[Macrophages in rheumatoid synovial membrane: an update]. / Les macrophages de la synoviale rhumatoïde: une mise au point.

The immunophenotype of lining and subintimal synovial mononuclear phagocytes (MP) of rheumatoid arthritis (RA) were sought by immunohistology and compared with osteoarthritis (OA) tissue in order to determine the significance of MPs in the pathobiology of RA. Almost all the lining cells (SLCs) in RA consisted of MPs (80 to 90% expressing CD45/CD14/CD68). A major proportion of the interaggregate areas of the rheumatoid subintima was also made of MP cells (50 to 70% expressing CD14/CD68). A marked variation in the immunohistological reaction of antibodies reacting within intimal MPs and between intimal and subintimal MPs was found. Intimal MPs expressed a wide range of macrophage-associated antigens, including receptors for Fc (CD16, CD32, CD64) and complement (CD35, CD11b, CD11c) as well as several integrin and non-integrin cell adhesion molecules (CD29/CD49b, CD49d, CD49f, CD51/CD61, CD11a, CD31, CD54, CD44, CD9, CD63). The monocyte marker, CD14, was down-regulated on SLCs in both RA and OA. When compared to intimal expression of leucocyte common antigen (CD45), CD68, a pan-macrophage maturation antigen, was found to be an unreliable macrophage antigen in OA intima. There was no difference in antigenic phenotype of SLCs in inflammatory and non-inflammatory OA with early activation markers (CD25, CD71) mainly present on MPs. In RA, synovial MPs showed increased expression of activation, maturation and functional antigens suggesting that they are rapidly and fully activated. The fact that their recruitment was independent of the degree of lymphocyte infiltration further emphasises the central importance of synovial MPs in RA.

Arthroscopic debridement versus open repair for rotator cuff tears. A prospective cohort study.

We compared two treatments for tears of the rotator cuff of 1 to 4 cm in size. One group of 22 patients had an arthroscopic subacromial decompression and rotator-cuff debridement; the other comparable group of 23 patients had open repair and acromioplasty. Review was at 2 to 5 years postoperatively. Both groups had similar pain relief and range of active forward flexion, with significant improvement from the preoperative condition. The open repair group scored better for function, strength and overall score, but patient satisfaction was similar in the two groups. We recommend the use of arthroscopic subacromial decompression and debridement for low-demand patients who require mainly pain relief and range of movement. Open repair is necessary if strength and functional recovery are the prime objectives.

Anterior impingement of the ankle treated by arthroscopic removal of bony spurs.

We reviewed 17 patients after arthroscopic resection for anterior impingement in the ankle. All had had painful limitation of dorsiflexion which had failed to respond to conservative treatment. Review at an average of 39 months showed very significant improvements in levels of pain, swelling, stiffness, limping and activity. There was a significant improvement in the range of dorsiflexion but not of plantar flexion. One poor result was due to a superficial infection, and two other patients had residual numbness of the foot which persisted for several months.

Arthroscopic acromioplasty. The superiority of the posterior portal over the lateral portal.

The authors demonstrate that the posterior portal is superior to the lateral portal for performing an arthroscopic acromioplasty by using pre- and postoperative three-dimensional computed tomography scans to quantitate bone shape and volume. The posterior portal gives superior resection of volume of bone as well as superior contour of the bone, especially in removing the anterior acromial hook.

Bone resorption by cells isolated from rheumatoid synovium.

Cellular mechanisms accounting for the osteolysis of rheumatoid erosions are poorly understood. Cells were isolated and characterised from the synovium of 16 patients with rheumatoid arthritis (RA) and four patients with osteoarthritis and their ability to resorb bone was assessed using a scanning electron microscope bone resorption assay. Macrophages were the major cell type isolated from the synovium of patients with RA. These produced extensive roughening of the bone surface without resorption pit formation. This low grade type of bone resorption was not affected by systemic (calcitonin, parathyroid hormone, 1,25-dihydroxyvitamin D3) or local (interleukin 1, prostaglandin E2) factors influencing bone resorption. Macrophage mediated bone resorption differs qualitatively and quantitatively from that of osteoclasts but is likely to play an important part in the development of marginal erosions in RA.

Adhesion receptors of intimal and subintimal cells of the normal synovial membrane.

The distribution of cell adhesion molecules (CAMs) and matrix proteins in the normal synovium of four subjects was studied by immunohistology in order to determine the factors governing the cellular and tissue organization of the intimal and subintimal compartments. Basement membrane proteins, laminin, and collagen type IV, as well as vitronectin and fibronectin, were identified in the intima and there was corresponding expression of integrin and non-integrin receptors (e.g., CD29, CD49b, CD49d, CD49e, CD49f, CD51, CD61, CD44) for these matrix proteins. There were notable differences in CAM expression between intimal, subintimal, and vascular compartments of the synovial membrane. Phenotypic heterogeneity for CAMs involved in cell-cell interactions, particularly CD11a, CD11b, ICAM-1, and HLA-DR, was also present. The range of CAMs expressed by synovial and endothelial cells not only indicates a structural role for these antigens, but also suggests that they may control leucocyte traffic into the membrane, including recruitment of cells into the synovial lining.

Histological distribution of the interleukin-4 receptor (IL4R) within the normal and pathological synovium.

The authors sought the synovial distribution of the interleukin-4 receptor in the synovium of 3 normal subjects, 5 cases of osteoarthritis (OA) and 10 cases of rheumatoid arthritis (RA) and various other inflammatory arthritic conditions. The specific receptor for interleukin-4 was mainly found on cells around subintimal blood vessels and within lymphocytic aggregates where dendritic-like cells were strongly stained. Conversely, synovial lining cells did not express the interleukin-4 receptor. In conclusion, it is believed that the expression of interleukin-4 receptor is restricted to the early activation stage of the mononuclear cells in the pathological joint.

Primary chest wall tumor appearing as frozen shoulder. Review and case presentations.

The term frozen shoulder may apply to a primary, common, recognizable entity with a predictable course to a painful stiff condition with periarthritis secondary to trauma, rotator cuff or arthritic source. We studied 140 cases of frozen shoulder, referred to a surgical clinic for manipulation when conservative care was not effective. Investigations showed only 40 cases had "primary" frozen shoulder and among these were 3 patients with a local primary invasive neoplasm mimicking the exact features of the common condition. The attending physician and surgeon should be suspicious of tumor in younger patients with progressive pain among the other features of primary frozen shoulder.

[Operative arthroscopy of the ankle. 107 cases]. / Arthroscopie opératoire de la cheville. 107 observations.

Ankle arthroscopy was performed in 127 patients. It was possible to evaluate 107 of these patients. Follow-up covered a mean period of 39 months (12 to 94 months). A figure of 80% good results was found in disorders such as osteochondral fractures of the dome of the talus, anterior osteophytosis of the tibia or after synovectomy with arthroscopic direct vision in synovial diseases such as benign tumours or chronic inflammatory rheumatism. The role of arthroscopy in ankle instability and in osteoarthrosis is declined. This endoscopic procedure is associated with a 13% postoperative complication rate, the most serious being a permanent neurological lesion and septic arthritis.