Articular Damage Research Articles

Bioengineered Nanoparticles Loaded-Hydrogels to Target TNF Alpha in Inflammatory Diseases.

Rheumatoid Arthritis (RA) is an incurable autoimmune disease that promotes the chronic impairment of patients’ mobility. For this reason, it is vital to develop therapies that target early inflammatory symptoms and act before permanent articular damage. The present study offers two novel therapies based in advanced drug delivery systems for RA treatment: encapsulated chondroitin sulfate modified poly(amidoamine) dendrimer nanoparticles (NPs) covalently bonded to monoclonal anti-TNF α antibody in both Tyramine-Gellan Gum and Tyramine-Gellan Gum/Silk Fibroin hydrogels. Using pro-inflammatory THP-1 (i.e., human monocytic cell line), the therapy was tested in an inflammation in vitro model under both static and dynamic conditions. Firstly, we demonstrated effective NP-antibody functionalization and TNF-α capture. Upon encapsulation, the NPs were released steadily over 21 days. Moreover, in static conditions, the approaches presented good anti-inflammatory activity over time, enabling the retainment of a high percentage of TNF α. To mimic the physiological conditions of the human body, the hydrogels were evaluated in a dual-chamber bioreactor. Dynamic in vitro studies showed absent cytotoxicity in THP-1 cells and a significant reduction of TNF-α in suspension over 14 days for both hydrogels. Thus, the developed approach showed potential for use as personalized medicine to obtain better therapeutic outcomes and decreased adverse effects.

Acetabular Edge Loading During Gait Is Elevated by the Anatomical Deformities of Hip Dysplasia.

Developmental dysplasia of the hip (DDH) is a known risk factor for articular tissue damage and secondary hip osteoarthritis. Acetabular labral tears are prevalent in hips with DDH and may result from excessive loading at the edge of the shallow acetabulum. Location-specific risks for labral tears may also depend on neuromuscular factors such as movement patterns and muscle-induced hip joint reaction forces (JRFs). To evaluate such mechanically-induced risks, we used subject-specific musculoskeletal models to compare acetabular edge loading (AEL) during gait between individuals with DDH (N = 15) and healthy controls (N = 15), and determined the associations between AEL and radiographic measures of DDH acetabular anatomy. The three-dimensional pelvis and femur anatomy of each DDH and control subject were reconstructed from magnetic resonance images and used to personalize hip joint center locations and muscle paths in each model. Model-estimated hip JRFs were projected onto the three-dimensional acetabular rim to predict instantaneous AEL forces and their accumulative impulses throughout a gait cycle. Compared to controls, subjects with DDH demonstrated significantly higher AEL in the antero-superior acetabulum during early stance (3.6 vs. 2.8 × BW, p ≤ 0.01), late stance (4.3 vs. 3.3 × BW, p ≤ 0.05), and throughout the gait cycle (1.8 vs. 1.4 × BW*s, p ≤ 0.02), despite having similar hip movement patterns. Elevated AEL primarily occurred in regions where the shallow acetabular edge was in close proximity to the hip JRF direction, and was strongly correlated with the radiographic severity of acetabular deformities. The results suggest AEL is highly dependent on movement and muscle-induced joint loading, and significantly elevated by the DDH acetabular deformities.

Functional outcome of arthroscopic meniscal repair in meniscal tears: a prospective study in tertiary care hospital in North India

<p><strong>Background:</strong> A Meniscal injury can result in intra articular damage and which can eventually result in osteoarthritis if not treated on time and the objective should be to save the meniscus wherever possible. This study was done to analyse the functional outcome of arthroscopic meniscal repair done in different types of Meniscal tears.</p><p><strong>Methods:</strong> The study was conducted on a group of 28 patients with meniscal injury admitted in government medical college Jammu from November 2018 to October 2020. All the tears were located in the red-red and red-white zones. The functional outcome was assessed on the basis of Lysholm Tegner scoring. A standard rehabilitation protocol was followed post repair.<strong></strong></p><p><strong>Results:</strong> Twenty-eight patients were included in the study. Male patients outnumbered the females and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by road traffic accidents and falls. Bucket handle tears were most commonly seen in the group of patients. ACL injury was the major associated injury to be noted. The functional outcome between pre and post operation was statistically significant (p<0.05). In one of the patient failures was seen. Two patients were lost to follow up and were not included in the study.</p><p><strong>Conclusions:</strong> Arthroscopic meniscal repair is a has a very good functional outcome according to our study and should be preferred over meniscectomy (subtotal or total), as meniscus being a very important shock absorber present between the knee joint can lead to delay in osteoarthritis of knee joint. Therefore, our priority should be to save the meniscus and restore the normal anatomy of the knee joint for its biomechanical stability and normal function.<strong></strong></p>

