Synovial Volume Research Articles

1H NMR Metabolomics Identifies Underlying Inflammatory Pathology in Osteoarthritis and Rheumatoid Arthritis Synovial Joints.

Despite osteoarthritis (OA) and rheumatoid arthritis (RA) being typically age-related, their underlying etiologies are markedly different. We used 1H nuclear magnetic resonance (NMR) spectroscopy to identify differences in metabolite profiles in low volumes of OA and RA synovial fluid (SF). SF was aspirated from knee joints of 10 OA and 14 RA patients. 100 μL SF was analyzed using a 700 MHz Avance IIIHD Bruker NMR spectrometer with a TCI cryoprobe. Spectra were analyzed by Chenomx, Bruker TopSpin and AMIX software. Statistical analysis was undertaken using Metaboanalyst. 50 metabolites were annotated, including amino acids, saccharides, nucleotides and soluble lipids. Discriminant analysis identified group separation between OA and RA cohorts, with 32 metabolites significantly different between OA and RA SF (false discovery rate (FDR) < 0.05). Metabolites of glycolysis and the tricarboxylic acid cycle were lower in RA compared to OA; these results concur with higher levels of inflammation, synovial proliferation and hypoxia found in RA compared to OA. Elevated taurine in OA may indicate increased subchondral bone sclerosis. We demonstrate that quantifiable differences in metabolite abundance can be measured in low volumes of SF by 1H NMR spectroscopy, which may be clinically useful to aid diagnosis and improve understanding of disease pathogenesis.

Ethylenediaminetetraacetic acid (EDTA) anticoagulant affects the refractometric measurement of total protein concentration in equine synovial fluid

SummaryThe objectives of this study were to (i) determine the effect of ethylenediaminetetraacetic acid (EDTA) concentration on the refractometric measurement of the total protein (TP) concentration of equine synovial fluid and (ii) assess the effect of time and temperature on the refractometric measurement of TP concentration. Synovial fluid was retrieved aseptically from horses presenting to Liphook Equine Hospital either (a) immediately after euthanasia or (b) from those requiring arthrocentesis as part of their clinical investigation. Samples were aliquoted into commercially available (i) plain tubes (0.5 mL; control) and (ii) EDTA tubes (at different volumes to obtain serial dilutions of EDTA:synovial fluid). TP concentration was measured by two independent observers using a calibrated hand‐held refractometer. Samples from a separate group of horses were stored for 24 h at 4°C and 20°C before analysis to assess the effects of time and temperature. Results were compared using repeated measures ANOVA. TP concentration was significantly higher at all EDTA concentrations compared to control samples, with the greatest effect seen with higher concentrations (P&lt;0.0001 for samples with ≥3.17 mg EDTA/mL). Storage time or temperature did not significantly affect TP concentration. Refractometric measurement of small volumes of synovial fluid in commercially available EDTA tubes leads to artificially elevated TP concentrations. Delays in sample analysis and alterations in storage conditions did not significantly affect TP concentration within the parameters studied. The magnitude of overestimation of synovial total protein concentration could result in misclassification of suspect synovial sepsis cases where EDTA tubes are used.

Synovial Fluid Metabolites Differentiate between Septic and Nonseptic Joint Pathologies.

Osteoarthritis (OA), osteochondrosis (OC), and synovial sepsis in horses cause loss of function and pain. Reliable biomarkers are required to achieve accurate and rapid diagnosis, with synovial fluid (SF) holding a unique source of biochemical information. Nuclear magnetic resonance (NMR) spectroscopy allows global metabolite analysis of a small volume of SF, with minimal sample preprocessing using a noninvasive and nondestructive method. Equine SF metabolic profiles from both nonseptic joints (OA and OC) and septic joints were analyzed using 1D 1H NMR spectroscopy. Univariate and multivariate statistical analyses were used to identify differential metabolite abundance between groups. Metabolites were annotated via 1H NMR using 1D NMR identification software Chenomx, with identities confirmed using 1D 1H and 2D 1H 13C NMR. Multivariate analysis identified separation between septic and nonseptic groups. Acetate, alanine, citrate, creatine phosphate, creatinine, glucose, glutamate, glutamine, glycine, phenylalanine, pyruvate, and valine were higher in the nonseptic group, while glycylproline was higher in sepsis. Multivariate separation was primarily driven by glucose; however, partial-least-squares discriminant analysis plots with glucose excluded demonstrated the remaining metabolites were still able to discriminate the groups. This study demonstrates that a panel of synovial metabolites can distinguish between septic and nonseptic equine SF, with glucose the principal discriminator.

