Synovium and blood capillaries at the femoral attachment of anterior cruciate ligament are significantly abundant than those at the tibial attachment / Sinovial y capilares sanguíneos en la inserción femoral del ligamento cruzado anterior son significativamente más abundantes que los de la inserción tibial

SUMMARY: The anterior cruciate ligament (ACL) is a ligament that mainly controls the anterior and rotational mobility of the knee joint, and its surface is covered by a synovial membrane with large number of blood vessels. In general, nutritional supply to the ligament is from many capillaries in the adjacent synovium. However, statistical studies of the capillaries distributed to the ACL are insufficient. In this study, we examined cross-sectional histological images of the femoral attachment (femoral level), middle level of the tendon (middle level), and tibial attachment (tibial level) of the ACL and statistically analyzed blood capillary distribution among the three levels. The ACLs of 10 cadavers were divided into 5 equal sections, and 4mm-thick paraffin sections were made at the femoral level, middle level, and tibial level, and then hematoxylin-eosin (HE) staining were performed. The area of each transverse section was measured using Image-J 1.51n (U. S. National Institutes of Health, Bethesda, MD, USA). Fiber bundles of the ACL were relatively small and sparse in cross-sectional area at the femoral level and became larger and denser toward the tibial level. Many blood levels. The synovium at the attachment of ACL covered the surface of the fiber bundle and also penetrated deeply between the fiber bundles. In particular, the blood capillaries were densely distributed in the synovium at the femoral attachment rather than another two levels. Indeed, the number of capillaries were also most abundant in the femoral level. The cross-sectional ACL area at the femoral level is significantly small, however, the blood capillaries were most abundant. Therefore, when the ACL is injured, its reconstruction with preservation of the femoral ligamentous remnant may be clinically useful for remodeling of the grafted tendon.

El ligamento cruzado anterior (LCA) es un ligamento que controla principalmente la movilidad anterior y rotacional de la articulación de la rodilla, y su superficie está cubierta por una membrana sinovial con gran cantidad de vasos sanguíneos. En general, el suministro de nutrientes al ligamento proviene de muchos capilares en la sinovial adyacente. Sin embargo, los estudios estadísticos de los capilares distribuidos en el LCA son insuficientes. En este estudio, examinamos imágenes histológicas trans- versales de la inserción femoral (nivel femoral), el nivel medio del tendón (nivel medio) y la inserción tibial (nivel tibial) del LCA y analizamos estadísticamente la distribución de los capilares sanguíneos entre los tres niveles. Los LCA de 10 cadáveres se dividieron en 5 secciones iguales y se realizaron cortes en parafina de 4 µm de espesor a nivel femoral, medio y tibial, y luego se realizó tinción con hematoxilina-eosina (HE). El área de cada sección transversal se midió utilizando Image-J 1.51n (Institutos Nacionales de Salud de EE. UU., Bethesda, MD, EE. UU.). Los haces de fibras del LCA eran relativamente pequeños y escasos en el área de la sección transversal a nivel femoral y se hicieron más grandes y más densos hacia el nivel tibial. La membrana sinovial en la unión del LCA cubría la superficie del haz de fibras y también penetraba profundamente entre entre los haces de fibras. En particular, los capilares sanguíneos estaban densamente distribuidos en la unión femoral de la sinovial respecto a los otros dos niveles. De hecho, el número de capilares también fue más abundante a nivel femoral. El área transversal del LCA a nivel femoral era significativamente pequeña, sin embargo, los capilares sanguíneos fueron los más abundantes. Por lo tanto, cuando hay una lesión del LCA su reconstrucción con preservación del ligamento femoral remanente puede ser clínicamente útil para remodelar el tendón injertado.

Lipoma Arborescente: uma causa de sinovite crônica? / Lipoma Arborescens: a cause of chronic synovitis?

