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PubMed1991

The T-cell-receptor repertoire in the synovial fluid of a patient with rheumatoid arthritis is polyclonal.

We have analyzed the T-cell-receptor repertoire expressed in the synovial fluid of a patient with rheumatoid arthritis by using an inverse polymerase chain reaction. Total RNA was isolated from Ficoll-purified mononuclear cells and converted into circularized double-stranded cDNA. Specific amplification of alpha- and beta-chain variable regions (V alpha and V beta) was achieved with inverted alpha- and beta-chain constant region (C alpha and C beta) primer pairs, and the amplification products were cloned into phage vectors. A total of 78 alpha and 76 beta clones were sequenced, and 67 and 72 productively rearranged alpha and beta genes were identified, respectively. Thirty-one V alpha, 33 alpha-chain joining region (J alpha), 29 V beta, and 12 beta-chain joining region (J beta) gene segments were found in the productively rearranged clones, indicating that the T-cell repertoire expressed in the synovial fluid of this RA patient is highly heterogenous and polyclonal. Comparison of peripheral blood and synovial fluid repertoires showed that the most abundant V beta sequences, V beta 2.1 and V beta 3.1, were enriched in the inflamed joint by a factor of 2 to 3. It is possible that T cells expressing these V beta gene segments, which recognize bacterial superantigens, play a role in the disease.

Amino Acid Sequence↗
PubMed1994

Comparison of microheterogeneity of alpha-1-acid-glycoprotein in serum and synovial fluid from rheumatoid arthritis patients.

Microheterogeneity of alpha-1-acid glycoprotein was studied using affinity immunoelectrophoresis with concanavalin A as a ligand in the samples of serum and synovial fluid obtained at the same time from 22 patients with rheumatoid arthritis. Individuals with intercurrent infection or other illnesses were excluded from the study. The results were expressed as reactivity coefficient (RC). Disease activity was evaluated by Mallya-Mace Activity Score, Lansbury Joint Index and laboratory tests. In most of the studied samples the glycosylation pattern was similar, composed of a nonreactive variant and 2 reactive (the first and the second) with Con A variants. In seven samples of synovial fluid an extra third peak representative of the strongly reactive one with Con A fraction was observed. It was the cause of the remarkable elevation of AGP-RC. Moreover, the level of IgM and IgA RF was higher in the synovial fluid derived from these patients--with the presence of the third peak in AFF-EP with Con A--than in those without the considered fraction.

Adult↗
PubMed1980

Synovial fluid in seronegative juvenile rheumatoid arthritis: studies of immunoglobulins, complements, and alpha 2-macroglobulin.

Synovial fluid of 20 children with seronegative juvenile rheumatoid arthritis (JRA) and 20 patients with other joint pathology was examined for levels of total hemolytic complement and selected components, immune complexes, and alpha 2-macroglobulin (alpha 2-M). When adjusted for total protein, synovial levels of total hemolytic complement, C3, C4, and alpha 2-M did not differ significantly in the two groups. The concentrations of IgM and IgG were elevated in the JRA synovial fluid, but immune complexes were not increased when compared with non-JRA group as determined by the Raji cell technique. alpha 2-M activity against substrates of C1 esterase was absent. therefore, evidence of specific increase in immune complexes and complement activation was sought but not found, suggesting that they may not be a major factor in the pathogenesis of seronegative, pauciarticular JRA.

Adolescent↗
PubMed1993

High concentrations of immunoreactive gliostatin/platelet-derived endothelial cell growth factor in synovial fluid and serum of rheumatoid arthritis.

Since neovascularization plays an important role in the propagation of rheumatoid synovitis, we analyzed the concentration of gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF), a potent angiogenic and chemotactic factor, in the synovial fluid and serum of rheumatoid arthritis (RA) patients. The immunoreactive GLS/PD-ECGF concentrations (mean value +/- S.D.) in synovial fluid, measured by a sandwich enzyme immunoassay, were significantly higher in RA patients than in osteoarthritis (OA) patients (233.02 +/- 219.40 vs. 9.09 +/- 14.86 ng/g, P < 0.001), and the serum concentrations were also higher in RA patients than in age-matched controls (8.77 +/- 7.60 vs. 3.74 +/- 2.61 ng/ml, P < 0.005). These results suggest that GLS/PD-ECGF may participate in the endothelial proliferation resulting in initiation of the extensive emigration of mononuclear cells and proliferation of the synovial tissues in rheumatoid arthritis, and that the immunoreactive GLS/PD-ECGF in serum as well as synovial fluids may be a useful diagnostic marker of RA.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Extracellular aggregates of immunoglobulin in synovial fluid from rheumatoid arthritis.