Correlation between pain severity and levels of anxiety and depression in osteoarthritis patients: a systematic review and meta-analysis

AbstractObjectivesOsteoarthritis (OA) is a chronic degenerative musculoskeletal disease that causes articular damage and chronic pain, with a prevalence of up to 50% in individuals >60 years of age. Patients suffering from chronic painful conditions, including OA, also frequently report anxiety or depression. A systematic review and meta-analysis were performed to assess the correlation between pain severity and depressive and anxious symptomatology in OA patients.MethodsA systematic search was conducted using four databases (PubMed, Medline, Scopus, and Web of Science) from inception up to 14 January 2020. We included original articles evaluating pain severity and anxiety and/or depression severity in OA-diagnosed patients. Detailed data were extracted from each study, including patients’ characteristics and pain, anxiety, and depression severity. When available, the Pearson correlation coefficient between pain and depression severity and pain and anxiety severity was collected, and a meta-analysis of random effects was applied.ResultsThis systematic review included 121 studies, with a total of 38 085 participants. The mean age was 64.3 years old, and the subjects were predominantly female (63%). The most-used scale to evaluate pain severity was the Western Ontario and the McMaster Universities Osteoarthritis Index, while for anxiety and depression, the Hospital Anxiety and Depression Scale was the most used. The meta-analysis showed a moderate positive correlation between pain severity and both anxious (r = 0.31, P <0.001) and depressive symptomatology (r = 0.36, P <0.001).ConclusionOur results demonstrate a significant correlation between pain and depression/anxiety severity in OA patients, highlighting the need for its routine evaluation by clinicians.

Analysis and comparison of functional and radiological outcomes of distal end radius fractures managed with operative interventions

Context: Distal end radius fractures are among the commonest fractures encountered in public health care. These injuries are associated with osteoporosis, articular damage, comminution and complex fracture pattern. These fractures should be managed according to fracture configuration and functional demand of patient. Material and Methods: 110 patients with distal end radius fractures were managed with different surgical fixation. Out of them 58 were operated by locking plates, 44 were operated by percutaneous k wire pinning and external fixation was done in 8 patients. Mean age of study population was 46.4 year (range 20-75year) with slight male dominance. All patients were assessed post operatively by clinical and radiological methods in forms of DASH score, VAS pain score, range of motion at wrist joint, operative complication of each treatment modality, pinch and grip strength of both hands. Results: Patients managed with plating had significantly better function, strength and range of motion as compared with patients operated with K-wiring or distractor in all 8 types of fractures (p

Enthesis lesions are associated with X-ray progression in psoriatic arthritis.

To analyze the relationship among enthesis ultrasound (US) lesions and radiological structural damage in psoriatic arthritis (PsA) patients. Consecutive PsA patients with swelling of at least 1 of the 2nd to 5th metacarpophalangeal joints were included. Clinical and demographic data were collected. The Madrid Sonographic Enthesitis Index (MASEI) was selected to evaluate the enthesis, with its total score and MASEI-activity and MASEI-structural damage subscores. The modified Sharp van der Heijde method for PsA and the New York criteria for sacroiliitis were selected to evaluate cumulative bone damage on X-rays. Twenty-seven patients were included. Male gender, older age, longer PsA duration and acute reactant factors were associated with greater bone cumulative damage. Enthesis tendon thickening, enthesophytes, total MASEI and the MASEI-structural damage subscore showed significant correlations with radiographic peripheral and sacroiliac damage scores. Tendon thickening and enthesophytes were the enthesis lesions more frequently associated with radiographic damage in PsA. The enthesis MASEI score was associated with axial and articular radiographic structural damage in PsA patients. The MASEI-structural damage subscore correlated better with cumulative bone damage in PsA than the MASEI-activity subscore.

