Osteoarthritis of the first carpometacarpal joint: a study of radiology and clinical epidemiology. Results from the Copenhagen Osteoarthritis Study.
BACKGROUND: The radiological and epidemiological data from the Copenhagen Osteoarthritis Study (COS) were analysed in order to assess the prevalence of osteoarthritis (OA) of the first carpometacarpal joint (CMCJ). Another aim of the study was to analyse relationships between radiologic CMCJ OA and self-reported pain. The third aim was to analyse if additional information could be obtained applying a new method of correlating individual radiological features to self-reported pain, compared to Kellgren and Lawrence's (K-L's) radiologic OA classification. METHODS: Between 1992 and 1994 standardised radiographs of both hands were recorded in 3,355 participants of the COS cohort. Subjects with known rheumatoid arthritis, other inflammatory arthritis or earlier fractures of the hand were excluded. OA of the CMCJ was assessed according to K-L's radiologic classification by two senior radiologists at our institution. The radiologists further evaluated individual radiologic features of CMCJ OA as recommended by K-L according to the text attached to each picture in their radiologic atlas of OA. To estimate inter- and intraobserver reproducibility a subset of 100 radiographs was reread. RESULTS: Our analyses demonstrated that the K-L method was not able to classify all X-rays. In 608 (18.1%) cases, combinations of joint space width (JSW) measurements, the graduation of osteofytes, sclerosis and cysts fell outside the classification. The radiological evaluation of individual features of OA demonstrated an acceptable reproducibility, intrapersonal (kappa=0.79) as well as interpersonal (kappa=0.65). The prevalence of each radiological feature increased after the fifth decade, progressively more so among women (P<0.001), with the highest prevalence (36.0%) of grades 3 and 4 JSW reduction among women>80 years. A significant correlation was found between signs of radiologic degeneration and self-reported pain (P<0.001); however, different combinations of OA features had different relations to symptoms. Logistic regression analyses revealed sclerosis to have an independent influence on pain in the thumb compared with the presence of osteofytes, cysts and diminished JSW. Body mass index (BMI) was positively related to radiological changes. In logistic regression analyses BMI did not demonstrate an independent positive relation to OA. CONCLUSION: Radiological degenerative changes in the CMCJ by age especially among women are quite common. However, it is demonstrated that global radiologic classifications of OA of the CMCJ have serious limitations in epidemiological studies. Not all cases fit into classification based on the K-L-atlas. Among the radiological features, subchondral sclerosis is significantly related to self-reported pain. Specific radiologic data should be incorporated in epidemiological studies on hand OA. (+info)
Role of canonical Wnt-signalling in joint formation.
The individual elements of the vertebrate skeleton are separated by three different types of joints, fibrous, cartilaginous and synovial joints. Synovial joint formation in the limbs is coupled to the formation of the prechondrogenic condensations, which precede the formation of the joint interzone. We are beginning to understand the signals involved in the formation of prechondrogenic condensations and the subsequent differentiation of cells within the condensations into chondrocytes. However, relatively little is known about the molecules and molecular pathways involved in induction of the early joint interzone and the subsequent formation of the synovial joints. Based on gain-of function studies Wnt-signalling, in particular the canonical pathway, has been implicated in the joint induction process. Here we provide genetic evidence from loss-of function analysis of embryos lacking either the central player of the canonical Wnt-pathway, beta-catenin, in the limb mesenchyme or the two ligands, Wnt9a and Wnt4, demonstrating that canonical Wnt-signalling plays an important role in suppressing the chondrogenic potential of cells in the joint thereby actively allowing joint formation. Furthermore our data show that the beta-catenin activity is not essential for the induction of molecular markers expressed in the joint interzone. Thus, suggesting that canonical Wnt-signalling is not required for the induction, but for the subsequent maintenance of the fate of the joint interzone cells. (+info)
The use of veterinary cuttable plates for carpal and tarsal arthrodesis in small dogs and cats.
