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PubMed1984

Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test.

This study applied threshold analysis and likelihood ratios to determine the usefulness of a diagnostic test. Eleven staff rheumatologists or rheumatology fellows provided probability estimates for the most likely diagnoses both before and after synovial fluid analyses were performed on 180 patients with joint effusions. They also indicated whether the planned therapy was altered by the test results. The therapeutic thresholds and log likelihood ratios were derived for the six most frequent diagnoses. Synovial fluid analysis was most useful for patients likely to have gout, pseudogout, or infectious arthritis. The derived therapeutic thresholds were consistent with recommended medical practice, for example, with a lower threshold for possible septic arthritis (20%) than for possible gout (65%). This study demonstrates that threshold analysis and likelihood ratios can be used to assess the clinical contribution of diagnostic tests.

Arthritis, Infectious↗
PubMed1980

[Study of the effects of free radicals produced by ultraviolet rays on viscosity of human synovial fluid. Methodological details].

After having pointed out a method measurement of the synovial Fluid (S.F.) viscosity by means of a white blood cell diluting pipette, obtaining results similar to those of Ostwald's viscometer, the AA have studied the osteoarthrotic S.F. viscosity after Ultra Violet Illumination. The production of Free Radicals induced by U.V., determines a fall of osteoarthrotic S.F. viscosity towards the values found in arthritic S.F..So, the AA, indirectly, confirme the capacity of Free Radicals to induce a S.F. viscosity modification like that provoked by the phlogistic process.

Arthritis, Rheumatoid↗
PubMed2005

Serum amyloid A isoforms in serum and synovial fluid in horses with lipopolysaccharide-induced arthritis.

The aim of the study was to determine the intraarticular serum amyloid A (SAA) response pattern in horses with inflammatory arthritis. Inflammatory arthritis was induced by injection of lipopolysaccharide (LPS) into the radiocarpal joint of four horses. Serum and synovial fluid (SF) samples were collected before and at 4, 8, 12, 24, 48, 72, 96, and 144 h after injection. Concentrations of SAA were measured by immunoturbidometry, and expression of SAA isoforms was visualized by denaturing isoelectric focusing and Western blotting. The LPS injection caused systemic and local clinical signs of inflammation. Serum amyloid A appeared in serum and SF within 8h after LPS injection. Isoelectric focusing showed three major SAA bands with apparent isoelectric points (pI) of 7.9, 8.6, and >9.3 in serum and SF. Synovial fluid contained two additional isoforms with highly alkaline apparent pI values (apparent pI value extrapolated from standard curve=10.0 and 10.2), which were not present in any of the serum samples. In conclusion, intraarticular injection of LPS induced systemic and local inflammatory responses in the horses. By demonstrating SF-specific SAA isoforms the results of the present study suggest that SAA is synthesized locally in the equine inflamed joint, similar to what has been demonstrated in humans previously. The marked local SAA synthesis suggests an important pathophysiological role in inflammatory arthritis.

Animals↗
PubMed1984

Prospective study of morphology and phagocytosis of synovial fluid monosodium urate crystals in gouty arthritis.

Crystals can be identified in synovial fluids (SF) in the absence of acute inflammation as well as during acute gouty arthritis. We examined gouty joint effusions to evaluate whether observable properties of the crystals correlate with the clinically detectable inflammation. Higher SF leukocyte counts and more crystal phagocytosis were confirmed during more severe arthritis. We found no differences between crystal sizes, numbers of shapes in severe versus mild inflammation. Some patients with severe acute gout had few crystals or only punctate birefringent fragments. Factors other than those we examined must affect the severity of the inflammatory response in gouty arthritis.

Arthritis↗
PubMed1992

Stimulation of neutrophils by insoluble immunoglobulin aggregates from synovial fluid of patients with rheumatoid arthritis.

Insoluble immunoglobulin aggregates present in the synovial fluid of patients with rheumatoid arthritis have been examined for their ability to activate reactive oxidant and granule enzyme secretion from bloodstream neutrophils. These insoluble complexes activated luminol chemiluminescence, but did not activate O2-, H2O2 or granule enzyme secretion and did not activate lucigenin chemiluminescence, which also measures reactive oxidant secretion. Hence, the luminol chemiluminescence detected after activation by insoluble immunoglobulin aggregates must be due to intracellularly generated reactive oxidants, i.e. produced within phagolysosomes. Because reactive oxidant and granule enzyme secretion has occurred within rheumatoid joints, other mechanisms of neutrophil activation must exist.