Surgical outcome of intra-articular fractures of distal end of radius managed by external fixator - our experience

Background & Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 yrs of documented clinical experience. The main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation.Methods: In a prospective controlled study, 30 cases of intra-articular fractures of distal end radius in adult patients were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis and augmentation by K wires. Mean age of the patients was 37.3years, External fixator was applied for a mean duration of 6 weeks and cases were followed up for an average of 37.0 weeks post operatively.Results: Assessed as per De merit point system of Gartland and Werley (modified by Sarmiento 1975) for functional results at the end of 6 months of follow up. Excellent to good functional result was noted in 83.3%.Conclusion: External fixation and ligamentotaxis provides better functional and anatomical results in intra-articular fractures of distal end radius. The success not only depends on the anatomical restoration of the articular surface. It also depends on the associated soft tissue injuries and articular damage.

ADIPOCYTOKINES IN RHEUMATOID ARTHRITIS: LATENT RELATIONASHIP BETWEEN INFLAMMATION AND CARDIOMETABOLIC COMORBIDITIES

Rheumatoid arthritis is a chronic autoimmune disease that affects the synovial membrane of the joints and leads to progressive articular damage, disability and reduced quality of life. Despite the emergence of more innovative therapeutic strategies that have improved the duration of remission, rheumatoid arthritis is associated with high levels of comorbidities, infections, malignancies and cardiovascular disease. It is known that some pathogenic proinflammatory mediators in rheumatoid arthritis, such as interleukin-1β (IL-1β) and tumour necrosis factor, may play a central role in the development of cardiovascular disease. Interestingly, various preclinical and clinical studies have shown that biologic agents, who are widely used in the therapy of patients with rheumatoid arthritis, may be effective in the therapy of cardiovascular diseases as well. For this purpose we have studied adipocytokines. Adipocytokines are pleiotropic molecules that are mainly released by white adipose tissue and immune cells. Adipocytokines modulate the function of different tissues and cells, and, in addition to energy homeostasis and metabolism, enhance inflammation, immune response and tissue damage. Adipocytokines may contribute to the proinflammatory conditions in patients with rheumatoid arthritis and the development of bone damage. In addition, they may be associated with the development of cardiovascular disease. In this study, we considered the already known evidence about adipocytokines in the pathogenesis of rheumatoid arthritis, because they are also actively involved in the pathogenesis of cardiovascular disease and are possible biomarkers of prognosis and treatment outcomes, because of their potential, as a possible new therapeutic target.

Cumulative Damage in Juvenile Idiopathic Arthritis: AMulticenter Study From the Pediatric Rheumatology ArabGroup.

To report the cumulative articular and extraarticular damage in Arab children with juvenile idiopathic arthritis (JIA) and to identify variables that correlate with disease damage. We conducted a multicenter, cross-sectional study among 14 pediatric rheumatology centers from 7 Arab countries. JIA patients who met the International League of Associations for Rheumatology classification criteria and had a disease duration of >1 year were enrolled. Disease activity status was assessed using the Juvenile Arthritis Multidimensional Assessment Report. Disease damage was assessed by the Juvenile Arthritis Damage Index, articular (JADI-A) and extraarticular (JADI-E). A total of 702 (471 female) JIA patients with a median age of 11.3 years (interquartile range [IQR] 8.0-14.0 years) were studied. Median age at disease onset was 5 years (IQR 2.0-9.0 years) and the median disease duration was 4 years (IQR 2.0-7.0 years). The most frequent JIA categories were oligoarticular JIA (34.9%), polyarticular JIA (29.5%), and systemic JIA (24.5%). Clinical remission was achieved in 73.9% of patients. At the last clinic visit, 193 patients experienced joint damage, with a mean ± SD JADI-A score of 1.7 ± 4.5, while 156 patients had extraarticular damage, with a mean ± SD JADI-E score of 0.5 ± 1.1. Patients with enthesitis-related arthritis had the highest JADI-A score. JADI-A correlated significantly with the presence of a family history of JIA. JADI-A and JADI-E had a significant correlation with long disease duration. Cumulative damage was common in this Arab JIA cohort, and consanguinity and JIA in a sibling were frequent findings and were associated with a greater cumulative damage.

