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RMD Open Feb 2022The aim of this work was to summarise the literature evaluating the impact of biopsy procedures, tissue handling, tissue quality and disease-specific aspects including...
Impact of synovial biopsy procedures and disease-specific aspects on synovial tissue outcome: a systematic literature review informing the EULAR points to consider for the minimal reporting requirements in synovial tissue research in rheumatology.
BACKGROUND
The aim of this work was to summarise the literature evaluating the impact of biopsy procedures, tissue handling, tissue quality and disease-specific aspects including joint biopsied and disease stage, on synovial tissue outcome.
METHODS
Two reviewers independently identified eligible studies according to the Patients, Intervention, Comparator and Outcome framework obtained for five research questions formulated during the first EULAR task force meeting to produce points to consider (PtC) for minimal reporting requirements in synovial tissue studies. The databases explored were Medline, Embase, CENTRAL and Cinhal. The risk of bias of each study was evaluated using an adapted version of the Joanna Briggs Institute checklist for analytical cross-sectional studies.
RESULTS
Of the 7654 records yielded, 75 full texts were assessed, leading to the inclusion of 26 manuscripts in the systematic literature review (SLR). Two papers assessed the impact of biopsy procedures on the quality and quantity of tissue retrieved alongside patient tolerability; six papers focused on synovial tissue variability. Four papers studied the impact of sample handling or randomisation and 14 assessed the impact of disease stage and state, namely early or established active rheumatoid arthritis and remission on histopathological and transcriptomic results.
CONCLUSIONS
This SLR informs the EULAR PtC for minimal reporting requirements in synovial tissue research in rheumatology. Characteristics related to the study design, population, sample handling, randomisation and analysis can affect the final synovial tissue outcome in the studies reviewed. Thus, accurate reporting of these factors is required in order to ensure the scientific validity of manuscripts describing synovial tissue outcomes.
Topics: Arthritis, Rheumatoid; Biopsy; Cross-Sectional Studies; Humans; Rheumatology; Synovial Membrane
PubMed: 35177556
DOI: 10.1136/rmdopen-2021-002116 -
Seminars in Arthritis and Rheumatism Aug 2020Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to...
INTRODUCTION
Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to identify domains that have been reported in prior clinical studies in CPPD, to inform the development of a core set of domains for CPPD studies.
METHODS
We performed a scoping literature review for clinical studies in CPPD, searching in Medline (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases; published from January 1, 1946 to January 7, 2020. All reported outcomes and study design data were extracted and mapped to the core areas and domains as defined by the OMERACT Filter 2.1.The protocol was registered on PROSPERO (CRD: 42019137075; 09-07-2019).
FINDINGS
There were 112 papers identified, comprising of 109 observational studies and three randomized controlled trials. Most studies reported clinical presentations of OA with CPPD or acute CPP crystal arthritis. Outcomes that mapped to 22 domains were identified; the most frequently reported measures mapped to the following domains/sub-domains: imaging (joint damage on imaging tests - 59 studies; joint calcification on imaging tests - 28 studies), joint pain (26 studies), response to treatment (23 studies), side effects of treatment (15 studies), inflammation in the joint fluid or blood (ESR or C-reactive protein - 12 studies; synovial fluid markers - 4 studies; other blood markers - 2 studies), overall function (14 studies), joint swelling (12 studies) and range of joint movement (10 studies). Very few studies mapped to domains related to life impact, societal/resource use or longevity.
CONCLUSION
There is substantial variability in outcomes reported in CPPD studies. Outcomes that map to imaging manifestations, joint pain and response to treatment domains are most often reported.
