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Rev. bras. ortop ; 56(6): 689-696, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357130


Abstract Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing posttraumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.

Resumo A osteoartrite (OA) é caracterizada por uma degradação crônica, progressiva e irreversível da superfície articular, associada a inflamação articular. A principal etiologia da OA do tornozelo é pós-traumática e sua prevalência é maior entre os jovens e obesos. Apesar dos avanços no tratamento das fraturas ao redor do tornozelo, o risco geral de desenvolver OA pós-traumática do tornozelo após 20 anos do trauma é de quase 40%; especialmente nas fraturas bimaleolares de Weber tipo B e C e fraturas envolvendo a borda tibial posterior. Nas fraturas do tálus, essa prevalência se aproxima de 100%, dependendo da gravidade da lesão e do tempo de seguimento. Nesse cenário, é fundamental a compreensão atual das vias de sinalização moleculares envolvidas na senescência e apoptose dos condrócitos. O tratamento da OA do tornozelo é estagiado e guiado pelos sistemas de classificação, condições locais e do paciente. Os principais problemas são a limitada capacidade de regeneração da cartilagem articular, o baixo suprimento de sangue e a escassez de células-tronco progenitoras. A presente atualização resume evidências científicas básicas recentes da OA póstraumática do tornozelo, com foco principal nas alterações metabólicas da sinóvia, da cartilagem e do líquido sinovial. Epidemiologia, fisiopatologia, implicações clínicas, e opções de tratamento são também discutidas.

Humans , Osteoarthritis/diagnosis , Osteoarthritis/therapy , Synovial Fluid , Cartilage , Cartilage, Articular , Prevalence , Fractures, Bone , Ankle Fractures , Ankle/physiopathology
Bol. méd. postgrado ; 37(1): 7-14, Ene-Jun 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147872


La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)

Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)

Humans , Male , Female , Arthritis, Rheumatoid , Ultrasonography , Hand Joints/diagnostic imaging , Synovial Fluid , Immune System Diseases
Braz. j. med. biol. res ; 54(2): e10366, 2021. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1142575


Recent publications have investigated the potential role of the protein level of matrix metalloproteinase-1 (MMP-1) in the susceptibility to rheumatoid arthritis (RA) and osteoarthritis (OA). However, no unanimous conclusion was obtained. Therefore, we carried out a meta-analysis to explore the association between MMP-1 expression and these two clinical disorders. After database searching and screening, we enrolled a total of eighteen articles for the pooled analysis. We observed a significant association between RA cases and controls in the whole population [SMD (standard mean difference)=1.01, P=0.017]. There were similar positive results in the subgroup analysis of "population-based control" (SMD=1.50, P=0.032) and "synovial fluid" (SMD=1.32, P=0.049). In addition, we observed an increased risk in OA cases, compared with controls, in the overall analysis (SMD=0.47, P=0.004) and subsequent subgroup analysis of "knee OA" (SMD=0.86, P<0.001), "Asian/China" (SMD=0.76, P=0.003), "cartilage-Asian/China" (SMD=1.21, P<0.001), and "synovial fluid-Asian/China" (SMD=0.73, P=0.004). In summary, a high protein level of MMP-1 in synovial fluid may be associated with the susceptibility to RA, and the high MMP-1 level in the cartilage tissue or synovial fluid may be related to the pathogenesis of knee OA in the Chinese population. This should be confirmed by larger sample sizes.

Humans , Arthritis, Rheumatoid/genetics , Osteoarthritis, Knee/genetics , Matrix Metalloproteinase 1/genetics , Synovial Fluid
Int. j. morphol ; 38(6): 1539-1543, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134474


SUMMARY: Meniscus tear is an important injury affecting the quality of life. This work is aimed to investigate the activity of CD68 and ADAMTS-5 in cells in synovial fluid in male and female patients with meniscal tear. In this study ,18 male and 22 female patients with meniscal tears were included. Local pain sensation during patients' physical examination, swelling, performing daily activities and difficulty in running-walking complaints were determined. 5 cc synovial fluids were aspirated from the lateral suprapatellar pouch part of the knees with meniscal pain. After routine histological follow-up of the samples, they were embedded in paraffin and sectioned with microtome and 5 micrometer thickness. CD68 and ADAMTS-5 primary antibodies were used for immunohistochemical analysis. Sections were taken and evaluated with a stylish microscope. The distribution of blood cells after meniscus tear was higher in female patients than in male patients. CD68 distribution in female patients appeared higher than in male patients. CD68 expression was high in macrophage cell cytoplasm. ADAMTS-5 expression was higher in female patients in degenerative cells and apoptotic cells. ADAMTS-5 is an important metallo-protein involved in the development of apoptotic signal and extracellular matrix synthesis in patients with ADAMTS-5 meniscus tear, and it may be an important criterion for the treatment developed after injury. CD68 and ADAMTS-5 activity was thought to be one of the important signal pathways that can be identified in the treatment of meniscus tear.

