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Journal of Orthopaedic Research :... Jan 2022Infrapatellar fat pad (IPFP) morphology and Hoffa-synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare...
Infrapatellar fat pad (IPFP) morphology and Hoffa-synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa-synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post-ACLR. We assessed IPFP volume and Hoffa-synovitis from magnetic resonance imaging (MRI) in 111 participants 1-year post-ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post-ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa-synovitis prevalence were compared between groups with analysis of covariance and χ tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa-synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score-Pain Subscale, Anterior Knee Pain Scale). No significant between-group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm , Control 34.27 ± 7.56cm ) and Hoffa-synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1-year post-ACLR was associated with greater odds of patellofemoral BMLs at 1-year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5-year post-ACLR (OR: 1.234 [1.026, 1.483]). Hoffa-synovitis at 1-year post-ACLR was associated with greater odds of worsening patellofemoral BMLs at 5-year post-ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa-synovitis prevalence are similar between individuals 1-year post-ACLR and controls. Greater IPFP volume and Hoffa-synovitis appear to be associated with the presence and worsening of some early OA features in those post-ACLR, but not pain.
Topics: Adipose Tissue; Humans; Knee Joint; Magnetic Resonance Imaging; Osteoarthritis, Knee; Pain; Synovitis
PubMed: 33458849
DOI: 10.1002/jor.24987 -
Arthritis & Rheumatology (Hoboken, N.J.) May 2020To define the relationship of synovial B cells to clinical phenotypes at different stages of disease evolution and drug exposure in rheumatoid arthritis (RA).
OBJECTIVE
To define the relationship of synovial B cells to clinical phenotypes at different stages of disease evolution and drug exposure in rheumatoid arthritis (RA).
METHODS
Synovial biopsy specimens and demographic and clinical data were collected from 2 RA cohorts (n = 329), one of patients with untreated early RA (n = 165) and one of patients with established RA with an inadequate response to tumor necrosis factor inhibitors (TNFi-IR; n = 164). Synovial tissue was subjected to hematoxylin and eosin and immunohistochemical staining and semiquantitative assessment for the degree of synovitis (on a scale of 0-9) and of CD20+ B cell infiltrate (on a scale of 0-4). B cell scores were validated by digital image analysis and B cell lineage-specific transcript analysis (RNA-Seq) in the early RA (n = 91) and TNFi-IR (n = 127) cohorts. Semiquantitative CD20 scores were used to classify patients as B cell rich (≥2) or B cell poor (<2).
RESULTS
Semiquantitative B cell scores correlated with digital image analysis quantitative measurements and B cell lineage-specific transcripts. B cell-rich synovitis was present in 35% of patients in the early RA cohort and 47.7% of patients in the TNFi-IR cohort (P = 0.025). B cell-rich patients showed higher levels of disease activity and seropositivity for rheumatoid factor and anti-citrullinated protein antibody in early RA but not in established RA, while significantly higher histologic synovitis scores in B cell-rich patients were demonstrated in both cohorts.
CONCLUSION
We describe a robust semiquantitative histologic B cell score that closely replicates the quantification of B cells by digital or molecular analyses. Our findings indicate an ongoing B cell-rich synovitis, which does not seem to be captured by standard clinimetric assessment, in a larger proportion of patients with established RA than early RA.
Topics: Adult; Aged; Arthritis, Rheumatoid; B-Lymphocytes; Cohort Studies; Disease Progression; Female; Humans; Male; Middle Aged; Phenotype; Synovitis
PubMed: 31785084
DOI: 10.1002/art.41184 -
Swiss Medical Weekly 2012This article is to share some of the key scientific insights made by Dr Barry Bresnihan in rheumatoid arthritis. Dr Bresnihan elaborated new and visionary concepts in... (Review)
Review
This article is to share some of the key scientific insights made by Dr Barry Bresnihan in rheumatoid arthritis. Dr Bresnihan elaborated new and visionary concepts in arthritis research, which still influence current thinking. He had been particularly dedicated to investigate the inflammatory tissue (synovitis) in RA, which he considered as a clue to understand the pathogenesis of this disease. He thereby pioneered the concept of synovial biopsy as a technique, which allows to directly analyse synovitis and has stimulated many other rheumatologists in joining his efforts. He was also dedicated to understand why synovitis triggers bone destruction in joints and started to work on defining the molecular interactions between inflammation and the bone. This article picks up some of the major insights achieved by Dr Bresnihan's work and how these findings influenced today's understanding of arthritis.