Topics: Calcinosis; Calcium Pyrophosphate; Chondrocalcinosis; Female; Humans; Male; Observational Studies as Topic; Synovial Fluid
PubMed: 32521326
DOI: 10.1016/j.semarthrit.2020.05.015 -
Hand (New York, N.Y.) Jan 2020Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. We... (Meta-Analysis)
Meta-Analysis
Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. We identified 255 articles reporting outcomes of SLIL reconstruction. Of these, 40 studies (978 wrists) met eligibility requirements and reported sufficient data on radiographic outcomes to be included in the study. The mean and standard deviation of preoperative and follow-up assessments including scapholunate gap (SLG) and scapholunate angle (SLA) were used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CIs). For other radiographic or clinical outcomes, there were not enough reported data to calculate a pooled effect size, and pooled nonstandardized comparisons were made. The SMD between preoperative and postoperative SLA in tenodesis reconstruction was 0.7 (CI, 0.29 to 1.11, = .001) and 0.04 (CI, -0.27 to 0.38, = .8) for capsulodesis reconstruction. For SLG, tenodesis demonstrated an SMD of 1.1 (CI, 0.6 to 1.55, < .001) compared with 0.1 (CI, -0.36 to 0.59, = .6) for capsulodesis reconstruction. Tenodesis had a significant improvement compared with capsulodesis in SLA ( = .01) and SLG ( = .005). Tenodesis also showed improvement in grip strength and Disabilities of the Arm, Shoulder and Hand scores. Comparing preoperative and postoperative radiographic measurements, tenodesis reconstruction demonstrated significantly improved SLG and SLA relative to capsulodesis. Interpreted in the context of the limitations, existing data demonstrates some benefit of tenodesis reconstruction.
Topics: Adult; Chronic Disease; Female; Humans; Joint Capsule; Ligaments, Articular; Lunate Bone; Male; Middle Aged; Radiography; Plastic Surgery Procedures; Scaphoid Bone; Tenodesis; Treatment Outcome; Wrist Injuries; Wrist Joint
PubMed: 30027766
DOI: 10.1177/1558944718787289 -
Cartilage Dec 2021Biomarkers in osteoarthritis (OA) could serve as objective clinical indicators for various disease parameters, and act as surrogate endpoints in clinical trials for...
OBJECTIVE
Biomarkers in osteoarthritis (OA) could serve as objective clinical indicators for various disease parameters, and act as surrogate endpoints in clinical trials for disease-modifying drugs. The aim of this systematic review was to produce a comprehensive list of candidate molecular biomarkers for knee OA after the 2013 ESCEO review and discern whether any have been studied in sufficient detail for use in clinical settings.
DESIGN
MEDLINE and Embase databases were searched between August 2013 and May 2018 using the keywords "knee osteoarthritis," "osteoarthritis," and "biomarker." Studies were screened by title, abstract, and full text. Human studies on knee OA that were published in the English language were included. Excluded were studies on genetic/imaging/cellular markers, studies on participants with secondary OA, and publications that were review/abstract-only. Study quality and bias were assessed. Statistically significant data regarding the relationship between a biomarker and a disease parameter were extracted.
RESULTS
A total of 80 studies were included in the final review and 89 statistically significant individual molecular biomarkers were identified. C-telopeptide of type II collagen (CTXII) was shown to predict progression of knee OA in urine and serum in multiple studies. Synovial fluid vascular endothelial growth factor concentration was reported by 2 studies to be predictive of knee OA progression.
CONCLUSION
Despite the clear need for biomarkers of OA, the lack of coordination in current research has led to incompatible results. As such, there is yet to be a suitable biomarker to be used in a clinical setting.
Topics: Biomarkers; Collagen Type I; Collagen Type II; Genetic Markers; Humans; Osteoarthritis, Knee; Peptides; Synovial Fluid; Vascular Endothelial Growth Factor A
PubMed: 32680434
DOI: 10.1177/1947603520941239 -
The Iowa Orthopaedic Journal Dec 2023To perform a systematic review to evaluate the incidence of capsulolabral adhesions following hip arthroscopy (HA) for femoroacetabular impingement (FAI); including risk...
BACKGROUND
To perform a systematic review to evaluate the incidence of capsulolabral adhesions following hip arthroscopy (HA) for femoroacetabular impingement (FAI); including risk factors and post-treatment outcomes.
METHODS
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we queried PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for English-language studies with minimum 6-month follow-up after primary or revision HA for FAI, which reported the incidence of capsulolabral adhesions. Potential adhesion risk factors, such as anchor type used and protocol for capsule closure, were assessed. Pre-operative and post-operative modified Harris Hip Score (mHHS) values were compared in studies that reported them.
RESULTS
Thirty-seven articles were included (24 primary HA; 13 revision HA). There were 6747 patients who underwent primary HA (6874 hips; 3005 female, 44%). The incidence of capsulolabral adhesions, confirmed surgically during revision HA, was low. Patients undergoing surgical treatment reported postoperative improvement per modified Harris Hip Scores. Data for 746 patients undergoing second revision HA (761 hips; 449 female, 60%), showed an incidence of adhesions greater than that of primary HA patients.
