Case report of a patient with knee gout

A 46-years old male presented with an attack of gout (knee arthritis or gonagra). It is interesting that the patient was HLA B27 positive antigen found a couple of years ago, but on admission he had a normal findings of uric acid in serum, while cytological examination of synovial fluid obtained from knee joint no urates were found. Therefore, diagnostically besides gout arthritis a reactive arthritis as well as other connective tissue diseases were considered. In further diagnostic procedure arthroscopy was performed and in biopsy specimen from the cyst of lateral condyle of right femur urates were found. One day after the arthroscopy was performed a clear clinical picture of podagra developed. After the diagnosis was made the treatment of gout arthritis with Indometacyn began, and with improvement of inflammation, surgery was performed--cyst excochelation of lateral condyle of right femur with filling of the defect with an autologous graft from iliac crest.     

False-positive human immunodeficiency virus antibody test in a dialysis patient

A patient developed end-stage renal disease secondary to p-anti-neutrophil cytoplasmic antibody (p-ANCA) positive rapidly progressive glomerulonephritis. He subsequently had human immunodeficiency virus (HIV)-1 antibody screening performed as part of a pre-transplant evaluation. The HIV-1 enzyme immunoassay (EIA) antibody test was repeatedly reactive. The HIV-1 western blot was indeterminate. The western blot pattern revealed non-specific staining obscuring bands in that region. Another sample of serum was sent and the results were identical to the first result. An HIV-1 proviral qualitative polymerase chain reaction test was then performed several months later and no HIV-1 DNA was detected. One year later, an HIV-1 RNA test was negative. Thus, the positive antibody EIA test and the indeterminate western blot represent a false-positive result, most likely due to cross-reacting antigens in the patients serum with various HIV antibodies. Throughout this period and thereafter, the patient has exhibited no symptoms of HIV infection.     

Antibacterial properties of synovial fluid in the knee

This study evaluated antimicrobial properties of synovial fluid against 3 gram-positive organisms: Staphylococcus aureus, Streptococcus pyogenes, and Staphylococcus epidermidis. Synovial fluid was collected from the knees of 52 patients. Three gram-positive bacteria culture lines were incubated in wells containing either synovial fluid and broth, or broth alone. Fluid was plated and incubated, and colonies were counted after 1, 4, and 24 hours to determine bacterial growth. Statistically significant differences in bacterial counts were found between control and experimental groups at 0, 4, and 24 hours for all 3 bacterial species. Bacterial counts in the control specimens demonstrated exponential growth over 24 hours as would be expected in the absence of growth inhibition. In contrast, bacterial counts in all of the synovial fluid specimens decreased steadily over 24 hours. These results demonstrate synovial fluid possesses potent bactericidal activity against the most common gram-positive pathogens responsible for septic arthritis. Delineating these antimicrobial properties further may offer avenues to augment the body's protection against bacterial infections.     

Polyethylene wear particles in synovial fluid after total knee arthroplasty

The aims of the current study were to examine polyethylene particles in synovial fluid at an early stage, and to compare a newly introduced medial pivot total knee prosthesis with an established posterior-stabilized total knee prosthesis. Synovial fluid was obtained 1 year after knee arthroplasty from 17 patients with well-functioning prostheses (22 knees, 11 posterior-stabilized prostheses and 11 medial pivot prostheses) under complete sterile conditions. Polyethylene particles were isolated and analyzed by scanning electron microscopy. Particle size (equivalent circle diameter) was 0.78 +/- 0.08 microm (mean +/- standard error) in posterior-stabilized prostheses and 0.67 +/- 0.06 microm in medial pivot prostheses. Particle shape (aspect ratio) was 2.30 +/- 0.22 in posterior-stabilized prostheses and 1.90 +/- 0.16 in medial pivot prostheses. The total numbers of particles were 1.16 +/- 0.57 x 10(8) in posterior-stabilized prostheses and 9.01 +/- 2.95 x 10(6) in medial pivot prostheses. Particles were smaller and rounder in medial pivot prostheses than in posterior-stabilized prostheses, but the differences were not significant. The difference in the common logarithm of particle number was significant. The medial pivot prosthesis generated less wear particles than the posteriorstabilized prosthesis, and these findings may have an impact on the incidence of osteolysis and aseptic loosening.     