RESUMEN: La rotura del menisco es una lesión importante que afecta la calidad de vida. El objetivo fue investigar la actividad de CD68 y ADAMTS-5 en células del líquido sinovial en pacientes masculinos y femeninos con desgarro meniscal. Se incluyeron 18 pacientes masculinos y 22 femeninos con desgarros meniscales. Se determinó la sensación de dolor local durante el examen físico de los pacientes, la hinchazón, la realización de actividades diarias y la dificultad al correr y caminar. Se aspiraron 5 cc de líquido sinoviale de la parte de la bolsa suprapatelar lateral de las rodillas de los pacientes con dolor meniscal. Después del seguimiento histológico de rutina, las muestras se incluyeron en parafina y se seccionaron con un micrótomo de grosor de 5 micrómetros. Para el análisis inmunohistoquímico se usaron los anticuerpos primarios CD68 y ADAMTS-5. La distribución de las células sanguíneas después del desgarro del menisco fue mayor en pacientes femeninos que en pacientes masculinos. La distribución de CD68 en pacientes femeninos fue más alta que en pacientes masculinos. Además la expresión de CD68 fue alta en el citoplasma de los macrófagos. La expresión de ADAMTS-5 fue mayor en pacientes femeninos en las células degenerativas y células apoptóticas. ADAMTS-5 es una metaloproteína importante en el desarrollo de la señal apoptótica y la síntesis de matriz extracelular en pacientes con rotura de menisco ADAMTS-5, y puede ser un criterio importante para el tratamiento después de la lesión. La actividad de CD68 y ADAMTS-5 era una de las vías de señal importantes que se pueden identificar en el tratamiento de la rotura del menisco.

Humans , Male , Female , Tibial Meniscus Injuries/metabolism , Tibial Meniscus Injuries/pathology , Knee Joint/metabolism , Knee Joint/pathology , Synovial Fluid/chemistry , Immunohistochemistry , Antigens, CD/analysis , Synoviocytes/metabolism , ADAMTS5 Protein/analysis , Knee Joint/cytology
Rev. argent. reumatolg. (En línea) ; 31(3): 32-35, set. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1149673


La artritis séptica poliarticular se define como la infección de dos o más articulaciones, casi siempre de etiología bacteriana y diseminación hematógena. Es considerada una emergencia médica, lo que conlleva reconocerla precozmente, evitar la diseminación de la infección asociada con alta mortalidad y el riesgo de daño estructural articular. Presentamos tres casos de artritis séptica poliarticular, destacándose la importancia de la sospecha clínica y el estudio temprano del líquido sinovial para el diagnóstico y el tratamiento con antimicrobianos, evacuación y lavado articular.

Polyarticular septic arthritis is defined as the infection of two or more joints, almost always of bacterial etiology and hematogenous spread. It is considered a medical emergency, which should be recognized early, avoiding the spread of infection, associated with high mortality and the risk of joint structural damage. We present three cases of polyarticular septic arthritis, highlighting the importance of clinical suspicion and early synovial fluid study for diagnosis and treatment with antimicrobials, joint evacuation and joint lavage.

Humans , Male , Arthritis, Rheumatoid , Arthritis , Synovial Fluid , Therapeutics , Arthritis, Infectious
Med. leg. Costa Rica ; 37(1): 45-53, ene.-mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1098371


Resumen La Artritis Idiopática Juvenil es la enfermedad reumática más frecuente en niños. Es una enfermedad crónica, degenerativa y de etiología desconocida; que puede dejar múltiples secuelas en la población pediátrica. Consta de siete afecciones definidas por la International League of Associations for Rheumatology del 2001: Artritis Sistémica, Oligoartritis, Artritis con Factor Reumatoide positivo o Factor Reumatoide negativo, Artritis relacionada a entesitis, Artritis psoriasica y Artritis indiferenciada; distintas tanto en el aspecto clínico, patogénico como evolutivo. Esta enfermedad se caracteriza por una alteración de la regulación del sistema inmunitario innato con una falta de linfocitos T autorreactivos y autoanticuerpos. La inflamación continua estimula el cierre rápido y prematuro del cartílago de crecimiento provocando un acortamiento óseo. Para llegar a su diagnóstico no se requiere más que una buena historia clínica y examen físico, ya que no hay laboratorios o gabinete lo bastante sensible que nos puedan ayudar. Fármacos como el metrotexate y los inhibidores del factor de necrosis tumoral han venido a modificar la evolución de la enfermedad y mejorar la calidad de vida de estos pacientes.

Abstract Juvenile idiopathic arthritis is the most common rheumatic disease in children. It is a chronic and degenerative disease, with an unknown etiology; that can leave multiple sequels in the pediatric population. There are seven conditions defined by 2001 International League of Associations for Rheumatology: Systemic Arthritis, Oligoarthritis, Arthritis with positive rheumatoid factor or negative rheumatoid factor, enthesitis-related arthritis and undifferentiated arthritis; distinct in clinical, pathogenetic and evolutionary aspects. This disease is characterized by an alteration on the regulation of the innate immune system with a lack of autoreactive lymphocytes T and autoantibodies. Continuous inflammation stimulates the rapid and premature closure of the growth cartilage causing bone shortening. To arrive at the diagnosis, it is only necessary to have a good medical history and physical exam, since there are no laboratory test sensitive enough to help us. Drugs such as methotrexate and tumor necrosis factor inhibitors have come to modify the evolution of the disease and improve the quality of life of these patients.

