Finger joint synovitis in rheumatoid arthritis: quantitative assessment by magnetic resonance imaging.
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OBJECTIVE: To assess quantitatively, by magnetic resonance imaging (MRI), the synovial membrane volume in second to fifth metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis and healthy controls, and to compare the synovial membrane volumes with a more easily obtained semi-quantitative score for hypertrophic synovial membrane. PATIENTS AND METHODS: MCP joints of the dominant hand of 37 patients and five controls were examined clinically and by MRI. Laboratory assessments were performed. RESULTS: Median synovial membrane volumes were considerably larger in clinically active rheumatoid arthritis (RA) joints (e.g. 0.97 ml in the second MCP joint) than in clinically inactive joints (0.54 ml) and control joints (0.04 ml). Nevertheless, group distributions overlapped and marked volume differences were found within clinically uniform groups. The semi-quantitative score was highly correlated with the synovial volumes (Spearman rho = 0.79; P < 0.00001). Synovial membrane volumes were poorly related to the presence of rheumatoid factor and to laboratory markers of inflammation. CONCLUSION: These findings suggest that synovial membrane volumes, as determined by MRI, in finger joints are related to clinical signs of synovitis, but also that the volumes may vary more than what can be accounted for by the clinical appearances. A semi-quantitative score may be sufficient for more routine purposes. (+info)
A preliminary study of ultrasound aspiration of bone erosion in early rheumatoid arthritis.
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OBJECTIVE: To develop a new technique to assess the primary lesion in early rheumatoid arthritis (RA). METHODS: Ten patients with early RA and radiographically or MRI confirmed erosions had a needle introduced into the base of the erosion under sonographic guidance. Material was then aspirated from this site. RESULTS: The procedure was well tolerated with no complications. Small samples of necrotic bone and tissue were obtained in five out of 10 cases. In one case, a distinctive population of pleomorphic CD34 + cells with characteristics of bone marrow progenitors was isolated. Tissue invading bone with a characteristic appearance of pannus was not seen. CONCLUSION: A new method of sampling the earliest lesion in RA is described. The findings raise questions about the nature of bone damage in early RA. (+info)
Sensory processing in Parkinson's and Huntington's disease: investigations with 3D H(2)(15)O-PET.
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There is conjoining experimental and clinical evidence supporting a fundamental role of the basal ganglia as a sensory analyser engaged in central somatosensory control. This study was aimed at investigating the functional anatomy of sensory processing in two clinical conditions characterized by basal ganglia dysfunction, i.e. Parkinson's and Huntington's disease. Based on previously recorded data of somatosensory evoked potentials, we expected deficient sensory-evoked activation in cortical areas that receive modulatory somatosensory input via the basal ganglia. Eight Parkinson's disease patients, eight Huntington's disease patients and eight healthy controls underwent repetitive H(2)(15)O-PET activation scans during two experimental conditions in random order: (i) continuous unilateral high-frequency vibratory stimulation applied to the immobilized metacarpal joint of the index finger and (ii) rest (no vibratory stimulus). In the control cohort, the activation pattern was lateralized to the side opposite to stimulus presentation, including cortical [primary sensory cortex (S1); secondary sensory cortex (S2)] and subcortical (globus pallidus, ventrolateral thalamus) regional cerebral blood flow (rCBF) increases (P < 0.001). Between-group comparisons (P < 0.01) of vibration-induced rCBF changes between patients and controls revealed differences in central sensory processing: (i) in Parkinson's disease, decreased activation of contralateral sensorimotor (S1/M1) and lateral premotor cortex, contralateral S2, contralateral posterior cingulate, bilateral prefrontal cortex (Brodmann area 10) and contralateral basal ganglia; (ii) in Huntington's disease, decreased activation of contralateral S2, parietal areas 39 and 40, and lingual gyrus, bilateral prefrontal cortex (Brodmann areas 8, 9, 10 and 44), S1 (trend only) and contralateral basal ganglia; (iii) in both clinical conditions relative enhanced activation of ipsilateral sensory cortical areas, notably caudal S1, S2 and insular cortex. Our data show that Parkinson's disease and Huntington's disease, beyond well-established deficits in central motor control, are characterized by abnormal cortical and subcortical activation on passive sensory stimulation. Furthermore, the finding that activation increases in ipsilateral sensory cortical areas may be interpreted as an indication of either altered central focusing and gating of sensory impulses, or enhanced compensatory recruitment of associative sensory areas in the presence of basal ganglia dysfunction. Altered sensory processing is thought to contribute to pertinent motor deficits in both conditions. (+info)
Fibrocartilage in the extensor tendons of the human metacarpophalangeal joints.
