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The Veterinary Clinics of North... Jul 2022Indications for injecting synovial joints may include diagnostic, therapeutic, or combination. Diagnostic injectates aim to reduce or eliminate the contribution of pain... (Review)
Review
Indications for injecting synovial joints may include diagnostic, therapeutic, or combination. Diagnostic injectates aim to reduce or eliminate the contribution of pain to lameness and may be assessed both subjectively or objectively by the clinician. Diagnostic joint injections are not specific for a disease and their limitations must be remembered when interpreting a response-including false-negative results. Patient selection and sterile technique throughout the procedure minimize adverse effects. Risks of intra-articular (IA) injections may include transient soreness, cartilage damage, and, rarely, septic arthritis. Ultrasound guidance with a trained clinician may provide further benefits including the reduction of periprocedural discomfort, reduction in iatrogenic cartilage damage during needle insertion, and improvement in synovial fluid feedback. The removal of some synovial fluid before administering an IA injection should be considered to confirm needle placement, provide diagnostic sampling, and help accommodate injectate volume.
Topics: Animals; Injections, Intra-Articular; Joints; Synovial Fluid; Ultrasonography
PubMed: 35562222
DOI: 10.1016/j.cvsm.2022.02.004 -
Immunological Reviews Jul 2021Rheumatoid arthritis is an immune-mediated inflammatory disease in which fibroblasts contribute to both joint damage and inflammation. Fibroblasts are a major cell... (Review)
Review
Rheumatoid arthritis is an immune-mediated inflammatory disease in which fibroblasts contribute to both joint damage and inflammation. Fibroblasts are a major cell constituent of the lining of the joint cavity called the synovial membrane. Under resting conditions, fibroblasts have an important role in maintaining joint homeostasis, producing extracellular matrix and joint lubricants. In contrast, during joint inflammation, fibroblasts contribute to disease pathology by producing pathogenic levels of inflammatory mediators that drive the recruitment and retention of inflammatory cells within the joint. Recent advances in single-cell profiling techniques have transformed our ability to examine fibroblast biology, leading to the identification of specific fibroblast subsets, defining a previously underappreciated heterogeneity of disease-associated fibroblast populations. These studies are challenging the previously held dogma that fibroblasts are homogeneous and are providing unique insights into their role in inflammatory joint pathology. In this review, we discuss the recent advances in our understanding of how fibroblast heterogeneity contributes to joint pathology in rheumatoid arthritis. Finally, we address how these insights could lead to the development of novel therapies that directly target selective populations of fibroblasts in the future.
Topics: Arthritis, Rheumatoid; Fibroblasts; Humans; Inflammation; Inflammation Mediators; Synovial Membrane
PubMed: 34096076
DOI: 10.1111/imr.12986 -
Sports Medicine and Arthroscopy Review Mar 2021There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip... (Review)
Review
There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.
Topics: Arthroscopy; Biomechanical Phenomena; Hip Injuries; Hip Joint; Humans; Joint Capsule; Joint Diseases; Range of Motion, Articular
PubMed: 33395226
DOI: 10.1097/JSA.0000000000000272 -
Stem Cells Translational Medicine Aug 2019Patients with late-stage Kellgren-Lawrence knee osteoarthritis received a single intra-articular injection of 1, 10, or 50 million bone marrow mesenchymal stromal cells...
