Insights into osteoarthritis from MRI

Magnetic resonance imaging (MRI) has added a new dimension to the study of osteoarthritis, a long-known degenerative joint disease with limited therapeutic options. It has advanced our understanding of joint pathophysiology and identifying that osteoarthritis as a simple 'wear and tear' process of the articular cartilage has indeed become a thing of the past. Recent work has focused on the study and validation of MRI scoring/quantification systems, as well as the identification of MRI predictors of symptoms/disease progression. The latter may serve to identify patients at greater risk for osteoarthritis disease progression to be enrolled in clinical trials. Like all imaging tools, MRI use has its associated problems. Structural changes seen in patients with osteoarthritis are often seen in asymptomatic subjects and this makes an MRI definition of osteoarthritis less straightforward. The ability to pick up multiple structural abnormalities simultaneously and high sensitivity in delineating structural changes can makes interpretation of true pathology more complicated. Although there has been much progress in the field of MRI in osteoarthritis, there remain many clinical/technical issues that need to be addressed. Until more data are obtained from clinical trials, the question of whether MRI is useful in therapeutics intervention in osteoarthritis remains unanswered.     

Synovitis of the wrist joint caused by an intraarticular perforation of an osteoid osteoma of the scaphoid

Uncommon location and atypical presentation of the osteoid osteomas of the scaphoid can pose a diagnostic challenge. Because of its intraarticular location, scaphoid osteoid osteoma can present with synovitis which is the more commonly reported presentation for other intraarticular locations like in hip and elbow and only rarely reported at the wrist. We report a case of perforation of the osteoid osteoma into the wrist joint, resulting in exuberant synovitis. The clinical significance of this report is to reinforce that synovitis can be a presentation of osteoid osteoma and it should be considered in the differential diagnosis of monoarticular arthritis. Prolonged synovitis may cause damage to the other joint surfaces of the wrist and hence carpal osteoid osteoma should be considered for early surgical excision.     

The Irritable Hip Syndrome in Children: A Long-Term Follow-up

This paper gives the results of a long-term follow-up study of 101 children with “Irritable Hips” who were admitted to the Mater Children's Hospital, Brisbane, Queensland, between 1962 and 1972.

The case notes and the laboratory data from their original presentation have been reviewed and all the children were recalled for clinical and radiological examination. Clinical abnormalities were found on eighteen occasions but none could be proved to be related to the child's episode of transient synovitis. Radiological changes were found on four occasions. Two of these were related to the disease in question, but two were probably coincidental findings. One case of Perthes' disease was found and one case of coxa magna, and these long-term complications are more likely to be found in patients with prolonged symptoms or radiological abnormalities on admission.     

膝创伤性滑膜炎的实验与防治研究

1987年开始设计并进行大白鼠及家兔膝创伤性滑膜炎动物模型的实验研究和临床防治研究。动物实验结果表明;关节过度运动之后,关节腔内压升高及氧分压下降是导致创伤性滑膜炎的重要原因之一;双氧水关节腔内灌注冲洗可升高关节腔内氧分压,促进滑膜组织修复。临床应用双氧水及生理盐水灌冲关节腔的方法治疗军训所致膝创伤性滑膜炎病人53例,总有效率达94.7％。     

Kinetics of salicylates in blood and joint fluid

Summary Samples of blood and joint fluid from 30 patients who had taken buffered acetylsalicylic acid were examined for concentrations of total salicylates (TSA), acetylsalicylate (ASA) and salicylate (SA). The data were arranged in groups according to diagnosis of the joint disease. Analysis of the data did not show significant difference in the kinetics of TSA into blood. In groups the time to first appearance of 0.3 mg/l averaged 6.3 min for TSA; these values averaged 7.7 min for ASA and 10.9 min for SA. Close to maximum concentrations in blood averaged 18.9 mg/l for TSA, 3.3 mg/l for ASA, and 23.3 mg/l for SA. The time for first appearance of 0.3 mg/l of total salicylates in joint fluid ranged from 10 to 34 min with an average of 18.1 min; the values of ASA averaged 19.4 min and those of SA 21.9 min. The maximum concentration in joint fluid averaged 15.7 mg/l for TSA, 2.5 mg/l for ASA, and 14.5 mg/l for SA. Transport of salicylates from blood to joint fluid showed a pattern consistent with the type of joint disease. Support was found for the hypothesis that diffusion was the major factor in the movement of salicylates from blood to joint fluid.This study was partly supported by grants of U.S. Public Health Service AM 01431 and Bristol-Myers Company.     

