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Long-term FEIBA prophylaxis does not prevent progression of existing joint disease.

Activated prothrombin complex concentrates have been used to treat bleeding episodes for patients who have developed an inhibitor to factor VIII (FVIII). FEIBA-Vh (FVIII bypassing activity, FEIBA) has been used since 1970 for this purpose and with FVIII for immune tolerance programmes. Studies have not been presented to show the safety and efficacy of FEIBA when given over a long period of time to prevent haemophilic arthropathy with bleeding into the joints of these patients. This study was undertaken to ascertain the outcome of haemophilic arthropathy with FEIBA prophylaxis. Data were collected on seven patients with known long-standing high-titre FVIII inhibitors given FEIBA prophylaxis for 3-6(1/2) years. Patients were given 50-100 units of FEIBA three to four times weekly. A functional joint evaluation revealed some degree of arthropathy already present in all patients at time of prophylaxis initiation. Safety was measured by medical status, evidence of thrombosis, life-threatening bleeding and inhibitor titre. Efficacy was measured for joint outcome by a functional physical therapeutic scale. At the conclusion of the study, efficacy was mixed as all of the joints for which the patients were placed on prophylaxis had progressed and developed synovitis. Two patients had a functional improvement in their arthropathy, and all were functional enough to attend regular school. The product was deemed safe for long-term use, as there were no complications of therapy with no thrombosis, no life-threatening bleeding episodes and no anamnesis caused by FEIBA alone. Inhibitor titres fell in all patients over the course of the study. Total product usage ranged from approximately 9373-15,571 U kg(-1) year(-1). FEIBA is safe for long-term prophylaxis when given in the recommended dosage for an extended period of time. Efficacy to prevent arthropathy could not be seen as all patients had some degree of arthropathy at time of prophylaxis initiation. An additional study needs to be performed using FEIBA before arthropathy has developed.

Blood Coagulation Factors↗

[Nuclear medical diagnosis of hip joint diseases in adults].

Skeletal scintigraphy has a high sensitivity but low specificity in early detection and follow up of hip diseases. Unexplained hip pain or indistinct X-rays may be the reason for scintigraphic examination. On the other hand, there is a wide range of clinical indications for nuclear medicine examination, such as metastatic and primary malignant disease, tumor-like lesions, inflammatory, infectious, degenerative and avascular diseases, and posttraumatic and postoperative changes. White blood cell scintigraphy is highly sensitive and highly specific in the detection of infectious disease of the hip. In the vast majority of cases, physiologic or postoperative granulocytic accumulation can be differentiated from infectious accumulation, which requires therapy.

Adult↗

Human parvovirus B19 infection is not followed by inflammatory joint disease during long term follow-up. A retrospective study of 54 patients.

OBJECTIVE: To investigate whether recent human parvovirus B19 (B19) infection provokes inflammatory arthritis, we assessed the outcome of 54 patients with recent B19 infection who were referred to the Department of Rheumatology. METHODS: Consecutive patients referred between 1985 and 1995 and found to have a recent B19 infection were studied retrospectively by sending a questionnaire and, if necessary, by physical examination. RESULTS: In the acute phase of B19 infection, all patients had arthralgia and many also complained of myalgia and malaise. Arthritis was found in 61% of the patients, skin rash in 72% and fever in 64%. Except for the arthralgia and malaise, most of the symptoms resolved rapidly. After a mean followup of 5 years (SD 2.9 yrs.) none of the patients reported persistence of joint swelling or restricted motion. CONCLUSION: None of the 54 patients with recent B19 infection developed chronic arthritis.

Acute Disease↗

Chronic inflammatory joint disease revealing borderline leprosy.

Musculoskeletal symptoms are not infrequent in leprosy and, when inaugural, may be difficult to differentiate from other conditions, most notably rheumatoid arthritis. We report the case of a 24 year-old man with a 5 year history of intermittent inflammatory arthritis and fever. Physical findings and radiographs were normal initially. Several years later, he had severe wasting of the hand muscles, stocking-glove sensory loss, burn scars on the hands, and plantar ulcers. Electrophysiological test results indicated sensory-motor neuropathy with predominant demyelination. Laboratory tests showed inflammation without immunological abnormalities. A prominent endoneurial inflammatory infiltrate composed of mononuclear cells was seen on a nerve biopsy specimen, suggesting leprosy. A family study then revealed that the patient's aunt had been diagnosed with leprosy. Dapsone, clofazimine, and rifampin were given. The joint manifestations and laboratory tests for inflammation improved. However, no changes were noted in the neurological symptoms.

Adult↗

Effects of combination M40403 and dexamethasone therapy on joint disease in a rat model of collagen-induced arthritis.

