Mseleni joint disease: biochemical survey.
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While the biochemical mechanism which leads to the destruction of joints in the course of degenerative and inflammatory arthropathies has not been cleared up completely to this day, basic differences have been noted in the way the two types of arthropathy affect the articular cartilage. The differences are described from the viewpoint of pathobiochemistry as they are fundamental to causal therapy.
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Synovial fluid samples (139) from 121 patients with rheumatoid arthritis, osteoarthritis, pseudogout, chronic pyrophosphate arthritis, gout, and reactive arthritis were analysed for cartilage proteoglycan components. Keratan sulphate (KS) epitope was determined by a competitive radioimmunoassay, and total sulphated glycosaminoglycans (S-GAG) were determined after papain digestion by a specific dye binding assay. Increased concentration of both KS epitope and S-GAG were found in synovial fluid from joints with acute inflammatory arthropathy (gout, pseudogout, and reactive arthritis). Analysis of consecutive samples from the same joint at different stages showed that the concentration of KS epitope or total S-GAG varied with acute inflammatory activity. In samples from patients with chronic conditions during active and inactive inflammatory phases concentrations were much lower and not distinguishable among these disease groups. The detection of raised concentration of proteoglycan components may reflect the rapid depletion or greatly increased turnover of proteoglycan in the articular cartilage during acute inflammation in the joint. This did not appear to be sustained in most patients with chronic joint diseases.
A realistic assessment of the nature, severity, and prognosis of arthritic disorders, appropriate patient education, allaying unrealistic patient fears and minimizing realistic ones, and maintaining the patient's functional independence should be prime considerations in the management of the older patient. Appropriate management of arthritic disorders will alleviate pain, increase functional capacities, and prolong independence. This article considers the diagnosis, presentation, and treatment of specific joint disorders found in the older population, including osteoarthritis, rheumatoid arthritis, gout, and other frequently seen rheumatic disorders.
In this paper, the principles of vibration arthrography are briefly described and the analysis of the resulting signals is explained. Using such a system, localisation of signals from within the joint is possible. Finally, the development of a vibration-based arthrographic system is proposed as a safe, relatively inexpensive, and totally non-invasive aid to the diagnosis of internal disease of the knee.
This study deals with the application of bone morphogenetic protein (BMP) as an osteoinductive factor in the treatment of fractures and elbow disease in the dog. Partially purified canine bone morphogenetic protein (cBMP) was used in the repair of a delayed union fracture and a pseudoarthrosis. The cBMP was applied in Biocoral and Tricalciumphosphate carriers using a subcortical grafting method. Two dogs suffering from incongruence and subluxation of the elbow joint were treated with a partially purified bone morphogenetic protein of moose bone origin placed in the gap produced by ulnar osteotomy.
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The first total synthesis of alpha-D-glucopyranosyl-(1-->2)-beta-D-galactopyranosyl-O-pyridinoline using a short "one-pot" assembly of its 1,4,5-trisubstituted 3-hydroxypyridinium ring is reported.
A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Nonphysiologic overstrain of any cause should be diagnosed and corrected.
The technique was applied in 12 patients with temporomandibular joint dysfunction without X-ray features of arthrosis, and in 7 patients with facial pains of unclear etiology. Radionuclide investigation data compared with clinical and X-ray data, the new technique proved highly sensitive to detect early stages of temporomandibular joint arthrosis and to determine temporomandibular joint involvement in cases of facial pains. This suggests the use of the technique for screening in prosopalgia.
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The short range tissue destruction of beta-emitting radioisotopes can be utilized in painful metastatic disease of the skeleton by employing a radionuclide that is specifically metabolized in or adjacent to these lesions. Sodium phosphate P 32 has been used for this purpose for the past 25 yr. It uptake in skeletal tumor and in osteoblastic new bone adjacent to tumor can be markedly increased by pharmacologic stimulation using androgenic steroids, or during rebound deposition after a course of parathyroid hormone. Although efficacy in terms of subjective pain relief is high, more objective signs of success are often lacking, and survival, while more confortable, is not prolonged. Marrow depression is the most significant side effect. A beta-emitting, bone-seeking isotope, 89Sr, may have a better therapeutic/toxic ratio, and should receive further trial. Radiation-induced necrosis has also been applied, though more hesitantly, to the proliferative, destructive, but nonmalignant synovium in rheumatoid disease. Here, a number of colloidal preparations, most commonly 198Au, have been employed. Again, relief of symptoms, particularly recurrent joint effusions, is quite high, although the basic disease process is not reversed. The major hazard here appears to be leakage of material to regional lymph nodes, resulting in irradiation of circulating lymphocytes. Although chromosomal damage can be detected when such cells are then cultured, the actual consequences of this, if any, are not presently known. Both shorter-lived (165Dy) and longer-lived (32P) larger-size colloids are being evaluated, which may prove safer in this regard than 198Au.