Tophaceous gout in a patient with rheumatoid arthritis

Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. However, these conditions are not typically identified concomitantly and can be hard to distinguish from one another. We report a rare case of a 50-year-old white woman with a history of chronic gout and rheumatoid arthritis who presented with intradermal tophaceous gout. Physical examination and laboratory results are described.     

Polyethylene particle morphology in synovial fluid of failed knee arthroplasty

Synovial fluid from the knees of 16 patients undergoing revision knee arthroplasty for aseptic failure was subjected to base digestion and ultrafiltration. Filtered particles were scanned using scanning electron microscopy and analyzed with an image program. Polyethylene particles were identified visually and confirmed with the use of electron diffraction spectroscopy. Averaging more than 1500 particles per patient sample, 25,148 particles were analyzed. This corresponded to a concentration of 3000 polyethylene particles per milliliter of synovial fluid. Three populations of wear debris were identified in the fluid. Small globular particles with a mean area of 75 mu 2 represented 94% of all particles observed. The particles averaged 10 mu in diameter and often were seen in clumps. Long fibrous particles with a mean area of 1164 mu 2 made up 4% of the particle population. Large rhomboidal particles with an area of 557 mu 2 were observed least commonly and comprised the remainder of the particles visualized. All three particle types were observed in each fluid sample regardless of the wear pattern of the retrieved polyethylene liner. There were no differences in absolute particle counts, particle morphologic characteristics, or particle size between patients with and without gross polyethylene wear.     

关节液中脂联素水平与膝关节骨关节炎严重程度的相关性研究

背景：众所周知,肥胖是引起骨关节炎发生、发展的危险因素之一。肥胖人群容易发生关节炎的原因是超载作用和代谢因素。脂肪组织是一个活跃的器官,它的分泌脂肪细胞因子包括脂联素进入全身循环,参与了骨关节炎的发病。 目的：测量骨关节炎患者血清和关节滑液中脂联素水平,分析其与膝关节骨关节炎严重程度的相关性。 方法：64例膝关节骨关节炎患者（关节炎组）和19例因半月板或韧带损伤患者（对照组,行关节镜检查后排除软骨损伤）被纳入本研究。采用Kellgren-Lawrence（KL）标准对关节炎患者的膝关节前后位X线片进行评估分级。使用酶联免疫吸附试验检测脂联素在对照组和关节炎组患者血清和关节滑液中的表达水平。使用WOMAC量表（Western On-tario and McMaster Universities Arthritis Index）评估患者膝关节功能。 结果：骨关节炎组患者血清中的脂联素水平[（6177.8±991.0）ng/ml]高于对照组[（5793.4±673.3）ng/ml],但差异无统计学意义（P=0.12）。但在骨关节炎组患者,血清中的脂联素浓度[（6177.8±991.0）ng/ml]显著高于关节滑液中的脂联素[（824.3±304.7）ng/ml,P〈0.001）。关节炎患者关节液中脂联素浓度与评估疾病的严重程度呈负相关（r=-0.51,P〈0.001）,但血清脂联素浓度与疾病的严重程度关联不显著（r=-0.17,P=0.18）。血清脂联素水平、滑膜液脂联素水平与MOMAC疼痛评分均不显著相关（r=-0.01和r=-0.13,P＞0.05）。 结论：骨关节炎患者滑膜液中脂联素水平与膝关节炎严重程度呈负相关。检测关节滑液中的脂联素可能有助于早期发现关节炎。     