Topics: Arthritis, Rheumatoid; Humans; Synovitis
PubMed: 23136037
DOI: 10.4414/smw.2012.13692 -
Medicina (Kaunas, Lithuania) Jun 2022Background and Objectives: Early undifferentiated arthritis (UA) is a group of inflammatory joint diseases that are not classified under any specific rheumatic or...
Background and Objectives: Early undifferentiated arthritis (UA) is a group of inflammatory joint diseases that are not classified under any specific rheumatic or connective tissue disorder and might evolve into chronic inflammatory arthritis or may be a self-limiting condition. Early recognition and treatment are crucial for the future course of the disease. Vascular endothelial growth factor (VEGF) is an angiogenic regulator that induces the growth of new capillary blood vessels, which are important in joint invasion and destruction during the progression of chronic inflammatory arthritis. The aim of this study was to assess VEGF levels associated with sociodemographic, clinical, laboratory, and ultrasound findings in the early UA patient cohort as well as to evaluate VEGF as a potential prognostic marker for arthritis outcomes. Materials and Methods: Seventy-six patients with inflammatory arthritis in at least one joint, with a duration of arthritis <12 months at the study entry that did not meet any rheumatic disease classification criteria, were enrolled after informed consent was obtained. Patient’s sociodemographic, laboratory data, and clinical disease characteristics were recorded, VEGF levels were measured, and ultrasound (US) of tender and swollen joints was performed. Results: VEGF levels had positive correlation with conventional rheumatic disease activity and diagnostic markers: erythrocyte sedimentation rate (ESR), C−reactive protein (CRP), and rheumatoid factor (RF) (p < 0.05). RF-positive patients had higher VEGF values (p = 0.024). A statistically higher number of patients whose VEGF levels were below the median value presented with active infection (p = 0.046). In patients with a higher number of swollen joints, and a higher score of synovitis and power doppler (PD) seen on US, VEGF levels were statistically significantly higher. Patients who after 12-month follow-up developed rheumatoid arthritis (RA) had statistically higher VEGF levels at baseline compared with those who developed spondyloarthropathies (p = 0.028). Conclusions: This study demonstrated that VEGF levels significantly represented inflammatory processes that were present in the joints (number of swollen joints, synovitis, and PD changes) of the early UA cohort.
Topics: Arthritis, Rheumatoid; Blood Sedimentation; Cohort Studies; Humans; Severity of Illness Index; Synovitis; Vascular Endothelial Growth Factor A
PubMed: 35744097
DOI: 10.3390/medicina58060833 -
Clinics in Orthopedic Surgery Mar 2021Rotator cuff tears can be asymptomatic in some cases; however, even when the tear size is small, clinical symptoms can be very severe. This suggests that symptoms of...
BACKGROUND
Rotator cuff tears can be asymptomatic in some cases; however, even when the tear size is small, clinical symptoms can be very severe. This suggests that symptoms of rotator cuff tears are related to factors other than the size. Although synovitis has been cited as one of the factors, there is no grading system for synovitis in rotator cuff tears. Moreover, there are few studies that evaluated the relationship between synovitis and clinical features in patients with rotator cuff tears.
METHODS
Patients with medium-sized rotator cuff tears, who were scheduled for arthroscopic repair, were recruited for this study. The glenohumeral joint was divided into 4 quarters. Then, vascularity and hypertrophy of the joint were graded in each quarter using a modified scoring system. Clinical assessment was performed preoperatively and at 3 months and 6 months after surgery. Finally, correlation between the severity of synovitis and clinical features was analyzed.
