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1.
Rev. bras. ortop ; 57(2): 314-320, Mar.-Apr. 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1388003

RESUMO

Abstract Objective Our goal was to evaluate the modulation of the synovial fluid cells (SFC) from patients with and without osteoarthritis (OA) by bone morphogenetic protein 4 (BMP-4), Smad-3 and transforming growth factor beta (TGF-β). Methods Synovial fluid was collected from patients submitted to knee arthroscopy or replacement and were centrifuged to isolate cells from the fluid. Cells were cultured for 21 days and characterized as mesenchymal stem cells (MSCs) according to the criteria of the International Society of Cell Therapy. Then, we performed an [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay (MTT) assay after exposing cells with and without OA to TGF-β, Smad3 and BMP-4 pathway inhibitors and to different concentrations of BMP4. Results Exposure to the TGF-β, Smad3 and BMP-4 inhibitors modifies the mitochondrial activity of the SFCs. The activity of the SFCs is modified by influences of increasing concentrations of BMP4, but there is no difference in cellular activity between patients with and without OA. Conclusion TGF-β, Smad3 and BMP-4 modulate the activity of SFCs from patients with and without knee OA.


Resumo Objetivo Nosso objetivo foi avaliar a modulação das células do líquido sinovial (SFCs, na sigla em inglês) de pacientes com e sem osteoartrite (OA) por proteína morfogenética óssea 4 (BMP-4), Smad3 e transformador do fator de crescimento β (TGF-β). Métodos O do líquido sinovial foi coletado de pacientes submetidos a artroscopia ou artroplastia do joelho, e centrifugados para isolar as células do liquido sinovial. As células foram cultivadas por 21 dias e caracterizadas como células-tronco mesenquimais (MSCs, na sigla em inglês) de acordo com os critérios da International Society of Cell Therapy. Em seguida, realizamos um ensaio de brometo de 3-4,5-dimetil-tiazol-2-il-2,5difeniltetrazólio (MTT) depois de expor células com e sem OA para TGF-β, inibidores de via Smad3 e BMP-4 e para diferentes concentrações de BMP-4. Resultados A exposição aos inibidores TGF-β, Smad3 e BMP-4 modifica a atividade mitocondrial das SFCs. A atividade das SFCs é modificada por influências sobre o aumento das concentrações de BMP-4, mas não há diferença na atividade celular entre pacientes com e sem OA. Conclusão TGF-β, Smad3 e BMP-4 modulam a atividade das SFCs de pacientes com e sem OA do joelho.


Assuntos
Humanos , Masculino , Feminino , Osteoartrite , Líquido Sinovial , Fator de Crescimento Transformador beta1 , Células-Tronco Mesenquimais
2.
Rev. Investig. Salud. Univ. Boyacá ; 9(2): 118-135, 20220000. tab, ilust
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1445037

RESUMO

Introducción: La artritis séptica es considerada una emergencia en ortopedia. Se define como el proceso inflamatorio desproporcionado, desencadenado por la colonización de algún microorganismo en el espacio articular que con los cambios fisiopatológicos ocasionados degradan el cartílago y aumentan la morbimortalidad, la prolongación de la estancia hospitalaria, las secuelas irreversibles, así como los costos para el sistema de salud. Por tal razón, es vital que el médico general, quien tiene el primer contacto con el paciente, sea capaz de reconocer las manifesta-ciones, e instaure un tratamiento para evitar complicaciones y secuelas del paciente. Objetivo: Identificar los aspectos importantes de la artritis séptica y proporcionar al lector información relevante de forma práctica y concreta para su actuar médico diario. Método: Búsqueda de artículos originales en bases de datos, empleando términos MeSH y DeCS, consulta de textos guía, en el periodo 2010-2022. Resultados: Con mayor frecuencia se ven afectados pacientes en extremos de edad, como los mayores de 60 años y los menores de 20 años, y la rodilla es la principal articulación afectada. La fiebre no es un criterio necesario para el diagnóstico de artritis séptica y el principal factor de riesgo es la enfermedad articular previa. Conclusiones: El análisis del líquido sinovial y la tinción de Gram, junto con el cultivo, permiten hacer el diagnóstico. El tratamiento antibiótico empírico es guiado por los factores de riesgo del paciente y, posteriormente, por los resultados del cultivo


Introduction: Septic arthritis is considered an emergency in orthopedics, it is defined as the dispro-portionate inflammatory process triggered by the colonization of some microorganism in the joint space, causing pathophysiological changes that degrade the cartilage causing increased morbidity and mortality, prolongation of hospital stay, irreversible sequelae, as well as increased costs for the health system, for this reason it is of vital importance that the general practitioner who has the first contact with the patient can recognize the manifestations, and establish treatment to avoid compli-cations and sequelae of the patient.Objective: To identify the important aspects of septic arthritis and provide the reader with relevant information in a practical and concrete way for his daily medical practice.Method: We searched for original articles in databases using MeSH and DeCS terms, consulting guide texts, with a search period from 2010 to 2022. Results: Patients in extremes of age are more frequently affected, such as patients older than 60 years and younger than 20 years, being the knee the main affected joint. Fever is not a necessary criterion for the diagnosis of septic arthritis and the main risk factor is previous joint disease. Conclusions: Synovial fluid analysis and Gram stain together with culture allow making diagnosis. Empirical antibiotic treatment is guided by the patient's risk factors, then by the culture results.


