactec (Becton Dickinson Microbiology Systems, USA) bottle, all inoculated with Kingella kingae strains mixed with pooled synovial fluids. For each strain the same inoculum and volume of synovial fluid was distributed into each of the four bottles. All 24 strains tested grew in the BacT/Alert Aerobic (100%) and the BacT/Alert Pedi-BacT (100%) bottles. Twenty-one strains grew in the BacT/Alert FAN aerobic (88%) bottle, and 15 strains grew in the Bactec Plus Aerobic F (63%) bottle, in both systems within 12 days (P<0.01). The Kingella kingae strains were first detected in the BacT/Alert Pedi-BacT bottles (P<0.001). The results were reproducible. The BacT/Alert blood culture bottles were superior to previously described blood culture systems in isolating Kingella kingae from synovial fluid, even with small inoculums and small volumes of synovial fluid.

Blood↗

PubMed1988

The changes in human synovial fluid osmolality associated with traumatic or mechanical abnormalities of the knee.

Synovial fluid osmolality was determined in 22 knees at the time of arthroscopic evaluation. The arthroscopy was for traumatic or mechanical abnormality of the knee. The results indicate no significant difference in osmolality among the conditions studied, but there was a significant decrease in synovial fluid osmolality compared to the values for the normal knee. The information presented provides baseline data for various pathologic conditions and a basis for future work.

Adolescent↗

PubMed2003

[Three dimensional ultrasound volumetric assessment of the synovial fluid in the ankle and hindfoot: Technique and normative data].

PURPOSE: Since synovial fluid is an important marker of disease, we performed three-dimensional ultrasound volumetric measurements of synovial fluid to provide baseline normative data. MATERIALS AND METHODS: Volume data were acquired using a 7-10 MHz three dimensional ultrasound probe on 40 ankles in 20 volunteers (25-61 years). Amounts of fluid were assessed in the ankle joint recesses, bursae and tendon sheaths. Images were acquired in the sagittal plane and were reconstructed in three orthogonal planes; transverse, sagittal and coronal. Fluid volumes were calculated from the volume data set using the manual planimetric method. RESULTS: Fluid in tendon sheaths was most common about the peroneals, and unlike prior MRI results, was less common around the flexors. In the flexors, fluid was most common around the flexor hallucis longus tendon, less common around posterior tibial tendon, and rare around fleksor digitorum longus tendon. In the extensors, fluid was less common but, when present, of greater volume, especially around the extensor hallucis longus tendon. Fluid was most common around the anterior tibial tendon and rare around the extensor digitorum longus tendon. Sparse fluid was seen in the majority of retrocalcaneal bursae. Fluid in the anterior ankle recess was quite common. Visualization of fluid in the posterior ankle recess was infrequent. CONCLUSION: Three-dimensional ultrasound permits measurement of fluid volume in the normal ankle/hindfoot; normative data are provided.

Adult↗

PubMed1992

Transforming growth factor-beta in synovial fluids modulates Fc gamma RII (CD16) expression on mononuclear phagocytes.

Mononuclear phagocytes in the synovium of patients with arthritis, in contrast to blood monocytes, were found to express a third receptor for the constant region of Ig (Fc gamma RIII), in addition to Fc gamma RI and Fc gamma RII. Previously identified on mature mononuclear phagocytes or phagocytes exposed to transforming growth factor-beta (TGF-beta) in vitro, this study documents the presence of Fc gamma RIII (CD16) expressing cells at an inflammatory site. Furthermore, the presence of CD16 on the majority of the LeuM3 (CD14) positive synovial monocytic cells could be mimicked by exposing blood monocytes to synovial fluids from patients with rheumatoid arthritis (17 of 19) and synovial fluids from patients with osteoarthritis (4 of 4). In additional studies, the soluble factor in inflammatory synovial fluids responsible for regulating CD16 expression was found to be consistent with the presence of TGF-beta. Inhibition of the activity in synovial fluids with a neutralizing antibody to TGF-beta confirmed a role for this peptide in synovial phagocytic cell CD16 expression. Moreover, signal transduction through CD16 on synovial phagocytes resulted in augmented extracellular release of superoxide anion that may contribute to tissue damage and other inflammatory sequelae. Identification of TGF-beta and its association with upregulation of CD16 at sites of chronic inflammation may provide insight into the destructive lesions associated with inflammatory arthropathies.

Antigens, Differentiation↗

PubMed2001

Analysis of aggrecan in human knee cartilage and synovial fluid indicates that aggrecanase (ADAMTS) activity is responsible for the catabolic turnover and loss of whole aggrecan whereas other protease activity is required for C-terminal processing in vivo.

