Reactive Synovitis Research Articles

БОЛЕВОЙ СИНДРОМ ПРИ ПЛАНТАРНОМ ФАСЦИИТЕ, РЕАКТИВНОМ СИНОВИТЕ СУСТАВОВ СТОПЫ, ГОЛЕНОСТОПНОГО СУСТАВА И ЛИМФОСТАЗЕ В ОБЛАСТИ НИЖНЕЙ КОНЕЧНОСТИ

An analysis of management tactics in the presence of pain in a patient with plantar fasciitis, reactive synovitis of the joints of the foot, ankle and lymphostasis in the lower limb is provided. Against the background of the therapy, a clear positive dynamics was noted — restoration of the function of the longitudinal arch of the foot, a more even distribution of the load between the right and left foot.

Effect of reactive inflammation in osteoarthritis on extracellular traps formation by circulating neutrophils

The results of recent studies demonstrating the presence of pro-inflammatory mediators in osteoarthritis (OA), as well as known similarity of histological signs of inflammation in rheumatoid arthritis (RA) and OA, suggest an important role of NETosis in immune inflammation in OA patients. Our objective was to assess ability of blood neutrophils from ОA patients to generate NETosis spontaneously and after in vitro induction, and impact of reactive synovitis on the dynamics of NETosis indexes. Thirty-one patients with verified OA and 30 healthy volunteers were included into the study. Circulating neutrophils were isolated with one-step density gradient centrifugation using double layers of Iohexol gradient. Subpopulational profile of isolated neutrophil fractions, their viability, and nonspecific activation were evaluated microscopically using Trypan Blue exclusion test, as well as nitro-blue tetrazolium test. NETs were induced by phorbol-12-myristate13-acetate (PMA). Spontaneous and induced formation of NETs was assessed using fluorescence microscopy. The ОA patients were in clinical remission at the time of inclusion in the study. In 23 OA patients, an exacerbation was diagnosed during the study. The neutrophil fractions showed high purity and a high content of viable nonactivated cells. These parameters were comparable in the study groups. Mean percentage of spontaneous NETs in OA patients in remission was significantly increased comparing to healthy controls. Usage of PMA, as inducing agent was accompanied by a significant increase in ability of neutrophils to form NETs. Transition of OA to exacerbation was characterized by further significant increase in spontaneous and PMA-induced NETs. Spontaneous and induced NETs in OA patients at acute stage of the disease are significantly higher than in OA patients in remission state. The growth rate of spontaneous NET formation is 3.74 times higher than the induced NET formation in OA patients upon exacerbation. Statistically significant increase in the ability of peripheral neutrophils to spontaneous and induced formation of extracellular traps was found, depending on the stage of osteoarthritis. The data obtained suggest an opportunity for participation of circulating neutrophils via NETosis in pathogenesis of immune inflammation in OA.

Response to commentary: Reactive synovitis of the knee joint and COVID-19 vaccination.

International Journal of Rheumatic DiseasesEarly View CORRESPONDENCE Response to commentary: Reactive synovitis of the knee joint and COVID-19 vaccination Eliska Vanaskova, Eliska Vanaskova orcid.org/0000-0001-9211-2226 Department of Orthopedics, University J. E. Purkinje and Masaryk Hospital, Usti nad Labem, Czech RepublicSearch for more papers by this authorTomas Novotny, Corresponding Author Tomas Novotny tomas.novotny@kzcr.eu orcid.org/0000-0002-3855-0038 Department of Orthopedics, University J. E. Purkinje and Masaryk Hospital, Usti nad Labem, Czech Republic Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic Correspondence Tomas Novotny, Department of Orthopedics, University J.E. Purkinje and Masaryk Hospital, Socialni pece 3316/12A, 401 13, Usti nad Labem, Czech Republic. Email: tomas.novotny@kzcr.euSearch for more papers by this author Eliska Vanaskova, Eliska Vanaskova orcid.org/0000-0001-9211-2226 Department of Orthopedics, University J. E. Purkinje and Masaryk Hospital, Usti nad Labem, Czech RepublicSearch for more papers by this authorTomas Novotny, Corresponding Author Tomas Novotny tomas.novotny@kzcr.eu orcid.org/0000-0002-3855-0038 Department of Orthopedics, University J. E. Purkinje and Masaryk Hospital, Usti nad Labem, Czech Republic Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic Correspondence Tomas Novotny, Department of Orthopedics, University J.E. Purkinje and Masaryk Hospital, Socialni pece 3316/12A, 401 13, Usti nad Labem, Czech Republic. Email: tomas.novotny@kzcr.euSearch for more papers by this author First published: 20 October 2022 https://doi.org/10.1111/1756-185X.14459Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Reactive synovitis of the knee joint and COVID-19 vaccination: Commentary.

