Down-modulation of chemokine receptor cartilage expression in inflammatory arthritis.

OBJECTIVE: To evaluate in vivo expression of chemokine receptors in cartilage tissue samples from healthy and diseased joints. METHODS: Presence and distribution of several chemokine receptors in cartilage samples from patients with osteoarthritis (OA) or inflammatory arthritis (IA) and from multi-organ donors were assessed by immunohistochemistry. The expression of messenger RNA (mRNA) for chemokine receptors was also analysed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Normal and OA-affected cartilage showed a moderate to high expression of chemokine receptors, while staining of IA samples ranged from low to absent. Differences between OA and IA samples were present for all receptors but CCR2 and CXCR4. Moreover, mRNAs for CCR1, CCR5 and CXCR1 were found both in normal and pathological chondrocytes, suggesting that chemokine receptor down-modulation seen in IA samples could be a post-transcriptional event. CONCLUSION: Data on normal and pathological chondrocytes underline the role of chemokines in cartilage homeostasis and suggest an imbalance towards catabolic processes in inflammatory conditions.

Morphological analysis of knee synovial membrane biopsies from a randomized controlled clinical study comparing the effects of sodium hyaluronate (Hyalgan) and methylprednisolone acetate (Depomedrol) in osteoarthritis.

OBJECTIVE: The study was part of a randomized open-label clinical trial designed to evaluate the effects of intra-articular injections of hyaluronan (Hyalgan) (HY) in osteoarthritis (OA) of the human knee. Data were compared with those obtained after treatment with methylprednisolone acetate (Depomedrol) (MP). METHODS: Synovial membranes from patients with OA of the knee, primary or secondary to a traumatic event and classified according to the American College of Rheumatology criteria, were examined by arthroscopy and by light and electron microscopy before and 6 months after local injection of HY (2 ml of 500-730 000 MW hyaluronan, 10 mg/ml in saline, one injection per week for 5 weeks) or MP (1 ml of methylprednisolone acetate, 40 mg/ml, one injection per week for 3 weeks). RESULTS: Arthroscopy revealed a significant decrease in inflammatory score after both treatments. Histology showed that HY treatment was effective (P< or =0.05) in reducing the number and aggregation of lining synoviocytes, as well as the number and calibre of the vessels. MP treatment significantly reduced the number of mast cells in primary OA. Both treatments tended to decrease the number of hypertrophic and to increase the number of fibroblast-like lining cells, to decrease the numbers of macrophages, lymphocytes, mast cells and adipocytes, and to decrease oedema, especially in primary OA, and to increase the number of fibroblasts and the amount of collagen. These phenomena were evident throughout the thickness of the synovial tissue. CONCLUSION: At least in the medium term, both HY and MP modified a number of structural variables of the synovial membrane of the osteoarthritic human knee towards the appearance of that of normal synovium. The effect was more evident in primary OA than in OA secondary to a traumatic event. This is the first evidence that local hyaluronan injections modify the structural organization of the human knee synovium in OA.

[Relapsing polycondritis associated with microscopic polyangiitis: description of a clinical case] / Policondrite ricorrente associata a poliangioite microscopica: descrizione di un caso clinico.

A clinical case of Relapsing Polychondritis (RP) with Microscopic Polyangiitis (MPA) is described in a 66 years old woman. This case represents a rare association of the two pathologies. Polychondritis is a rare inflammatory disease of unknown origin, but immunological mechanisms are essential in the pathogenesis. Histological features are inflammation and destruction of cartilage. The disease is systemic, may have a remitting course. The osteoarticular lesions are sometimes unusual, involving the temporomandibular or cervical articulations, and the renal lesions may be severe. This can be primary or associated with several other diseases. Microscopic Polyangiitis is a systemic disorder characterized by necrotizing vasculitis, affecting the small vessels. Most patient with MPA have Antineutrophil Cytoplasmic Antibodies for Myeloperoxidase (MPO-ANCA). ANCA have become an established tool for the diagnosis of systemic vasculitis. The primary target antigens for ANCA are myeloperoxidase (enzyme present in the secretory granules of neutrophils and monocytes) and antibodies to these antigens are tested by ELISA and IIF (indirect immunofluorescence). We describe a case of histologically confirmed MPA with Relapsing Polychondritis. Clinically she presented livedo reticularis in the lower limbs and pain in the joints. During the follow-up the patient developed asymmetric oligoarticular arthritis. Immunosuppressive drugs like glucocorticoids and cyclofosfamide are the drugs of choice, depending on the stage and severity of the disease.

