Intravenous neridronate in the treatment of acute painful knee osteoarthritis: a randomized controlled study.

OBJECTIVE: The aim of this randomized, double-blind, placebo-controlled study was to assess the efficacy of i.v. neridronate in controlling pain in patients with acute painful knee OA. METHODS: Sixty-four patients with acute knee pain (<3 months duration) suffering from knee OA with an MRI showing bone marrow lesions (BMLs) were randomized to receive either neridronate 100 mg given four times over 10 days or placebo. After 50 days the patients underwent clinical assessment and a further MRI was performed. Primary outcome was pain changes measured by a visual analogue scale (VAS; range 0-100). Secondary endpoints were WOMAC pain score, McGill pain questionnaire and 36-Item Short Form Health Survey. BMLs were evaluated by whole-organ MRI score. RESULTS: At the day of the last infusion the VAS decreased significantly more in the neridronate group [from 59.0 (s.d. 14.7) to 30.4 (s.d. 15.6); -48.4%; P < 0.001]. Fifty days later the VAS remained unchanged in the placebo group, while a further significant decrease was observed in the neridronate group [from 30.4 (s.d. 15.6) to 9.4 (s.d. 10.8); -69.1%; P < 0.001]. Significant improvements compared with the placebo group were found for most of the other indices of pain and quality of life. The BMLs score in the neridronate group showed significant decreases compared with basal values and those of the placebo-treated patients. Four months after the treatment, 72% of the placebo-treated patients resumed analgesic or anti-inflammatory drugs, but only 12.9% resumed treatment in the neridronate group. CONCLUSION: In patients with acute painful knee OA, four infusions of neridronate are associated with a clinically relevant pain benefit. TRIAL REGISTRATION: ClinicalTrials.gov (http://clinicaltrials.gov), NCT01803360.

The role of diagnostic imaging in synovial sarcoma. Our experience.

PURPOSE: Synovial sarcoma is a rare malignant mesenchymal tumour of soft tissues. It accounts for 8-10% of all soft-tissue sarcomas. The clinical symptoms at onset are often subtle and the course of the disease is slow. Therefore, diagnostic imaging is essential for the early diagnosis of a malignant tumoral lesion. The aim of this study was to assess the role and usefulness of the different imaging procedures in the diagnosis of synovial sarcoma and to present their findings. MATERIALS AND METHODS: Between 1985 and 2002, we retrospectively reviewed 35 patients (21 men and 14 women, aged 14-66 years) with synovial sarcoma treated in the Orthopaedic Oncological Surgery Division of our hospital. All patients had previously undergone conventional radiography, B-mode ultrasound, computed tomography and magnetic resonance imaging. RESULTS: Conventional radiography showed indirect signs of the neoplasm including soft-tissue swelling, calcifications and bone erosions. Ultrasound allowed the detection of focal nodular lesions but was non-specific in distinguishing malignant features. CT after intravenous injection of contrast medium demonstrated inhomogeneous enhancement in 90% of cases, suggesting an alteration in tumour microcirculation. In all cases examined, MRI enabled detection of the intrinsic structural alterations of the mass indicative of an aggressive lesion. CONCLUSIONS: Contrast-enhanced CT and MRI provide useful information on the intrinsic structure of the neoplasm, suggesting a presumptive diagnosis. Furthermore, they are necessary for tumour staging, surgical planning and follow-up. The definitive diagnosis is provided by biopsy and histology.