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Synovial fibroblasts and synovial macrophages from patients with rheumatoid arthritis and other inflammatory joint diseases show chromosomal aberrations.

Chromosomal aberrations were investigated in nuclei extracted from synovial tissue and first-passage synovial fibroblasts (P-1 SFB, 98% enrichment) or macrophages (P-1 Mphi) from patients with rheumatoid arthritis (n=10). The findings were compared with those in other rheumatic diseases (osteoarthritis, n=14; reactive arthritis, n=1), as well as with those in chronic obstructive pulmonary disease (n=8). Controls were paired peripheral blood lymphocytes from arthritic patients, synovial tissue or SFB/Mphi from joint trauma/normals (n=9), and peripheral blood monocytes from normal donors (n=10). GTG banding of metaphase chromosomes and interphase fluorescence in situ hybridization with centromere-specific probes were used. Comparable chromosomal aberrations were observed in synovial tissue and P-1 SFB of patients with rheumatoid arthritis, osteoarthritis, and reactive arthritis (polysomy 7 and aneusomies of chromosomes 4, 8, 9, 12, and 18). Notably, aneusomies of chromosomes 4, 6, 7, 8, 9, 11, 12, and/or X were also detected in P-1 synovial Mphi from rheumatoid arthritis (90% of the cases), osteoarthritis (93%), and reactive arthritis (1/1), as well as bronchial Mphi from chronic obstructive pulmonary disease (25%). No aberrations were detected in paired peripheral blood lymphocytes (except for one osteoarthritis case with a karyotype 45,X[10]/46,XX[17]), or in peripheral blood monocytes and synovial tissue of normals/joint trauma. Because Mphi aberrations were common to chronic joint and pulmonary disease, chronic inflammatory stress may induce chromosomal aberrations with potential functional relevance in local mesenchymal cells and infiltrating leukocytes in an organ-independent fashion.

Adult↗

Magnetic resonance imaging of the wrist and finger joints in patients with inflammatory joint diseases.

OBJECTIVE: To study magnetic resonance imaging (MRI) features in the wrist and metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in 4 patient groups: early rheumatoid arthritis (RA) (< 3 yrs); established RA (> 3 yrs); other arthritis; arthralgia. METHODS: MRI was obtained before and after contrast (gadodiamide) injection of the wrist and finger joints in 103 patients and 7 controls. The study included: (1) 28 patients with disease duration < 3 yrs who fulfilled the American College of Rheumatology (ACR) criteria for RA; (2) 25 patients with RA disease duration > 3 yrs who fulfilled the ACR criteria. (3) 25 patients with reactive arthritis, psoriatic arthritis, or mixed connective tissue disease; and (4) 25 patients with arthralgia. The following MRI variables were assessed: number of joints with enhancement after contrast injection, number of joints with joint fluid, and number of bones with edema in the wrist and fingers. The volume of the enhancing synovial membrane after contrast injection in the MCP, PIP, and DIP joints was manually outlined. MR images were scored independently under blinded conditions. RESULTS: Bone marrow edema was found in 68% of the patients with established RA, and the number of bones with edema was significantly higher in patients with established RA compared to patients with early RA, other arthritis, and arthralgia (Mann-Whitney p < 0.04). Bone edema was not found in patients with arthralgia. There was marked overlap within and between the patient groups. No differences in MRI features were found between patients with early RA and patients with other arthritis. The volumes of the synovial membrane in the MCP, PIP, and DIP joints were significantly higher in patients with arthritis compared to patients with arthralgia. CONCLUSION: Although there was marked overlap between the arthritis patient groups, MRI determined bone marrow edema and synovial membrane volumes provided additional information about disease activity and may be used as a marker of it. Bone marrow edema appeared with the highest percentage in patients with long duration of RA (> 3 yrs) and is probably secondary to changes in inflammatory activity.

Acute-Phase Proteins↗

[Tissue engineering: new treatment of cartilage alterations in degenerative joint diseases in horses--preliminary results of a long term study].