[4 cases of Horton's temporal arteritis. Hypothesis on the possible correlations with rheumatic polymyalgia]. / Quattro casi di arterite temporale di Horton. Ipotesi sulle possibili correlazioni con la polimialgia reumatica.

Giant cell arteritis (GCA) or temporal arteritis is an entity of unknown aetiology and uncertain autonomy for the close relationship with polymyalgia rheumatica (PMR). This work describes four patients with GCA alone. All patients had clinical and laboratoristic evidence of the disease and were treated with steroids. The distribution of HLA antigens showed an increased occurrence of DR4 and B8 antigens. Unfortunately, the small number of patients and the short period of observation don't allow to prove the exact nature of the link between GCA and PMR.

Microarthroscopic study of the morphologic features of normal and pathological synovial membrane.

The complex symptoms occurring in several internal knee diseases are usually related to changes in the synovial membrane, causing diagnostic and therapeutic problems. The conventional arthroscope, useful in establishing the diagnosis of internal derangement, is of questionable value in the differential diagnosis and evaluation of the stages of arthritis. With magnifying arthroscopy, it is possible to better show various forms of synovitis. Between 1983 and 1989, 3,000 knee joints were studied with conventional arthroscopy. In 400 of these joints, magnifying arthroscopic examination (microarthroscopy) was performed: 34 were normal, 57 had meniscal and ligamentous lesions, 220 had osteoarthritis, and 89 had inflammatory synovitis. We used two types of arthroscopes, Hamou-Storz and Microview-Wolf, adapted from a microhysteroscope, which provided a x 150 magnification of the conventional field. Referring to established microarthroscopic aspects of the synovial membrane in normal and pathological conditions, we have suggested microarthroscopic criteria for the differential diagnosis of synovitis in various pathological disorders. We believe that there are new applications for microarthroscopy because the instruments appear to have great potential value for both research and diagnosis.

Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in northern Italy.

We studied the epidemiology of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) in a Mediterranean population. Ninety-nine patients with PMR and/or GCA were identified over a 9-year period (1980-1988) in Reggio Emilia, Italy. The average annual incidence of PMR and GCA was 12.7/100,000 and 6.9/100,000, respectively, in a population aged 50 years or older. Frequencies of HLA antigens were determined in 49 patients with PMR and/or GCA who were followed by staff at our rheumatology unit during the 1980-1988 period. When compared with HLA findings in 242 healthy controls, DR4 was not found to be significantly associated with PMR (24% in PMR patients versus 14% in controls). Patients with GCA also showed an increased frequency of DR4 compared with controls (36% versus 14%), but this difference was also not statistically significant. The immunogenetic features of PMR and GCA and the relationship between the immunogenetic and epidemiologic patterns in different populations are discussed.

Clinical subgroups and HLA antigens in Italian patients with psoriatic arthritis.

The frequencies of HLA antigens were studied in 101 Italian patients with psoriatic arthritis. The total group showed a significant increase in frequency of A1 and B38, and a reduction of B5 when compared to healthy controls. No association between DR and/or DQw antigens and PA were demonstrated. The comparisons between the clinical subgroups and normal controls revealed a significant association of B38 with asymmetric peripheral arthritis, B27 and B39 with spondylitis (with or without peripheral involvement). When intergroup comparison were made, the patients with spondylitis had an increase in frequency of B27 and DQw3 as compared to those with symmetric and asymmetric peripheral disease. DR4 and DRw53 were associated with earlier age of onset of arthritis. There were also significant associations between DQw3 and severe disease, and between A9, B5 and presence of erosions and joint space narrowing. No association with DR4 was showed in a subgroup of patients with symmetric polyarthritis without DIP involvement.

