Osteoarthritis: a tale of three tissues

While research in osteoarthritis has focused on the events that lead to the destruction of articular cartilage, recent evidence suggests that two other components of the joints-bone and synovium-also play key roles in pathogenesis. All three tissues undergo alterations in concert at the structural levels in response to mechanical stress and joint malalignment. Advanced imaging studies such as MRI support this interdependence, revealing the classical changes of joint space narrowing and cartilage degeneration as well as the more recently appreciated bone marrow lesions and synovitis that may correlate with clinical symptoms. Molecular evidence also points to a coordinated release of cytokines and other inflammatory mediators from each of the three tissues together in progression of disease, although we are still in search of biochemical signatures that will predict the subset of patients who progress more quickly-and who will provide key clues to successful molecular targets in future therapies. At this time we lack definitive evidence pointing to which, if any, of the three tissues should serve as the main target for disease modification or structure protection, although most efforts have focused on cartilage. Thus current therapies focus on controlling symptoms, while research efforts search for reliable imaging and molecular biomarkers to help guide future trials of potential disease-modifying agents.     

Renal adenoma -- a misnomer.

Because it is difficult histologically to differentiate between a renal cell carcinoma and a renal adenoma, their differentiation has been based on size. Lesions less than 3 cm. have been called adenomas and those greater than 3 cm. carcinomas. It is a widely accepted concept that adenomas evolve into adenocarcinomas, and it is true that lesions less than 3 cm. rarely metastasize. However, as demonstrated by this case and others, metastasis can occur, therefore, it is suggested that the term renal adenoma no longer be used.     

From CKD to ESRD: a tale of two transitions

Transitions in levels of health offer important opportunities to affect patient outcomes. The transition from CKD to ESRD and dialysis dependence is costly in personal, social, and economic terms. This paper reviews these costs and offers resources that can be used by physicians and medical teams to help patients and their families weather the challenges of this process.