Degenerative Arthropathy Research Articles

OSTEOARTHRITIS: MANAGEMENT OF PATIENTS AND COMPLIANCE TO TREATMENT

Osteoarthritis (syn: arthrosis, osteoarthritis, osteoarthritic disease, deforming osteoarthritis, degenerative arthropathy, degenerative-dystrophic joint disease, Kellgren’s disease, etc.) is a heterogeneous group of joint diseases of various etiology with similar biological, and clinical and morphological manifestations and outcome, which gave occasion to determine its phenotypes at the current stage of studying this pathology.

An unusual cause of chronic low back pain: ochronosis.

A 45-year-old man presented with low back pain evolving since 8 years associated sometimes with a radicular radiation. The clinical examination found a patient in good general condition, a loss of the lumbar lordosis, an exaggeration of the dorsal kyphosis with stiffness of the lumbar spine. The cutaneous-mucosal examination showed a brownish appearance of the ears, conjunctiva, and lower eyelids. In biology there was neither inflammatory syndrome nor perturbation of the phosphocalcic balance. The standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images. Due to mucocutaneous signs, normality of biology and the radiological aspect, the diagnosis of ochronosis was suspected and confirmed by the test of blackening of the urine to the ambient air, the results of the cutaneous biopsy showed pigmented deposits yellow ocher and brownish in the dermis and the dosage of alkaptonuria. Symptomatic treatment resulted in moderate improvement. The family survey did not reveal any similar cases. Ochronosis or alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Ochronosis is of late onset, responsible for the rachis of extended disc calcifications with maximum spinal fusion. It is the cause of degenerative arthropathy. Early diagnosis and screening of this disease are then of great interest, especially for genetic counseling.

Results of Arthroscopic Bankart Repair for Anterior-Inferior Shoulder Instability at 13-Year Follow-up

Background: Anterior-inferior shoulder instability is a common injury in young patients, particularly those practicing overhead-throwing sports. Long-term results after open procedures are well studied and evaluated. However, the long-term results after arthroscopic repair and risk factors of recurrence require further assessment. Hypothesis: Arthroscopic Bankart repair results are comparable with those of open repair as described in the literature. Study Design: Case series; Level of evidence, 4. Methods: A total of 180 shoulders with anterior-inferior shoulder instability were stabilized arthroscopically, met the inclusion criteria and the patients were able to be contacted at a minimum of 10-year follow-up. Of these patients, 143 agreed to participate in the study. Assessment was performed clinically in 104 patients using the American Shoulder and Elbow Surgeons score, Constant score, American Academy of Orthopaedic Surgeons score, Rowe score, and the Dawson 12-item questionnaire. The Samilson-Prieto score was used to assess degenerative arthropathy in radiographs available for 100 shoulders. Additionally, 15 patients participated through a specific questionnaire and 24 patients through a telephone survey. Results: The overall redislocation rate was 18.18%. Redislocation rates for the different types of fixation devices were as follows: FASTak/Bio-FASTak, 15.1% (17/112); SureTac, 26.3% (5/19); and Panalok, 33.3% (4/12). Concomitant superior labral anterior-posterior repair had no effect on clinical outcome. Redislocation rate was significantly affected by the patient’s age and duration of postoperative rehabilitation. Redislocation rate tended to be higher if there had been more than 1 dislocation preoperatively (P = .098). Severe dislocation arthropathy was observed in 12% of patients, and degenerative changes were significantly correlated with the number of preoperative dislocations, patient age, and number of anchors. The patient satisfaction rate was 92.3%, and return to the preinjury sport level was possible in 49.5%. Conclusion: Clinical outcome at a mean follow-up of 13 years after arthroscopic repair of anterior-inferior shoulder instability is comparable with the reported results of open Bankart repair in the literature and allows management of concomitant lesions arthroscopically. Modifiable risk factors of postoperative redislocation and arthropathy must be considered. Stabilization after the first-time dislocation achieves better clinical and radiological outcomes than after multiple dislocations.