RESULTS
The intraobserver correlation coefficient was 0.815 to 0.918 and the interobserver correlation coefficient was 0.779 to 0.992 for the single measurement. Vascularity was significantly correlated with the range of motion, strength, and constant score within 6 months after surgery. Hypertrophy was correlated with the range of motion within 6 months after surgery.
CONCLUSIONS
Synovitis in the shoulder with rotator cuff tears can be graded by using our modified scoring system. The severity of synovitis was closely related to the clinical features after surgery. Therefore, when treating patients with rotator cuff tears, treatment of synovitis should also be considered.
Topics: Adult; Aged; Aged, 80 and over; Arthroscopy; Female; Humans; Hypertrophy; Male; Middle Aged; Muscle Strength; Pain Measurement; Range of Motion, Articular; Rotator Cuff Injuries; Synovitis
PubMed: 33747384
DOI: 10.4055/cios20002 -
RMD Open Dec 2023Knee synovitis is a highly prevalent and potentially curable condition for knee pain; however, its pathogenesis remains unclear. We sought to assess the associations of...
OBJECTIVES
Knee synovitis is a highly prevalent and potentially curable condition for knee pain; however, its pathogenesis remains unclear. We sought to assess the associations of the gut fungal microbiota and the fungi-bacteria correlation network with knee synovitis.
METHODS
Participants were derived from a community-based cross-sectional study. We performed an ultrasound examination of both knees. A knee was defined as having synovitis if its synovium was ≥4 mm and/or Power Doppler (PD) signal was within the knee synovium area (PD synovitis). We collected faecal specimens from each participant and assessed gut fungal and bacterial microbiota using internal transcribed spacer 2 and shotgun metagenomic sequencing. We examined the relation of α-diversity, β-diversity, the relative abundance of taxa and the interkingdom correlations to knee synovitis.
RESULTS
Among 977 participants (mean age: 63.2 years; women: 58.8%), 191 (19.5%) had knee synovitis. β-diversity of the gut fungal microbiota, but not -diversity, was significantly associated with prevalent knee synovitis. The fungal genus was inversely correlated with the prevalence and activity (ie, control, synovitis without PD signal and PD synovitis) of knee synovitis. Compared with those without synovitis, the fungi-bacteria correlation network in patients with knee synovitis was smaller (nodes: 93 vs 153; edges: 107 vs 244), and the average number of neighbours was fewer (2.3 vs 3.2).
CONCLUSION
Alterations of gut fungal microbiota and the fungi-bacteria correlation network are associated with knee synovitis. These novel findings may help understand the mechanisms of the gut-joint axis in knee synovitis and suggest potential targets for future treatment.
Topics: Humans; Female; Middle Aged; Dysbiosis; Cross-Sectional Studies; Synovitis; Fungi; Bacteria
PubMed: 38114197
DOI: 10.1136/rmdopen-2023-003529 -
Annals of the Rheumatic Diseases Oct 1989
Review
Topics: Free Radicals; Humans; Inflammation; Oxygen; Reperfusion Injury; Synovitis
PubMed: 2684056
DOI: 10.1136/ard.48.10.864 -
Frontiers in Immunology 2022Blau syndrome is a systemic autoinflammatory granulomatous disease caused by mutations in the nucleotide-binding oligomerization domain 2 () gene. NOD2 is an... (Review)
Review
Blau syndrome is a systemic autoinflammatory granulomatous disease caused by mutations in the nucleotide-binding oligomerization domain 2 () gene. NOD2 is an intracellular pathogen recognition receptor. Upon binding to muramyl dipeptide (MDP), NOD2 activates the NF-κB pathway, leading to the upregulation of proinflammatory cytokines. Clinical manifestations of Blau syndrome appear in patients before the age of four. Skin manifestations resolve spontaneously in some cases; however, joint and eye manifestations are progressive, and lead to serious complications, such as joint contracture and blindness. Currently, there is no specific curative treatment for the disease. Administration of high-dose oral steroids can improve clinical manifestations; however, treatments is difficult to maintain due to the severity of the side effects, especially in children. While several new therapies have been reported, including JAK inhibitors, anti-IL-6 and anti-IL-1 therapies, anti-TNF therapy plays a central role in the treatment of Blau syndrome. We recently performed an study, using peripheral blood and induced pluripotent stem cells from patients. This study demonstrated that abnormal cytokine expression in macrophages from untreated patients requires IFNγ stimulation, and that anti-TNF treatment corrects the abnormalities associated with Blau syndrome, even in the presence of IFNγ. Therefore, although the molecular mechanisms by which the genetic mutations in lead to granuloma formation remain unclear, it is possible that prior exposure to TNFα combined with IFNγ stimulation may provide the impetus for the clinical manifestations of Blau syndrome.