Particulate extracellular aggregates of immunoglobulin can be demonstrated in many whole synovial fluids from patients with rheumatoid arthritis but not in other diseases. These occur only in seropositive patients and correlate with more active inflammation and lowered synovial fluid C3. Aggregates were associated with intracellular inclusions but were more abundant and always contained both IgG and IgM. No aggregates were seen in 50 control fluids. These aggregates are compatible with immune complexes and should be included in studies of immunologic events in rheumatoid fluids.

Animals↗
PubMedDate not supplied

Protease inhibitors in rheumatoid synovial fluid: a quantitative analysis.

The concentrations of the main endogenous inhibitors of granulocyte proteases (anti-leukoprotease, alpha 1-antitrypsin, alpha 1-antichymotrypsin, and alpha 2-macroglobulin) were estimated in paired samples of synovial fluid and serum/plasma from seropositive rheumatoid arthritics and controls. Rheumatoid synovial fluid contained significantly higher levels of all inhibitors except antileukoprotease. The influence of the synovial membrane on these concentrations was taken into account by comparing the ratio between the observed concentration and that predicted from a certain regression curve fitted to a set of non-inhibitory reference proteins of extra-articular origin (orosomucoid, albumin, and ceruloplasmin). Divergences were interpreted as the net result of intra-articular production or consumption of the inhibitor in question. The results suggested a consumption of antileukoprotease and alpha 1-antitrypsin in the rheumatoid joint, while the increased levels of alpha 1-antichymotrypsin and alpha 2-macroglobulin probably reflected the altered trans-synovial membrane protein flux with some reservation for alpha 2-macroglobulin.

Adult↗
PubMed1998

Increased pentosidine, an advanced glycation end product, in plasma and synovial fluid from patients with rheumatoid arthritis and its relation with inflammatory markers.

Pentosidine is an advanced glycation end product (AGE) formed by combined processes of glycation and oxidation (glycoxidation) between carbohydrate-derived carbonyl group and protein amino group. Recent studies demonstrated the increased pentosidine levels not only in diabetic patients with hyperglycemia but also in normoglycemic uremic patients due to increased oxidative stress. Rheumatoid arthritis (RA) is a state of increased oxidative stress associated with chronic inflammation. This suggested an enhanced glycoxidation reaction and increased AGE levels in RA patients. In the present study, we therefore determined, by high performance liquid chromatographic (HPLC) assay, the concentrations of pentosidine in plasma and synovial fluid from 22 patients with rheumatoid arthritis (RA) and compared their levels with those in 17 patients with osteoarthritis (OA), 26 diabetic patients, and 25 normal subjects. The levels of inflammatory markers and markers of tissue destruction, metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), were also measured in the same samples. Pentosidine levels in plasma and synovial fluid from RA patients were significantly higher than those in OA patients, diabetic patients, and normal subjects. There was a significant correlation between the pentosidine levels in plasma and those in synovial fluid. Among markers of inflammation and matrix destruction, pentosidine levels in plasma from RA patients were correlated with the levels of C-reactive protein (CRP), erythrocyte sedimentation rate, white blood cell count, and platelet count. Multiple stepwise regression analysis reveals an independent influence of CRP on plasma pentosidine levels. In conclusion, pentosidine levels are significantly higher in plasma and synovial fluid from RA patients and may be useful as a biomarker of chronic inflammation in RA patients.

Acute-Phase Proteins↗
PubMed1994

Binding of IL-1 alpha, IL-1 beta, and IL-1 receptor antagonist by soluble IL-1 receptors and levels of soluble IL-1 receptors in synovial fluids.

