Single Joint Involvement Research Articles

Clinical and epidemiological features and therapeutic options of avascular necrosis in patients with sickle cell disease (SCD): a cross-sectional study.

Avascular necrosis (AVN) is a debilitating complication in sickle cell disease (SCD) patients, and its management is usually challenging. This study aims to evaluate the clinical and epidemiological features and therapeutic options of AVN in sickle cell patients in Qatar. A cross-sectional study was conducted on a 49 SCD patients who were diagnosed with AVN and attended the hematology clinic at the National Center for Cancer care & research, Hamad Medical Corporation, Qatar between Jan-2011 to Jan2021. Results: Forty-nine adult patients with SCD who were diagnosed with AVN were studied. The median age of the study population is 32 years, and the median age at the first AVN diagnosis was 26 years (range: 11-44 yr.). 37 (75.5%) patients suffered from multiple joints AVN while 12(24.5%) had single joint involvement. 31 (63.3%) patients had bilateral hip AVN and 18 (36.7%) had shoulder involvement. 30 patients (61%) were on Hydroxyurea treatment. Based on FICAT and Alert classification of AVN, 57 % of patients had stage III and above at first diagnosis. 20 (40.8%) were managed with a conservative approach, 11 (22.4%) received hyperbaric oxygen with good response, 6(12.2%) underwent hip core decompression and 12(24.5%) underwent hip replacement surgery. In SCD patients, AVN occurred more during the 3rd and 4th decades of life. The majority of AVN represented with advanced stage and had multiple joint involvements. We recommend adopting a low threshold of joint imaging for early detection and prevention of further complications.

Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients

BackgroundThis study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference.MethodsThis hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared.ResultThe uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P < 0.05). Patients in the hyperuricemia group with diabetes and tophi and those administered diuretics were more prone to acute gout attacks than those in the normal uric acid level group (P < 0.05). In the normal uric acid level group, 22 patients (84.6%) exhibited single joint involvement, whereas only 18 patients (47.4%) in the hyperuricemia group demonstrated single joint involvement (P < 0.05). After 1 year of follow-up, the gout recurrence rate in the hyperuricemia group was 44.7%, which was significantly higher that the recurrence rate in the normoglycemic group (11.5%; P < 0.05). Presenting tophi in perioperative orthopedic surgery patients was found to be an independent risk factor for gout recurrence within 1 year (RR = 4.80; P = 0.029).ConclusionThe recurrence rate of gout in patients with hyperuricemia during perioperative period increased 1 year after operation. Therefore, it is crucial to monitor the uric acid level to prevent acute gout attacks during the perioperative period and recurrence during the 1-year follow-up period. Moreover, the risk of an acute gout recurrence 1 year after operation increased in patients who presented tophi; therefore, it is necessary to maintain appropriate blood uric acid level during perioperative period among patients undergoing orthopedic surgery.

Clinical and Epidemiological Features and Therapeutic Options of Avascular Necrosis in Sickle Cell Patients: A Cross-Sectional Study