Effects of TNF-α inhibition on pre-clinical enthesitis: observational study on 49 psoriatic patients

Background Enthesitis is a hallmark of psoriatic arthritis (PsA) and echographic ultrasounds (US) represent a support for diagnosis of pre-clinical signs of enthesitis in asymptomatic patients at high risk for advanced forms. Early treatment with anti-TNFα could prevent permanent damage contrasting the degenerative course of the disease. Objectives To evaluate the effects of adalimumab on echographic and preclinical enthesitis signs in patients affected by plaque psoriasis. Methods 49 psoriatic patients undergoing adalimumab treatment for plaque-type psoriasis were subjected to echographic screening for identifying pre-clinical signs of enthesitis. Patients underwent clinical and ultrasonographic examination of hands, elbows and knees before starting adalimumab and after 24 and 48 weeks of treatment. Results We observed a reduction of the total number of echographic abnormalities and a significant decrease of the thickness of quadriceps tendons at week 24 and week 48. Furthermore, there was no evidence of significant articular damage progression during the entire study duration. Conclusions Entheseal ultrasonography may be used for preclinical diagnosis of PsA. Our study demonstrates that early detection and management with adalimumab leads to a block of articular damage progression. On quadriceps tendon, adalimumab has shown to be effective with a significant thickening reduction at week 24 and 48

Arthroplasty Rates Not Increasing in Young Patients With Rheumatoid Arthritis: A National Database Review, 2005 Versus 2014.

BackgroundFor 20 years, authors have predicted an expansion in total knee arthroplasty (TKA) and total hip arthroplasty (THA) utilization. Over this same period, the introduction of biological disease-modifying antirheumatic drugs has dramatically altered the treatment of rheumatoid arthritis (RA) with hopes of preventing articular damage and obviating the need for prosthetic replacement. The goal of our investigation was to evaluate TKA and THA utilization in young patients with RA (<65 years) in 2005 vs 2014 compared to patients with osteoarthritis (OA).MethodsUsing relevant International Classification of Disease Ninth Revision (ICD-9) and Current Procedural Terminology codes, the Truven MarketScan Database (over 46 million enrollees) was queried to determine THA and TKA incidence rates for RA and OA patients aged <65 years during the final decade of ICD-9 use. Patients with potentially confounding ICD-9 codes were excluded to limit coding variation. Statistical analysis consisted of student t-tests, Pearson's chi-square tests, and Breslow-Day tests.ResultsFor patients with OA, TKAs increased substantially from 0.07% in 2005 to 0.1% in 2014 (+42.9% change, P < .001). Similarly for patients with OA, THAs increased from 0.04% to 0.06% over the same time period (+66.0% change, P < .001). For young patients with RA, the rate of TKA remained relatively stable—1.06% in 2005 to 1.04% in 2014 (−1.7% change, P = .65)—as did THA—0.44% to 0.48% (+9.0% change, P = .14).ConclusionsDramatic increases in THA and TKA rates for OA patients aged <65 years were indeed observed from 2005 to 2014. This trend, however, was not seen in the RA population where TKA and THA rates remained unchanged.

A systematic review and meta-analysis of the hip capsule innervation and its clinical implications

Detailed understanding of the innervation of the hip capsule (HC) helps inform surgeons’ and anaesthetists’ clinical practice. Post-interventional pain following radiofrequency nerve ablation (RFA) and dislocation following total hip arthroplasty (THA) remain poorly understood, highlighting the need for more knowledge on the topic. This systematic review and meta-analysis focuses on gross anatomical studies investigating HC innervation. The main outcomes were defined as the prevalence, course, density and distribution of the nerves innervating the HC and changes according to demographic variables. HC innervation is highly variable; its primary nerve supply seems to be from the nerve to quadratus femoris and obturator nerve. Many articular branches originated from muscular branches of the lumbosacral plexus. It remains unclear whether demographic or anthropometric variables may help predict potential differences in HC innervation. Consequently, primary targets for RFA should be the anterior inferomedial aspect of the HC. For THA performed on non-risk patients, the posterior approach with capsular repair appears to be most appropriate with the lowest risk of articular nerve damage. Care should also be taken to avoid damaging vessels and muscles of the hip joint. Further investigation is required to form a coherent map of HC innervation, utilizing combined gross and histological investigation.

Skeletal Abnormalities and VDR1 Gene Polymorphisms in Mucopolysaccharidosis Patients.