Correlation Between Synovial Fluid Biomarker Concentrations and Bone Marrow Edema Lesion Volume in Patients with Acute ACL Ruptures

Objectives:Bone marrow edema lesions (BMELs) frequently occur following acute anterior cruciate ligament (ACL) rupture secondary to the pivot-shift mechanism of injury. The aim of the current study is to evaluate whether synovial fluid biomarker concentrations are associated with bone edema lesion volume as measured by magnetic resonance imaging (MRI) in patients undergoing ACL reconstruction.Methods:A total of 53 patients (26 females, 27 males, mean age 35.0 years [range 18-59]) undergoing ACL reconstruction with MRI knee scans available for analysis participated in the study. Synovial fluid was collected intra-operatively and analyzed for 10 biomarkers hypothesized to be involved in inflammation and post-traumatic osteoarthritis. BMELs were identified on MRI and their volumes (cm3) were quantified on two independent occasions using FireVoxel imaging software for image segmentation and region-of-interest drawing. The correlation between synovial fluid biomarker levels and BMEL volume was evaluated using Spearman’s correlation coefficient. Measurement reliability was assessed using intraclass correlation coefficient (ICC) analysis. Significance was set at p<0.05.Results:Mean time from initial injury to synovial fluid aspiration was 319 days (std. dev. 892; range 15-4320) and mean lesion volumes were: tibial=6.4 cm3 (range 0-38.6); femoral=5.8 cm3 (range 0-34.0); total=12.2 cm3 (range 0-50.5). Measurement reliability of BMEL volume was excellent [ICC(2,1)=0.968 (CI 0.945-0.981)]. Analysis of patients with MRI within 30 days of injury (n=35) showed increased tibial BMEL volume was significantly (p<0.05) correlated to decreased concentrations of interleukin (IL)-6 (ρ=-0.481), IL-1 receptor antagonist (ρ=-0.361), and vascular endothelial growth factor (VEGF) (ρ=-0.397) and increased time from injury to aspiration was correlated to decreased concentration of IL-6 (ρ=-0.463), monocyte chemotactic protein-1 (ρ=-0.453), VEGF (ρ=-0.457), IL-1Ra (ρ=-0.448), and matrix metalloproteinase (MMP)-3 (ρ=-0.426). However, among all patients, synovial fluid biomarker levels had no significant correlations to BMEL volume or time from injury to aspiration.Conclusion:Analysis of synovial fluid at the time of ACL reconstruction demonstrated that increased volume of injury-associated BMEL on MRI performed within 30 days of initial injury was significantly correlated to decreased concentrations of pro-inflammatory and growth factor cytokines. These findings suggest that the impact of the pivot-shift mechanism of injury and presence of BMEL may have an affect the local joint microenvironment.Table 1.Biomarker Values and Correlation with Bone Edema Lesion Size in Patients with MRI Within 30 Days of Initial InjuryNumber of samplesMean (pg/ml)Standard Deviation (pg/ml)Spearman correlation with lesion sizeTibiaFemoralTotalRANTES35591.071972.12-0.03-0.10-0.11IL-635177.69493.79 -0.48* 0.21-0.19MCP-135366.15213.50-0.310.17-0.12MIP-B3550.9885.41-0.180.12-0.03VEGF35328.79303.13 -0.39* 0.26-0.13TIMP135369909.29156363.48-0.070.10-0.05TIMP23593235.0296963.730.13-0.060.07IL-1Ra35418.071754.43 -0.36* 0.00-0.26MMP3353373710.563763593.71-0.130.310.04bFGF3548.4199.940.11-0.22-0.06*p<0.05

The clinical values of synovial volume measurement by MRI in patients with hemophilic arthropath receiving 32P radiation synovectomy