Reactive synovitis of the knee joint and COVID-19 vaccination: Commentary.

Hand Swelling in an Adolescent.

Hand Swelling in an Adolescent.

Neurovascular component of the dystrophic process and the development of osteonecrosis in Perthes disease

In 60 patients with reactive synovitis and Perthes disease the thermographic evaluation of neurovascular interconnection was performed. The importance of neurodynamic tissue regulation disturbances of the hip region including microvasculature in pathogenesis of preradiologic lesions transition into the decompensation phase with osteonecrosis development was shown. It was noted that important moment in osteonecrosis development was the achievement of threshold level of neurodynamic vascular regulation disturbances with the involvement of enormous number of neurons from the adjusted segments and loosing of hamper mechanism. Prevention of volume spreading of tissue and neurodystrophic reaction at preradiologic phase is of essential significance for the prevention of process of transition into osteonecrosis phase.

Роль костного метаболизма в патогенезе гонартроза

Актуальность проблем остеоартроза коленных сочленений (гонартроза) обусловлена широкой его распространенностью и высоким риском развития ограничений функции суставов с нарушением трудоспособности и снижением качества жизни пациентов. Целью и задачами данной работы стала оценка роли костного метаболизма при разных вариантах клинического течения гонартроза, связей с развитием остеопороза, с костно-деструктивными изменениями коленных суставов по данным рентгенографии, сонографии, магнитно-резонансной томографии, рентгеновской денситометрии. Материал и методы. Обследовано 104 больных остеоартрозом (47 % мужчин и 53 % женщин) в возрасте от 32 до 76 лет. Гонартроз установлен в 96 % наблюдений. Манифестный реактивный синовит по результатам клинико-сонографического исследования диагностирован в 62 % случаев, полиартроз — в 55 %, системный остеопороз — в 14 %, остеокистоз — в 91 %, а спондилопатия в виде остеохондроза и дугоотростчатого артроза — в 72 %. Результаты. У больных гонартрозом наблюдаются значительные изменения в крови маркеров костного метаболизма (МКМ), проявляющиеся дисбалансом остеоассоциированных макроэлементов (кальция, магния, фосфора) с развитием гипокальциемии, которая регистрируется соответственно в 98 %, высокой активностью щелочной фосфатазы (в 47 % случаев), признаками гиперпаратиреоидизма и гиперостеокальциемией. Нарушения костного метаболизма при остеоартрозе коленных сочленений связаны с темпами прогрессирования заболевания и распространенностью суставного синдрома, а показатели МКМ могут иметь прогностическое значение. МКМ (остеоассоциированные макроэлементы, гормоны — паратирин, кальцитонин, остеокальцин, а также фермент щелочная фосфатаза) участвуют в патогенетических построениях гонартроза, определяя развитие отдельных рентгенологических, сонографических и магнитно-резонансных артикулярных и периартикулярных признаков патологии коленных суставов (степень сужения суставных щелей, эпифизарный остеопороз, трабекулярный отек в мыщелках бедренной и большеберцовой костей, изменения рогов менисков, формирование кист Бейкера, интраартикулярных хондромных тел и тел Гоффа). Вывод. Нарушения костного метаболизма имеют клинико-патогенетическое значение при гонартрозе, что требует разработки специальной медицинской технологии проведения лечебно-реабилитационных мероприятий у таких больных.