O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresenta como aumento de volume articular indolor, lentamente progressivo, que persiste por muitos anos e é acompanhado por derrames articulares intermitentes. O envolvimento de sítios extra-articulares é incomum, mas pode ocorrer em bainhas tendíneas e bursas. A ressonância magnética é o melhor exame para o diagnóstico, embora a biópsia sinovial possa ser necessária em alguns casos. Relatamos três casos com o objetivo de destacar o espectro clínico da doença, as características da imagem e a resposta ao tratamento imunossupressor.

Lipoma arborescens is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. Extra-articular site(s) involvement is unusual, but can occur in tendon sheaths and bursas. Magnetic resonance imaging is the best diagnostic exam, although synovial biopsy may be necessary. We report three cases in order to highlight the clinical spectrum and imaging features of the disease, so that early diagnosis and appropriate treatment can be given.

Increased elastic modulus of the synovial membrane in a rat ACLT model of osteoarthritis revealed by atomic force microscopy

This study aimed to explore changes in nanoscale elastic modulus of the synovium using atomic force microscopy (AFM) in addition to investigate changes in synovial histomorphology and secretory function in osteoarthritis (OA) in a rat anterior cruciate ligament transection (ACLT) model. Sprague-Dawley rats were randomly assigned to sham control and ACLT OA groups. All right knee joints were harvested at 4, 8, or 12 weeks (W) after surgery for histological assessment of cartilage damage and synovitis in both the anterior and posterior capsules. AFM imaging and nanoscale biomechanical testing were conducted to measure the elastic modulus of the synovial collagen fibrils. Immunohistochemistry was used to visualize the expression of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and matrix metalloproteinase-3 (MMP-3) in the synovium. The OA groups exhibited progressive development of disease in the cartilage and synovium. Histopathological scores of the synovium in the OA groups increased gradually. Significant differences were observed between all OA groups except for the posterior 4W group. The synovial fibril arrangement in all OA groups was significantly disordered. The synovial fibrils in all ACLT OA groups at each time point were stiffer than those in the sham controls. OA rats displayed a significantly higher expression of IL-1β and MMP3 in the anterior capsule. In summary, synovial stiffening was closely associated with joint degeneration and might be a factor contributing to synovitis and increased production of proinflammatory mediators. Our data provided insights into the role of synovitis, particularly stiffening of the synovium, in OA pathogenesis.

IL-22 increases the production of sFRP3 by FLS in inflammatory joint diseases

Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) are inflammatory diseases with different bone remodeling patterns. Fibroblast-like synoviocytes (FLS) are cells involved in the transition from an acute and reparable phase to a chronic and persistent stage in these diseases. The distinction of joint phenotypes involves inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-17, and IL-22 directly or through key signaling pathways such as Wnt. To evaluate the role of FLS as the source of Wnt antagonists (sFRP3/FRZB and Dkk1) in the synovia, levels of TNF- α, IL-17, IL-22, Dkk1, and sFRP3 were measured by ELISA directly in the synovial fluid of patients with RA, PsA, or AS. Dkk1 and sFRP3 were also measured in the FLS culture supernatants after different inflammatory stimulus. sFRP3 and Dkk1 are constitutively expressed by FLS. IL-22 and sFRP3 were positively correlated (r=0.76; P<0.01) in synovial fluid. The stimulation of FLS with IL-22, but not TNF-alpha and IL-17, increased the production of sFRP3. No stimulus altered the basal expression of Dkk1. These results showed, for the first time, the ability of IL-22 to increase the expression of sFRP3/FRZB by human FLS in both in vitro and ex vivo models. This finding linked IL-22 to local inhibition of Wnt signaling and possibly to blockade of osteogenesis. Furthermore, FLS presented as a source of this inhibitor in synovial fluid, assigning to this cell a bone injury mechanism.

