[The correlation study on syndrome differentiation of rheumatoid arthritis and joint high frequency ultrasound performance].

OBJECTIVE: To observe the differential effect of joint ultrasound on the syndrome differentiation of rheumatoid arthritis (RA) by observing the high frequency ultrasound performances among inactive stage and different syndromes in active stage. METHODS: Totally 83 RA patients in the active stage were assigned to the dampness heat syndrome group (DHS, 59 cases)and the cold dampness syndrome group (CDS, 24 cases) according to Chinese medicine (CM) syndrome typing. Besides, 20 RA patients in the remission stage were recruited as the control group (abbreviated as the remission group). By using high frequency ultrasound and power Doppler ultrasound technology, a comparative observation of synovitis, tenosynovitis, synovial blood flow, and bone erosion in the 2nd-5th metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, wrist joints, knee joints, the second and the fifth metatarsophalangeal (MTP) joints (a total of 24 joints) was performed in all patients. Correlation analyses were performed between the ultrasound performance, laboratory indices, and the disease activity. Ultrasound data of each RA patient were analyzed by their total scores. Χ2 test was used for enumeration data. The measurement data was expressed as x ± s. One-way ANOVA was used for data of normal distribution, while non- parametric test was used for data of non-normal distribution. Correlation analysis of two variables was performed for clinical indicators and ultrasound indicators. Its significance was detected using Pearson correlation. RESULTS: Compared with the remission group, the severity degree of synovitis, tenosynovitis, synovial blood flow, and bone erosion significantly increased in the DHS group (P < 0.01). There was statistical difference in ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF (P < 0.05, P < 0.01). There was statistical difference in the severity degree of synovitis and synovial blood flow, and DAS28 score in the CDS group (P < 0.05). Compared with the CDS group, there was statistical difference in the four ultrasound indices (P < 0.05, P < 0.01), ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF in the DHS group (P < 0.05, P < 0.01). There was no statistical difference in G, IgG, IgA, or IgM among the three groups (P > 0.05). There existed positive correlation between ESR and the synovitis degree, synovial blood flow, and bone erosion in the DHS group (r = 0.444, 0.397, 0.486, P < 0.05).There existed positive correlation between ESR and the synovitis degree, bone erosion, and synovial blood flow in the DHS group (r = 0.378, 0.270, P < 0.05). There existed positive correlation between the DAS28 score and the synovitis degree and synovial blood flow in the DHS group (r = 0.304, 0.351, P < 0.05). CONCLUSIONS: The inflammation degree was the most severe in RA patients of DHS. High frequency ultrasound could provide better evidence for Chinese medical syndrome differentiation of RA patients.

Experimental model of synovitis/capsulitis in the equine metacarpophalangeal joint.

OBJECTIVE: To develop and define a model of acute synovitis/capsulitis in the equine metacarpophalangeal joint (fetlock) to study clinical effects of diagnostic or therapeutic procedures. ANIMALS: 5 adult Standardbreds. PROCEDURE: Polyvinyl alcohol foam particles were injected into the left front fetlock of horses; the right front fetlock was used as a control. Horses were examined clinically and for lameness on a regular basis. Blood samples were taken to measure routine variables. Synovial fluid samples were collected from both fetlocks, and macroscopic, microscopic, and biochemical variables were measured. The effects of local diagnostic nerve blocks and intra-articular anesthesia of the fetlock on ensuing lameness were determined on days 2 and 3. After macroscopic evaluation at necropsy, histologic examination was performed on the fetlock cartilage and capsule. RESULTS: Changes in synovial fluid variables included increased TNF-alpha and matrix metalloproteinases values and in other indicators of acute inflammation. With respect to application of local nerve blocks, lameness decreased most after a combination of metacarpal and palmar nerve blocks, whereas lameness could only partially be blocked by intra-articular anesthesia. At necropsy, mild chronic inflammation of the synovium and deeper layers of the joint capsule was found; polyvinyl alcohol particles had been incorporated into the joint capsule. There was no evidence of articular cartilage damage. CONCLUSIONS: Injection of polyvinyl alcohol foam particles induces transient synovitis/capsulitis in the fetlock, mimicking clinical joint disorders. The model does not seriously affect the horse's long-term wellbeing. Such model serves well for studying the effect of diagnostic or therapeutic procedures.

