Periarticular Structures Research Articles

The effect of age on the pressure pain threshold of asymptomatic ankles and knees in young individuals with haemophilia.

Despite adequate medical treatment, many young adults with haemophilia develop joint alterations-especially in ankles and knees. Undetected over years, subtle structural changes cause subclinical symptoms, before problems become obvious. To objectify these silent pressure pains, the pressure pain threshold (PPT) can be measured by algometry. The aim was to investigate and compare the effect of age on PPTs in asymptomatic ankles and knees between boys and young adults with haemophilia and age-matched controls, in order to gain better knowledge about the alteration of the periarticular structures with increasing age. Nineteen persons with haemophilia (PwH; severe or moderate; 8-30years) and 19 age-matched controls with 'healthy' ankles and knees were recruited. Asymptomatic joints with a Haemophilia Joint Health Score=0 were included. The PPT was measured on four periarticular points per joint, and the data were analysed with a linear mixed model. The PPT of the control group increased with age, whereas the PPT of the PwH decreased. The difference in age effect per year in kPa between PwH and controls was as follows: β [95%-CI]: -15.41 [-31.63; 0.79]. Although the result was not statistically significant (p=.08), a clear tendency was shown. The results suggest that subclinical alterations in the periarticular structures of these joints may evolve unnoticed over time. However, further research is warranted to determine whether this observed trend is confirmed in a larger sample and at what age the PPT begins to decrease in PwH compared to controls.

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Artritis microcristalinas

Microcrystalline arthritis are a group of diseases caused by the deposit of crystals at joint and periarticular structures. The most prevalent are gout and calcium pyrophosphate deposition disease (CPPD).Gout is caused by the deposition of monosodium urate crystals, for which it is necessary to have high uric acid levels in the blood. CPPD deposition occurs mainly in fibrocartilages and hyaline cartilage. Although joint involvement can be mono-, oligo- or polyarticular at diagnosis, monoarthritis is the most common manifestation at disease presentation. Identification of crystals in synovial fluid is key for diagnosis. Initial management in all cases is to treat the acute flare, individualizing anti-inflammatory treatment according to the patient's comorbidities. With regards to patients with gout, it is essential to normalize the serum uric acid levels, to reduce the previous urate deposits. For this purpose, there are several treatments that can be used in these patients, such as allopurinol, febuxostat and the most recently developed uricosuric drug, lesinurad. For CPPD no treatment has proved to be effective in decreasing crystals deposition in tissues or preventing acute flares.

Does the presence of cranial contrast spread during a sacroiliac joint injection predict short-term outcome?

BackgroundThe innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation originating from the lumbosacral plexus anteriorly as well as the sacral lateral branches posteriorly. Nociceptors are found...

Articular and periarticular spinal calcifications in relation to synovial fluid findings in patients with calcium pyrophosphate dihydrate deposition disease (CPPD)