Background: Vascular necrosis (AVN) is a well-described debilitating complication in sickle cell disease (SCD) patients, and the management is usually challenging. Data about the clinical presentation, risk factors, radiological features, and management options are lacking. This study aims to evaluate the clinical and epidemiological features and therapeutic options of avascular necrosis in sickle cell patients in Qatar. Patients and methods: A cross-sectional study was conducted on a group of 49 sickle cell disease patients who are suffering from avascular necrosis and attending a hematology clinic at the National Center for Cancer care & research hospital (NCCCR), Hamad Medical Corporation (HMC), Qatar between Jan-2011 to Jan2021. Clinical presentation, age at first AVN diagnosis, hemoglobin S level, affected joints, hydroxyurea treatment and compliance, and stage at diagnosis were recorded. Management options included conservative physiotherapy, hyperbaric oxygen, core decompression, and hip replacement. Results: Forty-nine adult patients with sickle cell disease complicated by avascular necrosis were reviewed. The median age of the study population is 32 years (range: 18-64) and the median age of AVN diagnosis is 26 years (range: 11-44). 25 patients (51 %) were males. 41 patients (83.6%) had hemoglobin SS, 3 (6.1%) with hemoglobin S/D (double Heterozygosity), 3 (6.1%) hemoglobin C/S, 1 (2.1%) with hemoglobin S/E, and 1 (2.1%) with sickle/thalassemia. 37 (75.5%) patients suffered from multiple joints AVN while 12(24.5%) had single joint involvement. 31 (63.3%) patients had bilateral hip AVN and 18 (36.7%) had shoulder involvement. The majority of the patients (79%) were symptomatic where joint pain and a limited range of motion were the most common symptoms. 30 patients (61%) of the recruited population were on Hydroxyurea; six of them (20%) were non-compliant. Based on FICAT and Alert classification of AVN, 8 (16.3%) patients had stage I, 13(26.5%) had stage II, 9 (18.4%) had stage III and 13 (26.5%)patients were at stage IV; 6(12.3%) patients were at stage V. 57 % of patients had stage III and above at diagnosis. 20 (40.8%) were managed with a conservative approach with physiotherapy only, 11 (22.4%) received hyperbaric oxygen with good response, 6(12.2%) underwent hip core decompression and 12(24.5%) underwent a hip replacement. Conclusion: The majority of AVN patients had an advanced stage and multiple joint involvements at diagnosis. We suggest a low threshold of joint imaging for early detection and prevention of further complications. Hyperbaric oxygen, if implemented early, might be a possible option to avoid or delay surgical intervention. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The relationship between single-joint and multi-joint osteoarthritis and heart disease risk profile

The relationship between single-joint and multi-joint osteoarthritis and heart disease risk profile

Neonatal septic arthritis: Clinical profile and predictors of outcome

Background: Neonatal septic arthritis deserves a special attention due to its subtle signs and symptoms and catastrophic consequences. There is paucity of literature regarding the clinical profile and predictors of outcome in neonatal septic arthritis. Objectives: The objective was to study the clinical profile of neonates admitted with septic arthritis, their clinical and radiological outcomes on follow-up, and factors that predict outcomes. Methodology: Neonates with septic arthritis as assessed by retrospective case sheet review were included. Prospective data collection of clinical and radiological outcomes was done during follow-upvisits. Children with good outcomes (controls) were compared to those with poor outcomes (cases) subsequently to identify the predictors of outcomes using a nested case–control design. Results: Data of 70 neonates admitted with septic arthritis were collected. Single joint involvement was common (75.8%), and hip joint was the most common joint involved. Gram-negative organisms were predominant (72%), and Klebsiella was the most common organism isolated from joint aspirate (36%), followed by Escherichia coli and Staphylococcus aureus. Of 52 babies who turned for follow-up, half had poor outcomes. In univariate analysis,multiple joint involvement (odds ratio [OR] 4.79, [confidence interval (CI): 1.14-20.21]), pre-intervention period ?7 days (OR 92, [CI: 14.06-601.9]), culture positive joint aspirate (OR 3.70, [CI: 1.55-11.86]), and restricted range of joint movements at discharge (OR 83.3, [CI: 9.2-749.9]) were significantly associated with poor outcomes. Pre-intervention period ?7 days (adjusted OR 107.99, [CI: 5.16-2258.8]) and restricted joint mobility at discharge (adjusted OR 139.53, [CI: 9.03-2154.04]) were the independent predictors of poor overall outcome by logistic regression analysis. Conclusions: Long pre-intervention period and restricted joint mobility at discharge were independent predictors of poor outcome in neonatal septic arthritis. We emphasize the importance ofearly diagnosis, prompt referral to tertiary centers, timely surgical intervention, appropriate measures to ensure good joint mobility, and regular follow-up in these neonates to achieve best outcomes.

