The synovium and synovial fluid in multicentric reticulohistiocytosis--a light microscopic, electron microscopic and cytochemical analysis of one case.

The synovium and synovial fluid have been studied in a patient with multicentric reticulohistiocytosis. Previously unreported histochemical, immunocytochemical and ultrahistochemical findings are presented and their relevance to the aetiology and pathogenesis are discussed. The synovial fluid analysis in this disease is characteristic and may be helpful in its early diagnosis.

Palindromic onset of rheumatoid arthritis. Clinical, synovial fluid, and biopsy studies.

Five patients had episodic arthritis consistent with palindromic rheumatism that evolved into definite or classic rheumatoid arthritis after 1 or more years. Synovial effusions during palindromic episodes had various leukocyte counts; mononuclear cells predominated in 4 patients. Neither these effusions nor needle synovial biopsies that showed subacute superficial inflammation and microvascular disease allowed any prediction that the disease would evolve into rheumatoid arthritis. Electron-dense deposits in vessel walls suggested circulating immune complexes. There was also prominent, unidentified debris in vessel walls and in phagocytic vacuoles, which might also be important in pathogenesis.

Urate spherulites in gouty synovia.

We have identified urate crystals in gouty synovial fluid in a spherulite form. Studies in vitro established these "beachball" structures as chemically identical to classic "needles" of monosodium urate monohydrate, the prime factor in gouty arthritis. Previously described in the 1890s by a German scientist, these structures have not been recognized by clinicians examining fluid from arthritic joints. We suggest an identification scheme for beach ball-like" structures in synovial fluid.

[Crystallographic and molecular structure of trihexosyl-ceramide deposits characteristic of Fabry's disease (particularly the rheumatic form). Digital imaging processing]. / Structure cristallographique et moléculaire des dépôts de trihexosyl-céramide caractéristiques de la maladie de Fabry (forme rhumatismale notamment). Approche par traitements numériques d'images.

The ceramide trihexoside inclusions, which characterize Fabry-Anderson disease, have been studied using electron microscopy and digital image processing. Results are given showing the various apparent periodicities of the inclusion lamellae and the orientation, perpendicular to the lamellae or oblique, of the ceramide molecular component.

Crystal-associated arthropathies: what's new in old joints.

Degenerative arthritis in the aged includes two major disease categories--osteoarthritis and the crystal-associated arthropathics. The crystals chiefly involved are monosodium urate (gout) and calcium pyrophosphate dihydrate (CPPD), although several others (e.g., cholesterol, brushite and apatite) have been implicated. This report illustrates how the newer diagnostic techniques such as polarized-light microscopy, analytical electron microscopy and x-ray microdiffraction have augmented knowledge concerning diseases associated with articular crystal deposition. For example, diffraction techniques are required for accurate identification of the apatite crystals found in synovial fluid effusions and in the matrix vesicles of degenerate cartilage. According to ultrastructural studies, monosodium urate crystals found in tophi, joint surfaces and effusions show a distinct morphology. Present in inactive joints, the crystal surfaces are bare; in acute gout, the crystals are covered with mucin, confirming the observation that protein binding to crystals is necessary for inflammation to proceed. CPPD disease is by far the most common crystal-associated arthropathy affeting the aged. The incidence of CPPD deposits in articular tissues increases with age but, in contrast to gout, affects both men and women. The pathogenesis of CPPD disease is a mystery, but factors under investigation include matrix abnormalities, ionic imbalances, and enzyme disorders.

Lysosomal activation by neutral saccharides in cell cultures of synovium.

On exposure to sucrose or neutral polysaccharides, cell cultures from human synovium showed cytoplasmic vacuolation, increased numbers of lysosomes, and ultrastructural changes simulating those described in rheumatoid synovial intima and similarly treated embryonic caritlage and bone. These changes were accompanied by raised intracellular lysosomal enzyme activity without corresponding increases in the extracellular level of these enzymes. Structural changes and enzymic responses were less intense during exposure to the neutral polysaccharides. The secretion of large polymers of hyaluronic acid was consistently decreased during sucrose treatment. Evidence of heightened hyaluronidase-like activity was found in cellular extracts of sucrose-treated cultures, but not in the culture medium.

Metastatic adenocarcinoma of synovium presenting as an acute arthritis. Diagnosis by closed synovial biopsy.

An acute arthritis may accompany the onset of cancer. A case of metastatic adenocarcinoma of the synovium presenting as an acute arthritis is described. The diagnostic importance of a careful synovial fluid analysis and the use of closed synovial biopsy are emphasized.

Mycoplasma in synovial fluid from the patients with rheumatoid arthritis.

Mycoplasma colonies were found on culture of synovial fluid in 14 of 18 cases of rheumatoid arthritis. It was possible to demonstrate the colonies in primary culture medium only by the method of hot water fixation and Giemsa staining. The organisms grown on solid medium were also observed electron-microscopically.