Humans , Child, Preschool , Child , Adolescent , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/drug therapy , Synovial Fluid/drug effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/analysis , Tumor Necrosis Factors/therapeutic use
Article in Korean | WPRIM | ID: wpr-816607


BACKGROUND: 16S rRNA gene-targeted next-generation sequencing (NGS) can detect microorganisms in a comprehensive reference database. To date, NGS has been successfully applied to samples such as urine, blood, and synovial fluid. However, there is no data for continuous ambulatory peritoneal dialysis (CAPD) fluid. The purpose of this study was to evaluate the clinical usefulness of microbiome analysis of CAPD fluids for the diagnosis of CAPD peritonitis.METHODS: We included 21 patients with high suspicion of CAPD peritonitis. Routine CAPD fluid culture was performed using a pellet of 50 mL CAPD fluid onto the chocolate and blood agar for two days, and thioglycollate broth for one week. 16S rRNA gene-targeted NGS of pellets, stored at −70℃ was performed with MiSeq (Illumina, USA).RESULTS: Many colonized or pathogenic bacteria were detected from CAPD fluids using NGS and the microbiomes were composed of 1 to 29 genera with a cut-off 1.0. Compared to the culture results, NGS detected the same pathogens in 6 of 18 valid results (three samples failed with low read count). Additionally, using NGS, anaerobes such as Bacteroides spp. and Prevotella spp. were detected in six patients. In two of five samples in which no bacterial growth was detected, possible pathogens were detected by NGS.CONCLUSION: To our knowledge, this is the first report about the application of 16S rRNA gene-targeted NGS for diagnosis of CAPD peritonitis. Etiology of culture-negative CAPD peritonitis can be better defined in NGS. Furthermore, it also helped the detection of anaerobic bacteria.

Agar , Bacteria , Bacteria, Anaerobic , Bacteroides , Cacao , Colon , Diagnosis , Humans , Microbiota , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Prevotella , Synovial Fluid
Article in Chinese | WPRIM | ID: wpr-826728


OBJECTIVE@#To observe the therapeutic effects of different waves of electroacupuncture (EA) on knee osteoarthritis (KOA), and to explore the mechanism of different waves of EA on promoting cartilage repair.@*METHODS@#Ninety- seven patients with KOA were randomly divided into a dilatational wave group (32 cases, 2 cases dropped off), a continuous wave group (32 cases, 2 cases dropped off) and a discontinuous wave group (33 cases, 3 cases dropped off). The same acupoints of Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35) and Neixiyan (EX-LE 4) were selected in the three groups. The dilatational wave (frequency of 2 Hz/10 Hz) was used in the dilatational wave group, the continuous wave (frequency of 10 Hz) was used in the continuous wave group, and the discontinuous wave (frequency of 10 Hz) was used in the discontinuous wave group. All the needles were retained for 30 min. All the treatment was given 3 times a week (on Monday, Wednesday and Friday) for 4 weeks. Lysholm knees scoring scale (LKSS) was used to evaluate the knee joint function before and after treatment, and the content of transforming growth factor-β1 (TGF-β1) in the joint effusion before and after treatment was determined by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#Compared before treatment, the total score and each score of LKSS were increased after treatment in the three groups (all <0.05). The improvements of total score, pain score, instability score, swelling score of LKSS in the continuous wave group and the dilatational wave group were superior to those in the discontinuous wave group (all <0.05). The content of TGF-β1 in the joint effusion in each group was increased after treatment (<0.05), and the improvement in dilatational wave group was superior to thoes in the continuous wave group and the discontinuous wave group (all <0.05).@*CONCLUSION@#The three different waves of EA could all improve the clinical symptoms of KOA, which may promote cartilage repair by increasing TGF-β1 content. The dilatational wave had the best overall effect, which can be used as a clinical optimal treatment.

Acupuncture Points , Electroacupuncture , Humans , Knee Joint , Osteoarthritis, Knee , Therapeutics , Synovial Fluid , Chemistry , Transforming Growth Factor beta1 , Treatment Outcome
Chinese Acupuncture & Moxibustion ; (12): 1328-1334, 2020.
Article in Chinese | WPRIM | ID: wpr-877536


OBJECTIVE@#To observe the effect of Miao medicinal acupuncture therapy on transient receptor potential vanilloid (TRPV) channel in knee joint synovial tissue of the rabbits with knee osteoarthritis (KOA) model and to explore the mechanism of Miao medicinal acupuncture therapy in treatment of KOA.@*METHODS@#Of 34 New Zealand male rabbits, 6 rabbits were selected randomly as the normal group. KOA model was established in the rest rabbits by injecting a mixture of papain and L-cysteine in right knee joints. The 24 successfully modeled rabbits were randomized into a model group, a Miao medicinal acupuncture therapy group, a dermal needle group and a smearing group, 6 rabbits in each one. In the Miao medicinal acupuncture therapy group, Miao medicinal acupuncture therapy was adopted, in which, the roller type of dermal needle was used on the surface of right knee joint [a rectangle shape formed by "Xuehai" (SP 10), "Liangqiu" (ST 34), "Yanglingquan" (GB 34) and "Yinlingquan" (SP 9)], rolling in a " shape, on which, Miao medicinal solution was smeared in advance. In the dermal needle group, the rolling stimulation was exerted on the right the right knee joint surface with the roller type of dermal needle. In the smearing group, Miao medicinal solution was smeared on the right knee joint surface. The intervention was given once every two days, 3 times weekly and the intervention was exerted consecutively for 4 weeks. Successively, on day 1, 21, 28, 35, 42 and 49 of experiment, paw withdrawal threshold (von Frey threshold) after mechanical stimulation was detected in the rabbits. HE staining was adopted to observe the histomorphological changes of the right knee joint cartilage in the rabbits. ELISA was used to determine the contents of interleukin-1 (IL-1β) and tumor necrosis factor-α (TNF-α) in the right knee synovial fluid. Western blot method and real-time PCR were used to determine the relative expressions of protein and mRNA of TRPV1 and TRPV4 in knee synovial tissue of the rabbits.@*RESULTS@#Compared with the normal group, on day 49 of experiment, von Frey threshold was reduced significantly in the rabbits of the model group (@*CONCLUSION@#Miao medicinal acupuncture therapy plays a role in treatment of KOA probably through inhibiting the expressions of IL-1β and TNF-α of knee synovial fluid and down-regulating the expressions of protein and mRNA of TRPV1 and TRPV4 in knee synovial tissue.