Objective To investigate the clinical value of eynovial membrane volume measurement by MRI in patients with hemophilic arthropathy receiving radionuclide synoviectomy. Methods Forty two patients, total 63 diseased joint, who hospitalized in the hemophilia diagnosis and treatment center of Henan Province People's Hospital were enrolled in the study after receiving both enhanced an non enhanded MRI, from May 2011 to January 2015. Sixteen patients (21 joints) were treated with 32P radionuclide synoviectomy (PRS) and followed up. The synovial membrane volume were evaluated by enhanced and non enhanded MRI before and after PRS. All data were analyzed by t test. Results The synovial membrane volume had no statistical difference by using the non enhanced (3 104.38±60.19)mm3 and enhanced (2 995.19±59.14)mm3 MRI scans (t=-1.369, P=0.191). The synovial membrane volume post PRS (2 479.45±46.48)mm3 much lower than that before PRS (2 983.30±42.87) mm3 (t=7.831, P=0.000). The magnetic resonance enhanced range after PRS (0.92±0.06) was significantly lower than that before treatment (1.17±0.07) (t=2.108, P=0.048). Conclusion Synovial membrane volume and magnetic resonance enhanced range are important index to predict clinical efficacy of PRS. Key words: Hemophilia; Osteoarthropathy, secondary hypertrophic; Clinical efficacy; Magnetic resonance imaging

Effect of vitamin d therapy on synovial tissue volume and bone marrow lesions in symptomatic knee osteoarthritis

Effect of vitamin d therapy on synovial tissue volume and bone marrow lesions in symptomatic knee osteoarthritis

Time required to achieve maximum concentration of amikacin in synovial fluid of the distal interphalangeal joint after intravenous regional limb perfusion in horses.

OBJECTIVE To determine the maximum concentration (Cmax) of amikacin and time to Cmax (Tmax) in the distal interphalangeal (DIP) joint in horses after IV regional limb perfusion (IVRLP) by use of the cephalic vein. ANIMALS 9 adult horses. PROCEDURES Horses were sedated and restrained in a standing position and then subjected to IVRLP (2 g of amikacin sulfate diluted to 60 mL with saline [0.9% NaCl] solution) by use of the cephalic vein. A pneumatic tourniquet was placed 10 cm proximal to the accessory carpal bone. Perfusate was instilled with a peristaltic pump over a 3-minute period. Synovial fluid was collected from the DIP joint 5, 10, 15, 20, 25, and 30 minutes after IVRLP; the tourniquet was removed after the 20-minute sample was collected. Blood samples were collected from the jugular vein 5, 10, 15, 19, 21, 25, and 30 minutes after IVRLP. Amikacin was quantified with a fluorescence polarization immunoassay. Median Cmax of amikacin and Tmax in the DIP joint were determined. RESULTS 2 horses were excluded because an insufficient volume of synovial fluid was collected. Median Cmax for the DIP joint was 600 μg/mL (range, 37 to 2,420 μg/mL). Median Tmax for the DIP joint was 15 minutes. CONCLUSIONS AND CLINICAL RELEVANCE Tmax of amikacin was 15 minutes after IVRLP in horses and Cmax did not increase > 15 minutes after IVRLP despite maintenance of the tourniquet. Application of a tourniquet for 15 minutes should be sufficient for completion of IVRLP when attempting to achieve an adequate concentration of amikacin in the synovial fluid of the DIP joint.

Clinical utility of eco-color-power Doppler ultrasonography and contrast enhanced magnetic resonance imaging for interpretation and quantification of joint synovitis: a review.

With the introduction of new biologics such as anti-TNF-alpha antibodies and other therapies in the treatment of inflammatory arthritis, capable of halting joint destruction and functional disability, there are new pressures on diagnostic and prognostic imaging. Early demonstration of pre-erosive inflammatory features and monitoring of the long-term effects of treatment are becoming increasingly important. Early detection of synovitis offers advantages in terms of allowing early instigation of therapy and may allow the identification of those patients displaying more aggressive disease who might benefit from early intervention with expensive DMARD therapy. Advanced imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) have focussed on the demonstration and quantification of synovitis and allow early diagnosis of inflammatory arthropathies such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Synovitis represents a potential surrogate measure of disease activity that can be monitored using either MRI or US; the techniques have, generally, focused on monitoring synovial volume or quality as assessed by its vascularity. However to achieve these goals, standardisation and validation of US and MRI are required to ensure accurate diagnosis, reproducibility and reliability. Each modality has different strengths and weaknesses and levels of validation. This article aims to increase the awareness of radiologists and rheumatologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses the role of US and colour or power Doppler sonography (PDUS) in the detection and monitoring of synovitis in inflammatory arthropathies. The second part will look at advanced MR imaging and Dynamic contrast-enhanced MRI techniques and in particular how they are applied to the monitoring of the disease process. (www.actabiomedica.it)

