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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Traction on wrist and metacarpophalangeal joints during radiography produces 'vacuum phenomenon' due to the release of intra-articular gas. The resultant pneumoarthrogram clearly portrays the articular cartilage. Manual traction radiography of the wrist and the metacarpophalangeal joints has the following potential uses. 1. Detection of joint effusion; increased interosseous space during traction without release of intraarticular gas is indicative of joint disease with effusion. 2. Separation of the carpal bones; the traction separates the carpal bones and allows evaluation. 3. Differentiation of arthralgia from arthritis. 4. Evaluation of midcarpal, radiocarpal compartments, and the metacarpophalangeal joints can be performed before the secondary ossification centers are ossified. 5. Evaluation of the integrity of the joint cartilage.
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PMID:The value of traction during roentgenography of the wrist and metacarpophalangeal joints. 51 48

We have examined the nature of some mononuclear cells from inflamed synovial membranes of patients with rheumatoid arthritis. It was found that cells which remained in the supernatant medium after overnight culture of trypsinized tissue contained a variable number of lymphocytes which were shown to be T cells by rosetting and mitogen response. This suggests a source of T cell lymphokines with an effect on macrophages and thus a role in the maintenance of inflammation. Another role for mononuclear cells is suggest by the cytotoxicity of blood mononuclear cells directed against cultured synovial cells. This was found to occur in an autologous system using fibroblasts from rheumatoid synovium, but was not specific for rheumatoid arthritis. Stimulatory factors from rheumatoid joint effusion macrophages for blood lymphocytes were sought, but although blast transformation occurred, the results were equivocal. In this communication we set out to examine the nature of lymphoid cells in the synovial membrane and the role which they may play in the pathogenesis of chronic inflammation. We also briefly consider cell-mediated mechanisms of tissue injury. Since an active role of lymphoid cells pre-supposes the presence of an agent or agents which serve to stimulate them, we also report some recent attempts to find evidence for this. One of the striking histological features of the inflamed synovial tissue in rheumatoid arthritis, but also in some other forms of chronic arthritis, is the presence of lymphocytes and plasma cells. Immunofluorescent studies and organ culture studies have shown the presence and synthesis of immunoglobulins, predominantly the domain of plasma cells. The production of immunoglobulins, formation of complexes and activation of complement is a major factor in pathogenesis, but lymphocytes may also have a direct role through the production of lymphokines. Until recently these substances have been attributed to T lymphocytes, but Rocklin et al. (1) have recently shown that B cells may also be involved in certain experimental circumstances. The availability of synovectomy specimens from patients with rheumatoid arthritis has enabled us to examine the nature of lymphoid cells from synovial membranes. (This part of the work is reported fully elsewhere.
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PMID:Some cellular aspects of chronic inflammation in joint disease. 108 94

The mechanisms involved in juxta-articular bone destruction are poorly understood. Osteocalcin or gamma-carboxyglutamic acid (GLA) protein is a small non-collagenous bone protein. It is a sensitive marker of osteoblastic bone formation. Its seric variations in the serum in such rheumatisms as rheumatoid arthritis remain unclear. Further information on local osteoblastic activity may be obtained by assaying the level of osteocalcin in the synovium. Its serum level can be evaluated by radioimmunoassay. The same method can be used in the synovial fluid. Paired serum and synovial fluid samples have been assayed from 63 patients, 33 patients with inflammatory arthritis (rheumatoid arthritis, psoriasis, chondrocalcinosis, pyogenic arthritis) and 30 patients with mechanical joint effusion (osteoarthritis, meniscal lesions). Serum levels of osteocalcin were the same in the inflammatory group (m: 8.69 +/- 0.68 ng/ml) and in the mechanical group (m: 10.2 +/- 0.67 ng/ml). In the synovial fluid, the levels of osteocalcin were significantly lower in the inflammatory group (m: 3.27 +/- 0.40 ng/ml) than in the mechanical group (m: 6.91 +/- 0.47 ng/ml). The same results were obtained with the ratio of synovial fluid osteocalcin on serum osteocalcin. There was a significant correlation between serum and synovial fluid osteocalcin and an inverse correlation between synovial fluid osteocalcin and the number of synovial fluid cells. The present study suggests that periarticular osteoblastic depression, among patients with inflammatory arthritis, is likely.
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PMID:Serum and synovial fluid osteocalcin in rheumatic diseases. 147 75