Acupuncture Therapy , Animals , Knee Joint , Male , Osteoarthritis, Knee/therapy , Rabbits , Synovial Fluid , Transient Receptor Potential Channels
Adv Rheumatol ; 60: 11, 2020. tab, graf
Article in English | LILACS | ID: biblio-1088644


Abstract Background: The current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis. Methods: We collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Each group included 34 patients. We compared the result of the synovial LE test with the result of the culture of each patient. Results: The mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture. Conclusion: The leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis.(AU)

Humans , Arthritis, Rheumatoid/diagnosis , Synovial Fluid/chemistry , Arthritis, Infectious/diagnosis , Leukocyte Count
Rev. bras. parasitol. vet ; 28(4): 779-785, Oct.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1057995


Abstract A free-living, adult male maned wolf (Chrysocyon brachyurus) was referred to the Governador "Laudo Natel" - FCAV/Unesp veterinary hospital after being found with skin lesions and a fracture on the right pelvic limb, which had to be amputated due to compromised integrity. Around 20 days later, bilateral accentuated swollen on humerus-radius-ulna articulation was observed. The synovial liquid was drained and sent to the laboratory for synovial cytology with Rosenfeld staining that revealed predominantly degenerated neutrophils with karyolytic chromatin associated with intracellular inclusions suggestive of Hepatozoon sp. gametocytes. Blood and synovial liquid samples were submitted to molecular analysis, aiming to amplify the Hepatozoon spp. 18S rRNA gene fragment. Despite the positioning of the found Hepatozoon sequence together with Hepatozoon canis previously detected in domestic carnivores, the BLAST analysis showed only 98% identity with H. canis. To the best of the authors' knowledge, this is the first time a Hepatozoon was detected in the synovial liquid by clinical pathology and molecular analyses.

Resumo Um lobo guará (Chrysocyon brachyurus) adulto, macho, de vida livre foi encaminhado para atendimento no hospital veterinário Governador "Laudo Natel" - FCAV/Unesp após ser encontrado com lesões de pele e fratura em membro pélvico direito, sendo amputado devido a comprometimento da integridade do membro. Aproximadamente 20 dias após a chegada ao hospital, foi notado acentuado aumento de volume bilateral em região de articulação úmero-rádio-ulnar. O líquido sinovial foi drenado e enviado para análise citológica com coloração de Rosenfeld, revelando a presença de neutrófilos degenerados com cromatina cariolítica associados a inclusões intracelulares sugestivas de gametócitos de Hepatozoon sp. Amostras de sangue e líquido sinovial foram submetidas a análises moleculares visando amplificar um fragmento do gene 18S rRNA de Hepatozoon spp. Apesar da sequência de Hepatozoon detectada se posicionar filogeneticamente no mesmo clado que H. canis previamente detectado em carnívoros domésticos, o resultado da análise do BLAST mostrou somente 98% de identidade com H. canis. De acordo com o conhecimento dos autores, esta é a primeira vez que Hepatozoon foi detectado no líquido sinovial por meio de patologia clínica e análises moleculares.

Animals , Male , Protozoan Infections/parasitology , Synovial Fluid/parasitology , Apicomplexa/genetics , Canidae/parasitology , Phylogeny , Brazil , RNA, Ribosomal, 18S/genetics , Apicomplexa/isolation & purification , Incidental Findings
Pesqui. vet. bras ; 39(6): 388-392, June 2019. tab
Article in English | LILACS, VETINDEX | ID: biblio-1012759


The aim of the study was to determine the concentration pattern of intra-articular acute phase proteins (APPs) and immunoglobulins in healthy crossbred cattle. Synovial fluid (SF) samples were collected from the radiocarpal joint of 25 heifers and 25 steers. Concentrations of APPs were measured by SDS-PAGE. The results were submitted to analysis of variance using the SAS statistical program, and means were compared by the Student-Newman-Keuls test (P<0.05). Thirty-seven proteins with molecular weights ranging from 7 to 37kDa were identified in SF of all animals. Eight were nominally identified with immunoglobulin A (IgA) and G (IgG), ceruloplasmin (Cp), transferrin (Tf), albumin (Ab), α1-antitripsin (AAT), α1-acid glycoprotein (AGP), and haptoglobin (Hp). The α1-antitripsin was only identified in the Sf of the heifers. The SF values of Cp, Hp, AGP and IgA were significantly higher in heifers than in steers. In sera, 34 proteins with molecular weights between 7 and 244kDa were identified in heifers and steers. Similar proteins were nominally identified in the sera, however the α1-antitrypsin was identified only in SF. The serum values Tf, AGP and IgG were significantly higher in heifers compared with steers. In conclusion, the physiological acute-phase proteins concentrations in synovial fluid of healthy ruminants can be useful in the interpretation of samples from animals with joint diseases. The SF electrophoretic profile of healthy ruminants differs depending on gender. Similar proteins were nominally identified in the sera, but only the SF of α1-antitrypsin.(AU)