Expression of inflammatory and structural matrix genes in synovial fluid following intra-articular administration of isoflupredone acetate to exercised horses.

Intra-articular use of corticosteroids is commonplace in performance horses. Isoflupredone acetate (IPA) is one of four Food and Drug Administration approved corticosteroids for intra-articular use in horses. The lack of published reports describing the efficacy and duration of effects of this drug warrant further study. To assess the effects of intra-articular administration of IPA on the expression of selected anti- and pro-inflammatory and structural matrix genes following intra-articular administration to exercised Thoroughbred horses and to correlate these effects with drug concentrations. Block design in vivo experiment. Twelve exercised horses received either a single intra-articular administration of 8 mg of IPA or 0.9% saline solution. Synovial fluid samples were collected prior to and up to 42 days post drug administration from the treated joints. Microarray and qRT-PCR analysis were used to assess changes in expression levels of various inflammatory and structural genes post drug administration. On microarray analysis, 855, 23,358 and 26,411 genes had a measurable fold change (increase or decrease in expression levels) when comparing baseline samples to 24 h, baseline samples to day 7 and 24 h samples to day 7, respectively. Of the genes selected for further study by qRT-PCR analysis, expression of ANXA-1 (lipocortin) was significantly increased and IL23A and MMP1 and MMP9 significantly decreased following IPA administration. Expression levels of collagen genes were not significantly different from baseline. Limitations include the use of a noninflammatory model as results may differ in the presence of an acute inflammatory insult and the inability to measure protein concentrations of inflammatory mediators due to limited synovial fluid sample volume. Expression relative to baseline, for both inflammatory and matrix genes for up to 42 days post IPA administration, suggests a prolonged effect relative to detection time in both plasma and synovial fluid.

Autologous bioscaffolds based on different concentrations of platelet rich plasma and synovial fluid as a vehicle for mesenchymal stem cells.

In the field of tissue engineering, diverse types of bioscaffolds are being developed currently for osteochondral defect applications. In this work, a novel scaffold based on platelet rich plasma (PRP) and hyaluronic acid with mesenchymal stem cells (MSCs) has been evaluated to observe its effect on immobilized cells. The bioscaffolds were prepared by mixing different volumes of synovial fluid (SF) with PRP from patients obtaining three formulations at PRP-SF ratios of 3:1, 1:1 and 1:3 (v/v). The live/dead staining revealed that although the cell number of each type of bioscaffold was different, these this constructs provide cells with a suitable environment for their viability and proliferation. Moreover, immobilized MSCs showed their ability to secrete fibrinolytic enzymes, which vary depending on the fibrin amount of the scaffold. Immunohistochemical analysis revealed the positive staining for collagen type II in all cases, proving the biologic action of SF derived MSCs together with the suitable characteristics of the bioscaffold for chondrogenic differentiation. Considering all these aspects, this study demonstrates that these cells-based constructs represent an attractive method for cell immobilization, achieving completely autologous and biocompatible scaffolds. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 377-385, 2018.

Microwave Heating of Crystals with Gold Nanoparticles and Synovial Fluid under Synthetic Skin Patches.