Role of human cartilage glycoprotein-39 and vitamin C in the development and clinical course of knee arthrosis in combination with coronary artery disease, hypertension, dyslipidemia, cholelithiasis

Aim. To study the role of human cartilage glycoprotein-39 (HC gp-39) and vitamin C in the development and clinical course of knee arthrosis (gonarthrosis) in combination with coronary artery disease (CAD), hypertension (HTN), dyslipidemia, cholelithiasis, depending on inflammatory changes in the joints, X-ray stage, pain intensity and the degree of joints’ functional impairment.Material and methods. We examined 140 patients with gonarthrosis in combination with CAD, HTN, dyslipidemia, cholelithiasis, who were treated in the rheumatology department of the North Ossetian State Medical Academy. In all patients, the main clinical parameters of gonarthrosis were assessed, and the content of HC gp-39, vitamin C, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum lipids was determined.Results. An increase in HC gp-39 levels was revealed in all examined patients. The highest rate of HC gp-39 was found in patients with X-ray stage III arthrosis, especially with reactive synovitis. A decrease in blood serum concentration of vitamin C was revealed depending on gonarthrosis stage. A significant correlation was noted between HC gp-39 level and main clinical indices of gonarthrosis, as well as CRP, ESR, cholesterol, atherogenic coefficient, and vitamin C.Conclusion. Changes in the levels of HC gp-39, vitamin C, CRP and lipid profile reflect the inflammation severity, which is an important component of the pathogenesis of osteoarthritis, atherosclerosis, and cholelithiasis.

Остеоартроз в различных экологических регионах. Сообщение 2. Связь с состоянием питьевой воды

Целью работы стала оценка клинико-патогенетических связей остеоартроза (ОА) с качественным составом питьевой воды в зонах проживания больных. Материал и методы. Под наблюдением находились 133 больных первичным ОA в возрасте 58,90 ± 0,83 года. Оценивали в 33 городских и сельских регионах уровни жесткости и минерализации питьевой воды, концентрации в ней хлоридов, сульфатов, фосфатов и нитратов, содержание токсичных микроэлементов (Ba, Li, Ni, Pb). Результаты. Низкое качество питьевой воды в регионах проживания людей способствует развитию ОА в более молодом возрасте, что в последующем определяет интегральную тяжесть артикулярного синдрома, характер костно-деструктивных изменений в суставах (развитие остеопороза, остеоузур, хондромных тел), формирование манифестного реактивного синовита (концентрации хлоридов и нитратов), темпы прогрессирования заболевания, появление внутрисуставных отложений кальцинатов, остеофитоза и эпифизарного остеопороза (степень минерализации и жесткости воды). Тяжесть ОА и темпы прогрессирования костно-деструктивных изменений со стороны суставов зависят от уровня микроэлементов, которые определяют распространенность суставного синдрома, развитие узелков Гебердена и/или Бушара, спондилопатии, степень реактивного синовита, остеопороза, субхондрального склероза, лигаментоза, интраартикулярных хондромных тел и тел Гоффа, а высокое содержание Pb является фактором риска неблагоприятного течения заболевания. Выводы: выявлены определенные клинико-патогенетические связи ОА с качественным составом питьевой воды в регионах проживания больных.

A semiquantitative color Doppler ultrasound scoring system for evaluation of synovitis in joints of patients with blood-induced arthropathy