Microorganismos periodontales en el líquido sinovial de pacientes con artritis reumatoide. Revisión sistemática de la literatura 2017 / Periodontal microorganisms in synovial fluid of patients with rheumatoid arthritis. Systematic review of the literature - 2017

RESUMEN Introducción: La enfermedad periodontal (EP) y la artritis reumatoide (AR) son enfermedades inflamatorias crónicas multifactoriales que tienen en común algunos factores etiopatogénicos y la destrucción de los tejidos dentoalveolares y de las articulaciones sinoviales, de tal forma que se han identificado anticuerpos contra microorganismos periodontales en el fluido crevicular, líquido sinovial y en la membrana sinovial. Objetivo: Identificar, recuperar, analizar críticamente y sintetizar la literatura disponible acerca de la prevalencia de microorganismos periodontales en el líquido sinovial de pacientes con AR. Materiales y métodos: Se realizó búsqueda sistemática en Medline, ScienceDirect, SciELO y Google Scholar a través de los descriptores en salud Rheumatoid arthritis, periodontal microorganisms y synovial fluid. Se incluyeron artículos que describieron la presencia de microorganismos periodontales aislados en líquido sinovial de pacientes diagnosticados con AR. La búsqueda se cerró en febrero de 2017 y fue realizada con metodología PRISMA. Se emplearon las fichas de lectura crítica OSTEBA para valorar la validez externa y el nivel de evidencia de cada artículo en función del rigor metodológico. Resultados: Catorce publicaciones describieron la presencia de microorganismos periodontales en líquido sinovial de pacientes con EP y AR. Seis publicaciones realizaron detección de microorganismos periodontales en muestras de líquido sinovial, identificando en todas a P. gingivalis. Conclusiones: Los estudios incluidos evidenciaron la presencia de microrganismos periodontales en el líquido sinovial en sujetos con EP y AR, asociando la prevalencia de P. gingivalis con el aumento de los niveles de anticuerpos anti-CCP, lo que podría exacerbar los procesos inflamatorios y producir reacciones autoinmunes en AR.

ABSTRACT Introduction: Periodontal disease (PD) and rheumatoid arthritis (RA) are multifactorial chronic inflammatory diseases that share similar aetiopathogenic mechanisms that lead to the destruction of both dental-alveolar tissues and synovial joints, in such way that antibodies against periodontal pathogens have been identified in the crevicular fluid and in the synovial fluid and membranes. Objective: To identify, recover, critically analyze and synthesize the available literature on the prevalence of periodontal microorganisms in synovial fluid of patients with RA. Materials and methods: A systematic search was performed in MEDLINE, ScienceDirect, SciELO and Google Scholar using the medical subject headings "Rheumatoid arthritis", "periodontal microorganisms" and "synovial fluid". Articles were included that described the presence of isolated periodontal pathogens in synovial fluid of patients diagnosed with RA. The search was closed in February 2017 and was performed using PRISMA methodology. The OSTEBA critical reading sheets were used to assess the external validity and level of evidence of each article in terms of methodological rigor. Results: A total of 14 publications were included that described the presence of periodontal pathogens in synovial fluid of patients with PD and RA. Seven publications detected periodontal pathogens in synovial fluid, with P. gingivalis being positive in all of them. Conclusions: The included studies provided evidence of the presence of periodontal microorganisms in the synovial fluid in subjects with PD and RA, associating the prevalence of P. gingivalis with increased levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies, which could exacerbate inflammatory processes and produce autoimmune reactions in RA.

Papel da exposição à Hidroquinona na artrite reumatoide experimental induzida pelo colágeno / Role of Hydroquinone exposure on experimental collagen-induced arthritis