The place of meloxicam in the series of modern non-steroidal anti-inflammatory drugs

The article describes the pharmacological characteristics of the first selective COX-2 inhibitor – meloxicam, aspects of its mechanism of action, peculiarities of pharmacodynamics and indications, as well as the advantages of the drug compared to the classic and highly selective NSAIDs in terms of safety. The efficiency and safety of meloxicam have been confirmed in 230 clinical trials, in which more than 30 thousands patients took part. In most of them it has been proven that meloxicam is as effective as classic NSAIDs, and moreover, it has a high safety profile, particularly with regard to the GI tract. By severity of the anti-inflammatory and analgesic effect meloxicam is not inferior to conventional NSAIDs, and compares favourably with them by good tolerability with regard to the gastrointestinal and cardiovascular safety, and it can be recommended as a drug of the first choice for the treatment of inflammatory and degenerative arthropathies.

The Role of Angiogenesis in Haemophilic Arthropathy: Where Do We Stand and Where Are We Going?

Haemophilia is an inherited bleeding disorder that can lead to degenerative joint arthropathy due to recurrent bleeding episodes affecting the musculoskeletal system of the patient. The cause of bleeding can be either traumatic or spontaneous. The pathogenesis of haemophilic arthropathy is unclear as many factors like iron, inflammatory cytokines, and angiogenic factors contribute to this process. Blood into joints can deteriorate the bone to such an extent that the patient experiences pain, reduction of the range of movement, and deformity of the joint, conditions that could have a great impact on quality of life. Over the years, management of haemophilic arthropathy has changed. Nowadays, early diagnosis with high resolution imaging like magnetic resonance imaging along with application of prophylaxis regimens can reduce the extent of damage to the joints. However, not all haemophilia patients have access to these interventions as cost may be prohibitive for some of them. The need for new, easy, and cost-effective strategies with the ability to identify early changes could be beneficial and could make a difference in the management of haemophilic arthropathy. Understanding the mechanism of processes like angiogenesis in the mechanism of developing arthropathy could be innovative for these patients and could help in the detection of new early diagnostic and therapeutic markers.

Surgical Protocol Based on Radiological Patterns in Osteoporotic Fractures (OPF) with Neurology

Introduction Neurological affection in OPF depicts dynamic instability in the fractured vertebral body. Surgical treatment favors posterior instrumentation in most reports, while hinting toward anterior decompression in selected cases. Guidelines for radiology-based selection of surgical protocol is lacking in literature. We propose a radiological classification and results of surgical treatment of OPFs. Study: Prospective, clinical case series (Level 3). Material and Methods 50 consecutive patients (M: F 21:29, average age 69.8) were grouped into 5 radiological patterns. Average BMD was -2.7 (−1.8 to -3.4). Radiological assessment was X-rays, MRI and CT scan. 1. Burst Fracture with retropulsion (23). 2. Tri-columnar instability (13). 3. Circumferential stenosis (9). 4. Intra-vertebral instability post vertebroplasty (2). 5. Unstable disc adjacent to OPF (2). 6. Progressive deformity (1). Average duration of fracture was 2.3 months (0.5 – 6) and neuro-deficit was 0.98months (0.25- 3). Fracture distribution (53 OPF) was D5 (2), D7 (1), D10 (4), D11 (5), D12 (18), L1 (11), L2 (4), L3 (5), and L4 (3). Surgical Protocol was: Pattern 4: Only Posterior stabilization (PS); Pattern 2: PS and VP; Pattern 1: PS and Vertebroplasty (VP) in 17. Posterior decompression (PD) 6; Pattern 3: PS, PD, VP (9), Inter-body cage (4); Pattern 5: PS, TLIF; Pattern 6: PSO. Result Average follow-up was 2 years (2008–2014). 47 completed study. Average pre & post treatment and final kyphosis was 27.8 degrees (10- 62), 15.7 degrees and 20.9 (loss of correction 5.2) degrees. Average Pre & post procedure and 2 year VAS pain scores were 8.2, 3.5 and 5.2 respectively. The pre-op ASIA grades were B (4), C (13), D (27). Final ASIA grades were A (1), B (1), C (9), D (32), E (4). Fracture above fixation caused paraplegia in one patient that did not improve. Implant loosening was seen in 19 (40.42%) and 7 (12.76%) required revision. Proximal junctional kyphosis occurred in 2. Pattern 1–4, PS & VP provided stability and clinical improvement. PD was required in 10 (21.27%) only (Specific root decompression in 4). Inter-body cage was used in 6 (early part of series). Authors believe vertebroplasty restores anterior stability and cage should be carefully selected. Pattern 3 is seen with severe degenerative or inflammatory arthropathy. PD sufficed and anterior approach was never preferred. Pattern 5 has not been described in literature. In 2 cases, the disc adjacent to the fractured end plate herniated 3 months after the fracture pain had resolved. Authors hypothesize that impairment of nutrition and stability both contributed to herniation and is a complication of OPF. Pattern 6 was a progressive lumbar kyphosis due to L3 and L4 collapse leading to posterior element failure. Pattern 4 is persistent intra-vertebral instability after vertebroplasty. The posterior osteo-ligamentous complex remained normal. Neurological deficit occurred 6 weeks after vertebroplasty. In contrast Pattern 2 was a combination of Pattern 1 with posterior element injury. Conclusion Identifying radiological pattern helps understanding mechanism of injury and formulates a simplistic surgical protocol that alleviates pain and helps neurological recovery.