BackgroundCalcium pyrophosphate dihydrate deposition disease (CPPD) is the second most common form of the crystal-associated arthritis. Diagnosis is achieved by detection of crystals by polarized light microscopy and/or detection of hyaline cartilage or fibrocartilage calcifications characteristic of CPPD deposition by musculoskeletal ultrasound (MSUS). Axial involvement with intervertebral disc calcification, sacroiliac erosions, and sub-chondral cysts of the facet joints occurs with CPPD deposition.AimTo assess the presence and relation between calcification of intervertebral discs, other articular and periarticular spinal structures, and synovial fluid analysis (SFA) and MSUS calcifications in patients with CPPD deposition disease.MethodsOne hundred patients with CPPD disease diagnosed according to the modified proposed diagnostic criteria by McCarty 1994 were included. Plain radiography on the spines, pelvis, and affected joints, MSUS on affected joints, and synovial fluid analysis (SFA) were done.ResultsSpinal calcification was present in 55% of patients. The commonest site was anterior longitudinal ligament (43%). Characteristic CPPD calcifications by plain radiography on the knee and wrist joints were present in 38% and 16% respectively. Characteristic CPPD calcifications by MSUS on the knee and wrist joints presented in 93% and 27% respectively. CPPD crystal detection by SFA was 97%. The accuracy of MSUS to diagnose CPPD deposition disease is more than double that of plain radiography, and it is comparable to that of synovial fluid analysis. The result of intra-rater analysis between SFA by polarized light microscopy and MSUS was kappa 0.767 (p < 0.001); this indicates substantial level of agreement between SFA and MSUS; between plain radiography and MSUS, it was kappa 0.188 (p = 0.32) which indicates slight agreement, and between plain radiography and SFA, it was kappa 0.037 (p = 0.1) which fails to reach a significant level of agreement. There was a significant positive relation between spinal calcification and wrist joint calcification by plain radiography.ConclusionConsiderable spinal affection by CPPD deposition disease can be detected. Although the most definitive, reliable direct approach for CPPD deposition disease diagnosis is SFA using polarized light microscopy, MSUS is considered a useful non-invasive diagnostic tool in this situation. In CPPD deposition disease, MSUS has proven to be an excellent technique for detecting calcification in the articular tissue disease compared to conventional radiography.

Shoulder ultrasound: current concepts and future perspectives.

Ultrasonography is an established and effective imaging technique that can be used to evaluate articular and periarticular structures around the shoulder. It has been shown to be useful in a wide range of rotator cuff diseases (e.g. tendon tears, rotator cuff calcific tendinopathy and bursitis) as well as non-rotator cuff abnormalities (instability, synovial joint diseases and nerve entrapment syndrome). A scanning protocol is highly recommended to reduce the rate of operators’ errors by following a standardized scheme including a list of main structures. Shoulder ultrasound has several advantages: it is a relatively cheap and widely available technique, free from ionizing radiation, that can reach excellent diagnostic accuracy even compared to magnetic resonance imaging. Moreover, it is the only imaging technique that allows dynamic evaluation of musculoskeletal structures, which is important for the evaluation of impingement. Also, due to the shoulder’s superficial anatomical position, ultrasound can also be helpful in guiding interventional percutaneous procedures, both for diagnostic (e.g. magnetic resonance arthrography) and therapeutic purposes (e.g. percutaneous treatment of calcific tendonitis). Contrast-enhanced ultrasound and speckle tracking offer complimentary evaluations of shoulder anatomy and biomechanics. Moreover, the advent of ultra-high-frequency US, with probes up to 70 MHz allowing for a resolution as low as 30 μm, is a promising tool for further evaluation of the shoulder anatomy, and diagnostic and therapeutic strategies.

Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 Patients

Introduction: Worldwide, knee osteoarthritis (KOA) accounts for 2.2% of total years lived with disability. There is low correlation between joint tissue damage and pain intensity. Periarticular structures may be involved and cannot be identified in X-rays. Objectives: To describe the main ultrasonography (USG) changes in symptomatic patients with primary KOA; to correlate number of USG findings with KOA severity assessed by Kellgren and Lawrence (K&amp;L) radiological scores, with pain intensity measured by a visual analogue scale (VAS) and with functioning scores assessed with Timed up and go test (TUG) and Western Ontario and McMaster Universities (WOMAC) questionnaire. Methods: 100 patients with primary symptomatic KOA were assessed with X-ray and USG. Quantitative and qualitative analyses were evaluated in a systematic manner. Results: The most frequent findings were joint effusion, pes anserinus bursitis, quadriceps tendon enthesopathy, popliteal cyst, iliotibial band tendinitis and patellar tendinitis. Pearson’s correlation analysis demonstrated a significant moderate positive association between VAS scores and number of USG findings (r=0.36; p&lt;0.0001). The number of USG findings was different between K&amp;L grades I and III (p=0.041), I and IV (p&lt;0.001), and II and IV (p=0.001, ANOVA with Bonferroni correction). There was significant association between number of USG findings and TUG (r=0.18; p=0.014) and WOMAC scores for pain (r=0.16; p&lt;0.029) and physical function domains (r=0.16; p&lt;0.028). Conclusion: The most frequent USG finding was joint effusion. Periarticular structures should be explored as potential sources of pain and disability.