Studies of aggrecan proteolysis in human joints have implicated both the aggrecanase [ADAMTS, a disintegrin-like and metalloprotease (reprolysin-type) with thrombospondin type 1 motif] and matrix metalloproteinase (MMP) families. We have analysed the aggrecan core protein species present in vivo in both articular cartilage and synovial fluids from normal, acutely injured and osteoarthritic joints. Normal cartilage contains at least seven major G1 domain (the N-terminal globular domain of aggrecan)-bearing species, of which three (full-length core, G1-NITEGE(373) and G1-VDIPEN(341)) have been identified. The C-terminals of the others are unknown but digestion of fetal human aggrecan with MMP-3 and crude aggrecanase suggests that they are products of MMP-like activity in vivo. Normal synovial fluids contain at least 10 species, of which nine result from ADAMTS-dependent cleavage, and this cleavage occurs at all of the five known aggrecanase sites. Aggrecan fragments in the cartilage and synovial fluids of acutely injured joints are generally similar to normal, but all contain a markedly increased ratio of G1-NITEGE to G1-VDIPEN. Aggrecan from the cartilage of late-stage osteoarthritis patients is remarkably similar to normal, whereas the synovial fluid aggrecan is more fragmented than that from normal or injured knees. The analyses suggest that the role of the ADAMTS and these MMP-like activities in human cartilage are distinctly different. Excessive ADAMTS activity in vivo is destructive to cartilage matrix, since the bulk of the glycosaminoglycan (GAG)-bearing products are released from the tissue into the synovial fluid following cleavage of the Glu(373)-Ala(374) bond. In contrast, the MMP-like activity appears to be essentially non-destructive, since much of the GAG-bearing product is retained in the tissue following cleavages that are in the more C-terminal regions of the molecule.

Aggrecans↗

PubMed1997

Highly increased levels of active stromelysin in rheumatoid synovial fluid determined by a selective fluorogenic assay.

Stromelysin-1 (MMP-3) is an important member of the matrix metalloproteinase family. In joint-degrading diseases like arthritis, elevated levels of MMP-3 protein are detected in synovial fluid using immunological methods. However, these methods do not discriminate between active and inactive enzyme. In the present study, a specific stromelysin activity assay was developed using the selective fluorogenic substrate TNO003 (Dabcyl-Gaba-Arg-Pro-Lys-Pro-Val-Glu / Nva-Trp-Arg-Glu-(EDANS)-Ala-Lys-NH2, / =cleavage site). For its use in biological media, cleavage of TNO003 by enzymes other than stromelysin was effectively blocked by a proteinase inhibitor cocktail. Spiking of MMP-3 to synovial fluid resulted in an MMP-3 concentration-dependent linear increase in activity. The measured MMP-3 activity was not affected by the addition of MMP-13, even in a 5-fold excess over MMP-3. Synovial fluid from rheumatoid arthritis patients demonstrated 100-fold higher levels of active stromelysin than control synovial fluids.

Arthritis, Rheumatoid↗

PubMed1990

Cellular fibronectin in rheumatoid synovium and synovial fluid: a possible factor contributing to lymphocytic infiltration.

Mouse monoclonal antibodies against ED sequence-containing cellular fibronectin (cFn) were used to show that Fn in the inflamed synovium is distinct from the major form of plasma Fn (pFn). An accumulation of cFn was seen at sites of hyperplasia of the rheumatoid synovial membrane and in the walls of small vessels in the synovium by immunofluorescence microscopy. cFn was also found in rheumatoid synovial fluid by immunoblotting. Approximately one-fifth of the T lymphocytes from rheumatoid synovial fluid bound to Fn. The binding of synovial fluid T cells was always higher than that from peripheral blood. These results have two implications. On the one hand, the cellular type of Fn may be an indicator of synovial inflammation. On the other hand, the deposition of Fn may be a factor contributing to the infiltration of mononuclear cells into the synovium.

Animals↗

PubMed1983

Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid.

A simple, rapid screening method using alizarin red S stain and ordinary light microscopy to detect microcrystalline or noncrystalline calcium phosphate salts was used on wet drop preparations of synovial fluids. This proved to be helpful in detecting apatite crystal clumps and small calcium pyrophosphate dihydrate (CPPD) crystals missed by polarized light. The staining was positive in 100% of synovial fluids from patients later proven to have apatite and/or CPPD deposition diseases. Apatite and CPPD crystals were commonly found together in the same fluids. In addition, some synovial fluids from patients with osteoarthritis, renal failure dialysis, rheumatoid arthritis, and gout also exhibited positive staining. The correlation of positive alizarin red S staining with radiologic evidence of osteoarthritis suggests that apatite crystals might be related to articular cartilage degeneration in different rheumatic diseases.

Anthraquinones↗