Intra-Articular Injection of Triptolide for Treatment of RAT Collagen Induced Arthritis

Rheumatoid Arthritis(RA) is a systemic autoimmune disorder of unknown origin with swelling of multiple joint synovitis. RA is a global distribution disease and one of the primary cause for disability. Nevertheless, there are many RA patients only a single joint involvement serious in clinical practice. It can reduce the side effects caused by systemic administration when direct injection in the joint cavity for local treatment. However, side effects were commonly in traditional local treatment agent of glucocorticoids. This article aims to explore the efficacy and safety of intra-articular injection of triptolide for treatment of rat collagen induced arthritis. Forty seven rats were randomly divided into 5 groups: normal group, PBS group, triptolide group, betamethasone group and etanercept group. Type II collagen (CII) and Freund's adjuvant were used to induce the rat arthritis model. PBS, triptolide, betamethasone and etanercept were injected into the affected ankle joints twice a week for 4 weeks. The animals were then scarified and the ankle joints were fixated in 10% formalin. After decalcification, paraffin embedding, slide preparation and HE staining, the tissues were observed. Cellular degeneration, necrocytosis,proliferation, hyperemia, inflammatory cell infiltration, damage of the cartilago articularis and bone, inflammatory cell infiltration of the subcutaneous tissue around the jointwere investigated. According to different extent of lesion on various part of joint, the levels are divided into“1 point (a little or mild)”“2 points (medium or moderate)”, “3 points (a lot or severe)”,“4 points (extremely severe)”,“0.5 points (very slight lesion)”,“0 point (no lesion)”. The total points should be accumulated to calculate the average points of each animal in each group. The lower point indicates a lower level of lesion. In addition to the normal group of synovial membrane has no significant changes, the other groups of synovial cells have varying degrees of congestion and edema, hyperplasia and inflammatory cell infiltration. The rats in the normal group(5 rats) were scored 0.50±0.41, PBS group (10 rats) scored 2.60±0.94, triptolide group (9 rats) scored 1.89±0.97, betamethasone group (10 rats) scored 1.50±0.85 and elephantine group (10 rats) scored 2.35±1.43 respectively. The scores of triptolide group and betamethasone group were significantly lower than that of PBS group. There was no significant difference between the triptolide group and the betamethasone group (P> 0.05). At present, the most commonly used drugs clinical application of intra-articular injection of RA is glucocorticoids. Our results showed that triptolide can be injected into the joint cavity for treatment of RA, while etanercept intra-articular injection has no significant effect. Triptolide can be used for the treatment of RA and can achieve a better effect(no significant difference compared to the most commonly used hormone drugs(P <0.05)), and it can become an alternative drug when glucocorticoids are not applicable.

Limited Joint Mobility in Childhood Diabetes: Discovery, Description, and Decline

The discovery of limited joint mobility (LJM) as the earliest clinically apparent complication of diabetes in children and adolescents nearly 40 years ago provided insights into the mechanism of diabetes complications. LJM, due to periarticular connective tissue thickening and stiffness, varied from single joint involvement bilaterally to obvious hand deformity and limitation of movement of the spine. Thick, tight, waxy skin was apparent with more severe changes; biopsy indicated thickening of the dermis and epidermis with accumulation of collagen and loss of skin appendages. Substantial growth impairment was associated with all levels of LJM. Risk for microvascular disease over a 16-year period was actuarially increased nearly 4-fold by the presence of LJM. Long-term glycemic control influenced the onset of LJM; for every unit increase in average glycated hemoglobin from onset there was a 46% increase in the risk of LJM. Between 1976-78 and 1998, the prevalence of LJM decreased from 30 to 7%, and the portion with moderate to severe changes decreased from 33 to 14%, with the disappearance of severely affected individuals. Furthermore, growth data markedly improved for those with and without LJM; 30% without LJM and 77% with LJM had been less than the 25th percentile for height, whereas the more contemporary group had 22% without LJM and 33% with LJM in this quartile. The elucidation of LJM as a novel and informative early complication of pediatric diabetes has provided insights into the evolution of the severe long-term complications of diabetes. The marked decrease in the frequency of LJM and statural deficit in children and youth with diabetes in the 20 years between the late 1970s and 1990s can be attributed to improved metabolic control of children and adolescents. The prevalence of LJM in a population may serve as a measure of quality of diabetes control.