Introdução: a artrite séptica é considerada uma emergência na ortopedia. É definida como um processo inflamatório desproporcional, desencadeado pela colonização de um microrganismo no espaço arti-cular que, com as mudanças fisiopatológicas causadas, degrada a cartilagem e aumenta a morbidade e a mortalidade, a permanência hospitalar prolongada, sequelas irreversíveis, assim como os custos para o sistema de saúde. Por esta razão, é vital que o clínico geral, que tem o primeiro contato com o paciente, seja capaz de reconhecer as manifestações, e instituir tratamento para evitar complicações e sequelas para o paciente. Objetivo: Identificar os aspetos importantes da artrite séptica e fornecer ao leitor informações relevan-tes de uma forma prática e concreta para a prática médica diária. Método: Pesquisa de artigos originais em bancos de dados, usando termos MeSH e DeCS, consulta de textos guias, no período de 2010-2022. Resultados: Os mais frequentemente afetados são os pacientes em extremos de idade, como aqueles com mais de 60 anos e menos de 20 anos, e o joelho é a principal articulação afetada. A febre não é um critério necessário para o diagnóstico de artrite séptica e o principal fator de risco é a doença articular prévia. Conclusões: A análise do líquido sinovial e a coloração de Gram, junto com a cultura em meios espe-cíficos, permitem que o diagnóstico seja feito. O tratamento antibiótico empírico é orientado pelos fatores de risco do paciente e, posteriormente, pelos resultados da cultura


Assuntos
Artrite Infecciosa , Osteomielite , Staphylococcus aureus , Líquido Sinovial , Artrocentese
3.
Rev. bras. ortop ; 56(6): 689-696, Nov.-Dec. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1357130

RESUMO

Abstract Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing posttraumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.


Resumo A osteoartrite (OA) é caracterizada por uma degradação crônica, progressiva e irreversível da superfície articular, associada a inflamação articular. A principal etiologia da OA do tornozelo é pós-traumática e sua prevalência é maior entre os jovens e obesos. Apesar dos avanços no tratamento das fraturas ao redor do tornozelo, o risco geral de desenvolver OA pós-traumática do tornozelo após 20 anos do trauma é de quase 40%; especialmente nas fraturas bimaleolares de Weber tipo B e C e fraturas envolvendo a borda tibial posterior. Nas fraturas do tálus, essa prevalência se aproxima de 100%, dependendo da gravidade da lesão e do tempo de seguimento. Nesse cenário, é fundamental a compreensão atual das vias de sinalização moleculares envolvidas na senescência e apoptose dos condrócitos. O tratamento da OA do tornozelo é estagiado e guiado pelos sistemas de classificação, condições locais e do paciente. Os principais problemas são a limitada capacidade de regeneração da cartilagem articular, o baixo suprimento de sangue e a escassez de células-tronco progenitoras. A presente atualização resume evidências científicas básicas recentes da OA póstraumática do tornozelo, com foco principal nas alterações metabólicas da sinóvia, da cartilagem e do líquido sinovial. Epidemiologia, fisiopatologia, implicações clínicas, e opções de tratamento são também discutidas.


Assuntos
Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Líquido Sinovial , Cartilagem , Cartilagem Articular , Prevalência , Fraturas Ósseas , Fraturas do Tornozelo , Tornozelo/fisiopatologia
4.
Bol. méd. postgrado ; 37(1): 7-14, Ene-Jun 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1147872

RESUMO

La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)


Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)


Assuntos
Humanos , Masculino , Feminino , Artrite Reumatoide , Ultrassonografia , Articulação da Mão/diagnóstico por imagem , Líquido Sinovial , Doenças do Sistema Imunitário
5.
Braz. j. med. biol. res ; 54(2): e10366, 2021. tab, graf
Artigo em Inglês | LILACS, Coleciona SUS | ID: biblio-1142575