O objetivo do estudo foi determinar o padrão de concentração de proteínas de fase aguda e de imunoglobulinas intra-articulares (APPs) em bovinos mestiços saudáveis. As amostras de fluido sinovial (SF) foram coletadas da articulação radiocárpica de 25 novilhas e 25 novilhos. As concentrações de APPs foram mensuradas por SDS-PAGE. Os resultados foram submetidos à análise de variância usando o programa estatístico SAS, e os meios foram comparados pelo teste Student-Newman-Keuls (P<0,05). Trinta e sete proteínas com pesos moleculares variando de 7 a 37kDa foram identificadas no SF de todos os animais. Oito foram nominalmente identificadas como imunoglobulina A (IgA) e G (IgG), ceruloplasmina (Cp), transferrina (Tf), albumina (Ab), a1-antitripsina (AAT), glicoproteína a1-ácido (AGP) e haptoglobina (Hp). A α1-antitripsina foi identificada apenas no SF das novilhas. Os valores de Cp, Hp, AGP e IgA no SF foram significativamente maiores em novilhas do que em novilhos. No soro, 34 proteínas com pesos moleculares entre 7 e 244kDa foram identificadas nas novilhas e novilhos. Proteínas similares foram identificadas nos soros, mas apenas o SF das novilhas apresentou a α1-antitripsina. Os valores séricos de Tf, AGP e IgG foram significativamente maiores em novilhas em relação aos novilhos. Conclui-se que a mensuração das concentrações das proteínas da fase aguda no líquido sinovial de animais saudáveis pode ser útil na avaliação de amostras oriundas de bovinos com afecções articulares. O perfil eletroforético do SF de ruminantes saudáveis difere em função do gênero e as diferenças devem ser levadas em consideração na interpretação dos achados.(AU)

Animals , Cattle , Synovial Fluid , Immunoglobulins/analysis , Acute-Phase Proteins/analysis , Cattle/blood
Acta ortop. mex ; 33(2): 127-135, mar.-abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1248647


Resumen: Actualmente contamos con diversos métodos de laboratorio para el diagnóstico de las infecciones periprotésicas, algunos ampliamente probados y otros en estudio. Han aparecido nuevos biomarcadores después del Consenso de Filadelfia, por tal motivo, nos planteamos hacer una revisión acerca de qué hay de nuevo para su diagnóstico después del Consenso y cuáles podrían ser los más útiles para el trabajo clínico diario. Material y métodos: Se revisaron artículos publicados entre 2013-2017 en cinco revistas de alto impacto. Las variables fueron: tipo de biomarcador, cifras de corte, sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, área bajo la curva, razón de momios diagnósticos y cocientes de probabilidad positivos y negativos. Se calificó nivel de evidencia. Resultados: Los resultados se agruparon en Tablas. Se encontraron 54 artículos, de los cuales 31 no se ajustaban a los criterios de inclusión y fueron excluidos; sólo se incluyeron 23. Se encontraron 19 biomarcadores, cinco de los cuales no habían sido reportados hasta antes de 2013: La α defensina sinovial 1, la β defensina humana 3, el lactato sinovial y los receptores tipo Toll 1 y Toll 6. Conclusión: Los biomarcadores que ofrecen mayor utilidad clínica para el diagnóstico de IAP son: la proteína C reactiva, la esterasa leucocitaria, la interleucina-6, la interleucina-1β, la α-defensina y la interleucina-17. Detectamos cinco nuevos marcadores. Los estudios analizados muestran heterogeneidad en sensibilidad, especificidad y en sus cifras de corte. En la mayoría no usan aplicaciones estadísticas avanzadas que los harían más confiables.

Abstract: We now have a great variety of laboratory diagnostic tools, for the detection of PJI, some of them widely used and others under study. After the Philadelphia Consensus, they have emerged some new biomarkers. Because of that, we consider useful to review which new biomarkers we have for the diagnosis of PJI after the Consensus and which of them could be more useful in daily clinic work. Material and methods: We searched for articles published from 2013 to 2017 in 5 high impact journals. The analized variables were: biomarker type, cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio. We value their evidence level. Results: Results were grouped in Tables. They were found 54 articles, 31 of them didn't meet the inclusion criteria so they were excluded; 23 studies were included in the revision. We found a total of 19 biomarkers studies, 5 of them weren't reported before 2013: Sinovial α defensin 1, human β defensin-3, sinovial lactate and Toll-like receptors 1 and 6. Conclusion: Of all the markers reviewed for the diagnosis of PJI, C reactive protein, esterase test strip, interleukin-6, interleukin-1 β, α defensin and interleukin-17 show the highest diagnostic utility. We found 5 new markers. The articles studies show high heterogeneity in their reported sensitivity, specificity and cutoff values. In most of them were not used advanced statistical tools which could make them more reliable.