OBJECTIVE: To investigate the effects of combination therapy with M40403, a superoxide dismutase mimetic (SODm), and dexamethasone (DEX) on collagen-induced arthritis (CIA) in rats. METHODS: CIA was elicited in Lewis rats by an intradermal injection of 100 mul of an emulsion of bovine type II collagen (CII) in Freund's incomplete adjuvant (IFA) at the base of the tail. On day 21, a second injection of CII in IFA was administered at the base of the tail. RESULTS: Lewis rats developed erosive arthritis of the hind paw when immunized with an emulsion of CII in IFA. The histopathology of CIA included erosion of the articular cartilage at the joint margins and subchondral bone resorption. Immunohistochemical analysis for nitrotyrosine, poly(ADP-ribose) polymerase (PARP), inducible nitric oxide synthase (iNOS), and cyclooxygenase 2 (COX-2) revealed positive staining in inflamed joints of collagen-treated rats. The combination therapy with M40403 2 mg/kg and DEX 0.01 mg/kg significantly reduced the development of the inflammatory process and reduced the degree of staining for iNOS, COX-2, nitrotyrosine, and PARP. No significant difference in the degree of staining between the combination therapy and the higher dose of DEX (0.1 mg/kg) was found. Furthermore, radiographic evidence of protection from bone resorption was apparent in the tibiotarsal joints of rats that received the combination therapy. CONCLUSION: This study shows that combination therapy with M40403 and DEX reduced the degree of chronic inflammation and tissue and bone damage associated with CIA in the rat. It supports the possible use of SODm in combination with steroids to reduce the dose necessary and the side effects related to the use of steroids in the management of chronic diseases such as rheumatoid arthritis.

Animals↗

Metabolism and characterisation of kinins and Hoe 140 (kinin antagonist) in the synovial fluid of patients with inflammatory joint diseases.

Methods have been optimised for the collection of synovial fluid and the chromatographic separation of individual kinins (bradykinin and kallidin) in the fluid by HPLC. In addition, the stability of the kinin antagonist, Hoe 140, in synovial fluid was compared with that of synthetic bradykinin. Although bradykinin was completely degraded after incubation for only 6 h in pooled synovial fluid obtained from patients with rheumatoid arthritis, Hoe 140 was stable for as long as 2 weeks under the same conditions. These studies will provide quantitative information regarding levels of kinins in inflamed joints and an insight into the therapeutic potential of kinin antagonists.

Anti-Inflammatory Agents, Non-Steroidal↗

[Pathophysiologic aspects of inflammatory and degenerative joint diseases].

Authors describe the physiological particularities of components of articular system (cartilage, synovialis, synovia, subchondral bone, ligamentous and neuromuscular apparatus). The essential resultant pathophysiological pattern in rheumatoid arthritis and osteoarthritis are demonstrated. Differences between temporary attendant synovitis in osteoarthritis and rheumatoid arthritis are pointed out.

Arthritis↗

Gas-filled parasymphyseal pubic cyst associated with degenerative joint disease.

Parasymphyseal cysts are a rare and poorly understood entity. This case report describes a gas-containing parasymphyseal cystic lesion associated with degenerative change and vacuum phenomenon in the pubic symphysis. The mass was discovered incidentally in a 72-year-old asymptomatic male who underwent a transrectal ultrasound-guided biopsy of the prostate and the nature of the lesion was confirmed on magnetic resonance imaging (MRI) and computed tomography (CT). We hypothesize that the gas within the parasymphyseal cystic mass arose from a vacuum phenomenon in the pubic symphysis, with subsequent extrusion of gas from the joint into the cyst itself. It is important for radiologists to be aware of the existence of this entity to avoid unnecessary surgery for patients.

Aged↗

[Specificity and indications of bone scan in non-neoplastic bone and joint disease in children. A study of seventy cases].

We studied 70 bone scans in pediatric patients to define the indications of this procedure in non-neoplastic disease. Sensitivity of bone scans in infections proved outstanding except in children under one year of age. Eighty-nine per cent of children with pain and fever and a positive bone scan had either an infection or osteochondritis. The same symptoms with a negative bone scan indicated either transient synovitis of the hip or the absence of bone lesions in 83% of cases. Children with pain as the only symptoms and a negative bone scan consistently had either transient synovitis of the hip, or normal bones and joints (100% of cases). Eighty-two per cent of children with pain and a positive bone scan had an infection or osteochondritis. Indications of bone scanning vary according to clinical features and include all children with functional impairment, pain and fever, and isolated limps with no obvious cause.

Adolescent↗

Behaviour of nitric oxide synthase isoforms in inflammatory human joint diseases: an immunohistochemical study.