Arthritis, Rheumatoid↗
PubMed1996

RT-PCR analysis of MMP-9 expression in human articular cartilage chondrocytes and synovial fluid cells.

This report presents a method for analyzing matrix metalloproteinase-9 (92 kD gelatinase) MMP-9 mRNA expression using reverse transcription polymerase chain reaction (RT-PCR). With this method, chondrocytes isolated from small samples of osteoarthritic cartilage showed significantly elevated signal for MMP-9 mRNA compared to normal cartilage. In addition, cells of synovial fluid samples aspirated from osteoarthritic joints also exhibited MMP-9 expression using this technique. RT-PCR proved to be a sensitive method for assessing MMP-9 regulation in osteoarthritic and normal cartilage, and may provide a useful index of arthritic cartilage and synovial fluid cell metabolism when limited tissue is available.

Cartilage, Articular↗
PubMed1975

A neutral protease in rheumatoid synovial fluid capable of attacking the telopeptide regions of polymeric collagen fibrils.

Fluorescent-labelled polymeric collagen fibrils have been prepared which contain three fluoresein residues in the telopeptide regions and four fluorescein residues in the helical region of each tropocollagen unit within the polymer. This material has been used as a substrate for the study of enzymes present in the synovial fluid of inflamed rheumatoid joints which are capable of degrading polymeric collagen fibrils. Two enzyme systems were observed, one inhibited by EDTA and having the properties of the known synovial collagenase, the other having the properties of a neutral protease. The neutral protease was found to be present in sonicates of the polymorphonuclear leucocytes in the synovial fluids of inflamed joints. This enzyme attacked the telopeptides of fluorescein-labelled polymeric collagen fibrils and was similar to trypsin in removing two residues of fluorescein-labelled peptides per tropocollagen molecule within the polymeric collagen fibrils but did not depolymerise the polymeric collagen fibrils.

Animals↗
PubMed1978

The synovial fluid hyaluronic acid in rheumatoid arthritis.

The intrinsic viscosity of hyaluronic acid in synovial fluid decreases significatively in mild and severe arthritis (24% and 37% respectively). Variation in hyaluronic acid concentration parallels the above results. Chondroitin-6-sulfate can be detected in about 30% of the arthritic fluids.

Adolescent↗
PubMed1999

Macrophage inflammatory protein 1 alpha expression by synovial fluid neutrophils in rheumatoid arthritis.

OBJECTIVE: To determine the contribution made by synovial fluid (SF) neutrophils to the augmented expression of macrophage inflammatory protein 1 alpha (MIP-1alpha) in rheumatoid arthritis (RA). METHODS: Neutrophils were isolated from samples of SF from RA patients and peripheral blood (PB) samples from RA patients and healthy controls. Cell associated MIP-1alpha was visualised immunohistochemically, and cell associated MIP-1alpha as well as MIP-1alpha secreted into the SF was assayed by ELISA. Steady state expression of MIP-1alpha mRNA was assessed by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Freshly isolated SF neutrophils contained significantly higher concentrations of both MIP-1alpha protein and its transcript than PB neutrophils from either RA patients or healthy controls; incubation in the absence or presence of tumour necrosis factor alpha for 24 hours resulted in a significant increase in MIP-1alpha secretion by RA SF neutrophils compared with neutrophils obtained from either normal PB or RA PB; and expression of MIP-1alpha by SF neutrophils was well correlated with both RA disease activity and SF mononuclear cell (MNC) counts. CONCLUSION: Expression and secretion of MIP-1alpha by SF neutrophils may be indicative of local and systemic inflammation in RA. Moreover, this C-C chemokine may contribute to the recruitment of MNCs from the bloodstream into synovial joints and tissues.

Adult↗
PubMedDate not supplied

[Study of the fibrin degradation products in the synovial fluid of rheumatological diseases (author's transl)].

FDP were studied in the synovial fluid of 23 patients with various rheumatological diseases. The levels, measured by the passive hemagglutination inhibition technique (Merskey technique), showed variable values, but were always found to be present. On half the cases a number of these molecules could be eliminated by a high dose of thrombin. Using three immune sera (anti-fibrinogen, anti-D, anti-E), immunoelectrophoresis revealed in half the cases one central nonmigrating arc and another with cathodic migration. This differs from results using FDP obtained by the digestion of fibrinogen by plasmin, but is, however, analagous with those obtained in vitro by the action of proteases of leukocyte origin. These results suggest that the intense fibrinogen catabolism within the pathological joints results from the action of proteolytic enzymes other than plasmin.

