Monocyte chemotactic protein-1 production and its correlation with disease activity and T-cell subsets in synovial fluid in psoriatic arthritis patients

Psoriatic arthritis [PsA] is a chronic inflammatory arthritis characterized by infiltration of the skin and joints with activated T lymphocytes. The latter have been implicated in both the initiation and maintenance of inflammatory lesions at these sites and it is mediated by the local production and secretion of chemotactic cytokines. To evaluate the role of monocyte chemotactic protein-1 [MCP-1] in the immunopathogenesis of PsA. Also, to find out whether evidence exists for a causal relationship between MCP-1 levels in synovial fluids and T cells recruitment to lesional sites during acute and chronic synovitis and its relation to disease activity in psoriatic arthritis patients. Thirty PsA patients were recruited for this study. They were subdivided into two groups: Group I: 15 patients with synovitis less than 6 months' duration [acute PsA]. Group II: 15 patients with synovitis more than 6 months' duration [chronic PsA]. The clinical activity of the disease was assessed by using modified disease activity score 28 [DAS28]. Their results were compared to 15 healthy age and sex matched volunteers [group III]. Peripheral blood [PB] and synovial fluid [SF] were obtained from PsA arthritis patients; also PB was obtained from normal controls. Immune cell populations in PB and SF samples were assessed with immunofluorescent labeling and flow cytometry, levels of soluble MCP-1 were determined in PB and SF samples with quantitative ELISA. DAS28 was significantly higher in group I [acute PsA] patients than group II [chronic PsA patients] [p<0.01]. CD4+, CD8+ T cells were significantly elevated in SF as compared to PB of acute but not chronic PsA patients and the majority of these cells expressed CD45RO [p<0.01]. Plasma MCP-1 levels were elevated in PsA [whether acute or chronic] relative to normal controls [p<0.01]. SF MCP-1 levels were significantly higher than paired plasma samples in acute PsA patients only [p<0.01]. A highly significant positive correlation was observed between MCP-1 levels in SF and DAS28 and also with T cell numbers in SF of acute PsA patients [p<0.01]. The elevated concentration of MCP-1 is concomitant with T cell infiltration in SF of acute PsA patients. This suggests that MCP-1 mediated chemotaxis is involved in the recruitment of T lymphocytes particularly memory cells into the synovial fluid in PsA during acute synovitis which is associated clinically with severely active disease and thus could be considered as an early inflammatory marker in acute PsA

Cartilage proteoglycan aggrecan: potential as serum marker of cartilage destruction in juvenile rheumatoid arthritis

To investigate whether aggrecan is to be considered a useful marker and a predictor of joint cartilage destruction in juvenile rheumatoid arthritis patients [JRA]. Aggrecan was quantified with ELISA in sera from 31 children suffering of JRA and synovial fluid [SF] of 10 of them. Patients were evaluated at baseline and 3 months later. a] Clinically with the overall articular severity score. b]Laboratory tests including ESR, CRP, total leucocytic and platelet counts, hemoglobin and rheumatoid factor. c] Radiologically with modified Larsen, malalignment and vanRossum's scores. Radiographs were also repeated after one year. A group of 15 normal healthy children and another of 10 children with arthritis due to other collagen vascular diseases were studied for comparison. Baseline serum aggrecan was significantly higher in JRA patients as compared to controls and to patients with other collagen vascular diseases with 93% sensitivity and 100% specificity at a cut off level of 18.6 ng/ml [control mean + 3 SD]. On reevaluation, a significant drop of serum aggrecan from baseline values was noticed [p < 0.01] that coincided with a significant drop in clinical and laboratory indices of active inflammation although their levels correlated poorly. Serum aggrecan levels were insignificantly different from those of SF and both correlated significantly with SF protein concentration. Lower levels of serum aggrecan were observed in patients with radiographic evidence of joint destruction and in those with evidence of deterioration one year later. Serum aggrecan can help to assess the extent of cartilage destruction and is useful as a prognostic tool to predict joint damage in patients with JRA

incidence of crystals deposition in inflammatory osteoarthritis

The present study was done to detect the incidence of Hydroxy apatite [HA] Calcium. Pyrophosphate Dihydrate [CPPD] and monosodium urate [MSU] crystals in synovial fluid of inflammatory Osteoarthritis [OA] by using alizarin red S stain and polarized light microscopy This study included 100 patients, 83 females [83%] and 17 males [17%] and their ages were ranged between 38-65 years with a mean of 45.9-1.3 years. HA was detected in 36% of cases, CPPD was detected in 30% of cases MSU was detected in 5% of cases while 55% of cases had no crystals in their synovial fluid. Also we found that there was coexistence between HA and CPPD crystals in 16 cases of those who had crystals in their synovial fluid [45 patients] and also the difference in the incidence between AH and CPPD crystals was statistically in-significant, while the difference between the incidence of HA and MSU as well as the difference between the incidence CPPD and MSU crystals was statistically significant. We concluded that alizarin red S staining is a rapid simple and sensitive technique helpful in detecting the presence of aptite crystals and that the concordance of HA and CPPD crystals might be of potential clinical and pathogenic significance