Osteolytic indicators found in total knee arthroplasty synovial fluid aspirates

Interleukin-1beta and tartrate resistant acid phosphatase concentrations in synovial fluid aspirates were examined to determine if they could be used as indicators of increased synovial inflammation and an osteolytic reaction in patients having total knee arthroplasty. Synovial aspirates were obtained from seven patients with severely osteoarthritic knees that were scheduled for primary total knee arthroplasty and from 20 patients with knees scheduled for total knee arthroplasty revision. Eleven of the revision cases involved titanium alloy prostheses and nine involved cobalt chrome alloy prostheses. The interleukin-1beta and tartrate resistant acid phosphatase concentrations were obtained and compared between the group having primary total knee arthroplasty and the group having revision total knee arthroplasty. The knees having revision surgery had higher concentrations of interleukin-1beta and tartrate resistant acid phosphatase than did the knees having primary total knee arthroplasty. These results indicate a greater inflammatory and osteolytic response in knees having revision surgery. Although the osteoarthritic knees and the knees needing revision surgery in this study are considered to have an inflammatory state, it was only after total knee arthroplasty when particulate wear debris would be present that appreciable concentrations of interleukin-1beta and tartrate resistant acid phosphatase were produced.     

膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性

Objective To examine osteopontin (OPN) levels in both synovial fluid and articular cartilage of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease. Methods Fifty patients with knee OA and 10 healthy controls were enrolled in this study.There were 15 males and 35 females with an average age of 61.8±7.4 years in OA group. The control group included 4 males and 6 females with an average age of 63.2±6.0 years. Mankin score were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. OPN levels in synovial fluid were measured using enzyme-linked immunosorbent assay. OPN levels in articular cartilage were assessed by immunohistochemical methods. Results Compared to healthy controls, the knee OA patients had higher OPN concentration in synovial fluid ([4519.60±1830.37] pg/ml vs. [1179.70±303.39] pg/ml) and articular cartilage([0.60±0.06] vs. [0.43 ±0.07]). In addition, synovial fluid OPN levels showed a positive correlation with articular cartilage OPN levels (r=0.411,P=0.003). Subsequent analysis showed that the OPN levels in synovial fluid significantly had been correlated with severity of disease using Kellgren-Lawrence criteria (r=0.581, P＜ 0.001). Furthermore,the levels of OPN in the articular cartilage also were correlated with disease severity using Mankin score (r=0.675, P＜ 0.001).Conclusion The data suggest that OPN in synovial fluid and articular cartilage is related to progressive joint damage and could be a predictive biomarker respect to disease severity and progression in knee OA.     

膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性

目的 探讨膝关节骨关节炎(osteoarthritis,OA)患者滑液和关节软骨骨桥蛋白(osteopontin,OPN)水平及其与病变严重程度的关系.方法 随机选取50例膝关节OA患者[男15例,女35例;年龄48～81岁,平均(61.8±7.4)岁]和10名健康对照者[男4例,女6例;年龄59～68岁,平均年龄(63.2±6.0)岁]作为研究对象.采用Mankin评分评价疾病严重程度,Kellgren-Lawrence标准进行放射学分级,酶联免疫吸附法测定关节滑液OPN水平,免疫组化方法测定关节软骨OPN光密度值.结果 OA患者与对照者相比,关节滑液OPN水平[(4519.60±1830.37)pg/ml:(1179.70±303.39)pg/ml)和关节软骨OPN光密度值[(0.60±-0.06):(0.43±0.07)]均明显升高.关节滑液OPN水平与关节软骨OPN表达呈正相关(r=0.411,P=0.003).关节滑液OPN水平与OA病变严重程度(KL分级)呈正相关(r=0.581,P＜0.001).关节软骨OPN表达与OA病变严重程度(Mankin评分)呈正相关(r=0.675,P＜0.001).结论 关节滑液和关节软骨OPN水平与病变严重程度相关.     