Localized Regressive Articular Cartilage Changes in the Hip Joint of the Rabbit following an Induced Synovitis

A talcum induced synovitis in the hip joint of the rabbit, which is known to cause articular cartilage hyperplasia followed by femoral head protrusion and joint incongruency, has in the present experiment also been shown to lead to localized regressive articular cartilage changes. The articular cartilage of the hip joints in 40 rabbits was examined histologically, at intervals, following induction of such a talcum synovitis. Regressive changes in the form of loss of surface chondrocytes and glycosaminoglycans sometimes accompanied by fibrillation, were found in the area of the femoral head articular cartilage which had become flattened following the head protrusion. Chondrocyte cloning facilitated subsequent cartilage repair. The biomechanical disturbance in the joint following the induced synovitis is felt to have caused the regressive changes. The experiment is considered to have some significance in connection with Legg-Calve-Perthes' Syndrome (L.C.P.S.) in children.     

Expression of c-kit protooncogene in human hepatocellular carcinoma

Using comparative genomic hybridisation, DNA copy number changes were investigated in 15 cases of pigmented villonodular synovitis of the knee joint. Additionally DNA content was analysed by flow cytometry. Screening revealed numerical chromosomal imbalances in five of the examined cases. A total number of 18 gains were detected. The most frequent gains involved subregions of chromosomal arms 22q and 16p and 16q. No losses were found. One of the cases showed an aneuploid DNA-pattern, which actually proved to be the case with the most numerical chromosomal changes.     

骨关节炎的治疗体会

骨关节炎的治疗应是一种综合性治疗,即非药物和药物治疗相结合,非药物治疗十分重要,包括患者教育、超重者减体重、有氧运动、合理使用矫形器和支具以及适量运动,运动即可锻炼肌肉力量又可改善关节功能。重视"年轻人老年膝",积极治疗年轻人由于运动不当或外伤致膝关节半月板和韧带损伤。避免急性滑膜炎反复发作,一旦发生积极治疗,在最短的时间内控制滑膜炎症。建议早期使用保护关节软骨(改善病情)的药物。     

An unusual case of pigmented villonodular synovitis after total knee arthroplasty

We describe a case of focal pigmented villonodular synovitis in the knee presenting 12 months after total knee arthroplasty. The abnormal synovial proliferation was noted at arthroscopy, and histological analysis of the resected tissue confirmed the diagnosis.     

Synovitis score: discrimination between chronic low-grade and high-grade synovitis

AIMS: To standardize the histopathological assessment of synovial membrane specimens in order to contribute to the diagnostics of rheumatic and non-rheumatic joint diseases. METHODS AND RESULTS: Three features of chronic synovitis (enlargement of lining cell layer, cellular density of synovial stroma, leukocytic infiltrate) were semiquantitatively evaluated (from 0, absent to 3, strong) and each feature was graded separately. The sum provided the synovitis score, which was interpreted as follows: 0-1, no synovitis; 2-4, low-grade synovitis; 5-9, high-grade synovitis. Five hundred and fifty-nine synovectomy specimens were graded by two independent observers. Clinical diagnoses were osteoarthrosis (n=212), post-traumatic arthritis (n=21), rheumatoid arthritis (n=246), psoriatic arthritis (n=22), reactive arthritis (n=9), as well as controls (n=49) from autopsies of patients without joint damage. Median synovitis scores when correlated with clinical diagnoses were: controls 1.0, osteoarthritis 2.0, post-traumatic arthritis 2.0, psoriatic arthritis 3.5, reactive arthritis 5.0 and rheumatoid arthritis 5.0. The scores differed significantly between most disease groups, especially between degenerative and rheumatic diseases. A high-grade synovitis was strongly associated with rheumatic joint diseases (P<0.001, sensitivity 61.7%, specificity 96.1%). The correlation between the two observers was high (r=0.941). CONCLUSION: The proposed synovitis score is based on well-defined, reproducible histopathological criteria and may contribute to diagnosis in rheumatic and non-rheumatic joint diseases.