Prospective evaluation of treatment regimens, efficacy and safety of a recombinant factor VIII concentrate in haemophilia A: the German EffeKt study.

Collecting clinical data under routine conditions remains important to monitor continuously efficacy and tolerability of an established product. This prospective observational study aimed at evaluating efficacy and tolerability of full-length sucrose-formulated recombinant FVIII (rFVIII-FS; KOGENATE(®) Bayer/KOGENATE(®) FS) in routine use and analysing concomitant diseases and medication. Haemophilia A patients treated with rFVIII-FS were followed up for 24 or 36 months. Efficacy, tolerability, concomitant medication and diseases were assessed at yearly intervals. Two hundred and twenty-one documented patients were mainly pretreated, predominantly with prophylaxis (74%). On study, 54 (31%) patients in the efficacy set (n = 174) documented regular prophylaxis, 91 patients (52.3%) failed to document their prescribed prophylactic infusions, 25 (14.4%) received on-demand treatment and four patients (2%) inhibitor adapted therapy. Patients on regular prophylaxis reported 8.4% of infusions for bleeding treatment and on-demand patients reported 55.3%. Young patients experienced mainly trauma-related bleedings and older patients reported spontaneous bleedings. Joint status was good overall. Median annual spontaneous joint bleeding rate in all groups was zero. A total of 79.0% of all bleedings were successfully treated with one or two infusions. Degenerative arthropathy and arterial hypertension were the most prominent concomitant diseases. Eighty-seven patients (40.5%) took at least one concomitant drug on study, mostly drugs for pain treatment related to haemophilic arthropathy. Two patients presented with positive inhibitor titres on study, one of them was a previously untreated patient and the other had a positive inhibitor history. This study corroborates the tolerability and efficacy profile of rFVIII-FS.

Morphology of Synovial Membrane and Articular Cartilage in the Knee Joint in Experimental Chronic Heart Failure.

Structural-and-functional reorganization of the synovial membrane and articular cartilage in the knee joint was studied in rats with experimental chronic heart failure. Separation of fibers, decrease in the relative volume density of microcirculatory vessels, and increase in the expression of MMP-9 and caspase 3 were found in the synovial membrane. A decrease in the thickness of the surface layer (tendency to erosion), vacuolization and necrosis of chondrocytes, and increase in their readiness to programmed cell death were observed in the articular cartilage. Changes in the content of type II collagen and metachromasia were revealed in the cartilage matrix. These changes illustrate the development of degenerative arthropathy in cartilage components.

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.