IntroductionArticular and bone damage, which is so disabling in Mucopolysaccharidosis (MPS), requires attention as to the explanatory bias of the pathogenetic mechanisms identified to date. The vitamin D receptor (VDR) has been investigated in many studies in correlation with bone metabolism, osteoporosis, and the impaired bone mineral density associated with certain polymorphisms of the VDR gene.AimThis study aims to observe whether there is an association between clinical features, phospho-calcium metabolism parameters and the VDR gene polymorphisms in patients with MPS.Patients and MethodWe evaluated six patients with MPS type I, 20 patients with MPS type II, two patients with MPS types IIIA and IIIB and three patients with MPS type IVB. In these patients, phospho-calcium metabolism, markers of bone formation, bone radiographs and bone densitometry were evaluated, as were four polymorphisms of the VDR gene (ApaI, BsmI, FokI and TaqI).ResultsThere was a deficiency in 25 hydroxy vitamin D in MPS type I patients at the final evaluation and in MPS type II patients, both at ERT initiation and at the last evaluation. The analysed polymorphisms were not associated with modified calcium-phosphor levels, but some differences were observed regarding the level of 25 OH vitamin D. Thus, in the case of AA polymorphism, all patients have a 25 OH vitamin D deficiency, and one patient with the AA genotype and three with Aa have a 25 OH vitamin D deficiency and secondary hyperparathyroidism due to this deficiency (four patients), all of them having the Bb phenotype.ConclusionIn MPS patients, vitamin D deficiency is observed, as it is in some patients with secondary hyperparathyroidism, which indicates vitamin D supplementation to protect bone metabolism. There are no obvious correlations between VDR polymorphism and bone metabolism in MPS patients.

Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals.

Background:The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification.Methods:Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software.Results:For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens).Conclusion:This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components.Clinical Relevance:The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

Arthroscopic ACL reconstruction-functional outcome with BPTB graft with interferential screws

Background: Anterior cruciate ligament (ACL) tear is the most common serious ligamentous injury to the knee joint. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. Anterior cruciate ligament deficiency leads to knee instability. This results in recurrent injuries and increased risk of intra articular damage, especially the meniscus. The goals of the ACL reconstruction are to restore stability to the knee, allow the patient to return to normal activities, including sports and to delay the onset of osteoarthritis. The bone patellar tendon bone graft is one of the most commonly used autograft for reconstruction and this study evaluates the functional outcome in a prospective study.Materials and Methods: This was a prospective study comprised of 30 diagnosed cases of ACL tear confirmed by clinical evaluation, MRI scanning and diagnostic arthroscopy in patients who have come with complains of knee instability/pain to KIMS hospital and research centre from February 2018 to February 2019. Patients between the age groups 18 years to 40 years were taken as test subjects and were managed by arthroscopic ACL reconstruction with BPTB graft and interferential screw and were followed for an average period of 8 months and the findings were recorded and compared pre op and post op using IKDC and Lysholm scoring scales.Results: There were significant improvements in IKDC and LYSHM scores and functional outcome of patients before and after the operation. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.

A Comparison between Early and Delayed Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study

Introduction: A complete Anterior Cruciate Ligament (ACL) injury can result in a progressively increasing symptomatic knee instability, which can cause recurrent intra articular damage and eventually results in osteoarthritis if not treated on time. Aim: To analyse the effects of delaying ACL reconstruction beyond a period of 12 weeks and compared the results with cases managed before that time period. Materials and Methods: A prospective cohort study was conducted between July 2017 to October 2019 in Government Medical College, Jammu on two groups of patients divided into early (&lt;12 weeks) and delayed (&gt;12 weeks) on the basis of interval between the injury and definitive surgery. ACL reconstruction was done using a quadrupled semitendinosus-gracilis graft. A standard rehabilitation protocol was followed and the results were compared. Patients were followed-up till one year postsurgery. Software used for statistical analysis was EpiInfo Version 3.0 and SPSS. Results: A total of 72 patients were included in the study. Forty patients were in the early group and 32 in delayed. Male patients outnumbered the females in both the groups and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by falls and road traffic accidents in both the groups. The incidence of grade 3/4 medial and Lateral Meniscal (LM) tears was more in the delayed group and the association was statistically significant (p&lt;0.05). There was significant thigh wasting in the delayed group (p&lt;0.05). Two patients were lost to follow-up and were not included in the study. Conclusion: Delay in ACL reconstruction surgery predisposes to higher grade meniscal lesions and significant thigh wasting and hence the surgery should be preferably done within the first 12 weeks after injury.