BackgroundIntra-articular bleeds in patients with inherited bleeding disorders lead to active synovitis which may progress to a chronic state over time. We explored the diagnostic value of color Doppler ultrasound in detecting synovitis in boys with bleeding disorders.ResultsSixty boys with hemophilia and 3 boys with type 3 von Willebrand disease aged 5 to 18 years (median 12.3 years) were imaged by gray-scale and color Doppler ultrasound (US) in three centers (Beijing, China [n = 22], Guangzhou, China [n = 12] and Toronto, Canada [n = 29])) in this observational study. Images were independently reviewed by two radiologists blinded to clinical data using a subjective semi-quantitative scoring system and objective measurements of synovial thickness and vascularity. Inter-reader reliability for using subjective versus objective color Doppler US methods for assessing synovial vascularity was excellent for the subjective method and moderate/lower range of substantial for the objective method. Agreement between degree of vascularity on color Doppler and extent of synovial hypertrophy on gray-scale US was overall poor for Canada data and moderate for China data. Correlations between degree of vascularity on color Doppler and synovial hypertrophy on gray-scale US, and clinical constructs (total and itemized HJHS scores and total Pettersson X-ray scores) for assessment of blood-induced arthropathy were all poor.ConclusionColor Doppler US is a valuable scoring method for evaluating reactive synovitis in joints of subjects with inherited bleeding disorders and holds potential for assessing post-bleed reactive synovitis once further information on its association with timing of the joint bleed becomes available in the literature.

Post-arthrogram synovitis: MRI and histopathologic findings

A 57-year-old patient developed severe, persistent pain following MR arthrography with iodinated contrast. MRI 1 week later showed synovitis which was new compared to the prior MRI. Arthroscopy showed severe synovitis. Histopathology showed synovitis characterized by lymphocytes, neutrophils, and necrosis. One out of 4 intraoperative cultures was positive, but ultimately believed to be due to contaminants. CRP normalized within 1 month. Repeat MRI 2 years later showed progressive degenerative findings, but no evidence of ongoing infection, or stigmata of previous infection. We believe this to be an unusually severe case of reactive synovitis. The purpose of the report is to add to knowledge of reactions to intra-articular contrast injection.

Rehabilitation of patients with osteoarthritis using tereklit clay in North Ossetia-Alania

Aim. To study the effectiveness of combined treatment of osteoarthritis (OA) using tereklit clay in the Republic of North Ossetia-Alania.Material and methods. The study included 110 patients aged 34 to 65 years with a disease duration of 1 to 10 years or more, in whom OA was diagnosed as polyosteoarthritis of I, II, III stages. All patients underwent clinical, X-ray and laboratory research, as well as osteodensitometry. In the conditions of the rehabilitation center in Vladikavkaz, patients were prescribed segmental reflex applications of tereklit clay on the affected joints at a temperature of 42 C for 15 minutes for 2 days in a row, followed by a day of rest. The course lasted 10 procedures.Results. As a result, favorable changes were observed, manifested in a decrease in pain and swelling in the joints, as well as in an improvement in its motor function on days 7-10 of treatment. The balneal reaction was not observed in any case.Conclusion. Tereklit clay applications are effective within combined therapy of patients with OA. Contraindication to clay therapy is OA with reactive synovitis, severe pain and exudation.

The results of polypropylene mesh application at anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) repair remains one of the most common surgeries in orthopedics and traumatology. The evolution of the ACL repair technique continues, new fixators appear, and the position of the graft, its shape and size are modified. Semi-tendon and gracilis muscle (STG) grafts are the most common used due to low-trauma and technically simple method of obtaining. Its disadvantage is a long period of intratunnel incorporation, one of the ways of this acceleration is the implantation of a polypropylene mesh. In an experiment on rabbits, we proved its positive effect. Objective. To develop a method of improving the intratunnel incorporation of STG-graft at ACL repair of the knee joint using polypropylene mesh. Methods. Results of 75 patients were analyzed. The study group consisted of 35 patients who underwent surgery during 2018–2019 using polypropylene mesh, comparative group — 40 patients who had surgical treatment in 2017. Evaluated demographic data, pre-operation period, recovery functions, complications rate, data of KOOS and IKDC scales. Results. Non-specific data of the inflammatory process (CRP and ESR) did not change significantly in patients with inserted polypropylene mesh. They did not have more pronounced pain after surgery, there were less cases of reactive synovitis with significantly minimized the number of the knee joint punctures. Restorationof knee function was faster, and early weight bearing of the leg allowed up to 6 months. Better results by the KOOS and IKDC scales received after surgery. Conclusions. Implantation of polypropylene mesh around the intratunnel part of STG-graft at ACL repair surgery did not increase the complications rate and allowed to improve the dynamics of limb function recovery up to 6 months after surgery.