Annals for Educators - 20 October 2020

Annals for Educators - 20 October 2020

Lumbar Facet Joint Cyst Caused by Calcium Pyrophosphate Arthropathy of the Spine: Case Report and Review of Literature

Background Data: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic disorder caused by the deposition of CPPD crystals in the articular or periarticular structures that leads to inflammation of the joints. Spine affection is rare. Purpose: To present a rare case of lumbar facet joint cyst caused by calcium pyrophosphate arthropathy. Study Design: A case report with a brief review of the literature. Patient and Methods: Seventy-three-year-old man, who underwent PLIF L5/S1 ten years ago, presented with right L4 nerve root compression symptoms that have started two months ago. Clinical examination revealed no motor function disturbance but hypoesthesia in the L4 dermatome. He has no history of crystal deposition disorder. The patient underwent decompression and fusion at this level. Results: The symptoms were completely resolved postoperatively and after one-year follow-up. Histopathological examination of the cyst revealed fibrous granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Conclusion: Calcium pyrophosphate arthropathy, although rare, should be incorporated into the differential diagnosis of cystic lesions of the facet joints. (2020ESJ221)

Relationship of Wnt pathway activity and organ involvement in scleroderma types.

Scleroderma (SSc) is a chronic inflammatory autoimmune disease characterized by fibrosis in the skin and internal organs. In SSc, the heart, lung, kidney, gastrointestinal (GIS) system, muscle, and peri-articular structures are damaged. There is no study of the relationship between SSc type, stage, pathogenesis, organ involvement, and Wnt signaling. In this study, we aimed to show the relationship of the Wnt gene family and antagonists in SSc subtypes and different organ involvement. Eighty-five SSc patients and 77 controls were included in this study. The gene expressions and protein levels of the Wnt family and antagonists were analyzed from blood samples. The relationship between these parameters and disease stage, type, and organ involvement were evaluated. Wnt-1, Wnt-10b, Wnt-2, and Wnt-6 gene expressions are increased and Axin-2, DKK-1, and Kremen protein expressions are decreased in SSc. Wnt-3a and Wnt-10a gene expressions are increased in generalized SSc compared to limited SSc. Wnt-1, Wnt-2 gene expressions are increased significantly in pulmonary arterial hypertension (PAH)(+) SSc compared to PAH(-) SSc. There was a positive correlation between the modified Rodnan skin score and Wnt-2 in SSc. There was a significant positive correlation between GIS involvement score and Wnt-1, Wnt-2, Wnt-4, Wnt-8a, Wnt-9b in SSc. Wnt-1 and Wnt-2 were found higher in scleroderma and organ involvement. They may play a role in the pathogenesis of the disease.

New developments in ultrasound in rheumatology: innovative tools and promising applications

In the setting of rheumatology, the assessment of the involvement of joints and peri-articular structures was the first application of ultrasonography in the management of rheumatic diseases. In this field, the main novelties are related to the development of new technical tools to help overcome some of the limitations of conventional ultrasonographic assessment. In the meantime, there has been a growing interest in the application of ultrasound to extra-articular sites, relying on the definition of new indications. The present review aims to provide a critical analysis of the technical developments and new fields of application of ultrasonography in rheumatology.