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The extensor tendons of the fingers cross both the metacarpophalangeal (MCP) and interphalangeal joints. Previous studies have shown that where the extensor tendons replace the capsule of the proximal interphalangeal (PIP) joint, they contain a sesamoid fibrocartilage that articulates with the proximal phalanx during flexion. The fibrocartilage labels immunohistochemically for a variety of glycosaminoglycans and collagens. In the current study, we investigate the molecular composition of the extensor tendons at the level of the MCP joints. This is of particular interest because the tendon has a greater moment arm at this location (and might thus be subject to greater compression), but is separated from the joint cavity by the capsule and peritendinous tissue. Six hands were removed from elderly cadavers (39-85 years of age) and the MCP joints were fixed in 90% methanol. The extensor tendons were dissected from all fingers, cryosectioned, and immunolabelled with a panel of monoclonal and polyclonal antibodies for types I, II, III, and VI collagens, chondroitin 4 and 6 sulphates, dermatan, and keratan sulphate and aggrecan. Antibody binding was detected with the Vectastain ABC 'Elite' avidin/biotin/peroxidase kit. The extensor tendons in all the fingers had a metachromatic sesamoid fibrocartilage on their deep surface which immunolabelled for types I, III, and VI collagens, and for all glycosaminoglycans and aggrecan. Labelling for type II collagen was also seen in some fibrocartilages and was a constant feature of all index fingers. This probably relates to the greater use of that digit and the higher loads to which its tendons are subject. Chondroitin 6 sulphate and type II collagen are the most consistent markers of the fibrocartilage phenotype and most of the chondroitin 6 sulphate is probably associated with aggrecan. It is concluded that the labelling profile of the tendon fibrocartilage in the different fingers at the MCP joints is broadly similar to that at the PIP joints. Thus, the potentially greater level of compression on the extensor tendons may be counterbalanced by the lack of fusion of the tendon with the joint capsule. It is suggested that the maintenance of a similar level of fibrocartilage differentiation at two different points along the length of the extensor tendon ensures that the tensile strength is the same in the two regions and that no weak link is present. (+info)
Synovitis of small joints: sonographic guided diagnostic and therapeutic approach.
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OBJECTIVE: The aim of this pictorial essay is to describe the sonographic guided approach to investigation and local injection therapy of a small joint in a patient with psoriatic arthritis (PA). METHODS: Sonographic pictures are obtained using a high frequency ultrasonography apparatus equipped with a 13-MHz transducer. RESULTS: Ultrasonography allows a careful morphostructural assessment of soft tissue involvement in PA patients. Sonographic findings include joint cavity widening, capsular thickening, synovial proliferation, synovial fluid changes, tendon sheath widening. Ultrasound guided placement of the needle within the joint and injection of corticosteroid under sonographic control can be easily performed. CONCLUSIONS: High frequency ultrasonography is a quick and safe procedure that allows a useful diagnostic and therapeutic approach in patients with arthritis of small joints. (+info)
Evaluation of pannus and vascularization of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis by high-resolution ultrasound (multidimensional linear array).
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OBJECTIVE: To evaluate the extent of intraarticular vascularization and pannus formation in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of patients with rheumatoid arthritis (RA) by high-resolution ultrasound (US). METHODS: A newly developed, high-resolution multidimensional linear array US was utilized to obtain longitudinal and transverse scans of joints with active RA (n = 21), moderately active RA (n = 39), or inactive RA (n = 93), and of joints from healthy controls (n = 120). RESULTS: Healthy joints had no detectable pannus, whereas pannus could be detected in 52% of the joints with active RA, 82% of the joints with moderately active RA, and 67% of the joints with inactive RA. There was a significant difference in vascularization in the joints of all subgroups of RA patients and those of healthy subjects (P < 0.001). Moreover, vascularization differed significantly among the RA subgroups: inactive versus moderately active RA (P < 0.02) and inactive versus active RA (P < 0.05). Both pannus and vascularization appeared to be localized preferentially on the radial side of the joints. CONCLUSION: Evaluation of pannus and the extent of vascularization within the joints of patients with RA by high-resolution US might be helpful in the assessment of disease activity, and thus influence therapeutic strategies. (+info)
Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up.
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A consecutive series of 40 trapeziectomies in 30 patients with basal thumb joint osteoarthritis was reviewed. Sixteen thumbs had pan-trapezial and 24 thumbs trapeziometacarpal osteoarthritis. Simple excision without soft tissue interposition was performed by the same surgeon using an identical surgical technique. Twenty-eight patients were female (mean age 57 years) with a mean follow-up of 11 (3-19) years. Twenty-eight patients were satisfied with their operation, with 26 thumbs being pain free. Thumb pinch strength was improved by 40% compared to preoperative values, but still remained 22% weaker than the non-operated side. (+info)
The potential of digital dental radiography in recording the adductor sesamoid and the MP3 stages.
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The current study was undertaken to evaluate the reliability of using a recent advance in clinical radiographic technique, digital dental radiography, in recording two growth indicators: the adductor sesamoid and MP3 stages. With an exposure time five times less than that used in the conventional approach, this method shows greatest flexibility in providing a high quality digitized radiographic images of the two growth indicators under investigation. Refereed Paper (+info)