Gout is a disease with elusive treatment options. Reduction of the size of l-alanine crystals as a model crystal for gouty tophi with the use of a monomode solid-state microwave was examined as a possible therapeutic aid. The effect of microwave heating on l-alanine crystals in the presence of gold nanoparticles (Au NPs) in solution and synovial fluid (SF) in a plastic pouch through a synthetic skin patch was investigated. In this regard, three experimental paradigms were employed: Paradigm 1 includes the effect of variable microwave power (5–10 W) and variable heating time (5–60 s) and Au NPs in water (20 nm size, volume of 10 μL) in a plastic pouch (1 × 2 cm2 in size). Paradigm 2 includes the effect of a variable volume of 20 nm Au NPs in a variable volume of SF up to 100 μL in a plastic pouch at a constant microwave power (10 W) for 30 s. Paradigm 3 includes the effect of constant microwave power (10 W) and microwave heating time (30 s), constant volume of Au NPs (100 μL), and variable size of Au NPs (20–200 nm) placed in a plastic pouch through a synthetic skin patch. In these experiments, an average of 60–100% reduction in the size of an l-alanine crystal (initial size = 450 μm) without damage to the synthetic skin or increasing the temperature of the samples beyond the physiological range was reported.

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

BackgroundBraces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.MethodOne hundred twenty-six men and women aged 40–70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts’s equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman’s correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.ResultsMean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA − 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.ConclusionThe reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.Trial registrationTrial registration number UK. ISRCTN50380458/Registered 21.5.2010.

Corrigendum to "Synovial volume vs synovial measurements from dynamic contrast enhanced MRI as measures of response in osteoarthritis" [Osteoarthritis Cartilage 24 (2016) 1392-1398

© 2017 We have been notified by the authors that there was an error in the second sentence of the paragraph headed ‘Image analysis: segmentation’ on p. 1394 of the above article. The term interobserver should have been intraobserver. The correct sentence is as follows: Manual segmentation of the synovial tissue layer was performed on these sagittal post-contrast knee images by a single observer (intraobserver ICC = 0.94), who assessed baseline and follow-up visit MR images paired, but blinded to order. The authors would like to apologise for any inconvenience caused.

Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis

BackgroundThe aim was to examine if structural factors could affect response to intra-articular steroid injections (IASI) in knee osteoarthritis (OA).MethodPersons with painful knee OA participated in an open-label trial of IASI where radiographic joint space narrowing (JSN) and Kellgren-Lawrence (KL) grade, whole-organ magnetic resonance imaging (MRI) scores (WORMS) and quantitative assessment of synovial tissue volume (STV) were assessed on baseline images. Participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a question about knee pain with a visual analogue scale for pain during nominated activity (VASNA), and Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess responder status within 2 weeks (short term) and 6 months (longer term). Regression models were used to examine predictors of short and longer term response to IASI.ResultsSubjects (n = 207) attended and had IASI. Information on responder status was available on 199 participants. Of these, 188 subjects, mean age 63.2 years (standard deviation (SD) 10.3), 97 (51.6%) female, had x-rays and 120 had MRI scans available. Based on the OMERACT-OARSI criteria, 146 (73.4%) participants responded to therapy and 40 (20.1%) were longer term responders. A few factors were associated with a reduced KOOS-pain and VASNA response though none were associated with OMERACT-OARSI responder status in the short term. Higher MRI meniscal damage (odds ratio (OR) = 0.74; 95% CI 0.55 to 0.98), increasing KL maximal grade (OR = 0.43; 95% CI 0.23 to 0.82) and joint space narrowing (JSN) maximal score (OR = 0.60; 95% CI 0.36 to 0.99) were each associated with a lower odds of longer term responder status. Baseline synovitis was not associated with treatment response. The predicted probability of longer term response decreased from 38% to 12% as baseline maximal JSN increased from grade 0 to 3.ConclusionCompared with those who have mild structural damage, persons with more severe knee damage on either MRI or x-ray are less likely to respond to knee IASI.Trial registrationISRCTN.com, ISRCTN07329370. Registered 21 May 2010. Retrospectively registered