The scintigraphic evaluation and genetic correlation of joint involvements in pediatric patients with familial Mediterranean fever

We aimed to evaluate the articular involvements in pediatric patients with familial Mediterranean fever (FMF) with joint symptoms by bone scintigraphy and to correlate the involved joints with the gene mutations. A total of 41 newly diagnosed patients in pediatric age group (28 girls and 13 boys; mean age 9.14 ± 2.91 years) with joint involvement symptoms were included in this study. Scintigraphic images were obtained at 5th min (blood pool or early phase) and starting at 3 h (late phase) after (after tracer injection) intravenous administration of technetium-99m (99mTc)-methylendiphosphonate (MDP). Genomic DNA was isolated from leukocytes using standard salting out procedure. The sequencing data were analyzed. Of the 41 patients, arthritis was found in 21 (51.2%) patients. Of the 21 patients, there was single joint involvement in 15 (71.4%) patients and multiple joint involvement in six (28.6%) patients. The mean age of patients with joint involvement (8 ± 2.3 years) were considerably lower than the patients without joint involvement (10.35 ± 3.04 years), and this was statistically significant (p = 0.008). The most commonly involved joints were ankles and knees. Multiple joint involvements were most frequently observed in the M694V and M694I gene mutations (16.7%). We use and recommend the bone scintigraphy in patients with FMF to determine the presence and distribution of arthritis, since bone scintigraphy is inexpensive, noninvasive, easy-to-use, and also is more sensitive in the diagnosis and distribution of arthritis than conventional radiological methods and clinical examination.

Study of Factors Affecting Progress of Locomotor Disability in a Slum in Mumbai

Abstract Locomotor disability is one of the most commonly prevailing type of disability in India. This study was conducted with the aim of assessing the severity and to study the factors affecting progress of locomotor disability. A community based cross-sectional observation study was conducted in an urban slum of Mumbai. Total sample of 3665 individuals were screened; 205 were identified with locomotor disabilities who were subjected to a structured questionnaire and physical examination. The prevalence of locomotor disabilities is found to be 5.59 %. Females are affected more than the males and unemployment was observed to be very high. Awareness about rehabilitative services was found to be very low and very few individuals had ever taken any treatment. Majority of the individuals detected with locomotor disability were ambulatory, showed good IADL score and muscle power as well as single joint involvement. Advancing age and longer duration of disability have been associated with low scores of IADL, low muscular power, multiple joint involvement and increased duration of disability. Treatment started at young age, on immediate diagnosis will halt the progress of the disease. Availability and awareness of rehabilitation facilities will go a long way in improving the quality of life of individuals with locomotor disabilities.

Scintigraphic changes of osteoarthritis: An analysis of findings during routine bone scans to evaluate the incidence in an Indian population

Aims:The reported prevalence of osteoarthritis (OA) varies according to the method that is used to detect it. X-rays are commonly used in the diagnosis of OA. However, marked osteoarthritic damage must be present to detect characteristic changes with radiologic imaging. Our intention was to evaluate bone scans (1) he occurrence of such changes, (2) he incidence of OA (single or multiple joints) in the general population (a mixture of urban and rural) who were asymptomatic. Data on OA incidence in India is sketchy and sparse as against more detailed information obtained from USA and European nations. Also, clinical rheumatologists are not well-versed with the potential application of bone scans in the management of arthritides.Materials and Methods:Two hundred and eighty nine planar images of routine bone scans were randomly evaluated by two trained nuclear medicine physicians. The ages of the patients ranged from 20 to over 80 years.Results:It is observed that as the age increases, the incidence of joint involvement increases. However, it is worth noting that even in the age group of 20-40 years, as many as 34% of asymptomatic persons have involvement of the joints. In this age group, as the manifestation is probably in the inception stage, there is a tendency for single joint involvement as against multiple joints seen in the older age groups. Another point to note is that the incidence of joint involvement was not affected by weight. In our patient population, gross obesity was not seen. The predominant joints involved are the knees and hips, followed by the shoulders and ankles. Females show a higher incidence than males. Some patients would be having only a single site or multiple site involvement. This observation is important as in a single, simple test whole body survey gives more information with low radiation burden.Conclusion:Scintigraphic prevalence of OA is higher than reported in US, Europe, and Asia as this test is more sensitive in detecting early changes as compared to radiological changes. These findings on scintigraphy in asymptomatic cases have not been described to the best of our knowledge. Epidemiological demography in published reports is based on clinical or radiological changes observed in single joints which are predominantly symptomatic and multiple joint involvement is rarely recorded. The sensitivity of scintigraphy to show early changes in bone homeostasis and remodeling needs to be exploited.

