Signs Of Synovitis Research Articles

Tissue response to a braided poly-L-lactide implant in an experimental reconstruction of anterior cruciate ligament

During follow-up periods of 6, 12, 24 and 48 weeks, the tissue response to a braided poly-L-lactide (PLLA) implant, 3.2 mm in diameter, was investigated in the reconstruction of experimental anterior cruciate ligament (ACL) ruptures in 32 sheep. In 16 sheep the cut ACL was removed and reconstructed with the fascia lata augmented with a PLLA implant. In 16 sheep the ACL was cut from its midportion, sutured, and thereafter augmented with a PLLA implant. The tissue reactions were typical of a scant non-specific-foreign-body reaction. The number of inflammatory and giant cells was greatest at six weeks, decreasing thereafter. Degradation of the PLLA was incomplete at 48 weeks. No signs of synovitis or changes in the cartilaginous surfaces were observed. The reconstructions in both groups were anchored to the bone by fibroconnective tissue, and remodelling of the bone was seen along the drill channels. After 48 weeks the maturation of the fibroconnective tissue and the orientation of the collagen fibres were higher (p<0.01) in the fascia-lata-PLLA group than in the primarysuture-PLLA group. Histologically, the braided PLLA implants proved to be suitable for ACL repair in sheep. The augmentation of the fascia lata with the PLLA implant seemed to be preferable to that of the primary suture of the ACL.

Silastic replacement of the trapezium

A retrospective study has been made of the long-term results of silastic replacement of the trapezium, including functional, clinical and radiological assessment of 43 hands, one to 13 years postoperatively. The results showed good function and relief of pain in 88% of hands. Radiolucent bone lesions, presumably due to silastic particle reaction, occurred in 53% of hands, but their presence did not correlate well with symptoms. Four patients (9%) developed significant synovitis which was improved by removal of the prosthesis. In this series, clinical silastic synovitis occurred in the first four years, and its incidence did not increase with further follow-up to 13 years.

TRAUMATIC SYNOVITIS ANALYSED BY ARTHROSCOPY AND IMMUNOHISTOPATHOLOGY

The synovitis induced in previously healthy subjects by knee joint trauma was investigated at arthroscopic surgery performed after 3-70 days. Synovitis was confined to the areas of the synovial membrane bordering the cartilage lesion and displayed a varied intensity of inflammation. Biopsies were sampled under direct vision from the area of the peak inflammatory intensity within each joint and analysed by immunohistopathology. Only sparse lymphocytic infiltration and a slight increase of lining cell layers were found in the biopsies after as long as 70 days. The restricted extent and limited intensity of the inflammatory changes contrast with previous findings in rheumatoid arthritis. However, the arthroscopic and immunohistopathological signs of synovitis were no different.

Transforming growth factor beta (TGF-β) can delay and reduce lethal effects of E. Coli septic shock: [formula omitted] Stanford University, Stanford, Ca 94304, University of California at San Francisco, San Francisco, CA, University Hospital, Zurich, Switzerland and Genentech, Inc., S. San Francisco, CA 94080

Type II collagen (CII) and ovalbumin (OV) reactive T cell lines were developed from the lymph node cells of Louvain rats previously immunized with the respective antigen. Histologic sections of rat knees injected intraarticularly (ia) with 106 cells from line CII (VA) or CII (VII) were graded blindly. Significant synovitis (P < 0.000001 and 0.004, respectively) was evident compared to OV line recipients. Pannus developed within 48 hr, persisted for at least 4 to 6 weeks, was inducible with fewer than 103 CII cells, and required viable lymphocytes. The process was independent of anticollagen antibodies and was associated with the lines' capacity to elaborate a previously described 65-kDa CII-binding arthritogenic lymphokine. Line CII (VIII), which could not elicit a synovitis, did not produce detectable quantities of this factor. A line-and antigen-specific synovitis, comparable to the ia injection protocol, was also induced by intravenous administration of 2 × 107 CII (VA) cells and ia challenge with soluble collagen. These studies demonstrate that CII lines bearing the T helper phenotype can evoke a sustained synovitis and suggest that this experimental process is associated with the release of an arthritogenic lymphokine and not dependent on the formation of antibodies to CII.

