Early results of cementless total hip replacement in inflammatory joint disease. The Rheumatism Foundation experience.
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On occasion, there is danger of TMJ injury from holding the violin in a playing position for long periods of time. A study of a patient with premature degenerative TMJ disease emphasizes the value of a routine occlusal and TMJ examination.
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A 10-year-old Labrador Retriever was admitted because of severe unilateral (left) forelimb lameness of 6 weeks' duration. Computerized tomography revealed bilateral fragmented coronoid processes (FCP) and unilateral fracture of the anconeal process. Surgery on the left elbow to remove the loose anconeal process and FCP resolved the severe lameness and improved the dog's overall activity, compared with that of the preceding 2 years. Unstable FCP can develop late in life, and a degenerative anconeal process may fracture. Surgical removal of loose fragments in a severely arthritic joint may be beneficial.
T lymphocytes play an important role in the pathogenesis of rheumatoid arthritis (RA). Murine monoclonal antibody OKT-3 (IgG2a), known to be specific for T lymphocyte 20 kD glycoprotein CD3 receptor was labelled with 5 mCi 99Tcm and given intravenously (i.v.) to seven RA and two psoriatic arthritis patients following informed consent to identify inflamed synovium. Anterior and posterior whole body scans and specific regional imaging was commenced 20 min later. At 1 h, approximately 20% of 99Tcm was associated with the lymphocytes. In these patients, all 41 asymptomatic joints and 43 joints with mild pain or minimal tenderness had normal scans. All 34 joints with moderate to severe pain had moderate to marked uptake of radioactivity. Two patients experienced shaking chills for 20-30 min within an hour of 99Tcm-OKT-3 infusion. These results suggest that 99Tcm-OKT-3 imaging serves as an objective surrogate for joint inflammation and could be useful as a measurement of therapeutic effectiveness in RA and other diseases with inflamed synovium. The side effect profile may limit the utility of 99Tcm-OKT-3 but other forms of antibodies directed toward lymphocyte subsets may be useful.
An enzyme linked immunosorbent assay for the quantification of proteoglycans or proteoglycan fragments in biological fluids is presented. The assay has been used to determine concentrations of articular cartilage proteoglycans and/or fragments thereof in synovial fluid in early stages of osteoarthrosis. Osteoarthrosis was induced in one knee joint of nine German wire haired pointers by transection of the anterior cruciate ligament. All dogs developed osteoarthrosis in terms of macroscopic as well as microscopic criteria. Attempts were made to aspirate synovial fluid, prior to surgery and at various times in the postoperative period, from the joint operated on as well as from the contralateral joint. Concentrations of proteoglycans (fragments) of one type of aggregating proteoglycan were significantly higher in the synovial fluid samples from the joint operated on compared to the contralateral joint (p less than 0.001), while the difference observed when the other type of aggregating proteoglycan was used as the test antigen was less significant (p less than 0.05). The concentration of proteoglycans (fragments) in synovial fluid samples from joints operated on was significantly higher after the operation when compared with the preoperative concentration (p less than 0.001). No correction has been made for the increased dilution due to hydrops of the joints operated on.
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Microwave thermography is a technique measuring microwave emission from sites of inflammation. Microwaves have a wavelength of around 10 cm and are therefore able to penetrate clinically useful depths of up to 4 cm directly measuring tissue thermal radiation. A microwave detector was applied to the study of joint inflammation in rheumatoid arthritis and in a normal control group. Fifty-two knees were scanned using the detector and a microwave thermographic index was calculated for each knee. A strong correlation was found between the microwave thermographic index, and the clinical and laboratory parameters measured. This technique was found to be reproducible, quick, simple to use at the bedside without a controlled environment and, since it measures internally emitted radiation, is inherently safe.
Children with hemophilia can develop progressive arthropathy. Arthroscopic synovectomy has been used to reduce hemarthroses, but few long-term results have been published. In this article the authors review their first 12 years of experience. Data are reported on 44 pediatric patients (69 joints: 39 ankles, 21 elbows, 7 knees, 2 shoulders). The median age at surgery was 10 years Median follow-up was 79 months. Joints with sufficient follow-up data showed a median bleeding frequency decline of 84% (P < 0.001). Median arc of motion was stable or improved in the year after surgery in ankles, elbows, and shoulders. Complications were rare. Radiographic scores worsened slightly. In this largest analysis of arthroscopic synovectomy for children with hemophilia, rehabilitation was not problematic.
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