Acute Effects of Whole-Body Vibration Exercise on Pain Level, Functionality, and Rating of Exertion of Elderly Obese Knee Osteoarthritis Individuals: A Randomized Study

Introduction: Among chronic diseases, knee osteoarthritis (KOA) is a joint disease that causes important progressive alterations in the articular and periarticular structures, including synovial inflammation. Exercise has been suggested as an intervention to KOA individuals, and studies suggest that whole-body vibration (WBV) exercise decreases pain levels and favours the functionality of KOA individuals. Objective: The aim of the present study is to analyze the acute effects of WBV exercise on pain levels, functionality (Timed Up and Go (TUG test), anterior trunk flexion (ATF)), and rating of exertion of elderly obese KOA individuals. Methods: Thirty-seven individuals with KOA were allocated to a WBV exercise group (WBVEG), n = 19 (15 females/4 males), and a control group (CG), n = 18 (15 females/3 males). WBVEG performed one session of WBV exercise (11 min, using 5 Hz, 2.5, 5.0, and 7.5 mm, 0.12, 0.25, and 0.37 g). Three bouts were performed (working time of 3 min and rest time of 1 min) using a side-alternating vibrating platform (VP). The same position was used in CG; however, the VP was turned off and there was equipment coupled to the VP that emitted a sound like the vibrations. The pain level was evaluated using a visual analog scale (VAS). Functionality was evaluated with a TUG test and ATF. The rating of subjectively perceived exertion was measured with the category ratio CR-10 (BORG Scale CR-10), Results: A reduction of pain levels in WBVEG after the intervention (p = 0.001) and intergroups (p = 0.041) was found. A decrease of TUG test time in both groups (p = 0.001) and intergroups (p = 0.045) was found, while no statistical changes were observed in the Borg Scale score. Significant improvements of flexibility in both groups (p = 0.001) and intergroups (p = 0.043) were found. Conclusion: One session of WBV exercise can lead to important improvements in individuals with KOA, possibly triggered by physiological responses. However, more studies are needed, in this clinical context, to confirm these results.

Osteoarthritis: Review of Etiopathology, Diagnosis and Management

Abstract&#x0D; Osteoarthritis (OA) is the most common type of arthritis in the world characterized by articular cartilage degeneration with inflammatory components in ageing population. It involves about 10% of adult population and is among the most disabling disease condition. It is multifactorial in its etiology with a number of non-modifiable and modifiable risk factors. Ageing is the most important risk factor followed by obesity in probably genetically susceptible individuals. The end result of inflammation and articular cartilage degeneration arising from repeated overloading of joint, mechanical or biochemical imbalance of repair and degeneration affects not only joint cartilage but also subchondral bone and periarticular structures. Patient mainly presents with variable degree of pain, stiffness and functional limitation with or without swelling and deformity. Diagnosis is clinical and plain imaging is useful for documentation, to see the grading and plan the suitable treatment. There are a number of treatment options in practice each having their pros and cons but no single treatment method is superior to all. There is no cure for it but judicious use of non-pharmacological and pharmacological measures, often in combination in tailored fashion help to ease the patient’s symptoms. Operative intervention in the form of arthroplasty is reserved for end stage arthritis with disabling symptoms not responding with conservative management. Numerous newer treatment modalities are under different phases of clinical trial to test the efficacy and clinical use.&#x0D; Aim of this narrative review article is to analyze literatures obtained from electronic database and present the synthesized relevant clinical update on etiopathology, diagnosis and treatment modalities of symptomatic osteoarthritis.

Extracorporeal Immunoparmacotherapy in Rheumatoid Arthritis

This disease causes inflammatory changes in the synovial membranes and periarticular structures associated with severe pain, joint stiffness up to ankylosis, and bone atrophy. The blood serum of the patients with rheumatoid arthritis contains high titres of antistreptokinase and anti-plasminogen autoantibodies of class IgG and IgA, as a rule after streptococcal infection. There are also antineutrophil autoantibodies – both anti-nuclear and cytoplasmic. Plasminogen synthesized by the liver is distributed in the vessels both internally and externally. At activation plasminogen turns in plasmin, regulating extracellular proteolytic activity, activating proteases. In these patient’s fibrinogen level is increased, and insoluble fibrin is found on the synovial membranes. Plasmin, in turn, inhibits the cartilages proteoglycan. All of it leads to destruction of the joints and the synovial membranes proliferation.