Nitric oxide (NO) is produced by nitric oxide synthases (NOS) expressed in various human tissues and, depending on the amount of NO produced in each tissue, the physiological function of NO is determined. Since increased inducibile nitric oxide synthase (iNOS) expression and NO generation are associated with pathogenesis of idiopatic osteoarthritis of synovial tissue and data about constitutive nitric oxide isoform (cNOS) in this tissue are scarce, in this study we investigated the localization and distribution of nitric oxide isoforms in normal, acute and chronic diseased synovium. The immunohistochemical and histologic analysis was performed in human synovial tissue obtained from 10 patients with post-traumatic inflammation, 14 patients with idiopatic osteoarthritis and normal synovial specimens were obtained from 7 patients undergoing surgery for reconstruction of the anterior cruciate ligament. Immunohistochemical data showed iNOS was strongly expressed in the synovial lining layer, subsynovium and blood vessels from patients with acute and chronic inflammation pathology, on the contrary, normal joints were negative. A similar pattern of cNOS immunoreactivity was seen in synovial lining and vascular smooth muscle in the pathological samples, while in the normal joint the intensity of staining was weaker than the inflammed. These data indicate that NO is produced locally in the pathological synovial lining not only by iNOS but also by cNOS.

Adult↗

Correlation of radiographic and arthroscopic findings with rotator cuff tears and degenerative joint disease.

The purpose of this study was to identify early signs of rotator cuff tear and glenohumeral articular cartilage degeneration by using conventional radiography. A non-weighted anteroposterior oblique and a weighted active abduction view were evaluated for superior humeral migration and matching degenerative changes at the inferolateral acromion and superior aspect of the greater tuberosity in 40 patients who underwent shoulder arthroscopy. Measurements of the glenohumeral distance were performed. Surgical reports were reviewed to determine rotator cuff and glenohumeral articular cartilage status. Matching degenerative changes correlate with complete rotator cuff tear (P =.04); superior migration does not. Severe glenohumeral cartilage loss correlates with narrowing of the superior joint space on the anteroposterior oblique radiograph (P =.02) and with narrowing of the mid joint space on the active abduction view (P =.05). Both glenohumeral articular cartilage degenerative change and rotator cuff injury, before formation of typical sequelae of chronic rotator cuff tear, can be detected with the use of conventional radiography.

Adult↗

Some cellular aspects of chronic inflammation in joint disease.

We have examined the nature of some mononuclear cells from inflamed synovial membranes of patients with rheumatoid arthritis. It was found that cells which remained in the supernatant medium after overnight culture of trypsinized tissue contained a variable number of lymphocytes which were shown to be T cells by rosetting and mitogen response. This suggests a source of T cell lymphokines with an effect on macrophages and thus a role in the maintenance of inflammation. Another role for mononuclear cells is suggest by the cytotoxicity of blood mononuclear cells directed against cultured synovial cells. This was found to occur in an autologous system using fibroblasts from rheumatoid synovium, but was not specific for rheumatoid arthritis. Stimulatory factors from rheumatoid joint effusion macrophages for blood lymphocytes were sought, but although blast transformation occurred, the results were equivocal. In this communication we set out to examine the nature of lymphoid cells in the synovial membrane and the role which they may play in the pathogenesis of chronic inflammation. We also briefly consider cell-mediated mechanisms of tissue injury. Since an active role of lymphoid cells pre-supposes the presence of an agent or agents which serve to stimulate them, we also report some recent attempts to find evidence for this. One of the striking histological features of the inflamed synovial tissue in rheumatoid arthritis, but also in some other forms of chronic arthritis, is the presence of lymphocytes and plasma cells. Immunofluorescent studies and organ culture studies have shown the presence and synthesis of immunoglobulins, predominantly the domain of plasma cells. The production of immunoglobulins, formation of complexes and activation of complement is a major factor in pathogenesis, but lymphocytes may also have a direct role through the production of lymphokines. Until recently these substances have been attributed to T lymphocytes, but Rocklin et al. (1) have recently shown that B cells may also be involved in certain experimental circumstances. The availability of synovectomy specimens from patients with rheumatoid arthritis has enabled us to examine the nature of lymphoid cells from synovial membranes. (This part of the work is reported fully elsewhere.

Arthritis, Rheumatoid↗

Assessment of temporomandibular joint disease by panoramic radiography: reliability and validity in relation to tomography.