Degenerative alterations in fetlock joints of the forelimb are common diagnoses for horses. The hyaline cartilage has a low capacity to regenerate and the treatment by veterinarians is often insufficient. As a final result, horses with articular cartilage defects are often not able to take part in competitions anymore. To establish an autologous cartilage repair method, we set artificial lesions (8 mm in diameter) into the fetlock joints of the forelimb of three horses. These defects were closed with autologous chondrocyte implants, which were fixed with titan-suture-anchors. After 3, 12 and 24 months, biopsies were taken by arthroscopy. One horse was euthanized after 9, another one after 24 months. The repair tissue was examined histologically and by biochemical analysis of hydroxyproline and glycosaminoglycan, which are typical cartilage related substances. After 9 months, the integration of the implant into native cartilage was demonstrated by electron microscopy. After 24 months, histological staining showed a similar morphology of the cartilage repair tissue compared with the surrounding native cartilage. Biochemical analysis of typical cartilage matrix molecules revealed formation of hyaline-like cartilage within tissue engineered autologous chondrocyte transplants.

Animals↗

Morphologic, radiologic and thermometric assessment of degenerative and inflammatory temporomandibular joint disease. An autopsy and clinical study.

TMJ autopsy specimens were examined with tomography. The joint surfaces were examined for structural changes. The radiologic methods was evaluated for ability of detecting these changes. A microscopic examination was performed concerning form and position of the disc, and histological features of radiologic cysts, erosion and sclerosis. Symptom-free individuals and patients with rheumatoid arthritis were examined thermometrically. The patients were also examined radiologically. The sensitivity of tomography increased with severity and extent of the structural changes and was higher for changes localized to the condyle than the temporal component. In areas with radiologic cyst, erosion and sclerosis there were macroscopic lesions in the condyle, while the temporal component more often was intact. Macroscopic structural changes were correlated between right and left TM joints. Anterior disc position was associated with perforation of the posterior attachment of the disc. Severity of radiologic changes in individuals with RA is correlated to duration and severity of subjective symptoms and clinical signs from the joint. The intra-articular temperature range in RA patients is greater than in symptom-free individuals. Pain and tenderness of the TMJ and masticatory muscles are thereby associated with hypothermia of the TMJ.

Adolescent↗

Facet joints diseases.

A review of the normal anatomy, developmental abnormalities, traumas and disorders affecting the facet joints is provided, with a recall of the major imaging modalities.

Arthrography↗

The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis--a high-resolution MRI and histological study.

OBJECTIVES: Diffuse swelling of the distal interphalangeal (DIP) joint beyond the joint margin is a common feature of arthritis in psoriatic arthritis (PsA). The purpose of this study was to explore the microanatomical basis for the inflammation and nail disease in PsA using a combined high-resolution magnetic resonance imaging (MRI) and histological studies. METHODS: High-resolution MRIs of the DIP joint were obtained in 30 subjects [10 PsA, 10 osteoarthritis (OA) and 10 normal volunteers]. The relationship between the DIP joint capsule and associated tendon enthesis and the nail bed and root were evaluated. Histological studies to define the relationship between the normal cadaveric DIP joint capsule and the nail root were performed on the middle and ring fingers of 10 dissecting room cadavers. RESULTS: On MRI, the dorsal capsular enthesis was the epicentre of an inflammatory reaction. This extended to involve the soft tissues adjacent to the nail in 8 of 10 cases in PsA, but only 4 of 10 cases in OA where the inflammation is less intense and in none of the normal fingers. The DIP joint capsule was intimately linked with the nail complex on histology, with the dorsal, volar and lateral aspects of the nail bed being ensheathed in fibres extending from the entheses. CONCLUSION: The study suggests that the extended nature of the enthesis organ associated with the DIP joint may explain the diffuse nature of the inflammatory response around the nail in PsA. Therefore the nail is as much an integral part of the enthesis organ as it is of the skin, which has implications for a better understanding of the disease.

Adolescent↗

Histopathological findings in joint diseases. Comparison with enzymatic changes and clinical laboratory data.

The histopathological diagNoses of 155 rheumatoid and osteoarthrotic patients, when made without knowing the clinical data, were in agreement with that made by clinicians in 70% of cases. No single histological feature was pathognomonic for either disease, though synovial tissue was most important for the diagnosis. Some correlations between histopathological changes, enzymatic status of joint compartments and the clinical laboratory data were found, but only in the case of mild synovitis. In the more severe synovitis cases, and in diseased cartilage and bone of rheumatoid and osteoarthrotic joints, the enzymatic changes were not systematically related with particular histopathological features. The histology reflects the past, while the enzymatic status anticipates the forthcoming events.

