Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy.

INTRODUCTION AND OBJECTIVES: Intra-articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound-guided corticosteroid injections for pain relief in patients with haemophilic arthropathy. PATIENTS AND METHODS: Ultrasound-guided intra-articular injections performed on haemophilia patients at UCSD between March 2012 and January 2016 were analysed. Needle placement and injection (40 mg triamcinolone; 3-5 mL lidocaine) were performed with musculoskeletal ultrasound and Power Doppler. Analysis included patient demographics, joint-specific parameters such as tissue hypervascularity and effusions, pain relief, and procedure-associated complications. RESULTS: Forty-five injections (14 ankles, 13 elbows, 18 knees) were administered in 25 patients. Advanced arthropathy with hypervascularity and/or effusions was present in 91% and 61% of joints, respectively. Ninety-one per cent of injections resulted in pain relief which was significant in 84% (>30% reduction). Median pain score was reduced from 7 of 10 to 1 of 10 (P < 0.001), usually within 24 h. Median duration of pain relief was 8 weeks (range 1-16 weeks). Haemophilia B patients experienced longer periods of relief, and high Pettersson scores were associated with shorter duration of relief. There were no procedure-associated complications. Repeat ultrasound of eight joints within 4 weeks of injection demonstrated nearly complete resolution of hypervascularity. CONCLUSIONS: Point-of-care ultrasound enabled intra-articular corticosteroid injections that provided highly effective, safe, and relatively long-lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy.

Effect of copper supplementation on the copper status of pasture-fed young Thoroughbreds.

The effect of copper supplementation of pasture fed mares and foals on the copper status of the foals, in terms of plasma, soft tissue and bone copper concentrations and caeruloplasmin activity, was investigated. Twenty-one Thoroughbred foals from either control mares (n = 9), or copper-supplemented mares (n = 12) were divided randomly into control (pasture only, n = 10) or supplemented (pasture and oral copper sulphate, n = 11) groups. The pasture diet was grazed by all animals, and contained 4.4-8.6 mg Cu/kg dry matter (DM). The copper supplement for the mares contained copper sulphate equivalent to 0.5 mg Cu/kg liveweight (LW)/day. This daily dose was converted to allow administration as a thrice weekly dose (i.e. multiplied by 7/3) which was given for 13-25 weeks prior to foaling. The supplemented foals, also dosed 3 times a week, received 0.2 mg Cu/kg LW/day at age 21 days, which was increased to 0.5 mg Cu/kg LW/day at 49 days and was continued at this level until euthanasia at 150 days. Foal plasma copper concentration and caeruloplasmin activity increased from birth to 21 days post partum and then plateaued at a concentration similar to the mare, but the rise in these indices was not affected by copper supplementation of the mare or foal. Copper supplementation of the foal increased foal liver copper concentration at 150 days (P<0.03). Copper intake of diets containing approximately 8-28 mg Cu/kg DM is well reflected by liver copper concentration, but is poorly reflected by bone, other soft tissue copper concentrations and circulating copper status indices.

The perivascular spaces of ovine and canine brains.

Abstract The specialised histology and anatomy of the central nervous system (CNS) is reflected in its pathology. This is particularly so for the perivenular/periarterial spaces in which inflammatory cells accumulate in inflammation. These spaces, although structurally not lymphatics, act as lymphatics draining fluid from brain to subarachnoid space and to lymphatics draining to deep cervical lymph nodes. Inflammatory cells may enter or leave the CNS by this route. In immune-based inflammation, they are colonised by subsets of immune cells allowing the processing of antigen, synthesis of antibody and development of cell mediated immune reactions.

An immunocytochemical method for studying patterns of cell proliferation in the wool follicle.

The identification of cell proliferation sites in the wool follicle bulbs of the skin of New Zealand Romney sheep was investigated with two immunocytochemical techniques. These methods were based on the in vivo labelling of DNA synthesising follicle matrix cells with the thymidine analogue 5-bromo-2'-deoxyuridine (BrdU) and a surgical preparation of the skin on the lateral abdominal flank of the sheep. Using a monoclonal antibody to BrdU, an indirect immunoenzyme method and a biotin-streptavidin method were compared for specificity and sensitivity in detecting replicating bulb matrix cells which had incorporated infused BrdU during the S-phase of the cell cycle. The immunocytochemical results for both methods showed a black-brown staining reaction of cell nuclei entering mitosis. The biotin-streptavidin method proved to be more highly specific and sensitive than the immunoenzyme technique. The immunocytochemical detection of cell cycle S-phase is highly suited for studying cell proliferation sites and cytokinetics in wool follicle bulbs and in other mitotically active tissues. Immunocytochemical detection of mitotically active cells has the advantages of high specificity, cost efficiency and rapidity and may be an alternative to methods employing metaphase arresting agents like colchicine or autoradiography.