Fibrin Fibrinogen Degradation Products↗
PubMed1986

Growth of monosodium urate monohydrate crystals: effect of cartilage and synovial fluid components on in vitro growth rates.

The effects of cartilage and synovial fluid components such as proteoglycans, chondroitin sulphate, hyaluronic acid, phospholipids, and albumin on the growth kinetics of monosodium urate monohydrate (MSUM) crystals were investigated. MSUM seed crystals were added to supersaturated sodium urate solutions, and the rate of decrease in the concentration of growth medium was used as a measure of the growth rate. A second order dependence of growth rate on supersaturation was found, and growth rate constants were determined with an integrated form of the growth equation. The additives, hyaluronic acid, proteoglycan monomer and aggregate, and phosphatidylserine, had no significant effect on the growth rate constant. Chondroitin sulphate and phosphatidylcholine increased the growth rate constant, possibly by promoting further nucleation in the growth medium. Albumin significantly inhibited MSUM crystallisation. The possible implications of these findings on in vivo MSUM crystallisation are discussed.

Albumins↗
PubMed1986

Serum and synovial fluid histidine: a comparison in rheumatoid arthritis and osteoarthritis.

The serum and synovial fluid (SF) histidine, sulphydryl, and protein concentrations were compared in simultaneous samples from 84 patients with rheumatoid arthritis (RA) and a control group comprising 29 patients with osteoarthritis (OA). The SF levels of histidine were higher than the serum levels in the RA patients but significantly lower than corresponding results in patients with OA (P less than 0.001). The latter had levels of serum and SF histidine which were equivalent and within the normal range. Greater quantities of protein were found in the SF of the patients with RA compared with the OA group. The serum and SF sulphydryl concentrations expressed as mumol/g protein were low but in equilibrium in patients with RA. However the SF sulphydryl (mumol/g protein) was depressed relative to serum levels in patients with OA.

Aged↗
PubMed1979

Markers of activated T cells on synovial fluid lymphocytes in rheumatoid arthritis.

Membrane markers of activated T lymphocytes of synovial fluid of two groups of patients with various forms of arthritis were studied. The first group (group A) concerns patients affected by rheumatoid arthritis (RA), and the other (group B) includes those affected by not immunologically-mediated arthropathies as osteoarthrosis, crystal synovitis, post-traumatic arthritis. Some other arthropathies included in a third group (group C) have been considered separately. Both the receptor for human group O Rh negative erythrocytes (H rosettes forming cells) and the receptor able to bind at 37 degrees C sheep red blood cells (stable-E-rosette forming cells) respectively were used as markers for the identification of activated T lymphocytes. The results show a marked increase of activated T cells in group A in comparison to group B. So the possible causes of this lymphocyte activation in rheumatoid patients are suggested.

Arthritis, Juvenile↗
PubMed1990

Spontaneous and in vitro activation of synovial fluid and peripheral blood lymphocytes in rheumatoid arthritis.

Peripheral blood (PB) and synovial fluid (SF) were compared in parallel samples in rheumatoid arthritis (RA). The kinetics of in vitro T-cell activation was assessed in phytohemagglutinin (PHA) stimulated PB or SF mononuclear cell cultures on days 0, 1, 3 and 5. The early lymphocyte activation as assessed by interleukin-2 receptor expression was faster in SF than in PB cell cultures. In particular, IFN-gamma secretion was higher in SF than in PB cell cultures (p less than 0.01). Accordingly, lymphocyte major histocompatibility complex (MHC) locus II antigen expression was higher in SF than in PB cell cultures (53 +/- 7% vs. 21 +/- 5%; p less than 0.01). Our results suggest that lymphocytes, which are particularly effective producers of IFN-gamma when stimulated in vitro are sequestered in the diseased joints in RA.

Adult↗
PubMed2000

Matrix metalloproteinases and tissue inhibitors of metalloproteinases in synovial fluids of patients with temporomandibular joint osteoarthritis.