Diagnostic criteria for bacterial suppurative arthritis include the demonstration of an inflammatory exudate by aspiration of synovial fluid and the isolation of bacteria from cultures of synovial fluid and/or blood. Clinical manifestations include joint effusion, swelling, tenderness, and pain, with or without redness of the overlying skin. Management consists of antimicrobial therapy, measures designed to relieve symptoms, surgical drainage of infected fluid, and physical therapy. Studies of new anti-infective therapy should be limited to cases of bacterial origin. Prospective, randomized, double-blind, or evaluator-blinded, active-control comparative clinical trials should be performed. Clinical response is characterized as success (cure), failure, or indeterminate outcome. The most common successful microbiological outcome is presumptive eradication. Follow-up should continue for 1 year before the final assessment.
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PMID:Evaluation of new anti-infective drugs for the treatment of acute suppurative arthritis in children. Infectious Diseases Society of America and the Food and Drug Administration. 147 26

Osteoid-osteoma is a frequent benign tumor of the bone. In cases with peri- or intraarticular localisation symptoms suggestive of arthritis may occur. We report on a 25-year-old patient with a painful hip during exercise as well as in the night. Conventional radiographs were unremarkable. However, ultrasound and computertomography revealed joint effusion of the hip. Scintigraphic and tomographic findings were compatible with an osteoid osteoma. Histology of the surgically removed tumor confirmed this diagnosis. Moreover, a lympho-follicular synovitis was found.
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PMID:[Intra-articular osteoid osteoma: a rare cause of coxitis]. 187 43

Of 400 patients with brucellosis, 104 (26%) had arthritis, of whom 96 could be followed up. The systemic disease in the 96 patients was acute in 54 (56%), subacute in 24 (25%), and chronic in 18 (19%). The main presenting symptoms were joint pain, fever, sweating, and easy fatigability. The joints most commonly affected were the sacroiliac joint (26%) and knee (25%) followed by hip (18%) and spine (8%). There was no particular pattern of joint affection in relation to age. Joint effusion occurred in 32/104 (30%) of cases, predominantly (94%) in the acute group. Culture of synovial fluid was negative in all, and analysis of synovial fluid for cellular profile, glucose, and protein content was not particularly helpful in diagnosis. Plain radiographs did not show major pathological changes. Among the laboratory tests, including haematological and liver function tests, the brucella enzyme linked immunosorbent assay (ELISA) was the most reliable in the diagnosis of disease, using serum and synovial fluid specimens. Treatment with a combination of streptomycin plus tetracyclines or rifampicin resulted in an excellent cure rate and resolution of arthritis without sequelae or mortality. Thus brucellosis should be considered in the differential diagnosis of arthritis, especially in areas in which the disease is endemic.
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PMID:Brucella arthritis: a study of 96 cases in Kuwait. 227 Sep 73

Magnetic resonance imaging (MRI) permits visualization of anatomic structures not appreciated by conventional radiographic imaging and may quantify inflammatory disease and its progression with greater sensitivity than available techniques. We therefore compared MRI with clinical evaluation and with radiographic examination of 17 patients with inflammatory arthritis of the knee. We sought to determine anatomic integrity of bone, cartilage, menisci, and ligaments, and to quantify joint effusion and synovial proliferation. Patients studied had rheumatoid arthritis (10 patients), juvenile rheumatoid arthritis (4 patients), ankylosing spondylitis (1 patient), and monoarticular arthritis (2 patients). In all patients MRI revealed clinically important abnormalities not detected by physical or conventional radiographic exams. These included proliferative synovitis (13 patients), cartilage thinning (2 patients), cartilage erosion (8 patients), bone infarction (1 patient), meniscal injury (1 patient), and synovial invagination into bone (1 patient). Also MRI indicated inflammatory disease to be quantitatively greater than had been appreciated on clinical examination or routine X-ray studies--proliferative synovitis (12 patients), erosion (7 patients), effusion (8 patients), cartilage thinning (11 patients), and ligamentous/meniscal damage (1 patient). These findings led to reassessment of anatomic staging and influenced therapeutic decision for these patients. Thus MRI provides clinically important information about joint integrity and inflammatory disease, with a sensitivity and resolution considerably beyond conventional techniques.
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PMID:Magnetic resonance imaging in patients with inflammatory arthritis of the knee. 233 54

