Noninvasive acceleration measurements to characterize knee arthritis and chondromalacia

Devising techniques and instrumentation for early detection of knee arthritis and chondromalacia presents a challenge in the domain of biomedical engineering. The purpose of the present investigation was to characterize normal knees and knees affected by osteoarthritis, rheumatoid arthritis, and chondromalacia using a set of noninvasive acceleration measurements. Ultraminiature accelerometers were placed on the skin over the patella in four groups of subjects, and acceleration measurements were obtained during leg rotation. Acceleration measurements were significantly different in the four groups of subjects in the time and frequency domains. Power spectral analysis revealed that the average power was significantly different for these groups over a 100–500 Hz range. Noninvasive acceleration measurements can characterize the normal, arthritis, and chondromalacia knees. However, a study on a larger group of subjects is indicated.     

Genetic Polymorphisms Modifying Oxidative Stress Are Associated with Disease Activity in Rheumatoid Arthritis Patients

Reactive oxygen and nitrogen species are involved in the pathology of rheumatoid arthritis (RA). Polymorphisms in genes coding for superoxide dismutases (SOD2 and SOD3), catalase (CAT), tumor necrosis factor-alpha (TNFA) and inducible NO synthase (NOS2A) may influence RA activity. We determined SOD2 Ala-9Val, SOD3 Arg213Gly, CAT C-262T, TNFA G-308A, TNFA C-857T and NOS2A (CCTTT)_n polymorphisms in 327 RA patients. Carriers of CAT -262T and TNFA -308A allele had lower mean disease activity score of 28 joint count (DAS28) values than patients with CAT -262CC and TNFA -308GG genotypes (p = 0.014 and p = 0.046, respectively). Patients with the combination of CAT -262T and TNFA -308A allele had lower mean DAS28 values and a higher probability for low disease activity than non-carriers (p = 0.003, OR = 3.585, 95% CI = 1.538–8.357). Our results suggest that CAT and TNFA polymorphisms alone and in combination influence the activity of RA.     

Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis

Journal of Digital Imaging - The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with...     

The Risk of Osteoporotic Fractures According to the FRAX Model in Korean Patients with Rheumatoid Arthritis

The aim of the current study is to identify patients without osteoporosis who met the criteria of the fracture risk assessment tool (FRAX) of the National Osteoporosis Foundation (NOF) only. The incidence of fractures was investigated in patients who met only the FRAX criteria of the NOF and patients who presented osteoporosis. Five hundred and forty five patients with rheumatoid arthritis who visited a single center were recruited in Korea. In the follow-up period of median 30 months, the new onset of fractures was investigated. Of 223 patients who have no osteoporosis, 39 (17.4%) satisfied the FRAX criteria for pharmacological intervention. During the follow-up period, 2 new onset fractures occurred in patients who met only the FRAX criteria and 22 new onset fractures did in patients with osteoporosis by bone mineral density. The incidence rate for new onset fractures of patients who met only the FRAX criteria was with 295.93 per 10,000 person-years higher than in the general population with 114.99 per 10,000 person-years. Patients who met the FRAX criteria of the NOF only need pharmacological intervention because their numbers of incidence for new onset fractures are similar to those of patients with osteoporosis by BMD.

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Influence of Infliximab on Cytokines Network and Markers of Bone Remodeling in Rheumatoid Arthritis Patients

Purpose

Our aim was to determine the effects of infliximab on bone mineral metabolism in rheumatoid arthritis (RA) patients and analyze the relationship between inflammatory markers of acute phase thought to play a major role in bone remodeling.

Materials and Methods

36 patients with established RA were investigated. All patients underwent physical examination and blood and urinary analysis at baseline, 2 weeks, 14 weeks, 6 months and 12 months after the initiation of treatment. The serum levels of: tumor necrosis factor alpha (TNF-alpha), tumor necrosis factor alpha receptor 1 (TNFR1), TNFR2, interleukin 6 (IL-6), IL-17, IL-23 and markers of bone remodeling such as osteocalcin (BGP), deoxypyridynoline (Dpd), and N-telopeptide of type I collagen (NTx) were measured by ELISA.

Results

The results showed significant decrease of all the above cytokines levels in RA patients in comparison with those after 2 weeks of treatment. After 6 months, the markers of bone formation and resorption decreased compared to baseline values. We found positive correlation between the levels of NTx and the levels of IL-6, IL-17 and TNFR1, and between the levels of Dpd and IL-6 and Dpd and TNFR2, whereas negative correlation between BGP and IL-23. After 12 months the positive association was found at the BGP level and IL-6 as well as Dpd and the level of IL-6. We also observed a positive relation between Dpd and TNF-alpha and negative between BGP and TNFR1.

Conclusion

We suggest that infliximab treatment may limit the risk of osteoporosis in RA patients.     