Fibroblast growth factor 2 in synovial fluid from an osteoarthritic knee with cartilage regeneration

 The levels of fibroblast growth factor 2 (FGF2) in synovial fluid of osteoarthritic knees were measured. The correlation between FGF2 and the severity of cartilage degeneration in varus-deformed knees with medial compartmental osteoarthritis or the articular cartilage regeneration that occurs after high tibial osteotomy (HTO) were investigated. Knees that underwent total knee arthroplasty (TKA) were categorized as either mildly or severely degenerated according to a modified Outerbridge's grading system for degeneration of articular cartilage. Regeneration of articular cartilage was observed in a biopsy specimen from the medial femoral condyle removed with the patient's consent during hardware removal approximately 2 years after HTO. The joint fluid FGF2 level was measured at that time using an enzyme-linked immunosorbent assay. Cartilage regeneration was classified as immature or mature according to the staging for regeneration of articular cartilage. The histological findings were analyzed using Pineda's evaluation method for cartilage regeneration. The mean concentration of FGF2 was 57.4 ± 17.6 pg/ml in the joint fluid from knees with severely degenerated cartilage. This was higher than the FGF2 concentration found in the mildly degenerated group. Approximately 2 years after HTO the FGF2 level in synovial fluid was lower in knees with mature regenerated cartilage than in those with immature regeneration. Osteoarthritic knees at a more mature regeneration stage had a lower Pineda's histological score. This result suggested that the FGF2 concentration in knees with osteoarthritis was influenced by articular cartilage degeneration and regeneration, and it correlated with the histological evaluation. Received: September 26, 2002 / Accepted: January 20, 2003 RID="*" ID="*" Offprint requests to: K. Orito     

膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性

Objective To examine osteopontin (OPN) levels in both synovial fluid and articular cartilage of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease. Methods Fifty patients with knee OA and 10 healthy controls were enrolled in this study.There were 15 males and 35 females with an average age of 61.8±7.4 years in OA group. The control group included 4 males and 6 females with an average age of 63.2±6.0 years. Mankin score were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. OPN levels in synovial fluid were measured using enzyme-linked immunosorbent assay. OPN levels in articular cartilage were assessed by immunohistochemical methods. Results Compared to healthy controls, the knee OA patients had higher OPN concentration in synovial fluid ([4519.60±1830.37] pg/ml vs. [1179.70±303.39] pg/ml) and articular cartilage([0.60±0.06] vs. [0.43 ±0.07]). In addition, synovial fluid OPN levels showed a positive correlation with articular cartilage OPN levels (r=0.411,P=0.003). Subsequent analysis showed that the OPN levels in synovial fluid significantly had been correlated with severity of disease using Kellgren-Lawrence criteria (r=0.581, P＜ 0.001). Furthermore,the levels of OPN in the articular cartilage also were correlated with disease severity using Mankin score (r=0.675, P＜ 0.001).Conclusion The data suggest that OPN in synovial fluid and articular cartilage is related to progressive joint damage and could be a predictive biomarker respect to disease severity and progression in knee OA.     

Metabolic analysis of knee synovial fluid as a potential diagnostic approach for osteoarthritis

Osteoarthritis (OA) is a leading cause of chronic joint pain in the older human population. Diagnosis of OA at an earlier stage may enable the development of new treatments to one day effectively modify the progression and prognosis of the disease. In this work, we explore whether an integrated metabolomics approach could be utilized for the diagnosis of OA. Synovial fluid (SF) samples were collected from symptomatic chronic knee OA patients and normal human cadaveric knee joints. The samples were analyzed using ¹H nuclear magnetic resonance (NMR) spectroscopy and gas chromatography‐mass spectrometry (GC‐MS) followed by multivariate statistical analysis. Based on the metabolic profiles, we were able to distinguish OA patients from the controls and validate the statistical models. Moreover, we have integrated the ¹H NMR and GC‐MS results and we found that 11 metabolites were statistically important for the separation between OA and normal SF. Additionally, statistical analysis showed an excellent predictive ability of the constructed metabolomics model (area under the receiver operating characteristic curve = 1.0). Our findings indicate that metabolomics might serve as a promising approach for the diagnosis and prognosis of degenerative changes in the knee joint and should be further validated in clinical settings. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1631–1638, 2015.