Humans , Biomarkers/analysis , Prosthesis-Related Infections/diagnosis , Synovial Fluid , alpha-Defensins/analysis , Consensus
Yonsei Medical Journal ; : 88-97, 2019.
Article in English | WPRIM | ID: wpr-719377


PURPOSE: Sodium chloride (NaCl) has been proposed as a driving factor in autoimmune diseases through the induction of pathogenic CD4+ T helper cells that produce interleukin-17 (Th17 cells). This study investigated the effects of NaCl on inflammatory arthritis in mice and humans. MATERIALS AND METHODS: Collagen-induced arthritis (CIA) mice were fed a normal or high-salt diet ad libitum, and clinical and histologic features of arthritis were evaluated. The proportion of Th17 cells in the spleens of CIA mice fed a normal or high-salt diet was evaluated by flow cytometry, and the expression of IL-17 in joints and intestines was determined by immunohistochemical staining. We also analyzed the effect of NaCl on Th17 differentiation from peripheral blood monocytes of patients with rheumatoid arthritis (RA) and osteoarthritis (OA) and evaluated the contents of sodium and IL-17 in the synovial fluid of RA and OA patients. RESULTS: NaCl increased murine and human Th17 cell differentiation in a dose-dependent manner. Clinical and histological arthritis was more severe in the high-salt-fed CIA mice, compared to control CIA mice. The proportion of Th17 cells among splenocytes was higher in CIA mice fed a high-salt diet. Expression of synovial and intestinal IL-17 was also higher in high-salt-fed CIA mice. Comparison of synovial fluid between RA patients and OA patients revealed that Na+ and IL-17 were more abundant in RA synovial fluid. CONCLUSION: This study suggests that NaCl can aggravate arthritis by affecting Th17 differentiation. Accordingly, limiting salt intake may be helpful for treating inflammatory arthritis, such as RA.

Animals , Arthritis , Arthritis, Experimental , Arthritis, Rheumatoid , Autoimmune Diseases , Diet , Flow Cytometry , Humans , Interleukin-17 , Intestines , Joints , Mice , Monocytes , Osteoarthritis , Sodium Chloride , Sodium , Spleen , Synovial Fluid , T-Lymphocytes, Helper-Inducer , Th17 Cells
Article in English | WPRIM | ID: wpr-786488


The authors present two cases in which the ruptured popliteal (Baker's) cysts remained undetected and were diagnosed only during an isotope investigation. The aim was to describe a specific imaging sign, the “arch sign”, that is indicative of ruptured Baker's cysts. In both cases, the whole-body imaging was performed 2 hours after injection of 706.7 MBq of Tc-99m-MDP. Single-photon emission computed tomography (SPECT) imaging was performed to localize an accumulation of the radiopharmaceutical. An analysis of literature was performed to connect these cases with previously reported data and to detect the pathognomonic radio image sign of ruptured popliteal cysts. The arch-shaped distribution of the radiopharmaceutical below the knee joints was seen already on the whole-body bone scan image in both cases. An anterior view of SPECT MIP images showed the arched accumulation of the Tc-99m-MDP bone tracer along the postero-medial aspect of the right calf secondary to synovial fluid leak from a ruptured Baker's cyst. The similar arthroscintigrams were published since 1971 without recognizing this sign as pathognomonic. Tc-99m-MDP bone scanning is sensitive for a Baker's cyst with synovial effusion, and distribution of a radiopharmaceutical in the medial posterior calf in a shape of an arch, the arch sign, may serve as an indicator of a ruptured popliteal cyst.

Knee Joint , Popliteal Cyst , Synovial Fluid , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-Photon
Article in English | WPRIM | ID: wpr-764393


BACKGROUND: Pain, limitations in opening, asymmetrical jaw movements, and temporomandibular joint (TMJ) sounds are the most common findings in temporomandibular joint disorders (TMDs), which causes excruciating pain, inflammation of the surrounding muscles, posterior fibers, and synovial fluid. This study aimed to evaluate and compare the effects of ultrasound heat therapy and low-level laser therapy (LLLT) in reducing TMD-related pain. METHODS: This prospective study included 42 patients (age range, 25–45 years), who were divided into two groups of 21 patients each. All patients were prescribed a non-steroidal anti-inflammatory drug (NSAID) twice a day for 5 days for temporary relief of pain prior to the commencement of treatment. Patients were kept on a soft diet and asked to restrict mouth opening during the same period. Fifteen sessions of LLLT (Group A) or ultrasound therapy (Group B) were administered to the affected side. RESULTS: Post-therapy, the mean visual analog scale score for group A and group B was 4.81 (2.01) and 6.19 (1.20), respectively; the difference was statistically significant and favoring the LLLT group. Similarly, the mean mouth opening for group A and group B was 3.99 (0.40) and 3.65 (0.41), respectively; the difference was statistically significant and favoring the LLLT group. CONCLUSION: Our study recommends LLLT for treating TMD-related pain with no underlying bony pathology.