Patients with late-stage Kellgren-Lawrence knee osteoarthritis received a single intra-articular injection of 1, 10, or 50 million bone marrow mesenchymal stromal cells (BM-MSCs) in a phase I/IIa trial to assess safety and efficacy using a broad toolset of analytical methods. Besides safety, outcomes included patient-reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); contrast-enhanced magnetic resonance imaging (MRI) for cartilage morphology (Whole Organ MRI Scores [WORMS]), collagen content (T2 scores), and synovitis; and inflammation and cartilage turnover biomarkers, all over 12 months. BM-MSCs were characterized by a panel of anti-inflammatory markers to predict clinical efficacy. There were no serious adverse events, although four patients had minor, transient adverse events. There were significant overall improvements in KOOS pain, symptoms, quality of life, and WOMAC stiffness relative to baseline; the 50 million dose achieved clinically relevant improvements across most PROMs. WORMS and T2 scores did not change relative to baseline. However, cartilage catabolic biomarkers and MRI synovitis were significantly lower at higher doses. Pro-inflammatory monocytes/macrophages and interleukin 12 levels decreased in the synovial fluid after MSC injection. The panel of BM-MSC anti-inflammatory markers was strongly predictive of PROMs over 12 months. Autologous BM-MSCs are safe and result in significant improvements in PROMs at 12 months. Our analytical tools provide important insights into BM-MSC dosing and BM-MSC reduction of synovial inflammation and cartilage degradation and provide a highly predictive donor selection criterion that will be critical in translating MSC therapy for osteoarthritis. Stem Cells Translational Medicine 2019;8:746&757.
Topics: Biomarkers; Bone Marrow Cells; Cartilage; Cells, Cultured; Female; Humans; Joint Capsule; Male; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Middle Aged; Osteoarthritis, Knee; Quality of Life; Synovitis; Treatment Outcome
PubMed: 30964245
DOI: 10.1002/sctm.18-0183 -
Physical Medicine and Rehabilitation... Nov 2021In this article, the literature describing the origin, course, and termination of the nerves innervating the ankle joint is reviewed and discussed. The anterior aspect... (Review)
Review
In this article, the literature describing the origin, course, and termination of the nerves innervating the ankle joint is reviewed and discussed. The anterior aspect of the joint capsule receives innervation from articular branches from the saphenous, superficial, and deep fibular nerves; laterally from the sural and superficial fibular nerves; and medially and posteriorly from the saphenous and tibial nerves. Comprehensive mapping of the trajectory, spatial relationships, and termination of the articular branches innervating the ankle joint capsule will aid in developing new and improving existing image-guided nerve block and radiofrequency ablation protocols to treat chronic joint pain.
Topics: Ankle Joint; Humans; Joint Capsule; Nerve Block; Tibial Nerve
PubMed: 34593144
DOI: 10.1016/j.pmr.2021.05.013 -
Frontiers in Endocrinology 2023Osteoarthritis (OA) is a disabling disease with significant morbidity worldwide. OA attacks the large synovial joint, including the peripheral joints and... (Review)
Review
Osteoarthritis (OA) is a disabling disease with significant morbidity worldwide. OA attacks the large synovial joint, including the peripheral joints and temporomandibular joint (TMJ). As a representative of peripheral joint OA, knee OA shares similar symptoms with TMJ OA. However, these two joints also display differences based on their distinct development, anatomy, and physiology. Extracellular vesicles (EVs) are phospholipid bilayer nanoparticles, including exosomes, microvesicles, and apoptotic bodies. EVs contain proteins, lipids, DNA, micro-RNA, and mRNA that regulate tissue homeostasis and cell-to-cell communication, which play an essential role in the progression and treatment of OA. They are likely to partake in mechanical response, extracellular matrix degradation, and inflammatory regulation during OA. More evidence has shown that synovial fluid and synovium-derived EVs may serve as OA biomarkers. More importantly, mesenchymal stem cell-derived EV shows a therapeutic effect on OA. However, the different function of EVs in these two joints is largely unknown based on their distinct biological characteristic. Here, we reviewed the effects of EVs in OA progression and compared the difference between the knee joint and TMJ, and summarized their potential therapeutic role in the treatment of OA.
Topics: Humans; Osteoarthritis; Temporomandibular Joint; Extracellular Vesicles; Synovial Membrane; Synovial Fluid
PubMed: 36950682
DOI: 10.3389/fendo.2023.1158744 -
Journal of Visualized Experiments : JoVE Feb 2022Arthrocentesis of the knee is a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. An arthrocentesis can be diagnostic or...