Augmented Numbers of HLA-DR-Positive T Lymphocytes in the Synovial Fluid and Synovial Tissue of Patients with Rheumatoid Arthritis and Juvenile Rheumatoid Arthritis

Twenty to 40 % of T cells from synovial fluid and synovial tissue and 3–11 % of the peripheral blood T lymphocytes from patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) expressed HLA-DR antigens as detected by monoclonal anti-HLA-DR antibodies in direct immunofluorescence. Synovial fluid and synovial tissue T lymphocytes had a stimulating capacity comparable to that of non-T cells in the allogeneic primary mixed lymphocyte reaction (MLR). The MLR was inhibited by monoclonal anti-HLA-DR antibodies. This is, to our knowledge, the first report on in-vivo-activated T lymphocytes as stimulator cells in MLR. The results suggest that T cells from synovial fluid and synovial tissue are locally activated by stimuli so far unidentified.     

Detection of T-Lymphocyte Subpopulations in the Peripheral Blood and the Synovium of Patients with Rheumatoid Arthritis and Juvenile Rheumatoid Arthritis Using Monoclonal Antibodies

Monoclonal antibodies with specificities for various human T-cell antigens were used in direct immunofluorescence to quantify the proportions of T lymphocytes with suppressor/cytotoxic-cell markers and with helper/inducer-cell markers and of T lymphocytes with HLA-DR antigens. Normal percentages of lymphocytes with suppressor/cytotoxic-cell markers were detected in the peripheral blood synovial fluid and synovial tissue lymphocytes from patients with juvenile rheumatoid arthritis (JRA) and rheumatoid arthritis (RA), respectively. Normal percentages of T lymphocytes with helper/inducer-cell markers were seen in the peripheral blood of RA and JRA patients and in the synovial tissues of RA patients. Slightly decreased percentages of cells with the helper/inducer-cell marker were detected in the synovial fluids of JRA patients. The proportions of HLA-DR-positive T lymphocytes were highly increased in the synovial fluid and synovial tissue, whereas the numbers of these cells in the peripheral blood were normal. No significant differences in T gamma cells were detected between peripheral blood, synovial fluid and synovial tissue of JRA patients or between peripheral blood and synovial tissue of RA patients.     

Con A-induced Suppressor Cell Activity and T-lymphocyte Subpopulations in Peripheral Blood Lymphocytes of Patients with Rheumatoid Arthritis and Juvenile Rheumatoid Arthritis

Suppressor cell activity was investigated in peripheral blood lymphocytes from twenty patients with rheumatoid arthritis (RA) and twenty patients with juvenile rheumatoid arthritis (JRA) using a concanavalin A/mixed lymphocyte culture assay. The mean suppression in the RA patients was slightly reduced compared with the suppressor cell activity in adult controls (25 +/- 5% suppression compared with 37 +/- 5%; P less than 0.05, Student's t test), whereas the JRA patients had normal suppressor cell activity (mean 46 +/- 5% versus 43 +/- 5% in healthy children matched for age and sex). The RA patients had normal proportions of T-cell subpopulations, 13.3% T gamma cells and 49.8% T mu cells, compared with 13.8% and 58.0% in controls. The JRA patients, however, had a significantly reduced mean percentage of T gamma cells, 6.6%, compared with 13.8% in healthy children (P less than 0.05, Mann-Whitney U-test). The mean percentage of T mu cells was 53.7%, versus 56.2% in the controls. The relation between suppressor cell activity and suppressor cells enumerated by membrane markers is discussed.     

类风湿关节炎患者血清IgG-IgM型类风湿因子免疫复合物检测的临床意义

目的 探讨血清IgM型类风湿因子与变性IgG抗原形成的复合物定量检测对类风湿关节炎诊断的临床意义.方法 收集类风湿关节炎(RA)患者36例、非RA患者41例和体检健康者40名作为研究对象.用包被有鼠抗人μ链抗体的ELISA孔板及HRP标记的兔抗人IgG对血清中IgM型类风湿因子(RF)与变性IgG抗原形成的免疫复合物水平进行检测,同时用胶乳凝集法检测RF,并对二者结果进行相关性分析;用ELISA试剂盒进行抗环瓜氨酸肽抗体(抗CCP抗体)的定性检测,并比较其与IgG-IgM型RF免疫复合物对于RA诊断的敏感性和特异性.结果 待检血清最佳稀释倍数为100倍.IgG-IgM型RF免疫复合物对于RA的敏感性为72.2％,特异性为95.3％.IgG-IgM型RF免疫复合物OD值与RF阳性程度相关系数为0.687(P ＜0.01).结论 血清IgG-IgM型RF免疫复合物水平对RA具有较高的敏感性和特异性,可作为RA诊断的参考指标.     