Primary Gastrointestinal Amyloidosis With Multiple Myeloma

Primary systemic amyloidosis (AL) is characterized by the deposition of fibrils composed of monoclonal light chains in the extracellular matrix of various organs including the gastrointestinal (GI) tract. A 53 year old African American female with history of hypertension presented with complaints of progressively worsening dysphagia and weight loss for the past 5 months. Recently, her dysphagia progressed from solids to liquids, leading to a 50 pound weight loss, associated with abdominal fullness, early satiety, and postprandial vomiting. Review of systems revealed dyspnea on minimal exertion and easy fatigability. She had no prior personal or family history of malignancy, renal failure or inflammatory conditions. She was found to have new anemia with a hemoglobin of 7.8 gm/dl, concerning for a GI malignancy. Esophagogastroduodenoscopy did not reveal any evidence of bleeding or esophageal or gastric masses, but showed generalized mucosal wall thickening in the stomach. The gastric biopsy showed vascular and stromal amyloid deposition, confirmed with Congo red stain (Figure 1) showing bright apple green birefringence under polarized light. Colonoscopy confirmed similar evidence of amyloid deposition. A bone marrow biopsy was obtained which showed evidence of advanced multiple myeloma (MM) (Figure 2), confirmed by electrophoresis showing elevated Kappa free light chains. An echocardiogram showed infiltrative cardiomyopathy with reduced ejection fraction. She was started on borteozomib and dexamethasone but ultimately developed intestinal obstruction requiring TPN, and palliative treatment was offered.Figure 1Figure 2AL due to any cause is a common disorder; however, primary GI amyloidosis (GAL) is found in approximately 8% of biopsy proven, and only 1% of clinically symptomatic patients with AL. Hepatic amyloidosis is more common than intestinal amyloidosis. 50% of GAL are seen in patients with chronic degenerative arthropathies (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis), chronic renal failure, and multiple myeloma. GAL can present with symptoms of either GI bleeding, chronic intestinal dysmotility causing intestinal obstruction, malabsorption and/or protein-losing enteropathy. Diagnosis is obtained by biopsy of the GI mucosa deep enough to include lamina propria since apple green birefringence is best identified in the wall of blood vessels. Treatment is largely dependent on reducing the production of amyloid precursor and controlling the primary cause. A few case reports have shown improvement with experimental humanized anti-IL6 receptor antibody. GAL causes significant morbidity, but death is usually due to underlying cardiomyopathy, renal failure or advanced malignancy.

Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review.

Whilst the detailed X-ray features of thoracic manifestations of sarcoidosis are now clearly defined and known by most radiologists, the same does not apply to osteoarticular and muscular features of the disease, which may however raise major diagnostic problems, either because they are the presenting features of the disease (7% of cases) or because they develop during its course. The bony lesions of sarcoid dactylitis (classical Perthes-Jüngling disease) are very characteristic and well known. Many other presentations of bone and bone marrow sarcoidosis may however raise major diagnostic difficulties, particularly uni- or multifocal osteolytic and sclerotic forms of the disease. The articular manifestations of sarcoidosis are difficult to distinguish from those of the other inflammatory and degenerative arthropathies. The muscular lesions in sarcoidosis are generally clinically silent and therefore often missed. MRI has shown them to be very common in active sarcoidosis. Acute forms carry a good prognosis whereas chronic lesions are a presenting feature of multi-organ sarcoidosis. Finally, clinicians should always think about the possibility of an iatrogenic origin for musculoskeletal abnormalities seen in sarcoidosis, particularly those related to corticosteroid therapy.

NEUROPATHIC ARTHROPATHY OF THE HAND ASSOCIATED WITH CERVICAL SYRINGOMYELIA

Neuropathic osteoarthropathy is a rare chronic, degenerative arthropathy associated with decreased sensory innervation. Numerous causes of this arthropathy have been described, syringomyelia, fluid-filled intramedular cavity, being among them. Neuropathic osteoarthropathy associated with syringomyelia is usually mono/oligo-articular, asymmetrical, involving the elbow, shoulder, rarely the wrist. Skin and nails trophic changes sometimes may appear. The present case is that of a female patient with asymmetrical oligoarthritis of right wrist and metacapophalangean joints with rapid reumathoid-like deformity of the hand. The diagnosis key was the radiologic aspect with both lytic and sclerotic lesions but also the thermal sensory impairment, minimized by the patient, longtime considered to be related to cervival spine osteoarthritis. The MRI examination of the cervical spine confirmed the fluid-filled cavity of the whole cervival region with secondary medular atrophy.