These studies have examined the binding of the three IL-1 ligands, IL-1 alpha, IL-1 beta, and IL-1 receptor antagonist (IL-1 ra), to soluble forms of types I and II IL-1Rs (sIL-1RI and sIL-1RII). This interaction was measured in direct binding experiments, in which the ligands bound to immobilized sIL-1R, and in inhibition experiments, in which sIL-1R in solution inhibited the binding of IL-1 ligands to immobilized sIL-1R. In addition, the effects of sIL-1R on the detection of IL-1 ligands by ELISA were examined. Finally, levels of sIL-1R in synovial fluid samples were determined, and their effects on measurement of IL-1 in these samples were estimated. IL-1 beta bound more avidly to sIL-1RII than IL-1 alpha or IL-1ra, primarily because of a slow dissociation rate. In contrast, IL-1 ra bound more avidly than IL-1 alpha or IL-1 beta to sIL-1RI, again because of a slow dissociation rate. sIL-1RII and sIL-1RI inhibited the detection of IL-1 beta and IL-1ra, respectively, by ELISA. Low levels of sIL-1RI (approximately 1.0-2.5 ng/ml) were present in all synovial fluids, irrespective of the degree of inflammation, and were correlated inversely with the levels of measured IL-1ra. In contrast, higher levels of sIL-1RII (approximately 10-20 ng/ml) were found in inflammatory synovial fluids and were not correlated with IL-1ra levels. IL-1 beta could not be detected in any synovial fluid. These results suggest that some IL-1 beta and IL-1ra may be bound in vivo to sIL-1RII and sIL-1RI, respectively, leading to underestimations of cytokine concentrations in body fluids when measured by ELISA.

Animals↗
PubMed1996

Adhesion molecules in untreated inflammatory arthritis: synovial expression and levels in synovial fluid and serum [corrected].

Adhesion molecules play a critical role in regulating leucocyte migration at sites of inflammation. The relationship of soluble forms in serum or synovial fluid (SF) to synovial membrane expression in inflammatory arthritis is controversial. We examined soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin levels in matched serum and SF, and their relationship to expression in synovium obtained at the same time in 13 patients with previously untreated inflammatory arthritis. Serum-soluble (s)ICAM-1 correlated with sedimentation rate (T = 0.45), Ritchie articular index (T = 0.47) and SF sICAM-1 (T = 0.48), and SF sICAM-1 correlated with membrane ICAM-1 expression (p < 0.02). sE-selectin and sVCAM-1 levels were unrelated to disease activity or membrane expression. Membrane E-selectin expression correlated inversely with ICAM-1 expression (T = -0.57) and serum sICAM-1 (T = -0.54). Serum sE-selectin correlated inversely with membrane ICAM-1 expression (T = -0.55). The correlations observed between ICAM-1 in serum, SF, synovium and disease activity suggest that ICAM-1 could be a useful target for immunotherapy. The inverse relationship of ICAM-1 and E-selectin suggest important differences in regulation and pathogenetic roles.

Adult↗
PubMed1988

Serum and synovial fluid steady-state concentrations of trimethoprim and sulfadiazine in horses with experimentally induced infectious arthritis.

The tarsocrural joints of 11 horses were inoculated with 1.2 to 2.16 x 10(6) viable Staphylococcus aureus organisms susceptible to a trimethoprim-sulfadiazine (TMP-SDZ) combination with minimal inhibitory concentration (MIC) of 0.25 micrograms of TMP/ml and 4.75 micrograms of SDZ/ml. Antimicrobial treatment consisted of oral administration of a TMP-SDZ combination--30 mg/kg of body weight given once daily (group-1 horses) or 60 mg/kg given as 30 mg/kg every 12 hours (group-2 horses). Paired serum and synovial fluid samples were obtained before intra-articular inoculation with the S aureus, after inoculation with S aureus but before antimicrobial treatment, and after inoculation at various hourly intervals after oral administration of the TMP-SDZ combination. The TMP-SDZ combination was administered daily in the 2 dosages for 21 days. Samples were collected after day 3 of repetitive drug administration so that drug steady-state concentration would have been achieved. Serum and synovial fluid samples were analyzed for TMP and SDZ concentrations. Administration of the TMP-SDZ combination at a dosage of 30 mg/kg once daily was not effective in maintaining TMP or SDZ concentrations above the MIC of TMP-SDZ for the S aureus (0.25 and 4.75 micrograms/ml for TMP and SDZ, respectively) in the infected synovial fluid or in maintaining adequate TMP concentration in the serum. The alternative use of the TMP-SDZ combination at a dosage of 60 mg/kg given as 30 mg/kg every 12 hours was effective in maintaining serum and synovial fluid concentrations of TMP and SDZ that were greater than the MIC for the infective organism.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMedDate not supplied

Synovial fluid lactic acid. A diagnostic aid in septic arthritis.