Effectiveness of Radiation Synovectomy with Samarium-153 Particulate Hydroxyapatite in Rheumatoid Arthritis Patients with Knee Synovitis: A Controlled Randomized Double-Blind Trial

OBJECTIVES:

The aim of the present study was to investigate the effectiveness of Samarium¹⁵³-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis.

METHODS:

Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium¹⁵³-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits.

RESULTS:

The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up.

CONCLUSION:

Intra-articular injection of Samarium¹⁵³-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up.     

美洛昔康的应用结合护理健康教育对类风湿关节炎患者的影响

目的评价美洛昔康的应用结合护理健康教育对l老年类风湿关节炎患者的影响。方法将105例类风湿关节炎老年患者随机分为实验组(53例)和对照组(52例),两组均给予同一厂家生产的美罗昔康片1片/次,1次/d,每片含美洛昔康75mg。实验组在此基础上给予规范性综合护理健康教育,包括饮食指导、心理护理和健康教育,使医护人员与患者建立良好的护患关系。两组疗程均为24w,在治疗0、4、8、12、24w后根据美国风湿病学会(ACR)制定的ACR20,ACR50,ACR70标准来评价疗效,并记录该试验进行过程中任何不良事件。结果最终完成试验的为97例,实验组50例,对照组47例。相较于治疗前两组患者治疗后触痛关节数、肿胀关节数、患者对疼痛的VAS评分等均有改善,差异有统计学意义(<0.05),同时实验组与对照组同期比较,差异有统计学意义(<0.05),但两组间不良事件发生率差异无统计学意义(>0.05)。结论美洛昔康的应用结合护理健康教育能更有效的改善老年人与类风湿关节炎相关的各项症状、体征,提高生活质量。     

Associations of IgA and IgA-Rheumatoid Factor with Disease Features in Patients with Rheumatoid Arthritis

In previous studies we have shown that levels of IgM-rheumatoid factor (RF) in plasma and peripheral blood mononuclear cell supernatants are correlated with disease activity and response to second-line therapy in patients with rheumatoid arthritis (RA). The present studies were designed to examine whether IgA-RF levels are also correlated with clinical features of this disease. Two groups of RA patients were studied. Group I consisted of 87 patients in whom extensive clinical data had been collected. Group II included nine patients beginning treatment with gold or methotrexate who were studied during the first year of therapy. Measurement of IgM, IgA, IgM-RF and IgA-RF in culture supernatants and plasma was done by an ELISA method. These data were examined for correlations with clinical and laboratory features. Levels of IgA-RF in supernatants and plasma were found not to be correlated with disease features in the cross-sectional analysis of Group I patients, while IgM-RF and total IgA levels did show significant clinical correlations. Treatment of Group II patients with gold or methotrexate was associated with significant decreases in plasma levels of total IgA and IgM-RF as well as a small but statistically significant decrease in plasma IgA-RF. Plasma levels of total IgM were not altered during therapy. These findings suggest that production of IgA but not IgA-RF is correlated with disease status in patients with RA.     

Associations of IgA and IgA-Rheumatoid Factor with Disease Features in Patients with Rheumatoid Arthritis

In previous studies we have shown that levels of IgM-rheumatoid factor (RF) in plasma and peripheral blood mononuclear cell supernatants are correlated with disease activity and response to second-line therapy in patients with rheumatoid arthritis (RA). The present studies were designed to examine whether IgA-RF levels are also correlated with clinical features of this disease. Two groups of RA patients were studied. Group I consisted of 87 patients in whom extensive clinical data had been collected. Group II included nine patients beginning treatment with gold or methotrexate who were studied during the first year of therapy. Measurement of IgM, IgA, IgM-RF and IgA-RF in culture supernatants and plasma was done by an ELISA method. These data were examined for correlations with clinical and laboratory features. Levels of IgA-RF in supernatants and plasma were found not to be correlated with disease features in the cross-sectional analysis of Group I patients, while IgM-RF and total IgA levels did show significant clinical correlations. Treatment of Group II patients with gold or methotrexate was associated with significant decreases in plasma levels of total IgA and IgM-RF as well as a small but statistically significant decrease in plasma IgA-RF. Plasma levels of total IgM were not altered during therapy. These findings suggest that production of IgA but not IgA-RF is correlated with disease status in patients with RA.     