Two rare involvement sites: synovial chondromatosis

Synovial chondromatosis (SC) is a rarely encountered benign disease of unknown etiology characterized by multiple joint mouse, as well as metaplastic cartilage points in the joint, bursa and tendon sheaths. Although single joint involvement is frequently encountered, multiple joint involvements may also occur. In this study, two patients with SC in the right shoulder joint and in both ankles were presented, reviewed according to literature.

Patterns of psoriatic arthritis.

To describe the clinical patterns of arthritis in psoriasis. Cross-sectional, observational study. Combined Military Hospital, Kharian Cantonment, Pakistan, from January to December 2007. One hundred consecutive patients with psoriasis reporting to dermatology outpatient department were included. Pregnant ladies (due to X-ray hazard) and rheumatoid factor positive patients were excluded. The demographic profile of patients was recorded. Psoriatic arthritis was diagnosed on the basis of Moll and Wright criteria. Standardized examination of axial and peripheral joints was made. The severity of psoriasis was assessed by PASI score. The presence of a clinical type of psoriatic arthritis, enthesitis, dactylitis, and nail changes were noted. X-ray films of involved joints were taken. A statistical analysis using chi-square test and student's t-test were done where applicable. The mean age of patients was 39.8+15.8 years. Seventy one percent were males and 29% were females. Forty six percent of the patients gave a history of joint involvement and fulfilled the Moll and Wright criteria. The mean PASI score in non-arthritic patients was 26.8+34.8 and in psoriatic arthritis patients it was 28.4+41.2, p=0.08. Thirteen patients (28.2%) had predominantly axial disease, while the rest had predominantly peripheral disease. Single joint involvement (monoarthritis) was the commonest clinical presentation. Nail involvement was seen in 29% of the patients without arthritis while in patients having arthritis, nail involvement was 74% (p=0.001). Joint involvement is common in psoriatic patients. However, the criteria of diagnosis lack consensus.

61 THE KNEE PAIN MAP: THE RELIABILITY AND REPRODUCIBILITY OF ASSESSING KNEE PAIN LOCALIZATION AND PATTERNS IN PARTICIPANTS FROM THE OSTEOARTHRITIS INITIATIVE

62 – Table 1 OA definitions Hypermobility Non-Hypermobility Odds 95% CI (% OA affected) (% OA affected) Ratio* Hand: Modified ACR criteria 2.6% 15.4% 0.15 0.02–1.12 Hand: Gogo criteria 2.6% 17.8% 0.12 0.02–0.94 Hand: Any single joint involvement by examination 18.4% 42.9% 0.30 0.30–0.71 Knee: ACR criteria 11.1% 34.4% 0.24 0.67–0.85 *Odds of OA compoaring hypermobility to non-hypermobility group; Hand OA data available for n=287; Knee OA data available for n=120. Conclusions: We have successfully demonstrated a system to identify and record the localization and pattern of pain in knee OA with excellent reliability. Knee pain was most often described as localized, with the medial and lateral joint lines as the most commonly reported zones. Only a small minority of patients reported diffuse pain or were unable to localize their knee pain. Additional studies are needed to determine if specific knee pain patterns or locations correlate with known risk factors for knee OA or with areas of pathologic changes seen on x-rays or MRIs in patients with knee OA.