Reconstruction of proximal humeral fractures without screws using a reinforced bone substitute

Multi-fragment fractures are still a challenge: current clinical practice relies on plates and screws. Treatment of fractures of the proximal humerus has the intra-operative risk of articular damage when inserting multiple screws. Distal-varus collapse of the head is a frequent complication in osteoporotic patients. The aim of this biomechanical study was to investigate if an Innovative-cement-technique (the screws are replaced by injection of cement) provides the same or better stability of the reconstructed head compared to the Standard-technique (locking screws). A four-fragment fracture was simulated in twelve pairs of humeri, with removal of part of the cancellous bone to simulate osteoporotic “eggshell” defect. One humerus of each pair was repaired either with a Standard-technique (locking plate, 2 cortical and 6 locking screws), or with the Innovative-cement-technique (injection of a partially-resorbable reinforced bone substitute consisting of PMMA additivated with 26% beta-TCP). Cement injection was performed both in the lab and under fluoroscopic monitoring. The reconstructed specimens were tested to failure with a cyclic force of increasing amplitude. The Innovative-cement-technique withstood a force 3.57 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative-cement-technique was 3.56 times larger than the contralateral Standard-technique. These differences were statistically significant. The Innovative-cement-technique, based on the reinforced bone substitute, demonstrated better biomechanical properties compared to the Standard-technique. These findings, along with the advantage of avoiding the possible complications associated with the locking screws, may help safer and more effective treatment in case of osteoporotic multi-fragment humeral fractures.

Flare‑up of cytokines in rheumatoid arthritis and their role in triggering depression: Shared common function and their possible applications in treatment (Review)

Chronic illnesses are associated with an increased risk of depression and anxiety. Rheumatoid arthritis (RA) is a chronic autoimmune disease that typically causes damage to the joints. RA extensively impacts patients, both physically and psychologically. Depression is a common comorbid disorder with RA, which leads to worsened health outcomes. There are several cytokines that are active in the joints of patients with RA. Inflammatory cytokines serve important roles in the key processes in the joints, which usually cause inflammation, articular damage and other comorbidities associated with RA. The key role of inflammatory cytokines could be attributed to their interactions within signaling pathways. In RA, IL-1, and the cytokines of TNF-α, IL-6 and IL-18 are primarily involved. Furthermore, depression is hypothesized to be strongly associated with systemic inflammation, particularly with dysregulation of the cytokine network. The present review summarizes the current state of knowledge on these two diseases from the perspective of inflammation and cytokines, and emphasizes the possible bridge between them by exploring the involvement of systemic cytokines in both conditions.

Role of Adiponectin in the Pathogenesis of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a systemic chronic inflammatory autoimmune joint disease, characterized by progressive articular damage and joint dysfunction. One of the symptoms of this disease is persistent inflammatory infiltration of the synovial membrane, the principle site of inflammation in RA. In the affected conditions, the cells of the synovial membrane, fibroblast-like synoviocytes and macrophage-like synovial cells, produce enzymes degrading cartilage and underlining bone tissue, as well as cytokines increasing the infiltration of immune cells. In patients with RA, higher levels of adiponectin are measured in the serum and synovial fluid. Adiponectin, a secretory product that is mainly white adipose tissue, is a multifunctional protein with dual anti-inflammatory and pro-inflammatory properties. Several studies underline the fact that adiponectin can play an important pro-inflammatory role in the pathophysiology of RA via stimulating the secretion of inflammatory mediators. This narrative review is devoted to the presentation of recent knowledge on the role played by one of the adipokines produced by adipose tissue—adiponectin—in the pathogenesis of rheumatoid arthritis.

Micronutrients: Essential Treatment for Inflammatory Arthritis?

Synovial inflammation is characteristic of inflammatory chronic arthropathies and can cause progressive articular damage, chronic pain, and functional loss. Scientific research has increasingly focused on investigating anti-inflammatory micronutrients present in fruits, vegetables, spices, seeds, tea, and wine. This review aims to examine the anti-inflammatory effect of polyphenols (phytonutrients present in plants) and other micronutrients described in randomized clinical trials conducted in patients with chronic inflammatory arthropathies. There is an increasing evidence that differences in micronutrient intake might play an essential role in pathogenesis, therapeutic response, and remission of synovitis. Randomized clinical trials with specific micronutrient- or nutrient-enriched food intake show improvement of symptoms and modulation of both pro- and anti-inflammatory mediators. We found convincing evidence of the anti-inflammatory effect of several micronutrients in arthritis symptoms and inflammation. Although in clinical practice nutritional recommendations to patients with chronic joint inflammation are not consistently prescribed, the addition of these nutrients to day-to-day eating habits could potentially change the natural history of inflammatory arthritis. Future research is needed for a consensus on the specific nutritional recommendations for patients with chronic synovial inflammation.