The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis

Knee pain is commonly seen in orthopedic and rehabilitation outpatient clinical settings. Patients with knee osteoarthritis (OA) are often complicated with joint soreness, swelling, weakness, and pain. These complaints are often caused by the excessive amount of synovial fluid (SF) accumulated in the bursae around the knee joint. This study was aimed to evaluate the effectiveness of platelet rich plasma (PRP) in treating patients with minor to moderate knee osteoarthritis (OA) combined with supra-patellar bursitis using a proteomic approach and clinical evaluation tool. In this study, 24 elderly patients with minor to moderate knee OA combined with supra-patellar bursitis were recruited. Musculoskeletal ultrasound was used for accurate needle placement for the aspiration of SF followed by subsequent PRP injections. Three monthly PRP injections were performed to the affected knees for a total of 3months. Approximately after the 2nd PRP injection, significant decreases in SF total protein concentrations, volumes, and Lequesne index values were observed. SF proteins associated with chelation and anti-aging physiological functions such as matrilin, transthyretin, and complement 5 increased at least 2-fold in concentrations. Proteins associated with inflammation, such as apolipoprotein A-I, haptoglobin, immunoglobulin kappa chain, transferrin, and matrix metalloproteinase decreased at least 2-fold in concentrations. Therefore, at least two monthly PRP injections may be beneficial for treating patients with minor to moderate knee OA combined with supra-patellar bursitis.

Therapeutic response of radiosynovectomy with p-32 colloid in 326 patients with hemophilic arthropathy

目的观察32P-胶体滑膜切除术治疗血友病性关节病的疗效，并评估MRI Denver评分对血友病性关节病进行分期的临床意义。方法对326例血友病患者的405个关节进行32P-胶体滑膜切除术治疗，根据MRI表现对102个关节进行Denver评分并比较0~6分和7~10分组临床疗效的差异，观察29个膝关节治疗前后滑膜体积变化。结果①全部326例血友病性关节病患者治疗前的疼痛评分为（3.2±2.4）分，治疗后6个月及1、2、3年分别为（1.2±0.6）分（285例）、（1.7±0.5）分（242例）、（2.1±1.1）分（212例）、（2.2±1.6）分（176例），均低于治疗前（P值分别为0.021、0.032、0.030、0.037）。②全部326例血友病患者治疗前的出血频次为（15.1±3.6）次/年，治疗后1、2、3年分别为（2.1±0.7）、（4.3±0.6）、（4.8±0.8）次/年，均低于治疗前（P值分别为0.016、0.011、0.025）。③治疗后6个月及1、2、3年靶关节活动度明显改善的比例分别为68.50%（248/362）、58.39%（181/310）、55.67%（162/239），42.61%（75/176）；Denver评分0~6分组治疗后6个月、1年和2年的HSS评分均高于7~10分组（P值分别为0.011、0.007、0.026）。④Denver评分0~6分组（45个靶关节）治疗前出血频次为（13.0±1.9）次/年，治疗后1、2年分别为（1.3±0.6）、（3.1±0.9）次/年，均低于治疗前（P值分别为0.002、0.009）；Denver评分7~10分组（57个靶关节）治疗前出血频次为（16.6±2.1）次/年，治疗后1、2年分别为（3.1±0.9）、（5.7±1.1）次/年，均低于治疗前（P值分别为0.008、0.004）。Denver评分7~10分组治疗前出血频次与0~6分组差异无统计学意义（P=0.773），治疗后1、2年均高于0~6分组（P值分别为0.028、0.042）。⑤29个膝关节治疗后6个月滑膜体积小于治疗前[（2 362.15±32.41）mm3对（3 012.40±39.78）mm3，t=7.621，P<0.001]。结论32P-胶体滑膜切除术治疗血友病性关节病安全有效。Denver评分0~6分的患者行滑膜切除术治疗效果更佳。

Brief Report: Synovial Fluid White Blood Cell Count in Knee Osteoarthritis: Association With Structural Findings and Treatment Response.

ObjectivesOsteoarthritis (OA) is a disease with a significant inflammatory component. The aim of this analysis was to determine the relationship between synovial fluid white cell count (SF WCC) and two parameters: disease severity and the reduction in knee pain after intra-articular steroid injection.MethodsSubjects with painful knee OA were recruited for participation in an open label study of intra-articular steroid therapy. Information was obtained about knee pain using the KOOS questionnaire and a proportion of subjects had magnetic resonance imaging (MRI) performed. Prior to injection with methylprednisolone acetate (80mg), the index knee joint was aspirated and the fluid obtained forwarded for assessment of SF WCC.ResultsInformation on SF WCC was available in 55 subjects. An increase in white cell count category (< 100, 101–250 and > 250–1,000 cells/mm3) was associated with an increase in synovial tissue volume (p = 0.028) and with other MRI-based measures of disease severity. Also, with each category increase in SF WCC there was a greater mean reduction in KOOS pain score after steroid injection; ≤100 cells/mm3 12.5 (SD 19.9) [referent], 101–250 cells/mm3 21.3 (SD 20.6) [β coefficient 0.279 p=0.049 ] and 251–1000 cells/mm3 29.3 (SD 15.2) [β coefficient 0.320 p=0.024].ConclusionAlthough within the ‘normal’ range, total synovial fluid white cell count appears to be a biomarker for MRI synovitis and may also predict response to anti-inflammatory treatment.