Increased intraarticular hydrostatic pressure (Pia) may inhibit juxtaarticular muscle function, obstruct blood supply to joint structures and promote anoxic joint destruction in chronic arthritis. Joint capsular stiffness together with synovial fluid volume determines Pia at rest. Seventeen knee joints with effusive arthritis and different degrees of radiological cartilage involvement in 13 patients with chronic arthritis were examined. Since capsular elastance was difficult to standardize, we introduce a measure of joint capsular stiffness where the intraarticular volume yielding a pressure of 50 mm Hg (V50) is used. After normalization of injected volumes according to the V50, pressure volume curves became similar. Intraarticular hydrostatic pressure and maximal voluntary isometric extensor torque were measured simultaneously, while altering the intraarticular fluid volume in 9 knee joints. In 5 of these, quantified electromyography (EMG) of the vastus medialis and lateralis portion of the quadriceps muscle was also monitored. Progressive inhibition of extensor torque and EMG was found as the intraarticular pressure volume was increased in both intact and destroyed joints. No difference in inhibition was found for the 2 portions of quadriceps muscle tested. Increased intraarticular hydrostatic pressure Pia levels between 200 and 1150 mm Hg were observed during maximal voluntary activation of extensor muscles. The reproducibility was good for all variables studied. In a few instances evidence of intraarticular compartmentalization was found at low volumes. We conclude that the V50 is a convenient expression of capsular stiffness. Furthermore, increasing Pia caused by joint effusion inhibits knee extensor muscle function and impairs synovial blood flow. Awareness of these relations will facilitate more rational therapeutic approaches in chronic arthritis.
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PMID:Joint capsular stiffness in knee arthritis. Relationship to intraarticular volume, hydrostatic pressures, and extensor muscle function. 281 Feb 60

We describe seven patients with primary HOA and review 125 cases reported in the English, French, and German literature. The salient clinical features of primary HOA are: a bimodal distribution of disease onset with one peak during the first year of life and the other at age 15, a male predominance (nine to one), uncommon benign joint effusion, and a variety of skin abnormalities resulting from cutaneous hypertrophy or glandular dysfunction. We concluded that HOA is not a synovial disease. It is suggested that synovial effusions, when present, are perhaps a sympathetic reaction to the neighboring periostitis. Proposed diagnostic criteria for HOA, including digital clubbing and radiographic periostitis, appear 86% sensitive. The clinical features, age of onset, and sex distribution suggest that a genetically controlled growth promoting factor, different from growth hormone, plays a role in the pathogenesis of this syndrome.
Semin Arthritis Rheum 1988 Feb
PMID:Primary hypertrophic osteoarthropathy. 307 78

Five normal knees and 20 knees with suspected abnormalities involving the menisci or articular surfaces were examined with high-resolution surface-coil MRI. Surgical correlation was available in 15 cases. Signal-to-noise ratios were optimized using a field strength of 1.5 T and a round 7.6-cm surface coil. Spatial resolution was maximized by using fields of view reduced to as small as 8 cm. Separate examinations of the medial and lateral joint compartments were performed with the surface coil positioned vertically adjacent to the meniscus of interest. Ten meniscal tears were identified using sagittal and coronal images. T1-weighted images were adequate to detect most meniscal tears, and T2-weighted images were useful for providing an "arthrogram effect" in the presence of a joint effusion. Extrameniscal lesions that were examined included osteonecrosis of the femoral condyle, subchondral cysts, rheumatoid arthritis, degenerative arthritis, and anterior cruciate ligament tears. MRI was useful in determining the integrity of articular cartilage overlying defects in the subchondral bone and in detecting gross cartilage lesions in arthritis, but was less sensitive than arthroscopy in evaluating moderate changes in the hyaline cartilage.
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PMID:1.5-T surface-coil MRI of the knee. 348 47


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