Experimental synovitis induced by collagen-specific T cell lines

Type II collagen (CII) and ovalbumin (OV) reactive T cell lines were developed from the lymph node cells of Louvain rats previously immunized with the respective antigen. Histologic sections of rat knees injected intraarticularly (ia) with 10 6 cells from line CII (VA) or CII (VII) were graded blindly. Significant synovitis ( P < 0.000001 and 0.004, respectively) was evident compared to OV line recipients. Pannus developed within 48 hr, persisted for at least 4 to 6 weeks, was inducible with fewer than 10 3 CII cells, and required viable lymphocytes. The process was independent of anticollagen antibodies and was associated with the lines' capacity to elaborate a previously described 65-kDa CII-binding arthritogenic lymphokine. Line CII (VIII), which could not elicit a synovitis, did not produce detectable quantities of this factor. A line-and antigen-specific synovitis, comparable to the ia injection protocol, was also induced by intravenous administration of 2 × 10 7 CII (VA) cells and ia challenge with soluble collagen. These studies demonstrate that CII lines bearing the T helper phenotype can evoke a sustained synovitis and suggest that this experimental process is associated with the release of an arthritogenic lymphokine and not dependent on the formation of antibodies to CII.

Clinical synovitis and radiological lesions in rheumatoid arthritis. A prospective study of 25 patients during treatment with remission-inducing drugs.

The joints of hands and feet of 25 patients (1150 joints) with rheumatoid arthritis were compared, joint by joint, clinically and radiologically, over 2 years of treatment with remission-inducing drugs. Joints with clinical signs of synovitis decreased from 47% to 17% (p less than 0.001), while the number of joints with radiological lesions increased from 23% to 27% (p less than 0.01). Definite radiological progression of bone lesions was seen in 7% of the joints. Joints with clinical synovitis had a higher risk of progressive bone damage than joints without clinical synovitis (p less than 0.001) and joints in which the clinical signs of synovitis persisted during the study had a higher risk of progressing bone lesions than joints in which the clinical synovitis subsided (p less than 0.001). Progressive bone damage was seen more often in swollen joints than in tender joints without swelling or joints without clinical signs of synovitis (p less than 0.001), the difference in radiological progression between the latter two groups being non-significant. Twenty-one per cent of the joints with progressive bone lesions had no clinical signs of synovitis during the period.

Rheumatoid Arthritis in the Elderly, Presenting as Polymyalgia Rheumatica

Two elderly patients presented with generalized aches and pains (particularly in the shoulders and the pelvic girdle), stiffness, fatigue, anemia, and an elevated erythrocyte sedimentation rate, but there were no signs or symptoms directly referable to the joints. Two and five months later respectively, pain, swelling, and signs of synovitis appeared in several joints in a symmetrical pattern, and a diagnosis of rheumatoid arthritis was made. Rheumatoid arthritis in the elderly may resemble polymyalgia rheumatica. On the other hand, synovitis in many patients with polymyalgia rheumatica may resemble rheumatoid arthritis. In the elderly, the differentiation of these two entities may be difficult. Moreover, patients initially presenting with the signs and symptoms of polymyalgia may eventually manifest typical rheumatoid arthritis.

SURGERY IN RHEUMATOID ARTHRITIS.

It is the chronic synovitis which leads to destruction of the joint in rheumatoid arthritis. Synovectomy is advocated whenever there is evidence of significant synovitis or effusion after three to six months of rest. This is the most useful of the operations for rheumatoid arthritis for it alters the course of the disease in the joint; the joint is refractory to exacerbations of the disease for a long period.