Эффективность применения инъекционного препарата хондроитина сульфата в лечении остеоартрита коленного сустава

Aim: to evaluate the efficacy of two-month therapy with chondroitin sulfate (CS) (Mucosat®) injections in patients with osteoarthritis and the drug potential in terms of structure-modifying action. Patients and Methods: an open prospective study with participation of 30 patients (mean age 52.5±11.7 years) with osteoarthritis, grade 2 gonarthrosis according to the Kellgren-Lawrence classification, and severe pain syndrome (more than 50 points according to VAS) was conducted. 76.7% of subjects had concomitant pathology. The drug was prescribed according to the standard regimen with a course of up to 25–30 injections. The examination included a clinical assessment of indicators of joint syndrome, life quality, joint function using WOMAC, Lekken, KOOS, EQ-5D scales, cartilage oligomeric matrix protein (COMP) and C-reactive protein (CRP), ultrasound of the knee joints. Results: after a two-month treatment course with Mucosat®, there was a significant (p<0.05) decrease in pain intensity by 1.8 times, the number of tender and swollen joints by 2 or more times, an improvement in indicators of functional activity and life quality of patients. Reactive synovitis of the knee joints, which was present at the beginning of the study in 53.3% of cases, was preserved clinically and according to ultrasound data only in 17% of subjects by the end of treatment. There was a tendency to decrease the levels of CRP and COMP. Ultrasound of the knee joints showed a significant (p=0.000) increase in the average thickness of articular cartilage from 1.55±0.26 mm initially to 1.67±0.27 mm after 2 months of treatment. More significant positive dynamics during therapy was observed in patients without arterial hypertension. In general, no adverse events were registered during treatment. Conclusion: in clinical practice, the use of the CS injections in patients with gonarthrosis is safe and effective. The tendency to decrease the cartilage degradation and increase its thickness suggests a positive effect of CS in the form of slowing the disease progression in the long-term period. KEYWORDS: osteoarthritis, cartilage degradation, synovitis, chondroitin sulfate, bioavailability, structure-modifying effect, Mucosat. FOR CITATION: Lapshina S.A., Mingaleeva G.F. Chondroitin sulfate injection efficacy in the treatment of knee osteoarthritis. Russian Medical Inquiry. 2021;5(5):301–306 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-301-306.

Effects of the use of hyaluronic acid as compared with standard chondroprotectors therapy in patients with various degrees of gonarthrosis

Effects of the use of hyaluronic acid as compared with standard chondroprotectors therapy in patients with various degrees of gonarthrosis

Nanotherapy Targeting NF-κB Attenuates Acute Pain After Joint Injury.

Inflammation after joint injury leads to joint responses that result in eventual osteoarthritis development. Blockade of inflammation, by suppressing NF-κB expression, has been shown to reduce joint injury-induced chondrocyte apoptosis and reactive synovitis in vivo. Herein, we demonstrate that the suppression of NF-κB p65 expression also significantly mitigates the acute pain sensitivity induced by mechanical injury to the joint. These results suggest that early intervention with anti-NF-κB nanotherapy mitigates both structural and pain-related outcomes, which in turn may impact the progression of post-traumatic osteoarthritis.

