Serum Gliostatin Levels in Patients with Rheumatoid Factor-Negative and -Positive Rheumatoid Arthritis and Changes of these Levels after Surgical Treatments

Gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF) has a potential for arthritogenic action. The aim of this study was to examine whether measurement of serum GLS can be used to evaluate symptomatic improvements after surgery (arthroplasty or synovectomy) as well as the aggressiveness of disease activity in rheumatoid arthritis (RA). Serum GLS levels were determined by enzyme immunoassay in rheumatoid factor (RF)-positive and -negative RA patients. In those undergoing surgery, levels were measured 3 months before and after the operations. Both RF-positive and -negative RA sera showed higher GLS levels than normal and osteoarthritis sera. Patients undergoing arthroplasty demonstrated a decrease in serum GLS levels after the operations, but patients undergoing synovectomy did not, reflecting the extent of remaining or reproliferating synovial tissues rich in GLS production. These findings suggest that the serum GLS level is a useful indicator for evaluation of synovitis and the systemic efficacy of surgical treatment. Received: 19 June 2000 / Accepted: 31 March 2001     

Dihydrotestosterone inhibits tumor necrosis factor alpha induced interleukin-1alpha mRNA expression in rheumatoid fibroblast-like synovial cells

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects multiple synovial joints. Proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF)alpha play important roles as principle inflammatory and destructive components of the disease. RA is known to be associated with significant gender differences in its prevalence and clinical features. We found that a potent androgen, 5alpha-dihydrotestosterone (DHT) inhibits IL-1alpha mRNA expression induced by TNFalpha and the DHT effect was inhibited by an androgen receptor antagonist, hydroxyflutamide (OHF). DHT inhibited the NF-kappaB activation induced by TNFalpha in a manner dependent on the androgen receptor (AR). These results suggest that DHT inhibits the TNFalpha-induced IL-1alpha mRNA expression by inhibiting NF-kappaB activation, and contributes to the gender differences of the disease.     

Extensor tendon rupture related to calcium pyrophosphate crystal deposition disease

We report a rare case of spontaneous rupture of the extensor tendons at the wrist which was shown histologically to be related to calcium pyrophosphate crystal deposition disease. The causes of tendon rupture were chronic synovitis with crystal deposition and a dorsal prominence of the ulnar head.     

Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction

Purpose

The purpose of this study was to investigate the risk of common peroneal nerve injury in FM drilling as compared to transtibial drilling in anatomical double-bundle ACL reconstruction.

Methods

Ten cadaveric knees without ligament injury or significant arthritis were used for this study. Knees were secured at 90° and 120° of flexion. In transtibial drilling groups, a guide pin was drilled through either the anteromedial bundle (AMB) or posterolateral bundle (PLB) tibial insertion site to either the AMB or PLB femoral insertion site (tibial insertion site–femoral insertion site: AM–AM, PL–PL, PL-AM and AM–PL). In FM drilling groups (FM-AM and FM-PL),the pin was drilled at the AMB or PLB femoral insertion site through the FM. We measured the shortest distance between the point at which the pin ran through the lateral cortex of the femur and the ipsilateral common peroneal nerve at a knee flexion of 90° and 120°.

Results

At a knee flexion of 90°, the shortest mean distance to the common peroneal nerve was 15.3?mm in the FM-PL group, 13.4?mm in the FM-AM group, 27.9?mm in the PL–PL group, 30.8?mm in the AM–AM group, 37.8?mm in the PL–AM group and 29.5?mm in the AM–PL group. At a knee of flexion 120°, the mean distance was 17.3?mm in the FM-PL group, 18.1?mm in the FM-AM group, 32.2?mm in the PL–PL group, 36.6?mm in the AM–AM group, 38.0?mm in the PL–AM group and 35.2?mm in the AM–PL group. Significant differences were observed between 90° and 120° of knee flexion in the FM-AM, PL–PL, AM–AM and AM–PL groups (P?<?0.05).Significant differences were observed at flex 90° between the FM-AM group and AM–AM group, and between the FM-AM group and PL–AM group. Significant differences were observed at flex 120° between the FM-AM group and AM–AM group, between the FM-AM group and PL–AM group and between the FM-PL group and AM–PL group.

Conclusion

The distance to the peroneal nerve in FM drilling was significantly longer at 120° than at 90° of knee flexion. Therefore, the risk of peroneal injury using FM drilling should decrease at a higher angle of knee flexion.     

Diagnosis and therapy of rheumatoid arthritis in the future

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic disease characterized by joint pain and destruction. We describe the importance of early diagnosis, recording magnetic resonance images images at an early stage, monitoring disease progression using gliostatin purified in our laboratory, and sugar-chain analysis of RA serum IgG. For treatment of RA, cyclooxygenase-2-selective inhibitors, disease-modifying antirheumatic drugs, biological products, and the possibility of gene therapy are discussed. The development of therapeutic methods based on the elucidation of the pathology of RA has progressed markedly in the past decade, and further progress and the development of an early diagnostic method are expected.