The effect of intra-articular Tenoxicam on knee effusion after arthroscopy.

NSAIDs and analgesic drugs are used intra-articularly after knee arthroscopy for pain relief. However, synovial effusion is still a common cause of delayed physical therapy. The aim of this study was to demonstrate the beneficial effect of intra-articular injection of Tenoxicam on knee effusion after arthroscopy. This was a prospective non-randomized study on 134 patients with a mean age of 36.7 years. Knee arthroscopy on a day-case basis was performed; normal saline was used for irrigation. At the end of the procedure, fluid was aspirated from the knee joint and 20 ml of Tenoxicam diluted with 20 ml of 0.9% normal saline was injected into the knee five minutes before deflation of limb tourniquet. The same surgeon performed clinical examination for knee effusion 14 days postoperatively. Encountered pathologies included meniscal injury, degenerative arthropathy, synovial plica and ACL rupture. Knee effusion developed in 15.7% of the patients, particularly in those with degenerative arthropathy (p = 0.006) and meniscal lesions (p = 0.06). Intra-articular Tenoxicam is a simple method for the prevention of postoperative knee effusion. Degenerative arthropathy and meniscal lesions are major risk factors for post arthroscopy knee effusion.

Efficacy, Indications and Limitations of Hallux Arthroscopy

Objective:First metatarsophalangeal joint arthroscopy is a realative new technique including particulars as sinovitis, osteochondral lesions, incipient degenerative arthropathies and loose bodies. The aim of this study was to define the indications, effectiveness and limitations of this procedure.Material and Method:16 patients were operated. The procedure was carried out through three dorsomedial, dorsolateral and medial portals. Indications were osteochondral lesions of the metatarsal head (N=8), osteochondral lesion of the proximal phalanx of the hallux (N=1), loose bodies (N=1), sinovitis (N=2) and early degenerative joint disease with dorsal osteophytosis of the first metatarsal head (N=4).Results:Monitoring of the patients was a minimum of two years. The clinical and radiological assesment were performed by the same team of surgeons. 87,5% of patients had complete remission of the symptomatology five months after surgery (N=14). Good functional but not complete remission of the symptomatology outcomes were detected in a patient with hallux rigidus (HR) Gl and another patient with (HR) Gll. There were no complications with this technique.Discussion:In osteochondral lesions, loose bodies and sinovitis, hallux arthroscopy has good outcomes without complications; but minor findings in patients with arthrosis degenerative changes and osteophytes (Hallux Rigidus). These patients requiere other tecniques such cheilectomy, osteotomies and arthrodesis in degenerative extensive injuries.

Resultados em longo prazo da artroplastia parcial não convencional para o tratamento da artropatia do manguito rotador

ObjectiveTo evaluate the evolution of the functional results from CTA® hemiarthroplasty for surgically treating degenerative arthropathy of the rotator cuff, with a mean follow‐up of 5.4 years. MethodsEighteen patients who underwent CTA® partial arthroplasty to treat degenerative arthropathy of the rotator cuff between April 2007 and June 2009 were reevaluated, with minimum and mean follow‐ups of 4.6 years and 5.4 years respectively. Pre and postoperative parameters for functionality and patient satisfaction were used (functional scale of the University of California in Los Angeles, UCLA). All the patients underwent prior conservative treatment for six months and underwent surgical treatment because of the absence of satisfactory results. Patients were excluded if they presented any of the following: previous shoulder surgery; pseudoparalysis; insufficiency of the coracoacromial arch (type 2B in Seebauer's classification); neurological lesions; or insufficiency of the deltoid muscle and the subscapularis muscle. ResultsWith a mean follow‐up of 5.4 years, 14 patients considered that they were satisfied with the surgery (78%); the mean range of joint motion for active elevation improved from 55.8 degrees before the operation to 82.0 degrees after the operation; the mean external rotation improved from 18.9 degrees before the operation to 27.3 degrees after the operation; and the mean medial rotation remained at the level of the third lumbar vertebra. The mean UCLA score after the mean follow‐up of 5.4 years was 23.94 and this was an improvement in comparison with the preoperative mean and the mean one year after the operation. ConclusionThe functional results from CTA® hemiarthroplasty for treating rotator cuff arthroplasthy in selected patients remained satisfactory after a mean follow‐up of 5.4 years.