Impact of multiple joint problems on daily living tasks in people in the community over age fifty‐five

To establish the prevalence of multiple joint problems and their impact on everyday tasks. A random sample of the UK population was assessed using a postal questionnaire. Data on overall joint pain, swelling and stiffness, and activities of daily living were obtained from 16,222 individuals >55 years of age (86% response rate). Prevalence estimates of joint problems were established and the impact of multiple joint pathologies on common physical tasks was determined. Single joint involvement was unusual (median joint involvement 4). Although the knee was the most frequently involved joint (220.30 per 1,000), isolated knee pathology accounted for only 1 in 11 patients with knee pain. Although single joint disorders increased the risk of experiencing functional difficulty, this risk was substantially increased with multiple joint problems: individuals with knee and feet problems were 14 times more likely to experience difficulty standing and walking than those without knee problems (odds ratio [OR] 14.50); knee and hip problems increased the risk >12 times (OR 12.43) whereas knee, back, feet, and hip involvement increased the risk 60 times (OR 62.41). Multiple-site joint problems are much more common than single joint problems. Although individual joint problems have a considerable impact on a person's functional ability, this risk is substantially increased when other joints are involved. With the increasing burden associated with the aging population, it is essential that the management of joint pain be considered in light of the impact of multiple, rather than single, joint problems.

Metacarpophalangeal joint synovial pad fibrotic proliferation in 63 horses.

Medical records, radiographs, and sonograms of 63 horses with metacarpophalangeal joint synovial pad proliferation were examined retrospectively. All horses had lameness, joint effusion, or both signs associated with one or both metacarpophalangeal joints. Bony remodeling and concavity of the distodorsal aspect of the third metacarpal bone (Mc3) just proximal to the metacarpal condyles was identified by radiography in 71 joints (93%); 24 joints (32%) had radiographic evidence of a chip fracture located at the proximal dorsal aspect of the proximal phalanx. Fifty-four joints (71%) were examined by ultrasound. The mean +/- SD sagittal thickness of the synovial pad was 11.3 +/- 2.8 mm. Seventy-nine percent of the horses had single joint involvement with equal distribution, between the right and left forelimbs. Sixty-eight joints in 55 horses were treated by arthroscopic surgery. Sixty joints (88%) had debridement of chondral or osteochondral fragmentation from the dorsal surface of Mc3 beneath the synovial pad and 30 joints (44%) had a bone chip fracture removed from the medial or lateral proximal dorsal eminence of the proximal phalanx. Complete or partial excision of both medial and lateral synovial pads was completed in 42 joints. Only the medial synovial pad was excised or trimmed in 21 joints, and 5 joints had only the lateral pad removed. Eight joints in eight horses were treated by stall rest, administration of intra-articular medication and systemic nonsteroidal anti-inflammatory drugs. Follow-up information was obtained for 50 horses treated surgically and for eight horses treated medically. Forty-three (86%) that had surgery returned to racing; 34 (68%) raced at an equivalent or better level than before surgery. Three (38%) of the medically treated horses returned to racing; only one horse raced better than the preinjury level. Horses that returned to racing at a similar or equal level of performance were significantly younger in age than horses returning at a lower level or not racing (P < or = .05). Overall, horses with synovial pad proliferation treated by arthroscopic surgery had a good prognosis for return to racing at a level equal or better than before injury.

Acute painful joints

The child with acutely tender joints is a relatively common problem. However the wide spectrum of possible diagnoses includes a number of diseases which are uncommon. With care and attention to detail the history may be the most revealing guide to a diagnosis concealed by examination alone. The examination is nevertheless of irreplaceable importance in assessing the child and, usually, only a few investigations are required. In the acute situation it is often not possible to make the definitive diagnosis which may only become apparent with the passage of time. Juvenile chronic arthritis (JCA) may be suspected but should only be diagnosed when symptoms have persisted for a minimum of 3 months, even though viral arthritis can last longer than this. In some cases of transient arthritis no particular cause is ever identified and it is better to leave the patient without a diagnostic label rather than prejudice future events. Table 1 shows the frequency of diagnoses of children under 16 years of age presenting to 3 paediatric centres in Helsinki with possible arthritis. They were referred from primary care physicians over an 18 month period. Acute painful joints will not all be thought of as possible arthritis hence the low incidence of septic arthritis and the absence of osteomylitis and trauma. In this report we have focused on the assessment of a child presenting with acute tender joints. While it is tempting to assess the child with a single tender joint separately from the child with multiple joint involvement, the latter often start with single joint involvement and this possibility must be considered. The most urgent aspect of assessing a child with single joint involvement is to consider a septic arthritis because delayed treatment increases the fre

CD3+4-8-WT31-(T cell receptor gamma+) cells and other unusual phenotypes are frequently detected among spontaneously interleukin 2-responsive T lymphocytes present in the joint fluid in juvenile rheumatoid arthritis. A clonal analysis.