Predictors of subclinical shoulder joint affection in patients with rheumatoid arthritis by ultrasonography

BackgroundTo assess subclinical involvement of shoulder joints in patients with rheumatoid arthritis (RA) by using musculoskeletal ultrasound (MSUS) and detect their predictors.ResultsWe found 75% of the patients have subclinical ultrasound changes in their shoulder joints where 65% of the patient’s shoulders are affected. About 57.5% of the shoulder joints showed peri-articular structural changes by ultrasound, while the articular changes were 36.9% with the most frequent one being supraspinatus tendinopathy (43.12%) followed by subacromial-subdeltoid bursitis [total (31.87%), effusion (16.87%), and synovial hypertrophy (15%)], supraspinatus tendon partial tear (30.62%), and long head of biceps tenosynovitis (effusion only) (28.75%), while the least frequencies were glenohumeral joint erosion (11.25%) and synovitis (12.5%). Older age and longer disease duration were significant predictors for the peri-articular changes with p value < 0.5, while high disease activity, seropositive rheumatoid factor, and long disease duration were significant predictors for the articular changes with p value < 0.5.ConclusionAlthough shoulders were clinically silent in RA patients, we found a high percentage of subclinical abnormalities detected by MSUS, which were more predominant in the peri-articular structures. MSUS is a simple and non-invasive technique that can be used to detect RA shoulder subclinical affection.

Andldquo;PLAYandrdquo; (Preventing Long-Term Arthritis in Youth) Program a Review of the Literature of the Etiology of Post-traumatic Osteoarthritis and Potential Preventative Treatments

Osteoarthritis (OA) is the most common form of arthritis, and it is one of the leading causes of disability around the world. Post-traumatic osteoarthritis (PTOA) can be triggered by athletic injury, falls, motor vehicle accidents, and surgeries. One of the most common joints injured is the knee, when supporting structures are not able to handle the forces delivered through the joint. Traumatic injuries are one of the leading causes of joint hemarthrosis and can result in damage of the periarticular structures. These insults accelerate a deleterious cytokine cascade which risks future cartilage degeneration ultimately leading to significant degenerative arthritis and functional decline. There is a potential role for joint aspiration in conjunction with targeted proteomics to slow down and hopefully arrest the inflammatory cytokine mediated cascade. Our hope is that early detection, treatment interventions and monitoring can prevent long term sequelae of arthritis following acute injury in youth.

The Effectiveness of High Resolution Ultrasonography in Assessment of Knee Peri-Articular Lesions: Comparative Study to MRI

Abstract Background: Knee pain is considered one of the main causes of referral to the Radiology Department. Many of the cases have abnormalities within or around the joint following an acute injury or chronic symptomatology. Ultrasound is a reliable method for detection of injury to the tendons, ligaments, and muscles of the knee joint with its capability to evaluate peri-articular lesions. The periarticular structures are best suitable for ultrasonography evaluation including peri articular masses, joint effusion and bursae. Aim of Study: The goal of our study is to evaluate role of high resolution ultrasonography in assessment of knee peri articular disorders compared to MR imaging. Patients and Methods: Our study included 61 patients between March 2018 and April 2019 with 14 patients having bilateral knee joint examinations. They included 37 females and 24 males with their ages ranging between 11-70 years. All of them suffering from painful knee joint with peri-articular lesions. Patients were referred to the Radiology Department at Kasr Al-Aini Hospital after full clinical examination to evaluate their knee joints using US and MRI. Results: High resolution ultrasonography had sensitivity and specificity ranging from 83 to 100 and 100% respectively with Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) and accuracy above 95%. Conclusion: The high correlation rate between the results of US and MRI have shown that in patients with knee joint peri-articular lesions, US is an effective alternative/ compli-mentary method of examination in detection of knee joint peri articular injuries, cystic and solid mass lesions.

Protecting the Normal Physiological Functions of Articular and Periarticular Structures by Aurum Nanoparticle-Based Formulations: an Up-to-Date Insight.