Artrite reumatoide (AR) é uma doença autoimune, que causa inflamação crônica nas membranas sinoviais de diversas articulações. O modelo experimenal de artrite induzida pelo colágeno (AIC) é empregado para investigar os mecanismos da AR e para identificar potenciais agentes terapêuticos. Embora a etiologia da AR ainda seja desconhecida, há evidências que a AR se desenvolve em indivíduos predispostos geneticamente, após exposição a fatores ambientais, como o tabagismo, que se destaca como maior fator de risco para indução da AR e para o agravamento em pacientes com AR já estabelecida. Porém, o mecanismo efetivo da ação dos diversos componentes do cigarros ainda precisa ser elucidado. A Hidroquinona (HQ) é um composto fenólico, encontrada em concentração elevada no cigarro, com maior ativade pró-oxidativa, além de ser produto da biotransformação do benzeno, também encontrado no cigarro. Neste caso, a HQ é responsável pela imunotoxicidade e mielotoxicidade do benzeno. Devido a alta exposição de fumantes à HQ e a associação do tabagismo com a AR, investigamos se a exposição à HQ teria participação no desenvolvimento da AIC em ratos Wistar. Para tanto, animais foram expostos à HQ em diferentes protocolos experimentais, a saber: A - por 35 dias consecutivos, durante fase de indução e desenvolvimento da artrite; B - por 14 dias consecutivos, até a segunda injeção de colágeno, na fase de sensibilização e indução da AIC; C - por 7 dias consecutivos, do 29º ao 35º dia, na fase posterior ao desenvolvimento da AIC. Os resultados obtidos mostraram que a HQ agravou a AR nos 3 grupos experimentais, aumentando os parâmetros clínicos, o número de células no líquido sinovial, a inflamação nas sinóvias, caracterizada por maior influxo de neutrófilos, proliferação de sinoviócitos (histologia por HE e imunohistoquímica), aumento nos níveis de IL-6 e IL-1ß (ELISA) no líquido sinovial e rearranjo do colágeno na sinóvia (microscopia por segundo harmônico). No entanto, os efeitos mais acentuados foram observados em animais dos grupos A e C, que também tiveram perda de peso significativa. Ademais, exposição à HQ, nos 3 grupos experimentais, causou expressão aumentada do receptor aril hidrocarboneto (AhR), um receptor ativado por xenobióticos durante a AR, e aumento nos níveis do fator de transcrição ROR e de IL-17 na sinóvia. Como AhR/ROR/IL-17 em linfócitos e neutrófilos é uma via importante na gênese da AR, ensaios in vitro foram realizados para elucidar o papel da HQ nesta via. A incubação com HQ in vitro de esplenócitos de animais naive elevou a expressão de AhR e de secreção de IL-17 (por citometria de fluxo), as quais foram bloqueadas pelo antagonista de AhR (α-naftoflavona). Em conjunto, os resultados obtidos nos permitem concluir que a HQ, como um importante componente do cigarro agrava a CIA em ratos, e a ativação via AhR/IL-17 é um possível mecanismo da patogênese da artrite

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation in the joint synovial membranes. The experimental model of collagen-induced arthritis (CIA) is used to investigate the involved mechanisms in RA and to identify novel therapeutic agents. The genesis of RA is multifactorial, involving interplay of genetic and environmental factors and smoking is the trigger factor in the development or RA and worsens the pre-existing RA but the mechanisms undlerlying are yet to be elucidated. Hydroquinone (HQ) is a phenolic compound, found in high concentrations in cigarette, where HQ is the major oxidative component. Moreover, HQ is benzene metabolite, which is also found in cigarette smoke, being responsible for the myelotoxicity and immunotoxicity detected during benzene exposure. Due to this association, we aimed to investigate the role of HQ exposure on CIA development in Wistar rats and the involved mechanisms. Animals were exposed to HQ according to different protocols: A - during 35 consecutive days, during the sensitization and devolpment phases of the disease; B - during 14 consecutive days, until the second injection of collagen, during the sensitization phase; C - during 7 consecutive days, from day 29 to 35, after the development phase of CIA. The results showed that HQ worsened the RA in the 3 experimental protocols, HQ elevated the clinical parameters of CIA development, increased inflammation in the synovial membrane, characterized by increased influx of neutrophis, synoviocytes proliferation (visualized by Immunohistochemistry and Histology analysis), augmented the levels of IL-6 and IL-1ß in the synovial fluid (ELISA assay) and led to intense collagen deposition on the synovia. The most pronounced effects where observed in animals from groups A and C, which also had weight body loss. In addition, in the 3 protocols, HQ exposure also increased the expression of AhR receptor, a receptor activated by xenobiotics during RA, and increased the expression of ROR and levels of IL-17 secretion in the synovial membranes. As AhR/ROR/IL-17 in lymphocytes and neutrophils is an important pathway involved in the genesis of RA, in vitro studies have been performed to elucidate the role of HQ exposure in this pathway. The HQ in vitro treatment augmented the expression of AhR and secretion of IL-17 by splenocytes (FACS assay) and the administration of an AhR antagonist (α-naphtoflavone) blocked these effects. Taken together, the results obtained here allow us to conclude that HQ, as an important cigarette component, aggravates CIA in rats, and the activation of AhR/IL-17 pathway is a possible mechanism involved in the RA pathogenesis