Clinical response to auranofin in patients with psoriatic arthritis.

Fifty-two patients with psoriatic arthritis (PA), treated with auranofin (AF), were entered into a one year prospective, open study. The total group showed a significant increase in frequency of HLA antigens A1 and B38, and a reduction of B5 when compared to healthy controls. There was a remission or an important improvement of disease in the 51% of 45 patients who completed the study. The rate of withdrawal due to side effects was low (8.8%) and the toxicity was mild in nature (diarrhoea and mucocutaneous rash). We prospectively sought predictors of response using HLA antigens, and clinical and laboratory parameters at the beginning of therapy. The only 3 factors found to be related to outcome were duration of psoriasis, physician and patient assessment of disease activity. No laboratory data or HLA specificities could be associated with substantial response to AF therapy.

New methods in arthroscopy: preliminary investigations.

The microhysteroscope, which affords direct in vivo observation of otherwise inaccessible surfaces, can be used to great advantage in arthroscopy. Although conventional arthroscopy can distinguish between 'inflammatory' and 'reactive' (post-traumatic) synovial changes, the microendoscope offers the possibility of more precise differentiation. Synovial membranes, joint cartilage, and menisci were studied at four different magnifications, including microscopic observation of vitally stained cells. Frankly pathological synovia (e.g., rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were compared and distinguished from examples of less florid synovial changes. The fibrocartilaginous structure of the menisci and secondary undulations and tertiary depression of joint cartilage become visible in vivo with the microendoscope; these may well point to early damage to these structures. The authors believe that the three dimensional images at the magnifications provided by this microendoscope go some way towards bridging the gap between the conventional arthroscope, the light microscope, and the scanning electron microscope. This report presents preliminary findings with this new technique.

Atypical spontaneous osteonecrosis of both knees. A case report.

One case of spontaneous osteonecrosis (S.O.N.) of the femoral condyles is described. Lesions were seen in both lateral femoral condyles; this implies a local, microtraumatic or circulatory factor. It is interesting that the patient was so young (a 14 year old girl). She presented with persistent pain in the right knee and at examination only a mild tenderness was noted. Radiography showed a radiolucent "halo" in the lateral condyles with a surrounding sclerotic reaction. Femoral condyles at arthroscopic examination appeared with a slight flattening over the articular cartilage. The diagnosis of S.O.N. was made by a bone scan that demonstrated an increased uptake of the tracer in the lateral femoral condyle bilaterally. A conservative therapy was successful after 18 months.

[The problematical painful knee. An arthroscopic study of 300 cases]. / Le genou douloureux problématique. Etude arthroscopique sur 300 cas.

The diagnosis of internal derangements of the knee sometimes presents a graft deal of difficulty. If today the expression "Internal derangement of the knee" is much more rare, it is due to the progress made in the field of diagnosis thanks, in particular, to arthrography and arthroscopy. The authors report the results of 300 arthroscopies of the knee. They present the most significant forms of the problem knee: hypertrophy of the adipose tissue, hypertrophy of the synovial folds, villo-nodular synovitis, synovial chondromatosis, radiolucent mobile foreign bodies, osteochondritis dessicans hidden meniscal lesions and specific and non-specific mono-arthritis. In the majority of cases, the clinical suspicion was confirmed, but in 29% of cases arthroscopy corrected the diagnosis. Arthroscopy, is judged to be of great value in the diagnosis of doubtful forms of the painful knee syndrome. Often it eliminates the need to open the joint and almost always directs the incision to the most appropriate region and, above all, it prevents the risk of unnecessary operation.