Duhuo Jisheng Decoction‑containing serum promotes proliferation of interleukin‑1β‑induced chondrocytes through the p16‑cyclin D1/CDK4‑Rb pathway.

Duhuo Jisheng Decoction (DHJSD) is a traditional Chinese herbal medicine that has multiple uses, including as a treatment for osteoarthritis (OA). However, the molecular mechanisms underlying the therapeutic effects of DHJSD on OA remain unknown. In the present study, a serum pharmacological method was applied to investigate the effects of DHJSD on the proliferation of chondrocytes treated with interleukin‑1β (IL‑1β) invitro. This is a cell model commonly used to reproduce the mechanisms involved in degenerative arthropathies, including OA. The most effective intervention conditions of DHJSD serum were examined by MTT assay. The degenerative chondrocyte model was established by IL‑1β‑culture for 24h, and was verified by optical microscopy and immunohistochemical analyses. Following the successful establishment of the degenerative chondrocyte model, the chondrocytes were subsequently randomly divided into two groups: The blank serum group and the DHJSD treatment group. Subsequent to treatment with the corresponding serum, cell proliferation was detected by MTT assay and DNA staining followed by FACS analysis, and the mRNA and protein expression levels of cyclinD1, cyclin‑dependent kinase4 (CDK4), retinoblastoma tumor suppressor protein (Rb) and p16 were measured by reverse transcription polymerase chain reaction and western blotting, respectively. The results indicated that the most effective condition for the promotion of chondrocyte proliferation was 10% concentration of DHJSD 2‑h serum, and the degenerative chondrocyte model was successfully reproduced by IL‑1β‑treatment for 24h. The mRNA and protein expression levels of cyclinD1, CDK4 and Rb in the DHJSD serum‑treated cells were significantly increased compared with those in the blank serum group, whereas p16 expression was significantly downregulated. These results indicate that treatment of cells with DHJSD‑containing serum is able to promote IL‑1β‑induced chondrocyte proliferation by promoting G1/Sphase transition via modulating the expressions of cyclinD1, CDK4, Rb and p16, which contribute to the clinical efficacy of DHJSD in OA.

Upregulation of miR-23b enhances the autologous therapeutic potential for degenerative arthritis by targeting PRKACB in synovial fluid-derived mesenchymal stem cells from patients.

The use of synovial fluid-derived mesenchymal stem cells (SFMSCs) obtained from patients with degenerative arthropathy may serve as an alternative therapeutic strategy in osteoarthritis (OA) and rheumatoid arthritis (RA). For treatment of OA and RA patients, autologous transplantation of differentiated MSCs has several beneficial effects for cartilage regeneration including immunomodulatory activity. In this study, we induced chondrogenic differentiation of SFMSCs by inhibiting protein kinase A (PKA) with a small molecule and microRNA (miRNA). Chondrogenic differentiation was confirmed by PCR and immunocytochemistry using probes specific for aggrecan, the major cartilaginous proteoglycan gene. Absorbance of alcian blue stain to detect chondrogenic differentiation was increased in H-89 and/or miRNA-23btransfected cells. Furthermore, expression of matrix metalloproteinase (MMP)-9 and MMP-2 was decreased in treated cells. Therefore, differentiation of SFMSCs into chondrocytes through inhibition of PKA signaling may be a therapeutic option for OA or RA patients.