Resistance exercise recovers the structure of cartilage and synovial membrane of the ankle joint of rats after sciatic compression

Aim: to determine the effects of sciatic compression and treatment with resistance exercise on the morphology of the ankle joint of Wistar rats. Methods: 32 male rats, aged 10 ± 1 week, weighing 376±22 grams were divided into the following four groups (n=8/group): CG (control), LG (lesion), EG (exercise) and LEG (lesion and exercise). Three days after sciatic compression, the animals in the EG and LEG were submitted to resistance exercise by climbing stairs (five days/week) for three weeks and a load of 100 grams was added. The exercise was carried out in two sets of ten consecutive ascents of the steps. The ankle joint tissues were analyzed for their morphometry and morphology using light microscopy. Results: Regarding the number of chondrocytes, the LG and EG had more cells in the anterior articular cartilage in the tibia (62 and 43%) and in the talus (57 and 45%) when compared to the CG. In the LEG there was a 25% and 26% reduction of chondrocytes in the anterior cartilage in the tibia and talus when compared to the LG. Changes were observed in the tibia and talus in the LG, with the presence of flocculation, invagination of the subchondral bone, discontinuity of tidemark and pannus covering the subchondral bone in the talus, as well as changes in the synovial membrane. These alterations were minimized in the articular cartilage and synovial membrane in the LEG. Conclusions exercise restores the tissue morphology of ankle joint in Wistar rats after sciatic compression.(AU)

Osteoarthritis model induced by intra-articular monosodium iodoacetate in rats knee

ABSTRACT PURPOSE: To evaluate the usefulness of a knee osteoarthritis model through functional, radiological and microscopic changes of the synovial membrane. METHODS: Forty eight rats were divided randomly into two groups. The first received 0.9% saline in the joint and corresponded to the control group. The second was submitted to experimental osteoarthritis of the right knee induced by monosodium iodoacetate and corresponded to the osteoarthritis group. All animals were subjected to comparative tests of forced ambulation and joint movements, inability to articulate and tactile allodynia on day 1 post-experiment by forced ambulation (Roto-rod test), joint assessment of disability (weight bearing test) and assessment of tactile allodynia (Von Frey test). After inflammatory induction they were divided into four sub-groups corresponding to the scheduled death in 7, 14, 21 and 28 days when they were submitted to radiographic examination of the knee, arthrotomy and collection of the synovial membrane. RESULTS: The osteoarthritis group showed significant differences compared to control group on days 7 and 14 in Roto-rod, in weight bearing and Von Frey tests in all days, and in radiological evaluation. Microscopic examination of the synovial membrane showed abnormalities of inflammatory character at all stages. CONCLUSION: The osteoarthritis induced by intra-articular monosodium iodoacetate in rats knee is a good model to be used in related research, because it provides mensurable changes on joint movements, tactile allodynia, progressive radiological degeneration and microscopic inflammation of the synovial membrane, that represent markers for osteoarthritis evaluation

The roles of Tenascin C and Fibronectin 1 in adhesive capsulitis: a pilot gene expression study