Arthrocentesis of the knee is a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. An arthrocentesis can be diagnostic or therapeutic. Synovial fluid may be removed for testing to determine the nature of the knee effusion. If septic arthritis is suspected, urgent arthrocentesis before initiation of antibiotic treatment is indicated. Moreover, arthrocentesis can also aid in diagnosing crystal-induced arthritis such as gout or pseudogout, or non-inflammatory arthritis such as osteoarthritis. Identifying the cause of the knee effusion can guide treatment. Furthermore, removing fluid from a knee can reduce intraarticular pressure to decrease pain and improve range of motion. There is no absolute contraindication to performing this procedure, but in selecting the needle entry site, an area of skin that is infected should be avoided. Therefore, caution should be exercised when a patient presents with suspected cellulitis over the knee joint to avoid the potential risk of causing iatrogenic septic arthritis. A knee that has undergone arthroplasty should be assessed for arthrocentesis by an orthopedic surgeon. Arthrocentesis of the knee is typically performed with the patient supine. The site for needle insertion is marked, and then the skin is disinfected. After a local anesthetic is administered, a needle is inserted along the pathway that was anesthetized. Synovial fluid is aspirated, and then the needle is withdrawn. Pressure is applied until any bleeding stops. The synovial fluid can be analyzed for infection and inflammation but cannot directly confirm a diagnosis of internal derangement or autoimmune causes of arthritis. In addition to the history and physical examination, laboratory findings and imaging can clarify the etiology of a knee effusion.
Topics: Adult; Arthrocentesis; Humans; Inflammation; Knee Joint; Osteoarthritis; Synovial Fluid
PubMed: 35285829
DOI: 10.3791/63135 -
Skeletal Radiology May 2023Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and... (Review)
Review
Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and arthroscopic techniques are still commonly performed and remain the gold standard, they are more invasive, expensive and not widely available. Ultrasound and X-ray-guided synovial biopsy are being increasingly performed by radiologists to diagnose both native and periprosthetic joint infection (PJI) to guide surgical and microbiological management. The purpose of this review article is to present the historical background to synovial biopsy particularly related to potential joint infection, including common and uncommon pathogens encountered, sampling techniques and pitfalls, focusing mainly on its role in PJI and its role in patient pathways and decision-making within a joint infection multi-disciplinary framework.
Topics: Humans; Sensitivity and Specificity; Synovial Membrane; Image-Guided Biopsy; Biopsy; Arthritis, Infectious; Ultrasonography; Prosthesis-Related Infections; Synovial Fluid; Biomarkers
PubMed: 36484841
DOI: 10.1007/s00256-022-04245-9 -
Best Practice & Research. Clinical... Mar 2023Accessing a joint with a needle (arthrocentesis) to extract synovial fluid is a skill intrinsic to the rheumatologist's praxis. Joint aspirations are essential for... (Review)
Review
Accessing a joint with a needle (arthrocentesis) to extract synovial fluid is a skill intrinsic to the rheumatologist's praxis. Joint aspirations are essential for diagnosing or excluding septic joints, are the gold standard for diagnosing acute crystal arthritis, and can provide valuable information about the nature of other forms of arthritis. In appropriate settings, injecting medications into joints can provide rapid, temporary, or even prolonged relief of pain and swelling and can provide a window of relief until other treatment modalities (anti-inflammatories, immunomodulators, and physical therapy) can enforce durable responses. Soft tissue aspirations (e.g., of bursae) and soft tissue injections (of bursae, tendons, trigger points, and areas of nerve compression) can provide similar relief, earning the practitioner the gratitude of the patient. Here, we provide a primary on joint and soft tissue aspiration and injection, including indications for and against procedures, preparing for procedures, and approaches to specific musculoskeletal structures.
Topics: Humans; Arthrocentesis; Arthritis; Synovial Fluid
PubMed: 37507281
DOI: 10.1016/j.berh.2023.101853 -
Frontiers in Immunology 2020
Topics: Animals; Antirheumatic Agents; Arthritis, Rheumatoid; Humans; Inflammation Mediators; Phenotype; RNA, Long Noncoding; Signal Transduction; Synovial Membrane; Synoviocytes
PubMed: 32508834
DOI: 10.3389/fimmu.2020.00955