Fibrous structure and connection surrounding the metacarpophalangeal joint.

The fibrous components of the metacarpophalangeal (MP) joint including the palmar plate, the collateral ligament and the dorsal plate were studied with particular attention paid to the fibrous structure of the fibrous tendon sheath and the deep transverse metacarpal ligament. The tough fibrillar structure around the MP joint, especially the force nucleus, consisted of three types of mixed fibers: the fibrous tendon sheath of the A1 pulley, the deep transverse metacarpal ligament, and the palmar plate. The tendon sheath was located on the ulnar side in the index and middle fingers, on the central position in the ring finger, and on the radial side in the little finger. These fibrous connections among the fingers formed a transverse arch in the hand. The palmar plate of the MP joint was relatively rigid and appears to function as a cushion when flexed. A fold-like protrusion of the synovial layer of the palmar plate of the MP joint had a meniscoid function, which was larger than that of the proximal interphalangeal joint. The capsule of the MP joint was thicker at the dorsal area, forming a dorsal plate, which is a sliding floor of the extensor mechanism and has a meniscoid function for joint congruity. The main lateral stabilizer consisted of collateral ligaments and accessory collateral ligaments anchored to the palmar plate. These structures act together as a "phalangeal cuff", connecting the proximal phalanx to the metacarpal head and stabilizing the MP joint.

Silicone-induced synovial and osseal granuloma following metacarpophalangeal and carpal arthroplasty.

Intraarticular particulate silicone rubber created by abrasion of silicone arthroplasty of the hand may be responsible for the development of an iatrogenic granulomatous synovitis and ostitis. Histological and ultrastructural appearances of the involved tissues are presented, together with a discussion of the possible mechanism and methods of pathological diagnosis.

Osteoarthrosis and apatite synovitis. Pathological study of a metacarpophalangeal joint.

A case of metacarpophalangeal osteoarthrosis associated with synovial apatite deposits is reported. The size of the crystals indicates that they have been thickened by a recrystallization process; the latter could have been provoked by Ca and Po4 ions released by dissolution of some apatite crystals brought by calcified debris of bone or cartilage coming from the abraded osteoarthrotic surfaces. The role of such thickened crystals in synovial inflammation is discussed as well as their possible diagnostic value in determining origin and pathogenesis of a given synovial apatite deposit.

Ultrastructure of the mineralizing metacarpophalangeal joint of progressive ankylosis (ank/ank) mice.

The metacarpophalangeal joint of the progressive ankylosis mouse was examined at 4, 6 and 8 weeks of age by using electron microscopy and electron probe microanalysis. These studies describe the progression of the disorder, and they reveal three overlapping phases: pannus proliferation, chondrophyte formation and mineralization, and articular cartilage mineralization. The chondrophyte mineralized in a manner fairly similar to endochondrial bone, whereas articular cartilage mineralized by advancement of a calcification front across the cartilage. Synovial crystal phagocytosis was also observed. The progressive ankylosis mouse should be an important model for studying both crystal deposition and abnormal articular cartilage calcification.

Polymorphonuclear granulocytes in rheumatic tissue destruction. III. an electron microscopic study of PMNs at the pannus-cartilage junction in rheumatoid arthritis.

Metatarsophalangeal and metacarpophalangeal joints from 3 patients with rheumatoid arthritis were investigated electron microscopically with regard to the occurrence of polymorphonuclear granulocytes (PMNs) at the pannus-cartilage junction. In all 3 cases PMNs could be detected at the junction and within the cartilaginous matrix. PMN cytoplasmic processes surrounded collagenous islands in the cartilage. From the morphological findings it is deduced that PMNs are cells capable of destroying cartilage in inflammatory joint diseases, in particular in rheumatoid arthritis.