OBJECTIVES: We evaluated mRNA expression levels of genes that encode TGF-β1; the TGF-β1 receptor; the collagen-modifying enzymes LOX, PLOD1, and PLOD2; and the extracellular matrix proteins COMP, FN1, TNC and TNXB in synovial/capsule specimens from patients with idiopathic adhesive capsulitis. Possible associations between the measured mRNA levels and clinical parameters were also investigated. METHODS: We obtained glenohumeral joint synovium/capsule specimens from 9 patients with idiopathic adhesive capsulitis who had not shown improvement in symptoms after 5 months of physiotherapy. Adhesive capsulitis was confirmed in all patients by magnetic resonance imaging. We also obtained specimens from 8 control patients who had underwent surgery for acute acromioclavicular joint dislocation and who had radiological indication of glenohumeral capsule alteration based on arthroscopic evaluation. mRNA expression in the synovium/capsule specimens was analyzed by quantitative reverse transcription PCR. The B2M and HPRT1 genes were used as references to normalize target gene expression in the shoulder tissue samples. RESULTS: The synovium/capsule samples from the patients with adhesive capsulitis had significantly higher TNC and FN1 expression than those from the controls. Additionally, symptom duration directly correlated with expression of TGFβ1 receptor I. CONCLUSION: Elevated levels of TNC and FN1 expression may be a marker of capsule injury. Upregulation of TGFβ1 receptor I seems to be dependent on symptom duration; therefore, TGFβ signaling may be involved in adhesive capsulitis. As such, TNC, FN1 and TGFβ1 receptor I may also play roles in adhesive capsulitis by contributing to capsule inflammation and fibrosis.

Malformación vascular de bajo flujo sinovial de la rodilla (hemangiolinfangioma): Reporte de caso / Low-low synovial vascular malformation of the knee (hemangiolymphangioma): Case report

Introducción: La malformación vascular venosa de bajo lujo se desarrolla generalmente durante la primera infancia y puede ser una causa poco frecuente de derrame recurrente de larodilla. La clínica, las pruebas de laboratorio y las radiografías suelen ser inespecíficas. Objetivo: Describir una patología infrecuente en pediatría, para enfatizar en la correcta clasificación y sospecha. Caso Clínico: Paciente de 2 años con historia de episodios de derrame articular de la rodilla derecha que requirió múltiples hospitalizaciones y tratamientos antibióticos. Exámenes de laboratorio normales. La radiografía simple de la rodilla no mostró cambios óseos. La resonancia magnética reportó malformación vascular de bajo lujo. Se realizó resección quirúrgica que evidenció lesión vascular entre las fibras musculares del vasto lateral del cuádriceps con extensión hasta la cápsula de la rodilla y disección de las fibras hasta el vasto lateral de la pierna derecha. El estudio histológico fue compatible con malformación vascular de bajo lujo. Ante el hallazgo benigno y la evolución favorable, continuó con tratamiento ambulatorio. Conclusiones: Aunque la malformación vascular de bajo lujo sinovial es una patología poco frecuente en la población pediátrica, debería considerarse la realización de un diagnóstico diferencial en pacientes con aparición repetida de hemartrosis sin historia de coagulopatía ni hemofilia.

Introduction: Low-low vascular malformation, which usually develops during the first stage of infancy, is a rare cause of recurrent effusion of the knee. History, laboratory and X-rays are usually non-specific. Objective: To describe a rare disease in pediatrics, emphasizing the correct classification and suspicion. Case Report: A case is presented of a two-year-old patient with a history of effusion of the right knee who required multiple hospitalizations and antibiotic treatments. Laboratory work-up was normal. Plain X-rays of the knee revealed no bone changes. MR imaging reported low-low vascular malformation. Surgical resection was performed, evidencing vascular lesion among the muscle fibers of the vastus lateralis of quadriceps until the capsule of the knee, as well as dissection of the fibers until the vastus lateralis of the right leg. Histology was consistent with low-low vascular malformation. Due to the benign outcome and favorable evolution, an outpatient management was possible. Conclusions: Although low-low synovial vascular malformation is a rare disease among the pediatric population, it should be considered in the differential diagnosis of patients with repeated hemarthrosis and no history of either coagulopathy or hemophilia.