Lactic acid concentrations in the synovial fluid of 84 patients with acute monoarticular arthritis were determined by gas liquid chromatography. Lactic acid values in 27 cases of nongonococcal septic arthritis were strikingly higher (mean 1170 mg/100ml) than in 45 cases of inflammatory or degenerative arthritis (mean 34 mg/100 ml), as well as in 12 cases of gonococcal arthritis (mean 27 mg/100 ml). With the proper equipment, determination of lactic acid can be a relatively rapid, reliable procedure. Synovial fluid lactic acid concentrations therefore can be used as a rapid, supplemental diagnostic aid in differentiating nongonococcal septic arthritis from both gonococcal and nonseptic acute arthritis.

Adult↗
PubMed1997

Cartilage and bone macromolecules in knee joint synovial fluid in rheumatoid arthritis: relation to development of knee or hip joint destruction.

OBJECTIVE: To examine the hypothesis that aggrecan, cartilage oligomeric matrix protein (COMP), and bone sialoprotein (BSP) concentrations in synovial fluid could provide information on variations of progression of joint destruction in rheumatoid arthritis. METHODS: Aggrecan, COMP, and BSP were quantified by enzyme linked immunosorbent assays in longitudinally collected knee joint synovial fluid samples of patients rapidly developing destruction in knees or hips, the "'destructive" group, n = 18, and in patients slowly developing destruction, the "non-destructive" group, n = 25. RESULTS: The aggrecan concentrations decreased from initially high levels (P < < 0.001), and the BSP concentrations increased (P < < 0.001) over time in the destructive group, whereas levels of both markers were low and did not change in the non-destructive group. The COMP levels did not change in any of the groups. The aggrecan concentrations were initially highest in the group developing destructions (P < < 0.001), whereas no difference between the groups was found regarding levels of COMP or BSP in the first sample. CONCLUSIONS: A destructive group was characterised by higher initial aggrecan concentrations and rising BSP concentrations in synovial fluid with time. Quantification of cartilage and bone derived macromolecules contributes to the assessment of extent of tissue destruction and may help in the early identification of patients at risk of rapidly progressing destruction.

Adult↗
PubMed1983

Analysis of T cell subsets in the peripheral blood and synovial fluid of patients with rheumatoid arthritis by means of monoclonal antibodies.

In an attempt to define the immunoregulatory mechanisms operating in rheumatoid arthritis we have enumerated T cell subsets in the peripheral blood and synovial fluid of patients with this disease. The peripheral blood analysis revealed an elevation of the ratio of inducer T cells (OKT4 positive) to suppressor/cytotoxic T cells (OKT5 positive) in patients with clinically active rheumatoid arthritis when compared with normal persons. This was due to a reduction in the percentage of suppressor/cytotoxic T lymphocytes in these patients. The synovial fluid in rheumatoid arthritis differed from the peripheral blood in 2 respects. Firstly, synovial fluid was characterised by a lower helper: suppressor ratio due to an increased number of suppressor/cytotoxic cells, and, secondly, it contained an increased number of activated T cells bearing HLA DR antigens. The majority of these activated T cells belonged to the helper/inducer T cell subset.

Adult↗
PubMed1999

Changes in CD4+ T lymphocyte subsets in circulating blood and synovial fluid following filtration leukocytapheresis therapy in patients with rheumatoid arthritis.

The purpose of this study is to determine the changes in CD4+ T lymphocyte subsets in the circulating blood and synovial fluid following filtration leukocytapheresis (LCP) therapy for patients with rheumatoid arthritis (RA). A Cellsorba column packed with polyester fibers was used for the removal of circulating leukocytes. For patients with RA, filtration LCP or sham procedures were performed 3 times with 1 week intervals between procedures. T lymphocyte surface markers in the peripheral blood and synovial fluid were measured by flow cytometry. The proportions of activated CD4+ T cells (CD4+DR+, CD4+CD25+, and CD4+CD71+) and CD4+CD29+ T cells increased significantly in the peripheral blood, but the counts of these cells were significantly reduced in the synovial fluid after 2 treatment sessions in the LCP group. No significant changes were observed in the proportion of these cells in the control group. Our findings suggest that filtration LCP may cause a redistribution of activated T cells from affected joints into the circulating blood.