Synovial fluid interleukin-1 beta in psoriatic arthritis

Synovial fluid from the knee joints of 20 psoriatic arthritis patients [8 with polyarthritis and 12 with mono / oligoarthritis] were studied to detect the value of interleukcin-1 beta. ESR and serum C-reactive protein were also measured. Quantitative immunoassay method showed a significant increase of interleukin-1 beta in the synovial fluid of polyarthritis group as compared to mono/oligoarthritis group, while, ESR, C-reactive protein and synovial fluid total protein, acid phosphatase and WBCs showed non significant changes between the two groups. So, the synovial fluid interleukcin-1 beta is one of the parameters which differentiate between the two groups. Synovial fluid interleukin-1 beta showed significant correlation with the number of affected Joints and Joint score and non-significant correlation with ESR and C-reactive protein. Results confirm the role of interleukin-1 beta in the pathogenesis of psoriatic arthritis as well as to select those who will be in need for aggressive and non conventional treatment

Comparative study between clinical assessment, laboratory markers, synovial fluid analysis and thermography in joint inflammation of juvenile rheumatoid arthritis

In this study the thermographic index [TI] of the knee joint was compared with the other parameters of joint inflammation of juvenile rheumatoid arthritis [JRA]. Twenty patients with JRA were included in the study [70% females and 30% males]. The mean age of our patients was 9.9 +/- 2.5 years. Ten healthy children matching our cases as regard; sex, age and weight served as a control group. All the patients were subjected to clinical assessment [joint score], laboratory investigations [ESR, CRF, HB%], synovial fluid analysis [TLC and glucose] and TI measurement. A significant correlation was observed between the joint score, ESR, HB% and TLC of the synovial fluid Insignificant correlations were reported between the joint score and CRP and between the TLC, CRP and HB%. The glucose level in the synovial fluid insignificantly correlated with all the other clinical and laboratory variables. The TI was found to be significantly correlated with the joint score, ESR, HB% and TLC of the synovial fluid while, it was found to be insignificantly correlated with the CRP and the glucose level of the synovial fluid. It is concluded that the TI is a good index for the assessment of joint activity in JRA with an equivalent efficacy to the other clinical and laboratory parameters of joint inflammation

Synovial fluid collagenase and acid prosphatase in rheumatoid arthritis and osteoarthritis

Svnovial fluid from the knee joints of 3l rheumatoid arthritis [RA] patients [17 active and 14 inactive] and 27 patients with osteoarthritis [OA] were studied to detect the enzymatic activity of collagenase and acid phosphatase. The activity of both enzymes showed a significant increase in patients with active RA than those with inactive disease synovial fluid collagenase and acid phosphatase in RA patients Showed a significant correlation with ESR, morning stiffness, Pain Score, articular index and grip strength while an insignificant correlation with age and disease duration was recorded. There was a significant increase in the activity of both enzymes in RA patients when compared with OA patients

Importancia del sinovianálisis en reumatología / Importance of synovial fluid examination in rheumatology

El examen del líquido articular debe ser parte obligada de la investigación del derrame articular. Se describe la metodología de estudio del líquido sinovial que realizan los autores. Analizan los elementos normales, las alteraciones físicas y químicas, los cambios en la celularidad y la aparición de cristales correlacionando los cambios con las probables patologías que las determinan. Se desglosa en tres secciones de acuerdo a la forma de conservar la muestra, facilitando la comprensión de los procedimentos de estudio a los que se somete el líquido sinovial

Synovial fluid changes in mycoplasma induced septicaemic polyarthritis of goat kids.