The role of MCP-1-CCR2 ligand-receptor axis in chondrocyte degradation and disease progress in knee osteoarthritis

BACKGROUND: Osteoarthritis (OA) is a common arthritic disease and multifactorial whole-joint disease. Interactions of chemokines and OA is inadequately documented. RESULTS: In vivo and in vitro studies were conducted to investigate monocyte chemoattractant protein 1 (MCP-1) and receptor chemokine (C-C motif) receptor 2 (CCR2) in chondrocyte degradation and cartilage degeneration. Chondrocytes from 16 OA patients and 6 normal controls were involved in this study. After stimulation of MCP-1, the expression of MCP-1 and CCR2 increased significantly (P < 0.001) and the expression of MMP-13 also increased (P < 0.05). MCP-1 stimulation also induced (or enhanced) the apoptosis of OA chondrocytes (P < 0.05). Additionally, the degradation of cartilage matrix markers (metalloproteinase 3 and 13, MMP3 and MMP13) in the culture medium of normal chondrocytes was also assessed. Furthermore, intra-articular injection of MCP-1 in mouse knees induced cartilage degradation and the CCR2 antagonist did not impede cartilage destroy in rats knees of monosodium iodoacetate (MIA) model. CONCLUSIONS: The results of this study demonstrate that the MCP-1-CCR2 ligand-receptor axis plays a special role in the initiation and progression of OA pathology. Patients with ambiguous etiology can gain some insight from the MCP-1-CCR2 ligand-receptor axis.

Effects of immobilization and remobilization on the ankle joint in Wistar rats

A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint.

Lipoma arborescente de joelho: relato de caso / Lipoma arborescens of the knee: a case report

Relato de caso de um paciente do sexo feminino de 26 anos que apresentava queixas de dores eventuais e episódios recorrentes de derrame articular no joelho esquerdo havia aproximadamente 10 anos. Após anamnese, exame físico, exames radiográficos e exames de imagem por ressonância magnética foi firmado o diagnóstico de lipoma arborescente de joelho. A paciente foi submetida a tratamento artroscópico para ressecção da lesão. No pós-operatório foi encaminhada para reabilitação fisioterápica, com boa evolução.

Case report of a female patient of 26 years who complained of pain and recurrent episodes of joint swelling in his left knee about 10 years ago. After anamnesis, physical examination and radiographic imaging and magnetic resonance were diagnosed with arborescent lipoma of the knee, and the patient underwent arthroscopic treatment for resection of the lesion. Postoperatively the patient was referred to physical therapy rehabilitation with good evolution.

Extra-pulmonary manifestations of paracoccidioidomycosis associated with acquired immunodeficiency syndrome: a case report

We present a patient with Paracoccidioidomycosis/HIV coinfection which has been investigated because of chronic monoarthritis and mucocutaneous lesions. A biopsy of the synovial membrane and skin revealed structures consistent with Paracoccidioides brasiliensis. At diagnosis, the count of CD4 + T cells was 44 cells/mm3. We emphasize the importance of clinical suspicion of Paracoccidioidomycosis in patients with HIV/AIDS who live in or are from risk areas.

Asociación de artritis reumatoide en paciente joven con anemia aplásica / Rheumatoid arthritis associated with aplastic anemia in a young patient

La artritis reumatoide es una enfermedad crónica, sistémica e inflamatoria, de etiología desconocida, que afecta, principalmente la membrana sinovial de las articulaciones. Se caracteriza por dolor crónico, y destrucción articular que conlleva un aumento de la mortalidad y un elevado riesgo de invalidez con altos costos para el enfermo y la sociedad. Describimos el caso de un paciente joven con anemia aplásica desde los 8 años, que inicia en 2009 cuadro de dolor y aumento de volumen articular en manos, muñecas y tobillos bilaterales, cumpliendo los criterios para artritis reumatoide.