Taking the articular and periarticular structures as a litmus test for gold-based nanoformulations, the potential of gold nanoparticles in protecting the normal physiological functions of these structures particularly in geriatric patients is one of the research areas of current interest. Aside from its use to make the traditional and fashionable ornaments for human usage, the gold metal is also known for its rich therapeutic activity. This is especially true when the gold is converted from its bulk form into nanosized form before its administering into the human body. Since it is the age of nanocomponents in medical and pharmaceutical research areas, this review is therefore mainly focused on nanoparticulate systems consisting of aurum. Accumulating research reports nevertheless show concrete evidence indicating the potential of gold-based nanoformulations to manage joint syndromes such as osteoarthritis and rheumatoid arthritis. This review embarks from preparation techniques and characterization methods to therapeutical application potentials of gold-based nanoformulations.

Thinking outside the glenohumeral box: Hierarchical shape variation of the periarticular anatomy of the scapula using statistical shape modeling.

Variation in the shape of the glenoid and periarticular anatomy of the scapula has been associated with shoulder pathology. The goal of this study was to identify the modes of shape variation of periarticular scapular anatomy in relation to the glenoid in nonpathologic shoulders. Computed tomography scans of 31 cadaveric scapulae, verified to be free of pathology, were three-dimensionally reconstructed. Statistical shape modeling and principal component analysis identified the modes of shape variation across the population. Corresponding linear and angular measurements quantified the morphometric variance identified by the modes. Linear measures were normalized to the radius of the inferior glenoid to account for differences in the scaling of the bones. Five modes captured 89.7% of total shape variation of the glenoid and periarticular anatomy. Apart from size differences (mode 1: 33.0%), acromial anatomy accounted for the largest variation (mode 2: 32.0%). Further modes described variation in glenoid inclination (mode 3: 11.8%), coracoid orientation and size (mode 4: 9.0%), and variation in coracoacromial (CA) morphology (mode 5: 3.1%). The average scapula had a mean acromial tilt of 49 ± 7°, scapular spine angle of 61 ± 6°, the glenoid inclination of 84 ± 4°, coracoid deviation angle of 26 ± 4°, coracoid length of 3.7 ± 0.3 glenoid radii, and a CA base length of 5.6 ± 0.5 radii. In this study, the identified shape modes explain almost all of the variance in scapular anatomy. The acromion exhibited the highest variance of all periarticular anatomic structures of the scapula in relation to the glenoid, which may play a role in many shoulder pathologies.

Analysis of Physical Therapy in Knee Osteoarthritis

1,2, 1 1,2 1Department of Rehabilitation, Military Institute of Medicine, Warsaw, Poland Introduction: Osteoarthritis (OA) is the most common disorder of the musculoskeletal system. It is characterised by the destruction of joint cartilage and the presence of lesions in the subchondral bone, synovial membrane, joint capsule, and periarticular structures. OA damages the anatomical joint structure and impairs joint function. Aim: To analyse the effects of physical therapy procedures used during a two-week rehabilitation cycle on patients with OA. M aterial and Methods: The study involved 25 patients (19 women and 6 men aged 51 to 83 years) treated with electrotherapy, laser therapy, low-frequency alternating magnetic fields, ultrasound therapy, and kinesiotherapy. Rehabilitation outcomes were assessed with a survey questionnaire created by the authors and a VAS scale. Results: All study patients experienced pain reduction or elimination and an improvement in physical fitness after physical therapy. Conclusion: 1.Knee osteoarthritis is a clinical and social problem. 2. The physical therapy procedures used in the study considerably reduced pain in OA patients, both at rest and during movement, and resulted in improved physical fitness. 3. Seeing that a very large group of study patients with gonarthrosis declares no physical activity and avoids exercise due to pain, it is important to highlight the benefits of physical activity in OA prevention. 4. Seeing that the mean BMI in the study group usually indicated overweight or obesity, it is important to highlight the effects of a healthy lifestyle and diet in OA prevention.