A HISTOPATHOLOGICAL PERSPECTIVE FOR CARPAL TUNNEL SYNDROME

Background: Carpal tunnel syndrome(CTS) is the most frequent compressive neuropathy of upper extremity .Median nerve is compressed under flexor retinaculum because of primary or secondary reasons. Although primary CTS may have different causes, idiopathic CTS’s ethiology is unclear We aimed to evaluate tenosynovial tissue change under flexor retinaculum as a cause of idiopathic CTS even more as a possible cause of recurrent CTS. Materials and Methods: We operated 175 patients with carpal tunnel syndrome who had median nerve compression .110 patients were diagnosed as idiopathic CTS were included at our study. Open carpal tunnel release was performed by same surgeon and synovial samples were taken from synovial connective tissue under median nerve for pathological examination. Results: All patients were followed-up 22 months ( 12 to 35 months ) prospectively. Mean age was 45 years( 22 to 65). Preop VAS score was 6 post op VAS score was 1. Synovial hypertrophy was detected at 38 of 110 patients(34%). Other pathological results were; 13 reactive synovitis (11%), 8 ganglion(7.2%) , 51 fibrohyaline nodulation(46.3%). Conclusions: We recommend the evalution of tenosynovial tissue under flexor retinaculum after releasing the retinaculum. If there is an inflammation or a hypertrofi or a mass effect, surgeon must do partial tenosynovectomy to decrease the volume of the carpal tunnel and to prevent recurrence.

Synovitis following anterior cruciate ligament reconstruction using the LARS device.

The Ligament Augmentation and Reconstruction System (LARS®) has been at the forefront of a recent revival in the use of synthetic ligaments for ACL reconstruction. However, despite promising short-to-mid-term results its role has been approached with caution due to a high number of major complications in previous synthetic graft designs including mechanical failures, synovitis and osteoarthritis. This study aims to report on the incidence of synovitis in a series of patients undergoing second-look surgery following LARS ACL reconstruction. A retrospective analysis was performed of a single surgeon's series of 12 patients that underwent second-look arthroscopic surgery following primary LARS ACL surgery for indications including mechanical symptoms (meniscal tears/cyclops lesions/chondral flaps) and/or symptomatic instability secondary to LARS failure. In all cases an examination under anaesthesia (EUA) was performed, and a qualitative assessment of the synovium was carried out and graded as normal, reactive or inflammatory. A synovial biopsy was performed in all knees with visible evidence of synovitis and in all cases of LARS failure. The second-look arthroscopy was performed at a mean of 23 months (7-66) after the index surgery. In 6 (50%) knees the LARS device had failed necessitating removal and revision ACL reconstruction, while in the remaining 6 knees the LARS was still intact. Arthroscopic evaluation of the synovium revealed a normal appearance in 8 knees (67%) and reactive synovitis in 4 knees (23%); of these 4 knees, one had an intact LARS device and 3 had failed LARS. Histological examination from these 4 knees and the 3 knees with graft failures without visible synovitis revealed chronic hypertrophic synovitis (moderate 2, mild 5) in all cases with rare giant cells, consistent with a reaction to foreign body material. Foreign body synovitis is a common finding in our series of patients undergoing a repeat arthroscopy following a LARS ACL reconstruction. The histological diagnosis of synovitis was more frequently encountered than an arthroscopic appearance of synovitis. Whilst the results of this case series cannot support a direct causative link between LARS failure and the development of synovitis, this study highlights the need to remain vigilant about the risk of reactive synovitis following LARS ACL reconstruction due to exposure of the knee to foreign body material. Level IV, case series.

PATHOGENETIC SUBSTANTIATION OF COMPREHENSIVE TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMBINED WITH OSTEOARTHROSIS AND OBESITY CONCERNING THE CORRECTION OF THE DISORDERS IN THE PROTEINASE INHIBITOR SYSTEM AND METABOLISM OF THE CONNECTIVE TISSUE COM