T lymphocytes (E rosetting cells) isolated from the joint fluid of four patients with juvenile rheumatoid arthritis (JRA) were first analyzed for surface antigen expression. Approximately 15% of cells were CD25+ (interleukin, IL, 2 receptor positive), in addition, a remarkable proportion of cells expressed the CD2+3- phenotype. CD3+ cells outnumbered the sum of CD4+ and CD8+ cells as well as the cells reactive with the WT31 monoclonal antibody (which recognizes a framework determinant of the alpha/beta T cell receptor). Purified T cells were cloned under culture conditions (1% phytohemagglutinin, PHA plus IL2) which allow clonal expansion of most peripheral blood T lymphocytes. Under these conditions proliferating cells ranged from 25 to 65%; clones (derived from microcultures containing 0.5 or 0.25 cells/well) were tested for cytolytic activity against P815 cells (in the presence of PHA) or against the natural killer (NK)-sensitive K562 target cells. Fifty-four percent and 73% of clones obtained from the two patients with the polyarticular form of the disease displayed cytolytic activity in the lectin-dependent assay. Cytolytic clones were 22 and 29% in the two patients with single joint involvement. About half of all cytolytic clones displayed NK-like activity. Surface antigen analysis revealed that, in addition to conventional CD3+4+8- and CD3+4-8+, a noticeable fraction of clones (50/202) displayed unusual surface phenotypes. In particular, 33/50 coexpressed CD4 and CD8 antigens; 7/50 were CD2+3-4-8- and displayed NK-like activity; 10/50 expressed CD3 but lacked both CD4 and CD8 antigen and did not react with the WT31 monoclonal antibody. In order to allow selective growth of IL2-responsive cells, T lymphocytes were also cloned directly in IL2. As much as 57% of all clones thus obtained (48/84) displayed cytolytic activity. Moreover, about half expressed unusual surface phenotypes including CD2+3-4-8-, CD3+4+8+ and CD3+4-8-WT31-. Given the accumulation at the site of the joint involvement of unusual T cells, most of which displayed cytolytic activity and were likely to represent cells activated in vivo (IL2 responsive), one may speculate that these cells may be involved in the injury process.

Primary Osteoarthrosis of the Knee or Hip

One hundred twenty probands with primary osteoarthrosis of the hip or knee were examined prospectively; there were 194 controls. In addition, 193 patients with hip or knee arthrosis were examined retrospectively. Restriction of rotation on physical examination accurately differentiated arthrotic hips from normal ones. Among women, 38% of the controls and 49% of the probands had Heberden nodes (P more than .1). Their prevalence increased with age. Individuals with multiple arthrosis joints were not older than those with single joint involvement, and they has a similar prevalence of nodes. Of the probands, 14% had arthrosis of both the knee and hip. Of those with bilateral hip arthrosis, 33% had knee arthrosis as well. Heberden nodes are unrelated to osteoarthrosis of the knee or hip. Knee and hip arthroses frequently occur together and remain confined to the initially affected joints. They may have a common cause.

Primary osteoarthrosis of the knee or hip. Prevalence of Heberden nodes in relation to age and sex

One hundred twenty probands with primary osteoarthrosis of the hip or knee were examined prospectively; there were 194 controls. In addition, 193 patients with hip or knee arthrosis were examined retrospectively. Restriction of rotation on physical examination accurately differentiated arthrotic hips from normal ones. Among women, 38% of the controls and 49% of the probands had Heberden nodes (<i>P</i>&gt;.1). Their prevalence increased with age. Individuals with multiple arthrosis joints were not older than those with single joint involvement, and they had a similar prevalence of nodes. Of the probands, 14% had arthrosis of both the knee and hip. Of those with bilateral hip arthrosis, 33% had knee arthrosis as well. Heberden nodes are unrelated to osteoarthrosis of the knee or hip. Knee and hip arthroses frequently occur together and remain confined to the initially affected joints. They may have a common cause. (<i>JAMA</i>231:1256-1260, 1975)