Rheumatoid arthritis (RA) is a chronic, systemic, and inflammatory disease of unknown etiology that mainly affects the synovial membrane of the joints. It is characterized by chronic pain and joint destruction, which leads to premature mortality and risk of disability, with high costs to the patient and society. The case is presented of a young male patient with aplastic anemia since 8 years old who, in 2009, began with swelling and joint pain in the hands, wrists and ankles, fulfilling criteria for rheumatoid arthritis.

Artritis reumatoide en el anciano. Revisión narrativa / Rheumatoid arthritis in the elderly. A narrative review

Colombia está viviendo 2 fenómenos importantes, las transiciones demográfica y epidemiológica, los cuales se ven reflejados en un proceso acelerado de envejecimiento poblacional que, a su vez, aumenta la prevalencia de enfermedades crónicas, entre ellas la artritis reumatoide (AR). De acuerdo con la edad de aparición, la AR se clasifica en 2 subgrupos: la enfermedad reumatoide de aparición temprana y la AR de aparición tardía (en pacientes > 65 años). Anteriormente, se pensaba que la diferencia más importante entre los 2 subgrupos era que la AR de aparición tardía tenía un mejor pronóstico que la enfermedad reumatoide de aparición temprana. En la actualidad, se han descrito las diferencias que existen entre estas 2 formas de presentación de la AR. A través de este artículo se describirán las principales diferencias que existen en cuanto a la epidemiología, patogenia, manifestaciones clínicas, tratamiento, pronóstico y funcionalidad de los pacientes con AR de presentación temprana y tardía.

Colombia is experiencing two major phenomena, a demographic and an epidemiological transition, which is reflected in an accelerated process of population aging. This, in turn, increases the prevalence of chronic diseases, of which rheumatoid arthritis is one of them. According to the age of onset, it is classified into two subgroups: younger onset RA or YORA, and late onset RA or EORA (onset at 65 years or older). It was previously thought that the most important difference between the two subgroups was that EORA had a better prognosis than YORA. The differences between these two diseases has currently been described. This article presents the main differences as regards the epidemiology, pathogenesis, clinical manifestations, treatment, prognosis, and functioning of patients with RA of early and late presentation.

Expression of leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1) on osteoclasts and its potential role in rheumatoid arthritis

OBJECTIVE: Leukocyte-associated immunoglobulin-like receptor-1 is an inhibitory receptor primarily expressed by immune cells. This study was undertaken to define the role of this molecule in osteoclast differentiation and rheumatoid arthritis. METHODS: In vitro osteoclast assays were performed to characterize the role of Leukocyte-associated immunoglobulin-like receptor-1 in murine and human osteoclastogenesis. Human Leukocyte-associated immunoglobulin-like receptor-1 expression was assessed by immunohistochemistry staining in the synovium of patients with rheumatoid arthritis. The levels of soluble Human Leukocyte-associated immunoglobulin-like receptor-1 were determined by enzyme-linked immunosorbent assay. RESULTS: We found that multinucleated osteoclast formation from mouse bone marrow cells was inhibited by treatment with a monoclonal antibody against mouse Leukocyte-associated immunoglobulin-like receptor-1 in vitro. By immunohistochemistry, we found that Leukocyte-associated immunoglobulin-like receptor-1 was mainly expressed by macrophages in the inflamed synovial tissue of rheumatoid arthritis patients. In addition, serum and synovial fluid levels of soluble Leukocyte-associated immunoglobulin-like receptor-1 were higher in rheumatoid arthritis patients compared to healthy controls or osteoarthritis patients. Moreover, overexpression of Leukocyte-associated immunoglobulin-like receptor-1 in CD14+ monocytes from healthy volunteers also inhibited human osteoclastogenesis. CONCLUSION: Collectively, these data demonstrate for the first time that Leukocyte-associated immunoglobulin-like receptor-1 inhibits osteoclastogenesis. Therefore, these results may have therapeutic implications for the treatment of rheumatoid arthritis. .