Arthritis, Rheumatoid↗
PubMed1990

Identification and isolation of a phospholipase A2 activating protein in human rheumatoid arthritis synovial fluid: induction of eicosanoid synthesis and an inflammatory response in joints injected in vivo.

Eicosanoids are important mediators of the destructive arthropathy observed in rheumatoid arthritis. The rate-limiting step in the eicosanoid synthesis pathway is the availability of free arachidonic acid. The phospholipase enzymes release arachidonic acid from membrane phospholipids and thus play an important role in the regulation of eicosanoid production. We have previously demonstrated enhanced phospholipase A2 and C enzyme activities in cells from patients with rheumatoid arthritis and have also described a phospholipase A2 activating protein (PLAP) in mammalian cell lines. In an attempt to determine the biochemical basis of enhanced phospholipase A2 activity found in patients with inflammatory joint disease, we examined synovial fluid from patients with rheumatoid arthritis for PLAP. To determine whether PLAP was specific for rheumatoid disease, we assayed specimens from patients with other arthropathies. Histologic examination of rheumatoid joint tissue, with the use of immunohistochemical techniques, demonstrated high concentration of PLAP in monocytes, macrophages, chondrocytes, vascular smooth muscle, and endothelial cells. Human PLAP could be biochemically isolated from synovial fluid from patients with rheumatoid arthritis and was found to be similar to PLAP previously isolated from murine and bovine sources. To determine whether PLAP could directly mediate any aspect of inflammatory disease, purified PLAP was injected into rabbit knee joints. This resulted in an acute inflammatory arthritis with synovial cell proliferation and synovial fluid leukocytosis. Purified PLAP also induced eicosanoid formation both in vivo and in vitro. With enzyme-linked immunosorbent assays, we found more PLAP in synovial fluid specimens from patients with rheumatoid arthritis compared with samples from patients with other inflammatory arthropathies as well as osteoarthritis, a noninflammatory arthropathy. These data suggest that PLAP may be responsible, at least in part, for some aspects of the destructive inflammatory arthropathy that is observed in patients with rheumatoid arthritis.

Adult↗
PubMed1987

Plasma and synovial fluid concentrations of piroxicam during prolonged treatment with piroxicam pivalic ester.

Piroxicam pivalic ester (CHF 10/21) is a prodrug of piroxicam and is characterized by a reduced gastric irritant activity. Plasma and synovial fluid samples were simultaneously taken from 7 patients with mono- or poly-articular arthritis causing knee effusion, during 4 weeks of treatment with CHF 10/21 at the dose of 30 mg/day. The time courses of plasma levels of both the prodrug and the active principle were studied and a correlation of the latter with synovial fluid levels was made. After 14 days of treatment the steady-state was reached in the systemic (plasma) and peripheral (synovial fluid) compartments with therapeutically active drug levels. Clinical results were good and a complete disappearance of local pain occurred in 2 cases. Good gastric tolerance was also achieved.

Adult↗
PubMed1998

Synovial fluid cartilage metabolism marker concentrations in osteonecrosis of the femoral head compared with osteoarthrosis of the hip.

OBJECTIVE: Biochemical aspects of the etiology of articular cartilage degeneration in osteonecrosis of the femoral head have not been investigated extensively. We analyzed biochemical conditions in the hip joint cavity, regarding articular cartilage turnover in osteonecrosis of the femoral head (ONFH). METHODS: Cartilage metabolism markers in synovial fluid were measured. Synovial fluid (SF) samples were collected from 19 ONFH cases and 17 control hips with osteoarthrosis (OA). Concentrations of carboxy-terminal type II procollagen peptide (pCOL-II-C), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured. In addition, concentrations of unsaturated disaccharides of hyaluronic acid (delta di-HA), chondroitin 4-sulfate (delta di-4S), and chondroitin 6-sulfate (delta di-6S) in SF were measured by high performance liquid chromatography. RESULTS: The mean SF concentration of pCOL-II-C was higher on ONFH than in OA. The mean SF MMP-3 level was higher in ONFH than in OA, while the mean SF TIMP-1 level was the same in the 2 groups. The SF concentration of delta di-HA and the delta di-6S/delta di-4S ratio were higher in ONFH than in OA. CONCLUSION: Higher concentrations of cartilage metabolism markers in ONFH compared with OA SF suggest elevated cartilage turnover in the former disease.

Adolescent↗