Diet , Hot Temperature , Humans , Inflammation , Jaw , Low-Level Light Therapy , Mouth , Muscles , Pathology , Prospective Studies , Synovial Fluid , Temporomandibular Joint Disorders , Temporomandibular Joint , Ultrasonic Therapy , Ultrasonography , Visual Analog Scale
Immune Network ; : e21-2019.
Article in English | WPRIM | ID: wpr-764010


Calcium pyrophosphate (CPP) crystals can present as acute inflammatory arthritis which is known as an acute CPP crystal arthritis. Although monocytes/macrophages have been shown to play a role in the initiation of crystal-mediated inflammatory responses, differences in their phenotypes between acute CPP crystal arthritis and acute gouty arthritis have not yet been investigated. We examined the immunological characteristics of synovial monocytes/macrophages in patients with acute CPP crystal and acute gouty arthritis. CD14⁺CD3⁻CD19⁻CD56⁻ cell frequencies in synovial fluid mononuclear cells (SFMCs) were measured. Expression of pro- and anti-inflammatory cytokines and markers was determined. The SFMCs were dominated by a population of monocytes/macrophages in acute CPP crystal arthritis similar to that in acute gout. Synovial monocytes/macrophages showed the phenotypes of infiltrated monocytes as shown by expression of CD88, C-C chemokine receptor type 2, myeloid-related protein (MRP)8 and MRP14 but not proto-oncogene tyrosine-protein kinase MER. Comparatively, the CD14⁺ cells from patients with acute CPP crystal arthritis had similar high levels of IL-1β and TNF-α production but significantly lower expression of IL-10 and M2 marker (CD163). The monocytes/macrophages had the capacity to produce IL-8 in response to CPP crystals. Proinflammatory features were more dominant in monocytes/macrophages during acute CPP crystal arthritis than those during acute gouty arthritis.

Arthritis , Arthritis, Gouty , Calcium Pyrophosphate , Calcium , Cytokines , Gout , Humans , Interleukin-10 , Interleukin-8 , Macrophages , Monocytes , Phenotype , Phosphotransferases , Proto-Oncogenes , Synovial Fluid
Article in English | WPRIM | ID: wpr-764996


BACKGROUND: We aimed to assess the performance of the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for gout in Korean patients with acute arthritis and to compare the performance of the ACR/EULAR criteria to that of other sets of criteria for gout classification. METHODS: Patients with acute arthritis who underwent diagnostic arthrocentesis at one of the four participating rheumatology clinics were consecutively enrolled between February and December 2017. Crystal-proven gout was diagnosed upon confirming the presence of monosodium urate (MSU) crystals in patients with a clinical impression of gout as judged by the rheumatologist. The performance of the ACR/EULAR and other gout classification criteria, including the Rome, New York, American Rheumatism Association (ARA), Mexico, and Netherlands criteria, was analyzed regardless of the presence/absence of MSU crystals. RESULTS: The study enrolled 118 gout patients (all crystal-proven) and 95 non-gout patients. According to the area under the curve, the diagnostic performance was the highest for the ACR/EULAR classification criteria (sensitivity, 80.5%; specificity, 95.8%; area under the curve, 0.966), followed by the Netherlands, Rome, ARA, New York, and Mexico criteria. All six sets of criteria demonstrated lower sensitivity in patients exhibiting the first episode of acute arthritis. CONCLUSION: In Korean patients with acute arthritis, the ACR/EULAR classification criteria outperformed other sets of gout classification criteria even in the absence of information regarding the presence of MSU crystals. However, to enhance diagnostic sensitivity, synovial fluid analysis should be considered in patients with the first episode of acute arthritis.

Arthritis , Arthrocentesis , Classification , Gout , Humans , Mexico , Netherlands , Rheumatic Diseases , Rheumatology , Sensitivity and Specificity , Synovial Fluid , Uric Acid
Article in English | WPRIM | ID: wpr-758954


The intra-articular use of hyaluronic acid (HA) for the treatment of synovitis and osteoarthritis is still controversial. As a consequence, corticosteroids remain the most frequently employed therapeutic agents, despite their potential systemic and local deleterious effects. This study examined the anti-inflammatory, antioxidant, and chondroprotective activities of low and high molecular weight hyaluronic acid (LMW-HA and HMW-HA) on lipopolysaccharide (LPS)-induced synovitis in horses compared to triamcinolone acetonide (TA). LPS was injected in the metacarpophalangeal joints, which were treated intra-articularly with either TA (as control) or LMW-HA or HMW-HA. Joint clinical evaluation and synovial fluid (SF) analysis were performed at 0, 8, 24, and 48 h. The white blood cell counts (WBC), prostaglandin E2 (PGE2), interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, chondroitin sulfate (CS) and HA concentrations, oxidative burst, and HA molecular weights were measured. TA reduced the lameness, swelling, and PGE2 release but increased the SF CS concentrations enormously at 24h and 48h, and decreased the SF HA modal molecular weight. These results indicate the breakdown of articular cartilage aggrecan and SF HA. In contrast, LMW-HA and HMW-HA were less effective in reducing the inflammation symptoms, but preserved the joints because only a modest increase in CS occurred at 24 h, decreasing at 48 h, and the SF HA was maintained. The HA-treatment also had anti-inflammatory actions, and LMW-HA was the most effective in reducing the release of cytokine. In summary, the HA treatment inhibited efficiently the digestion of cartilage proteoglycans and SF HA breakdown.