Synovial fluid samples of goat kids inoculated (ip) with 5 ml of 48 hr log phase culture of Mycoplasma mycoides sub sp. mycoides (large colony type) containing 10(7) cfu/ml were analysed for physical, cytological and biochemical properties. The synovial effusions were exudative in nature with increased volume. Gross appearances were serofibrinous, haemorrhagic and turbid containing flocculent materials with immediate clot formation. Mucinous precipitate quality was very poor having friable precipitates with cloudy supernatant. There were high total leucocytic and erythrocytic counts with significant high numbers of both neutrophils and lymphocytes. Synovial fluid sugar contents were significantly reduced, whereas total protein contents were significantly increased with concomitant reduction in albumin:globulin ratio. The alkaline phosphatase and transaminase values were also markedly increased in the synovial fluids of mycoplasma induced polyarthritic goat kids. The results may provide a clinical guideline for diagnosis, chemotherapy and prognosis of different joint diseases in domesticated animals.

Diagnóstico de gota no período intercrítico pela funçäo articular e achado de cristais / Gout diagnosis in the intercritic period by joint puncturing and finding of crystals

O encontro de cristais de monourato de sódio em líquido sinovial é um critério diagnóstico maior e absoluto na gota, mas só recentemente tem-se usado esta propedêutica no período intercrítico. Os autores estudaram 14 pacientes, todos do sexo masculino, com idade variando entre 28-69 anos, assintomáticos, com diagnóstico prévio de gota näo tofácea, em período intercrítico; evidenciaram cristal de monourato de sódio em líquido sinovial do joelho de nove (64,2%) pacientes e em 13(59%) líquidos sinoviais dos 22 joelhos puncionados. Em nove pacientes, nos quais a punçäo foi bilateral, a positividade foi de 77,7%. Esses resultados säo concordantes com estudos anteriormente publicados na literatura internacional e valorizam a punçäo articular, para pesquisa de cristais de monourato de sódio, como método sensível no diagnóstico de gota näo tofácea, no período intercrítico

Ampliaçäo do espectro bioquímico da sinovianálise / Broadening the biochemical spectrum of synovial fluid analysis

Os autores avaliaram algumas técnicas bioquímicas (substâncias amilóide, lipídios e lactato), estabelecendo as limitaçöes e aplicaçöes práticas, objetivando melhor aproveitamento do líquido sinovial (LS) nos casos de dúvidas diagnósticas. Apresentam resultados próprios em relaçäo ao lactato e salientam as dificuldades na manipulaçäo do LS, principalmente devido a falta de uniformidade no processo técnico

Estudo artroscópico da prega sinovial sintomática do joelho / Arthroscopic study of the symptomatic synovial plica of the knee

Apresentam-se 70 pacientes (74 joelhos) portadores de prega sinovial sintomática, submetidos a diagnóstico e tratamento artroscópico, com seguimento médio de 14,4 meses. Aborda-se a técnica empregada e enfatiza-se a ressecçäo ampla da prega sinovial patológica. Em 46 casos (62,1%), os resultados foram considerados bons em 22 (29,7%), regulares e, em 6 (8,1%), maus

Derrames crônicos e recidivantes do joelho / Chronic and relapsing effusions of the knee

Säo discutidas as várias patologias responsáveis pelos derrames crônicos e recidivantes do joelho, assim como a seqüência propedêutica para se chegar, na maioria das vezes, ao diagnóstico etiológico

Osteomielite hematogênica de rótula em paciente adulto: apresentaçäo de um caso / Hematogenic osteomyelitis of the patella in an adult patient: report of a case

Apresenta-se um caso de osteomielite hematogênica localizada na rótula, em paciente de 30 anos do sexo feminino. Após apresentarem levantamento bibliográfico sobre a incidência da patologia com essa localizaçäo, comentam-se os métodos semiológicos utilizados para o diagnóstico

Artrite induzida por antígeno em coelhos: padronizaçäo dos métodos de induçäo e avaliaçäo do processo inflamatório articular / Antigen-induced sothritis in ralbbit: standardization of the methods of induction and evaluation of the articular inflamatory process

Em 48 coelhos foi induzida artrite por injeçäo intra-articular de soro-albumina bovina, antígeno ao qual os animais haviam sido previamente imunizados de acordo com um protocolo bem definido: os animais foram sacrificados em grupos de três após períodos que variaram de uma hora a oito meses a contar da induçäo da artrite. O estudo do líquido e membranas sinoviais revelou inflamaçäo articular aguda nas primeiras 24 horas após a injeçäo intra-articular do antígeno: em 48 horas as características foram intermediárias entre um processo agudo e crônico, assumindo caráter crônico nos animais sacrificados a partir de entäo. Foram avaliados 11 parâmetros histopatológicos indicadores de sinovite: erosäo da camada de revestimento, proliferaçäo vascular, hemorragia, infiltrado inflamatório, nódulos linfóides, granulomas, dilataçäo e congestäo vascular, hiperplasia e hipertrofia da camada de revestimento, viscosidades, fibrose e vasculite; a presença de três ou mais desses parâmetros forneceu o melhor critério objetivo para o diagnóstico de sinovite. As alteraçöes histopatológicas encontradas foram semelhantes àquelas descritas em membrana sinovial de pacientes com doença reumatóide; a padronizaçäo deste modelo experimental propicia-nos meio de grande utilidade para o estudo dessa patologia humana