Arthritis, Rheumatoid↗

Stress radiographs in the evaluation of degenerative femorotibial joint disease.

Thirty-eight osteoarthrotic knees were examined to assess the widths of the femorotibial joint spaces. Radiographs were exposed with the patient lying, in a standing position, and with an adduction and abduction force. Forced compression of the osteoarthrotic joint compartment caused, on average, 18% greater narrowing than when loading it in the standing position. Compared to the joint space at rest, the non-weight-bearing compartment widened by 16% in the standing position and narrowed by 20% when stress was applied. Furthermore, the results showed an increase in laxity proportional to the degree of arthrosis. Stress radiographs significantly display the real cartilage width of both joint compartments. Knowledge of the condition of the articular cartilage in the non-weight-bearing compartment is important when considering a transfer of loading stresses by means of osteotomy.

Adult↗

Anaesthetic implications of temporomandibular joint disease.

The purpose of this article is to review the functional anatomy of the temporomandibular joint (TMJ) mechanism in man, to discuss the various types of TMJ dysfunction and to suggest a plan for assessment, anaesthesia and airway management when reconstructive or unrelated surgery is required. Patients with restricted mouth opening, who require critical care treatment of severe upper airway obstruction or impending ventilatory failure are a special risk group. Regional anaesthesia or the use of a laryngeal airway should be considered. When tracheal intubation is essential and mouth opening is less than 25 mm, it is unlikely that the larynx will be visualized by direct laryngoscopy. Fibreoptic intubation is then indicated. All patients with severe TMJ dysfunction require assessment by an oral surgeon.

Anesthesia↗

The value of the nuclear medical scan in the diagnosis of temporomandibular joint disease.

A total of 125 patients with TMJ complaints underwent nuclear medical scans of their joints as part of their diagnostic work-ups. The scan results were compared with the radiographic and arthrogram findings of these patients. The results suggest that the nuclear medical scan is not a highly reliable diagnostic aid for the majority of temporomandibular joint patients.

Adolescent↗

Immunocytochemical demonstration of lymphocyte subsets and MHC class II antigen expression in synovial membranes from dogs with rheumatoid arthritis and degenerative joint disease.

The study describes the distribution of canine leucocyte antigens in synovial membrane biopsies from six dogs with canine rheumatoid arthritis (CRA) and from eight dogs with osteoarthritis (OA) secondary to spontaneous rupture of the cranial cruciate ligament (CCL) (n = 5) or patellar luxation (n = 3). Synovial membranes from five dogs without evidence of joint lesions were used as control tissues. In the subsynovium of dogs with normal joints CD5+, CD4+, CD8+ and alpha beta TCR+ lymphocytes were present only in low numbers. With monoclonal antibody (mAb) to MHC class II antigen, either none or up to 20-30% of synovial lining cells were immunoreactive. Furthermore, scattered MHCII+ stromal cells were seen in the deeper subsynovial layer. In synovial membrane biopsies from dogs with CRA numerous diffusely and perivascularly distributed CD5+ lymphocytes were found in the subsynovium. CD4+ cells outnumbered CD8+ cells and were more numerous in the perivascular areas. In all the CRA cases examined, there were markedly higher numbers of alpha beta TCR+ cells compared with gamma delta TCR+ cells. With mAb to CD21, low numbers of immunoreactive lymphocytes were demonstrated. In all the CRA cases, a marked increase of MHC class II antigen expression was noted. In the majority of samples, 50% or more than 90% of the synovial lining cells were strongly MHC class II+. Throughout the subsynovial layer there were numerous MHC class II+ cells and included those with dendritic morphology and inflammatory mononuclear cells. Furthermore, marked perivascular immunoreactivity for MHC class II antigen was found. In biopsies from dogs with OA, there were markedly lower numbers of subsynovial CD5+, CD4+ and CD8+ lymphocytes. T-cells were mainly diffusely distributed. In three of the eight OA dogs examined, there was an increased percentage of synovial lining cells expressing MHC class II. The majority of OA cases had subsynovial major histocompatibility complex (MHC) class II+ cells with a dendritic morphology.

Animals↗