Topics: Arthritis; Child; Cytokines; Humans; Nod2 Signaling Adaptor Protein; Sarcoidosis; Synovitis; Tumor Necrosis Factor Inhibitors; Uveitis
PubMed: 35711422
DOI: 10.3389/fimmu.2022.895765 -
Arthritis Care & Research Oct 2019To investigate associations between engagement in knee bending (stair climbing, kneeling, squatting, heavy lifting, getting in/out of a squatting position) and synovitis... (Observational Study)
Observational Study
Repetitive Knee Bending and Synovitis in Individuals at Risk of and With Knee Osteoarthritis: Data From the Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium.
OBJECTIVE
To investigate associations between engagement in knee bending (stair climbing, kneeling, squatting, heavy lifting, getting in/out of a squatting position) and synovitis prevalence on noncontrast magnetic resonance imaging (MRI) in individuals at risk of and with knee osteoarthritis.
METHODS
We included baseline data from 594 participants (mean ± SD age 61.5 ± 8.9 years, 61% had Kellgren/Lawrence grade ≥2; 59% were female; mean ± SD body mass index was 30.7 ± 4.8 kg/m ) of the Osteoarthritis Biomarker Consortium Foundation for the National Institutes of Health project. Knee bending activities were queried by a standard questionnaire, and the severity of Hoffa synovitis and effusion synovitis (surrogate outcomes of synovitis) were graded using the MRI OsteoArthritis Knee Scoring system. Logistic regression was used, unadjusted and adjusted, for metabolic syndrome, physical activity level, and sex. A grade ≥1 defined synovitis prevalence, with a grade ≥2 cutoff implemented in sensitivity analyses.
RESULTS
The prevalence of grade ≥1 Hoffa synovitis and effusion synovitis equaled 59% (n = 353) and 62% (n = 366), respectively. Adjusted for confounders, kneeling for ≥30 minutes during a single day was associated with grade ≥1 Hoffa synovitis prevalence (odds ratio [OR] 1.65 [95% confidence interval (95% CI) 1.11-2.47]). Participants engaging in this activity ≤1 day per week had greater odds for prevalent Hoffa synovitis than those who did not perform the activity (OR 1.88 [95% CI 1.11-3.18]). No other significant associations were found. Sensitivity analyses yielded similar findings.
CONCLUSION
In this selected sample with a preponderance of grade ≥1 Hoffa and/or effusion synovitis on noncontrast MRI, only prolonged kneeling was associated with Hoffa synovitis prevalence. Replication in other samples is warranted.
Topics: Aged; Biomarkers; Cohort Studies; Cross-Sectional Studies; Data Analysis; Female; Humans; Knee Joint; Male; Middle Aged; National Institutes of Health (U.S.); Osteoarthritis, Knee; Range of Motion, Articular; Synovitis; United States
PubMed: 30221482
DOI: 10.1002/acr.23760 -
The Quarterly Journal of Nuclear... Dec 2022
Topics: Humans; Synovitis
PubMed: 36106914
DOI: 10.23736/S1824-4785.22.03489-6