CONCLUSION
While the incidence of symptomatic capsulolabral adhesions after primary hip arthroscopy is low; revision hip arthroscopy is strongly associated with adhesion development. Lysis of adhesions in primary hip arthroscopy patients reliably improved patient-reported outcomes. .
Topics: Humans; Arthroscopy; Femoracetabular Impingement; Follow-Up Studies; Hip Joint; Incidence; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 38213862
DOI: No ID Found -
Osteoarthritis and Cartilage Apr 2019To perform a systematic review of the small molecule metabolism studies of osteoarthritis utilising nuclear magnetic resonance (NMR) or mass spectroscopy (MS) analysis...
OBJECTIVE
To perform a systematic review of the small molecule metabolism studies of osteoarthritis utilising nuclear magnetic resonance (NMR) or mass spectroscopy (MS) analysis (viz., metabolomics or metabonomics), thereby providing coherent conclusions and reference material for future study.
METHOD
We applied PRISMA guidelines (PROSPERO 95068) with the following MESH terms: 1. "osteoarthritis" AND ("metabolic" OR "metabonomic" OR "metabolomic" OR "metabolism") 2. ("synovial fluid" OR "cartilage" OR "synovium" OR "serum" OR "plasma" OR "urine") AND ("NMR" or "Mass Spectroscopy"). Databases searched were "Medline" and "Embase". Studies were searched in English and excluded review articles not containing original research. Study outcomes were significant or notable metabolites, species (human or animal) and the Newcastle-Ottawa Score.
RESULTS
In the 27 studies meeting the inclusion criteria, there was a shift towards anaerobic and fatty acid metabolism in OA disease, although whether this represents the inflammatory state remains unclear. Lipid structure and composition was altered within disease subclasses including phosphatidyl choline (PC) and the sphingomyelins. Macromolecular proteoglycan destruction was described, but the correlation to disease factors was not demonstrated. Collated results suggested arachidonate signalling pathways and androgen sex hormones as future metabolic pathways for investigation.
CONCLUSION
Our meta-analysis demonstrates significant small molecule differences between sample types, between species (such as human and bovine), with potential OA biomarkers and targets for local or systemic therapies. Studies were limited by numbers and a lack of disease correlation. Future studies should use NMR and MS analysis to further investigate large population subgroups including inflammatory arthropathy, OA subclasses, age and joint differences.
Topics: Animals; Biomarkers; Cartilage; Humans; Magnetic Resonance Spectroscopy; Mass Spectrometry; Metabolomics; Osteoarthritis; Synovial Membrane
PubMed: 30287397
DOI: 10.1016/j.joca.2018.08.024 -
Cartilage Jan 2019Osteoarthritis (OA) is one of the leading causes of disability in the adult population. Common nonoperative treatment options include nonsteroidal anti-inflammatory...
OBJECTIVE
Osteoarthritis (OA) is one of the leading causes of disability in the adult population. Common nonoperative treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and intra-articular injections of hyaluronic acid (HA). HA is found intrinsically within the knee joint providing viscoelastic properties to the synovial fluid. HA therapy provides anti-inflammatory relief through a number of different pathways, including the suppression of pro-inflammatory cytokines and chemokines.
METHODS
We conducted a systematic review to summarize the published literature on the anti-inflammatory properties of hyaluronic acid in osteoarthritis. Included articles were categorized based on the primary anti-inflammatory responses described within them, by the immediate cell surface receptor protein assessed within the article, or based on the primary theme of the article. Key findings aimed to describe the macromolecules and inflammatory-mediated responses associated with the cell transmembrane receptors.
RESULTS
Forty-eight articles were included in this systematic review that focused on the general anti-inflammatory effects of HA in knee OA, mediated through receptor-binding relationships with cluster determinant 44 (CD44), toll-like receptor 2 (TLR-2) and 4 (TLR-4), intercellular adhesion molecule-1 (ICAM-1), and layilin (LAYN) cell surface receptors. Higher molecular weight HA (HMWHA) promotes anti-inflammatory responses, whereas short HA oligosaccharides produce inflammatory reactions.
CONCLUSIONS
Intra-articular HA is a viable therapeutic option in treating knee OA and suppressing inflammatory responses. HMWHA is effective in suppressing the key macromolecules that elicit the inflammatory response by short HA oligosaccharides.
Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Hyaluronan Receptors; Hyaluronic Acid; Injections, Intra-Articular; Intercellular Adhesion Molecule-1; Knee Joint; Lectins, C-Type; Male; Osteoarthritis, Knee; Synovial Fluid; Toll-Like Receptor 2; Toll-Like Receptor 4; Treatment Outcome; Viscosupplements
PubMed: 29429372
DOI: 10.1177/1947603517749919 -
Le Infezioni in Medicina Mar 2020There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic...
There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic review searching scientific articles was performed with keywords "Procalcitonin", "Total Hip Replacement", and "Total Knee Replacement" (n=123). After review of the abstract and full text for relevance, ten articles were included (n=10). Serum PCT levels for chronic Total Hip Replacement (THR) and Total Knee Replacement (TKR) have a range of mean values from 1.5 ng/ml to 14.2 ng/ml. Specificity ranges from 0.27 to 0.98, while sensitivity is from 0.33 to 0.9. On primary THR/TKR with confirmation of non-infected status, serum PCT peaks between 1-3 days post-operatively, with peak levels varying from 0.12 - 0.79 ng/ml. Based on this review, serum PCT is not a good adjunct in diagnosing Prosthetic Joint Infection (PJI). Synovial fluid PCT fluid may add better clinical support but requires further studies. There were several limitations with this review: the studies are small and heterogeneous, there was a variable definition of PJI, and there was a wide range of mean values, sensitivity and specificity.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Humans; Procalcitonin; Prosthesis-Related Infections; Reference Values; Sensitivity and Specificity; Synovial Fluid
PubMed: 32172255
DOI: No ID Found -
Annals of the Rheumatic Diseases Aug 2000To consider the question: How strong is the evidence in favour of yttrium synovectomy in chronic knee arthritis in patients with rheumatoid arthritis in comparison with... (Review)
Review
OBJECTIVE
To consider the question: How strong is the evidence in favour of yttrium synovectomy in chronic knee arthritis in patients with rheumatoid arthritis in comparison with placebo and intra-articular steroid treatment?
METHODS
A systematic review of the literature was performed using Medline and the Embase database.
RESULTS
Initially, seven papers were identified, but only two met the inclusion criteria. Neither study showed evidence in favour of yttrium synovectomy.
CONCLUSION
From the point of view of evidence based medicine it should be seriously questioned whether yttrium synovectomy deserves a place in clinical practice.
Topics: Arthritis, Rheumatoid; Glucocorticoids; Humans; Injections, Intra-Articular; Knee Joint; Randomized Controlled Trials as Topic; Synovial Membrane; Treatment Outcome; Yttrium Radioisotopes
PubMed: 10913051
DOI: 10.1136/ard.59.8.583 -
The Iowa Orthopaedic Journal 2018Arthroscopic management of the hip capsule has become a topic of debate in recent literature. Few comparative studies exist to help establish clear treatment...
INTRODUCTION
Arthroscopic management of the hip capsule has become a topic of debate in recent literature. Few comparative studies exist to help establish clear treatment recommendations.
METHODS
Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was conducted using PubMed, CINAHL, EMBASE, sportDiscus (EBSCO) and Cochrane Central Register of Controlled Trials databases by two independent investigators. Comparative studies evaluating outcomes after two or more distinct treatment approaches to capsule management were included.
RESULTS
The review yielded 7 articles that met inclusion criteria. Outcomes included in the review include patient reported outcome measures (mHHS, HOS, NASH) in 5 articles, return to sport in 1 article, and formation of postoperative heterotopic ossification (HO) in 1 article. In two articles evaluating the outcomes of revision hip arthroscopy, plication was associated with > 10 point improvements in HOS-ADL and mHHS scores when compared to no plication. The literature is inconclusive regarding routine hip capsule closure in primary arthroscopy, with one study supporting the practice, and one study showing no difference; capsular closure may help accelerate return to sports and improve outcomes while decreasing revisions in cases of borderline dysplasia. Closure does not influence HO rates after surgery.
CONCLUSION
There is insufficient evidence in the present literature to suggest routine closure of inter-portal capsulotomies after primary hip arthroscopy impacts patient outcomes. Capsular closure or plication should be given strong consideration in revision cases. Complete closure or plication may influence outcomes in patients with borderline dysplasia, for athletes wishing to return to sport, and in cases of extensile capsulotomies, although the data are inconclusive. Prospective, high level studies are indicated to create evidence-based treatment recommendations for capsular management in hip arthroscopy.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Joint Capsule; Joint Instability; Treatment Outcome
PubMed: 30104930
DOI: No ID Found