类风湿关节炎患者焦虑及抑郁情绪与 疾病活动度的相关性

目的 分析类风湿关节炎患者焦虑及抑郁情绪与疾病活动度的相关性。方法 选取2017年1月~2018年3月在我院收治的类风湿关节炎患者105例作为研究对象,采用问卷调查的方式,调查患者焦虑、抑郁情绪评分以及疾病活动度程度,进一步分析患者焦虑及抑郁情绪与疾病活动度的相关性。结果 105例患者中存在焦虑情绪者43例,占40.95%,平均焦虑评分（42.94±3.88）分;抑郁情绪者33例,占31.42%,平均抑郁评分（46.83±3.91）分。患者平均疾病活动度指数得分（3.72±1.44）分,其中缓解期25例,占28.31%;轻度活动期16例,占15.23%;中度活动期44例,占 41.90%;重度活动期20例,占19.04%。不同疾病活动度患者焦虑、抑郁评分比较,差异有统计学意义（P＜0.05）;类风湿关节炎患者焦虑、抑郁情绪与疾病活动度评分呈正相关（r=0.273、0.322,P＜0.05）。结论 类风湿关节炎患者焦虑、抑郁情绪与疾病活动度存在一定的相关性,临床治疗过程中应重视对焦虑、抑郁情绪的疏导和环节,以促进患者的早日康复。     

血清中葡萄糖6-磷酸异构酶在类风湿关节炎中的诊断价值

目的探讨血清中葡萄糖6-磷酸异构酶（glucose-6-phosphate isomerase，GPI）抗原在类风湿关节炎（rheumatoid arthritis，RA）患者诊断中的意义。方法用酶联免疫吸附试验（ELISA）检测70例RA患者，26例其他风湿病患者和30例健康对照血清中GPI抗原的浓度，RA患者同时还检测了类风湿因子（RF）。结果70例RA患者血清中GPI浓度为（2．01±1．01）μg／mL，26例其他风湿性疾病组为（0．41±0．18）μg／mL，30例健康对照组为（0．090±0．030）μg／mL，RA患者血清中GPI浓度显著高于其他风湿病组和健康对照组（P〈0．01），在RA活动组和RA非活动组。亦有显著差异（P〈0．05）。通过分段回归分析发现GPI的浓度和RA病情活动成正相关。GPI抗原对RA检测的敏感性为61．4％．特异性为93．3％。结论GPI在部分RA患者血清中显著升高，有可能成为诊断RA及判断其疾病活动性的一个新指标。     

骨性关节炎对膝关节干骺端松质骨应力松弛性质影响的实验研究

研究正常国人新鲜尸体膝关节干骺端松质骨和老年骨性关节炎病膝关节干骺端松质骨的应力松弛力学性质,为临床提供生物力学参数。取正常和病态膝关节干骺端松质骨,在Shimadzu AUTOGRAPH电子万能试验机上进行应力松弛实验。得出了正常和病态组松质骨7200s应力松弛量、应力松弛随时间的变化规律以及应力松弛方程。表明病态组各项力学性质指标均显著低于正常组。     

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.

Graphical Abstract

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Influence of Meniscectomy and Meniscus Replacement on the Stress Distribution in Human Knee Joint

Studying the mechanics of the knee joint has direct implications in understanding the state of human health and disease and can aid in treatment of injuries. In this work, we developed an axisymmetric model of the human knee joint using finite element method, which consisted of separate parts representing tibia, meniscus and femoral, and tibial articular cartilages. The articular cartilages were modeled as three separate layers with different material characteristics: top superficial layer, middle layer, and calcified layer. The biphasic characteristic of both meniscus and cartilage layers were included in the computational model. The developed model was employed to investigate several aspects of mechanical response of the knee joint under external loading associated with the standing posture. Specifically, we studied the role of the material characteristic of the articular cartilage and meniscus on the distribution of the shear stresses in the healthy knee joint and the knee joint after meniscectomy. We further employed the proposed computational model to study the mechanics of the knee joint with an artificial meniscus. Our calculations suggested an optimal elastic modulus of about 110 MPa for the artificial meniscus which was modeled as a linear isotropic material. The suggested optimum stiffness of the artificial meniscus corresponds to the stiffness of the physiological meniscus in the circumferential direction.     

类风湿关节炎六种指标联合检测的临床意义

目的评价分析抗瓜氨酸化波形蛋白(MCV)抗体、抗葡萄糖-6-磷酸异构酶(GPI)抗体等六项指标在类风湿关节炎(RA)患者血清中的表达与疾病的相关性及应用价值。方法收集110例RA、26例SLE、23例强直性脊柱炎(OA)、20例干燥综合征(SS)患者和50名健康人血清标本,用ELISA检测血清中抗MCV、抗GPI和抗环瓜氨酸肽(CCP)抗体水平,采用间接免疫荧光法检测抗角蛋白(AKA)抗体,采用散射比浊法检测类风湿因子(RF)和hs-CRP水平。结果 4种抗体在RA患者组中的阳性率显著高于非RA疾病组和健康对照组。除AKA抗体阳性率较低(41.8%)外,其余抗体在RA组中的阳性率差异无统计学意义。结论抗MCV和抗GPI抗体诊断RA的敏感度最高;抗CCP抗体的特异性最高,AKA抗体具有较高的特异性,但敏感度最低,联合检测可弥补单项抗体检测造成的漏诊。