Adrenal Cortex Hormones , Aggrecans , Cartilage , Cartilage, Articular , Chondroitin Sulfates , Digestion , Dinoprostone , Horses , Hyaluronic Acid , Inflammation , Interleukin-10 , Interleukin-6 , Interleukins , Joints , Leukocyte Count , Metacarpophalangeal Joint , Molecular Weight , Necrosis , Osteoarthritis , Proteoglycans , Respiratory Burst , Synovial Fluid , Synovitis , Triamcinolone , Triamcinolone Acetonide
Rio de Janeiro; s.n; 2019. 103 p.
Thesis in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1179008


A infecção articular periprotética (IAP) é uma das complicações mais frequentes e graves da artroplastia total de quadril (ATQ). A presença de IAP requer a adoção de medidas terapêuticas específicas, frequentemente havendo necessidade de cirurgia de revisão. O diagnóstico preciso e o tratamento adequado são imprescindíveis para evitar a perda funcional e a evolução para infecção sistêmica. Entretanto, o diagnóstico correto da IAP é um desafio, uma vez que ainda não há um método diagnóstico padrão ouro, e os critérios diagnósticos existentes se baseiam em achados cirúrgicos e testes sorológicos, histológicos e microbiológicos, que são imprecisos e demorados. Entre os exames preconizados, a pesquisa de esterase leucocitária (PEL) tem as vantagens de fornecer resultados rápidos, "à beira do leito" ("point of care"), e ser de baixo custo, além de apresentar boa acurácia, de acordo com estudos internacionais. Seu desempenho na população brasileira, no entanto, é pouco conhecido. Dessa forma, este estudo se propõe a avaliar o desempenho da PEL para identificação da IAP pós ATQ nos pacientes submetidos à cirurgia de revisão da ATQ no INTO. Foram incluídos os pacientes nos quais foi possível coletar líquido sinovial (LS) durante o procedimento cirúrgico. Para diagnóstico de IAP foram utilizados os critérios preconizados pela Sociedade de Infecção Musculoesquelética. O valor diagnóstico da PEL foi comparado aos exames de cultura microbiológico, avaliação histopatológica da membrana periprotética, velocidade de hemossedimentação, quantificação de proteína C reativa no plasma, contagem de células brancas no LS e percentual de polimorfonucleares no LS. Foram incluídos no estudo 53 pacientes, sendo 25 (54,3%) homens e 21 (45,6%) mulheres. Dezessete pacientes tiveram diagnóstico de IAP confirmado, dos quais quinze tiveram crescimento de microrganismos na cultura do tecido periprotético. Foi possível realizar a PEL em 42 pacientes, 15 do grupo infecção e 27 do grupo não infecção. A PEL do líquido sinovial apresentou valores de sensibilidade e especificidade de 53% e 100%, respectivamente. A sensibilidade da PEL foi inferior apenas à sensibilidade do teste microbiológico. A baixa sensibilidade encontrada sugere que a PEL não deve ser utilizada como exame de triagem de IAP, já que seu valor preditivo negativo baixo (79,4%) não permite que o resultado negativo seja utilizado para excluir a hipótese de infecção. A especificidade e o valor preditivo positivo alto, aliados à rapidez, baixo custo e possibilidade de ser utilizada no intra-operatório, faz da PEL um exame bastante útil dentro do arsenal diagnóstico da IAP. Quando positiva, a PEL confirma o diagnóstico de infecção, sendo, portanto, capaz de mudar a conduta do cirurgião durante uma cirurgia de revisão classificada inicialmente como asséptica, de acordo com a avaliação pré-operatória. Desta forma recomendamos o uso rotineiro da PEL em todas as revisões aparentemente assépticas de quadril

Periprosthetic Joint Infection (PJI) is one of the most frequent and severe complications of total hip arthroplasty (THA). The presence of PJI requires the adoption of specific therapeutic measures, often requiring revision surgery. Accurate diagnosis and adequate treatment are essential to restore patient function and inhibit evolution to systemic infection. However, the correct diagnosis of PJI is challenging, since there is not such a gold standard, highly accurate, diagnostic method for this disease. PJI diagnosis is currently based on the combination of surgical findings and serological, histological and microbiological tests that are imprecise and time consuming. Among the exams recommended, the test of leukocyte esterase (TLE) has the advantages of providing quick results, at bed side ("point of care"), with low cost, besides having good accuracy, according to international studies. Its performance in the Brazilian population, however, is unknown. Thus, this study proposes to evaluate the performance of the TLE for the identification of the PJI post THA in patients submitted to revision surgery of THA, treated at INTO. Patients in whom was possible to collect synovial fluid (SF) during the surgical procedure were included. The criteria recommended by the Musculoskeletal Infection Society were used for the diagnosis of PJI. The diagnostic value of TLE was compared to microbiological culture, histopathological evaluation of periprosthetic membrane, erythrocyte sedimentation rate, plasma C-reactive protein quantification, white cell count in SF and percentage of polymorphonuclear in SF. The study included 53 patients, of which 25 (54.3%) were men and 21 (45.6%) were women. Seventeen patients had the diagnosis of infection confirmed, of which fifteen had growth of microorganisms in the periprosthetic tissue culture. It was possible to perform TLE in 42 patients, 15 of the infection group and 27 of the non-infection group. The TLE presented values of sensitivity and specificity of 57% and 100%, respectively. The sensitivity of TLE was significantly reduced in comparison to sensitivity of microbiological test. The low sensitivity suggests that TLE should not be used as an IAP screening test, since its low negative predictive value (79.4%) does not allow that the negative result lead to the exclusion of the hypothesis of infection. However, specificity and high positive predictive value, combined with the rapidity, low cost and possibility of being used intraoperatively, make TLE a very useful exam within the diagnostic arsenal of PJI. When positive, TLE confirms the diagnosis of infection and is, therefore, able to change the surgeon's behavior during revision surgery initially classified as aseptic, according to the preoperative evaluation. In this way, we recommend the routine use of TLE in all apparently aseptic hip revisions

Reoperation , Synovial Fluid , Arthroplasty, Replacement, Hip