MRI, Retrieval Analysis, and Histologic Evaluation of Adverse Local Tissue Reaction in Metal-on-Polyethylene Total Hip Arthroplasty

BackgroundThe severity and location of adverse local tissue reaction (ALTR) seen in metal-on-polyethylene total hip arthroplasty (THA) is not well described. MethodsWe retrospectively reviewed the records of patients who underwent a revision THA using our biomechanics database. We included all patients who underwent revision surgery for the diagnosis of ALTR with THA implants that had modularity solely at the head-neck junction and excluded patients with implant modularity at sites other than the head-neck junction. Magnetic resonance imaging (MRI) was evaluated by a fellowship-trained radiologist who specializes in evaluating metal artifact reducing MRI sequences to quantify the ALTR lesions. Histology was evaluated for findings of ALTR using the Campbell score. ResultsWe identified 11 patients in the database. Eight patients had an MRI ALTR grade of severe and 7 did based on the histology score. The mean synovial volume was 218,658 mm3 (range 23,461-451,435 mm3) with a mean maximal synovial thickness of 15.3 mm (range 3-34.3 mm). A disruptive infiltration of the abductors due to pseudocapsule invasion was seen in 67% of the patients with 3 not having abductor involvement. Mean preoperative cobalt and chromium levels were 5.4 ppb (range 1-12.3 ppb) and 1.1 ppb (range 0.6-2.4 ppb), respectively. ConclusionPatients with ALTR from head-neck junction corrosion in metal-on-polyethylene THA may present with large pseudotumors that have previously been under appreciated. Mean preoperative serum cobalt and chromium ion levels remained relatively low, and MRI was an effective way to characterize the size and location of these lesions.

Are changes in synovial fluid volume or distribution a determinant of biomechanical effects of passive joint movements?

Objectives: Biomechanical mechanisms underlying passive joint techniques commonly used in musculoskeletal medicine such as mobilization and manipulation are largely unknown. We aimed to visualize a...

Comparison between semiquantitative and quantitative methods for the assessment of knee synovitis in osteoarthritis using non-enhanced and gadolinium-enhanced MRI

To compare different semiquantitative and quantitative methods using both non-enhanced and gadolinium-enhanced MRI techniques for the assessment of synovitis in knee osteoarthritis (OA). Knees with end-stage clinical OA in patients undergoing total knee replacement surgery were included in this cross-sectional study. MRI was performed on all knees. Standard non-enhanced and gadolinium-enhanced sequences were acquired. Using non-enhanced MRI, we semiquantitatively assessed two features widely used as surrogates for synovitis: effusion-synovitis and Hoffa-synovitis. Using gadolinium-enhanced sequences, we semiquantitatively assessed synovial thickness. We quantitatively evaluated the total synovial volume on the gadolinium-enhanced sequences as well. We assessed the correlations of effusion-synovitis and Hoffa-synovitis with synovial thickness and volume, applying Spearman correlation analysis. The diagnostic performance of both synovitis features on non-enhanced MRI was assessed using synovial thickness on gadolinium-enhanced MRI as the reference. A total of 104 subjects (one knee per subject) were included. Correlations of effusion-synovitis with synovial thickness and volume were r=0.41 and r=0.43 (P < .001) r = 0.32 and r = 0.39 (P<.0001). Using synovial thickness assessed on gadolinium-enhanced sequences as the reference, effusion-synovitis showed superior correlations and sensitivity. Effusion-synovitis should be preferred over Hoffa-synovitis as a surrogate marker for synovial thickening, in studies of knee OA for which gadolinium-enhanced sequences are not available.