A propósito de um caso de líquido sinovial gorduroso / Apropos of a case of fatty synovial fluid

O fluido sinovial gorduroso, determinado por excessiva quantidade de gotículas de gordura extra e intracelular, pode ser considerado elemento auxiliar de diagnóstico, ao procurar diferenciar trauma, artrite séptica e artropatia microcristalina, entre outras injúrias articulares. A leucocitose sinovial, a presença de febre e de outras manifestaçöes inflamatórias, embora importantes, podem näo ser parâmetros decisivos. Procurando-se realçar esses aspectos, apresenta-se o caso de uma paciente que desenvolveu monartrite aguda (joelho direito), sem sinais nítidos de lesöes osteocartilaginosas e/ou ligamentares, acompanhada de febrículas e leucocitose sinovial. A presença de grande quantidade de gordura, a boa evoluçäo com o repouso e a utilizaçäo de antinflamatório näo hormonal sugeriram o diagnóstico de artropatia traumática

Ferritin measurement in synovial tissue and fluid in patients with inflammatorys joint disease

Se dosificó mediante ensayo inmunorradiométrico la concentración de ferritina (FET), una proteína que almacena hierro, en el líquido sinovial (LS) de 41 pacientes con sinovitis clínicamente activa de distinta etiología. De acuerdo al diagnóstico los enfermos se distribuyeron en cuatro grupos: el grupo de artropatía degenerativa (DA) formado por cuatro enfermos con osteoartosis; siete pacientes con gota y uno con pseudogota integraron el grupo de artropatía por depósito de cristales (AC); el grupo de artropatía inmune (AI) constituido por trece enfermos con artritis reumatoide y siete con lupus eritematoso sistémico; y un grupo de artropatías misceláneas (AM) formado por nueve pacientes. El grupo AD mostró nivele sde FET significativamente menores a los encontrados en los grupos AC, AI y AM. En cambio, no se observaron diferencias significativas en los valores de FET en LS entre los grupos AC, AI y AM. Además, se cuantificó FET en nueve muestras de suero y en cinco de tejido sinovial (TS). Los niveles de FET en LS correlacionaron en forma significativa con la cantidad de FET en TS y con el número de leucocitos en el LS, pero no existió correlación entre la FET en LS y en suero. Estos resultados indican que la dosificación de FET en LS tiene poca utilidad en el diagnóstico diferencial de las artropatías inflamatorias, y sugiere que probablemente los leucocitos y/o las células sinoviales sean la fuente de FET en el LS

Farmacodinamia clínica del ácido tiaprofénico / Clinical pharmacodynamics of the tiaprofenic acid

El ácido tiaprofénico [ácido alfa-benzoil-5-thienil- 2 propiónico ha demostrado ser un activo inhibidor reversible de la ciclooxigenasa. La evidencia de que ciertas prostaglandinas (PGs), enzimas lisozómicas y otros autacoides producían injuria articular y reacciones sinoviales, nos sugirió la investigación de la eficacia a corto plazo del ácido tiaprofénico, en el tratamiento de la artritis reumatoidea. El estudio fue realizado sobre 20 pacientes adultos, portadores de sinovitis con derrame, a los cuales fue suspendida toda otra medicación antiinflamatoria, 7 días antes de comenzar el estudio. En todos los pacientes se analizó la concentración de: PGE2 2, P6F2-alfa fosfatasa ácida, dehidrogenasa láctica y cantidad de células en el líquido sinovial, antes y después de 8 días de tratamiento con 600mg/día/vía oral, de ácido tiaprofénico. La detección de los niveles de las PGs se realizó por cromatografía sobre capa fina y ensayo biológico sobre fundus gástrico de rata, contra testigo. Luego del 5§ día se observó una disminución progresiva de la reacción inflamatoria. En corto tiempo el ácido tiaprofénico provocó una caída significativa en los valores de LDH (p<0,02), PGE2 (p<0,001), fosfatasa ácida (p<0,005)., PGF2-alfa (p<0,001) y en el número de células (p<0,02). Concluimos en que el ácido tiaprofénico es una droga anti-PGs y antiinflamatoria efectiva a corto período de tratamiento