Joint bleeding in factor VIII deficient mice causes an acute loss of trabecular bone and calcification of joint soft tissues which is prevented with aggressive factor replacement.

While chronic degenerative arthropathy is the main morbidity of haemophilia, a very high prevalence of low bone density is also seen in men and boys with haemophilia. This study investigates bone degradation in the knee joint of haemophilic mice resulting from haemarthrosis and the efficacy of aggressive treatment with factor VIII in the period surrounding injury to prevent bone pathology. Skeletally mature factor VIII knock-out mice were subjected to knee joint haemorrhage induced by puncture of the left knee joint capsule. Mice received either intravenous factor VIII treatment or placebo immediately prior to injury and at hours 4, 24, 48, 72 and 96 after haemorrhage. Mice were killed 2-weeks after injury and the joint morphology and loss of bone in the proximal tibia was assessed using microCT imaging. Quantitative microCT imaging of the knee joint found acute bone loss at the proximal tibia following injury including loss of trabecular bone volumetric density and bone mineral density, as well as trabecular connectivity density, number and thickness. Unexpectedly, joint injury also resulted in calcification of the joint soft tissues including the tendons, ligaments, menisci and cartilage. Treatment with factor VIII prevented this bone and soft tissue degeneration. Knee joint haemorrhage resulted in acute changes in adjacent bone including loss of bone density and mineralization of joint soft tissues. The rapid calcification and loss of bone has implications for the initiation and progression of osteoarthritic degradation following joint bleeding.

NEUROARTROPATÍA DE CHARCOT

La neuroartropatía de Charcot (NC) es un síndrome asociado con polineuropatía diabética (PND), caracterizado por fragmentación y destrucción ósea y articular que puede conducir a severas deformidades e incluso la amputación.Es una artropatía relativamente dolorosa, progresiva, degenerativa, de una o múltiples articulaciones, causada por un déficit neurológico subyacente.En 1868 Jean-Martín Charcot describió, por primera vez, esta enfermedad en los pacientes con tabes dorsal como la “artropatía de los atáxicos”.El primer caso reportado en la literatura de neuroartropatía en un paciente con diabetes data del año 1936.La diabetes es en la actualidad la causa más frecuente de neuroartropatía.El objetivo de esta revisión es proporcionar una visión general de la neuroartropatía de Charcot en términos de patogénesis, clasificación, presentación clínica, diagnóstico y tratamiento, con especial énfasis en los nuevos conceptos sobre patogenia y tratamiento.

Brief Report: Reconstruction of Joint Hyaline Cartilage by Autologous Progenitor Cells Derived from Ear Elastic Cartilage

In healthy joints, hyaline cartilage covering the joint surfaces of bones provides cushioning due to its unique mechanical properties. However, because of its limited regenerative capacity, age- and sports-related injuries to this tissue may lead to degenerative arthropathies, prompting researchers to investigate a variety of cell sources. We recently succeeded in isolating human cartilage progenitor cells from ear elastic cartilage. Human cartilage progenitor cells have high chondrogenic and proliferative potential to form elastic cartilage with long-term tissue maintenance. However, it is unknown whether ear-derived cartilage progenitor cells can be used to reconstruct hyaline cartilage, which has different mechanical and histological properties from elastic cartilage. In our efforts to develop foundational technologies for joint hyaline cartilage repair and reconstruction, we conducted this study to obtain an answer to this question. We created an experimental canine model of knee joint cartilage damage, transplanted ear-derived autologous cartilage progenitor cells. The reconstructed cartilage was rich in proteoglycans and showed unique histological characteristics similar to joint hyaline cartilage. In addition, mechanical properties of the reconstructed tissues were higher than those of ear cartilage and equal to those of joint hyaline cartilage. This study suggested that joint hyaline cartilage was reconstructed from ear-derived cartilage progenitor cells. It also demonstrated that ear-derived cartilage progenitor cells, which can be harvested by a minimally invasive method, would be useful for reconstructing joint hyaline cartilage in patients with degenerative arthropathies.