AIMS: Imbalance between matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) may be involved in the breakdown of articular cartilage matrix of the temporomandibular joint (TMJ). In this study, MMPs, TIMPs, and MMP-1/TIMP-1 complex levels were examined in TMJ synovial fluid samples aspirated from TMJ osteoarthritis (OA) patients (2 males, 8 females; mean age, 29.7 years) and asymptomatic control subjects (2 males, 8 females; mean age, 23.6 years) to determine the likelihood of increased proteolytic activity in the OA joints. METHODS: The various types of MMPs and TIMPs were detected by Western blotting with monoclonal antibodies and gelatin zymography. The MMP-1/TIMP-1 complex level was measured by an enzyme-linked immunosorbent assay kit. All aspirates were first analyzed for total protein content and then individually diluted to make the total protein levels equivalent. RESULTS: The mean MMP-1/TIMP-1 complex concentration in the synovial fluids of the OA patients was 3.92 +/- 1.39 ng/mL; this value was significantly lower (P < 0.05) than the value from control subjects (5.46 +/- 1.32 ng/mL). Matrix metalloproteinase-1 (52 kDa), MMP-3 (57 kDa), TIMP-1 (28 kDa), and TIMP-2 (26 kDa) were detected in all of the normal and the OA samples. However, MMP-1 (28 kDa), MMP-2 (72 kDa), MMP-3 (45 kDa), and MMP-9 (83 kDa) were detected in higher concentration in the OA samples. CONCLUSION: These findings suggest a strong association between the OA-active joints and the presence of biologically active forms of known tissue degradation enzymes (MMP-1, MMP-3, and MMP-9).

Adolescent↗
PubMed2000

Expression of vascular endothelial growth factor by synovial fluid neutrophils in rheumatoid arthritis (RA).

Most of the leucocytes infiltrating rheumatoid synovial fluid (SF) are neutrophils capable of producing a variety of inflammatory mediators known to contribute significantly to the disease process during active RA. In the present study, we investigated the contribution made by SF neutrophils to the elevated levels of vascular endothelial growth factor (VEGF) seen in rheumatoid SF. Rheumatoid SF neutrophils were found to contain significantly larger amounts of both VEGF protein and its mRNA than peripheral blood neutrophils from either RA patients or healthy controls. Levels of cell-associated VEGF were well correlated with free VEGF in SF, which was significantly higher than in SF from osteoarthritis patients. Levels of SF neutrophil-associated VEGF also correlated with RA disease activity and cell surface integrin expression. Thus, SF neutrophil-associated VEGF may be considered an indicator of both local and systemic inflammation of RA, contributing to the neovascularization seen during RA synovitis.

Arthritis, Rheumatoid↗
PubMed2006

Automated search for arthritic patterns in infrared spectra of synovial fluid using adaptive wavelets and fuzzy C-means analysis.

Analysis of synovial fluid by infrared (IR) clinical chemistry requires expert interpretation and is susceptible to subjective error. The application of automated pattern recognition (APR) may enhance the utility of IR analysis. Here, we describe an APR method based on the fuzzy C-means cluster adaptive wavelet (FCMC-AW) algorithm, which consists of two parts: one is a FCMC using the features from an M-band feature extractor adopting the adaptive wavelet algorithm and the second is a Bayesian classifier using the membership matrix generated by the FCMC. A FCMC-cross-validated quadratic probability measure (FCMC-CVQPM) criterion is used under the assumption that the class probability density is equal to the value of the membership matrix. Therefore, both values of posterior probabilities and selection criterion MFQ can be obtained through the membership matrix. The distinctive advantage of this method is that it provides not only the 'hard' classification of a new pattern, but also the confidence of this classification, which is reflected by the membership matrix.

Algorithms↗
PubMed1986

Characterization of synovial T lymphocytes in rheumatoid arthritis. I. Production of IL-2 dependent T cell clones from synovial fluid and peripheral blood.

Lymphocytes obtained from the peripheral blood (PBL) or synovial fluids (SFL) of patients with rheumatoid arthritis (RA) or other inflammatory joint diseases were compared with the PBL from normal individuals, by cloning under limiting dilution conditions in the presence of interleukin 2 (IL-2). The precursor frequency estimates of IL-2 responsive cells from these sources did not differ appreciably. However there were marked differences in the surface marker phenotypes of the clones derived from the PBL as compared to SFL. There was a predominance of OKT4-8+ cells in SFL from RA and non RA donors with inflammatory joint disease while PBL from all sources showed a marked prevalence of OKT4+8- cells. Comparison of precursor frequencies in the presence of PBL and SFL indicated that there were variations in the capacities of the SFL and PBL IL-2 dependent cells to grow on these fillers. SFL derived cells grew equally well on PBL or SFL filler, while PBL clones grew efficiently only on PBL fillers. Collectively these results indicate that there are marked differences in the surface phenotypes and growth requirements of IL-2 responsive SFL as compared to PBL.

Antigens, Surface↗