Introduction. The incidence of the co-morbid course of chronic pancreatitis (CP) and obesity has recently increased significantly both in Ukraine and all over the world, especially in individuals being in the second half of their adulthood and in the elderly ones. This combination of interdependent diseases is often complemented by osteoarthrosis (OA) of the large joints, which is characterized by severe, rapidly progressing course. The basis CP and OA progression, among various mechanisms of pathogenesis, is the proteinase-inhibitor imbalance, which leads to proteolytic damage and destruction of acinar epithelium and cartilage tissue, polymorphocyte infiltration of the tissue of the pancreas and synovial epithelium (reactive synovitis) under the influence of increased expression and activation of cellular adhesion factors, hyperproduction of proinflammatory cytokines, growth factors of anabolic action, acidosis, hypoxia, etc.Objective. Тo identify the mechanisms of mutual aggravation of chronic pancreatitis and osteoarthrosis of large joints in obese patients on the basis of the study of protein and carbohydrate-protein components of the extracellular matrix of the proteinase inhibitor system, to increase the efficiency of comprehensive treatment for this polymorbidity.Materials and methods. Тhe study involved 90 patients with CP, aged 45 to 63 years old , 22 of whom had normal body weight (1group 1), 27 patients with CP suffered from the first degree obesity (group 2), 41 patients had CP with comorbid first degree obesity and І-ІІ stage osteoarthritis of the of the hip and knee joints (group 3).To evaluate the effectiveness of the proposed treatment, the patients of group 3 were divided into two subgroups: 3A and 3B. Group 3А (21 individuals) received basic treatment of CP exacerbation: a hypocaloric diet with elimination of extractive foods, antisecretory (proton pump inhibitor), antispasmodic (mebeverine hydrochloride) for 1 month, multienzyme (kreon10-20 thousand units) preparations, L-carnitine (solution) 1.0 (10 ml) twice a day for 90 days. Group 3B (20 people), in addition to the above therapy, received the drinking form of L-carnitine 1.0 (10 ml) twice a day and L-glutathione (hepaval) 250 mg twice a day for 90 days.Results. Тhe proposed therapy contributed to the normalization of proteinase inhibitor homeostasis. Without proteinase inhibitors in the basic therapy the complex application of L-carnitine and L-glutathione contributed to a reliable decrease in the intensity of azole albumin lysis in patients of both groups: 1.2 and 1.6 times, respectively (p <0.05), due to significant inhibition of hyperproduction of proteinase inhibitors: the content of α2- macroglobulins in the blood dropped by 1.6 and 2.2 times (p <0.05) with normalization of the values.Conclusions. Patients with chronic pancreatitis, comorbid obesity and osteoarthrosis of large joints were studied during their therapy, the mechanisms of mutual aggravation were identified: hyperproduction of the extracellular matrix components, acute phase proteins, an increased degradation of fucoglycoproteins and proteinase-inhibitor imbalance.The integrated therapy of patients with CP and obesity which includes antioxidant (L-glutathione) and a metabolism stabilizer (L-carnitine) against the basic treatment resulted in the balance of the processes of synthesis and decomposition of collagen and glycoproteins, proteinase-inhibitor system homeostasis, collagenolysis enhancement with the achievement of the balance in the metabolism of the connective tissue components, homeostasis of hydrogen sulfide, which underlies the achievement of stable remission of CP and OA, reducing the risk of their progression.

Synovectomy using Samarium-153 Hydroxyapatite in the Elbows and Ankles of Patients with Hemophilic Arthropathy.

This study aimed to evaluate synovectomy with samarium-153 hydroxyapatite (153Sm-HA) in synovitis of the elbows and ankles of hemophilic patients. The synovectomy was performed using 185 MBq of 153Sm-HA in 166 joints of 82 hemophilic patients, with a mean age of 24.4 years and follow-up of 12 and 42 months, comprising 63 ankles and 84 elbows. Arthropathy was characterized by recurrent joint bleeding. Episodes of hemarthrosis, use of clotting factors, and pain intensity were evaluated before and after treatment. Scintigraphic controls and adverse effects were also considered. Statistical analyses used P ≤ 0,005 as significant. The results pointed that (a) reduction in hemarthrosis was 78% and 68% in elbows and 82% and 72% in ankles; (b) use of clotting factors was 80% and 70% in elbows and 85% and 75% in ankles; (c) pain was 37% and 34% in elbows and 61% and 57% in ankles, after 12 and 42 months, respectively. Three cases of mild reactive synovitis were observed in ankles and four in elbows. There was no joint effusion in any of the cases. In conclusion, the use of 153Sm-HA in elbows and ankles was effective, very safe, minimally invasive and showed consistency over time, is another material to utilize in median hemophilic joints.