The objective of the study was to evaluate, retrospectively, carpal and tarsal arthrodesis in small dogs and cats by using veterinary cuttable plates in 6 animals and comparing those with arthrodesis stabilized with other implants in 9 animals. Veterinary cuttable plates were used for 1 pancarpal, 2 partial tarsal, and 3 pantarsal arthrodeses. Other implants were used to stabilize 1 pancarpal, 6 partial tarsal, and 2 pantarsal arthrodeses. In the veterinary cuttable plates group, complications included 2 cases with pressure sores and 1 case with screw loosening. One animal was lost to follow-up and 4 of the remaining 5 were always weight-bearing. In the other group, there were 2 cases with pressure sores, 1 case with dermatitis, and 2 cases with pin migration. Six out of 9 animals were always weight-bearing. The use of veterinary cuttable plates appears to be a suitable option with a good clinical outcome. (+info)
Cultivation of Tropheryma whipplei from the synovial fluid in Whipple's arthritis.
This report describes a patient who presented with fever, weight loss, diarrhea, and adenopathy. At the time of presentation he had a 28-year history of unusually severe destructive polyarthritis. Duodenal biopsy revealed periodic acid-Schiff-positive macrophages. Polymerase chain reaction studies showed positivity for Tropheryma whipplei in synovial fluid, synovial tissue, and lymph node specimens, and Whipple's disease was diagnosed. T whipplei was successfully cultivated from the synovial fluid by both cell culture and axenic culture. This strain (named ART1) was subcultured and subsequently established and genotyped. Antibiotic treatment was instituted in the patient, after which his symptoms remitted. These findings show for the first time that Whipple's arthritis may be, at least in some cases, a septic arthritis. (+info)
The mechanical properties of the rabbit carpal tunnel subsynovial connective tissue.
The rabbit model is commonly used to study carpal tunnel syndrome (CTS). It has been proposed that the subsynovial connective tissue (SSCT) in the carpal tunnel may play a role in the etiology of CTS, but the material properties of the rabbit SSCT are unknown. The purpose of this study was to develop a method to measure the shear properties of the rabbit SSCT. In six rabbit cadaver forepaws, the excursion of the third digit flexor digitorum superficialis (FDS) and load to failure of the SSCT were measured in a custom device. The mean excursion to full flexion in this model was 7.08mm (S.D. 0.77). The mean shearing force at full flexion was 317 mN (S.D. 166). At full flexion percentage of maximum shear force in the SSCT was 54.5% (S.D. 19.4). The mean energy absorbed at full flexion was 0.29mJ (S.D. 0.31). The mean excursion needed to reach 5% of the maximum shear force was 3.04mm (S.D. 0.99). The testing model presented in this study demonstrates structural parameters to evaluate the shear properties of the SSCT in a rabbit model. The data presented could be used for estimating sample sizes in a more comprehensive study of the effect of CTS on the SSCT properties. (+info)
Requirement for protein kinase R in interleukin-1alpha-stimulated effects in cartilage.
Interleukin-1 (IL-1) has pleiotropic effects in cartilage. The interferon-induced, double stranded RNA-activated protein kinase PKR that phosphorylates eukaryotic initiation factor 2 (eIF2) alpha has been implicated in cytokine effects in chondrocytes. A compound was recently identified that potently suppresses PKR autophosphorylation (IC50 approximately 200 etaM) and partially restores PKR-inhibited translation in a cell-free system with significant effect in the nanomolar range. The objectives of this study were to exploit this potent PKR inhibitor to assess whether PKR kinase activity is required for catabolic and proinflammatory effects of IL-1alpha in cartilage and to determine whether IL-1alpha causes an increase in eIF2alpha phosphorylation that is antagonized by the PKR inhibitor. Cartilage explants were incubated with the PKR inhibitor and IL-1alpha. Culture media were assessed for sulfated glycosaminoglycan as an indicator of proteoglycan degradation and for prostaglandin E(2). Cartilage extracts were analyzed by Western blot for cyclooxygenase-2 and phosphorylated signaling molecules. Nanomolar concentrations of the PKR inhibitor suppressed proteoglycan degradation and cyclooxygenase-2 accumulation in IL-1alpha-activated cartilage. The PKR inhibitor stimulated or inhibited PGE(2) production with a biphasic dose response relationship. IL-1alpha increased the phosphorylation of both PKR and eIF2alpha, and nanomolar concentrations of PKR inhibitor suppressed the IL-1alpha-induced changes in phosphorylation. The results strongly support PKR involvement in pathways activated by IL-1alpha in chondrocytes. (+info)