OBJECTIVES: To assess the reliability and validity of panoramic radiography for TMJ evaluation in comparison with tomography. METHODS: One TMD specialist assessed the panoramic radiographs of 50 TMD patients and 20 non-TMD subjects on two occasions. A third evaluation was made after calibration with an oral radiologist who also assessed the radiographs twice and the patients' corresponding tomograms. Each TMJ was assessed for five features. RESULTS: Absence of TMJ disease varied between 56 and 87% for the different features and the two observers on the panoramic radiographs. Condylar flattening was the most frequent positive finding. Mean intra-observer agreement varied between 0.34 and 0.79. Mean inter-observer agreement varied between 0.22 and 0.65 and increased after calibration. Agreement was worse for the temporal component. Pathological findings were more frequent on the tomograms and varied between 6 and 19%. Mean sensitivity varied between 0.00 and 0.60 and mean specificity between 0.59 and 0.95. Mean PPV ranged from 0.25 to 0.90 and NPV from 0.02 to 0.22. CONCLUSIONS: Evaluation of bony changes on the condyles has acceptable reliability and specificity but low sensitivity, whereas the temporal component has low reliability and accuracy. Positive findings often correspond to disease while negative findings do not exclude it. If bony abnormality is suspected in the TMJ, and the panoramic radiograph is negative, tomography may be indicated.

Adult↗

Is inflammatory joint disease in HIV-infected patients a form of spondyloarthropathy?

UNLABELLED: In Congo-Brazzaville, the seroprevalence of HIV infection is in the range 7-8%, and AIDS is the leading cause of aseptic arthritis (60% of cases). PATIENTS, MATERIAL AND METHODS: The ESSG and Amor's criteria for spondyloarthropathy were evaluated in 83 patients with HIV infection admitted for aseptic arthritis to the rheumatology department of the Brazzaville teaching hospital, over an 8-year period. RESULTS: All 83 patients were CDC stage IV; 66 (80%) had polyarthritis and 17 (20%) oligoarthritis. A single patient met ESSG and Amor's criteria, with six points; one patient had five points and 15 had three points. The joint involvement was asymmetrical and nonerosive. Nonsteroidal antiinflammatory therapy ensured resolution of the manifestations within 4-8 weeks. The most common sites of involvement were the knees (84%), ankles (59%), and great toes (23%) at the lower limbs and the wrists (41%), elbows (29%), and metacarpophalangeal and interphalangeal joints (25%) at the upper limbs. CONCLUSION: Inflammatory arthritis in HIV patients does not meet ESSG or Amor's criteria for spondyloarthropathy.

AIDS-Related Opportunistic Infections↗

Calcitonin gene-related peptide II, substance P and vasoactive intestinal peptide in plasma and synovial fluid from patients with inflammatory joint disease.

Immunoreactive plasma and synovial fluid concentrations of calcitonin gene-related peptide II (CGRP II), substance P and vasoactive intestinal peptide (VIP) were measured in patients with osteoarthritis, gout and rheumatoid arthritis. Significantly higher levels of CGRP II and substance P-like immunoreactivity levels in synovial fluid were found in gout as well as CGRP II, substance P and VIP-like immunoreactivities in rheumatoid arthritis when compared to those in osteoarthritis. Plasma CGRP II, substance P and VIP-like immunoreactivity levels showed no significant differences among patients in the three different groups of arthritis. Our results suggest that these neuropeptides released from peripheral nerve endings into the synovial cavity probably play a pathogenic role in human joint inflammation.

Adult↗

[Multichannel muscular electric stimulation and lymphatic drainage of the tissue in the treatment of temporomandibular joint diseases].

Experimental and clinical trials were made to compare systemic effects of bipolar-impulse and sinusoidal modulated currents including redistribution of extracellular liquid. When used in patients with temporomandibular painful dysfunction syndrome and temporomandibular deforming arthrosis, the technique developed by the author promoted normalization of locomotor function and has a definite lymphodraining action.

Adult↗

[Laboratory diagnosis and antibacterial therapy in joint diseases].

The indication for arthrocentesis is a difficult medical decision. Once obtained, however, puncture fluid is unique and important examination material which should always be thoroughly analyzed for diagnostic purposes, and also stored in a serum bank. In addition to the total protein and/or albumin fractions, the individual immunoglobulins in particular have proved to be a key parameter: they enable mechanical, hydro, inflammatory, and chronic-inflammatory processes to be distinguished. Especially in combination with the serum value, CRP is the best marker for acute inflammatory and traumatic changes. Determination of complement factors C1, C4, and C3, also of total complement activity, CH50 and of rheumatism factors, enables chronic-immunologic/rheumatic conditions to be diagnosed and their course evaluated. Bacteriologic study of punctates should always be included--not least as confirmation for the examiner--as also should cytologic and histologic examination of the sediment. Since, with bacterial etiology, the infections concerned are usually in their later stages, e.g., gonorrhea, yersinia, rubella, arthritis, antibody assays should always be performed in the serum and the joint in addition to these tests. Controversy still surrounds the question of local binding of immunoglobulin antibody complement components in the synovia itself; the present authors' findings hitherto also fail to furnish any definitive data on this issue.

Arthritis, Infectious↗