RESUMO

Recent publications have investigated the potential role of the protein level of matrix metalloproteinase-1 (MMP-1) in the susceptibility to rheumatoid arthritis (RA) and osteoarthritis (OA). However, no unanimous conclusion was obtained. Therefore, we carried out a meta-analysis to explore the association between MMP-1 expression and these two clinical disorders. After database searching and screening, we enrolled a total of eighteen articles for the pooled analysis. We observed a significant association between RA cases and controls in the whole population [SMD (standard mean difference)=1.01, P=0.017]. There were similar positive results in the subgroup analysis of "population-based control" (SMD=1.50, P=0.032) and "synovial fluid" (SMD=1.32, P=0.049). In addition, we observed an increased risk in OA cases, compared with controls, in the overall analysis (SMD=0.47, P=0.004) and subsequent subgroup analysis of "knee OA" (SMD=0.86, P<0.001), "Asian/China" (SMD=0.76, P=0.003), "cartilage-Asian/China" (SMD=1.21, P<0.001), and "synovial fluid-Asian/China" (SMD=0.73, P=0.004). In summary, a high protein level of MMP-1 in synovial fluid may be associated with the susceptibility to RA, and the high MMP-1 level in the cartilage tissue or synovial fluid may be related to the pathogenesis of knee OA in the Chinese population. This should be confirmed by larger sample sizes.


Assuntos
Humanos , Artrite Reumatoide/genética , Osteoartrite do Joelho/genética , Metaloproteinase 1 da Matriz/genética , Líquido Sinovial
6.
Int. j. morphol ; 38(6): 1539-1543, Dec. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1134474

RESUMO

SUMMARY: Meniscus tear is an important injury affecting the quality of life. This work is aimed to investigate the activity of CD68 and ADAMTS-5 in cells in synovial fluid in male and female patients with meniscal tear. In this study ,18 male and 22 female patients with meniscal tears were included. Local pain sensation during patients' physical examination, swelling, performing daily activities and difficulty in running-walking complaints were determined. 5 cc synovial fluids were aspirated from the lateral suprapatellar pouch part of the knees with meniscal pain. After routine histological follow-up of the samples, they were embedded in paraffin and sectioned with microtome and 5 micrometer thickness. CD68 and ADAMTS-5 primary antibodies were used for immunohistochemical analysis. Sections were taken and evaluated with a stylish microscope. The distribution of blood cells after meniscus tear was higher in female patients than in male patients. CD68 distribution in female patients appeared higher than in male patients. CD68 expression was high in macrophage cell cytoplasm. ADAMTS-5 expression was higher in female patients in degenerative cells and apoptotic cells. ADAMTS-5 is an important metallo-protein involved in the development of apoptotic signal and extracellular matrix synthesis in patients with ADAMTS-5 meniscus tear, and it may be an important criterion for the treatment developed after injury. CD68 and ADAMTS-5 activity was thought to be one of the important signal pathways that can be identified in the treatment of meniscus tear.


RESUMEN: La rotura del menisco es una lesión importante que afecta la calidad de vida. El objetivo fue investigar la actividad de CD68 y ADAMTS-5 en células del líquido sinovial en pacientes masculinos y femeninos con desgarro meniscal. Se incluyeron 18 pacientes masculinos y 22 femeninos con desgarros meniscales. Se determinó la sensación de dolor local durante el examen físico de los pacientes, la hinchazón, la realización de actividades diarias y la dificultad al correr y caminar. Se aspiraron 5 cc de líquido sinoviale de la parte de la bolsa suprapatelar lateral de las rodillas de los pacientes con dolor meniscal. Después del seguimiento histológico de rutina, las muestras se incluyeron en parafina y se seccionaron con un micrótomo de grosor de 5 micrómetros. Para el análisis inmunohistoquímico se usaron los anticuerpos primarios CD68 y ADAMTS-5. La distribución de las células sanguíneas después del desgarro del menisco fue mayor en pacientes femeninos que en pacientes masculinos. La distribución de CD68 en pacientes femeninos fue más alta que en pacientes masculinos. Además la expresión de CD68 fue alta en el citoplasma de los macrófagos. La expresión de ADAMTS-5 fue mayor en pacientes femeninos en las células degenerativas y células apoptóticas. ADAMTS-5 es una metaloproteína importante en el desarrollo de la señal apoptótica y la síntesis de matriz extracelular en pacientes con rotura de menisco ADAMTS-5, y puede ser un criterio importante para el tratamiento después de la lesión. La actividad de CD68 y ADAMTS-5 era una de las vías de señal importantes que se pueden identificar en el tratamiento de la rotura del menisco.


Assuntos
Humanos , Masculino , Feminino , Lesões do Menisco Tibial/metabolismo , Lesões do Menisco Tibial/patologia , Articulação do Joelho/metabolismo , Articulação do Joelho/patologia , Líquido Sinovial/química , Imuno-Histoquímica , Antígenos CD/análise , Sinoviócitos/metabolismo , Proteína ADAMTS5/análise , Articulação do Joelho/citologia
7.
Rev. argent. reumatolg. (En línea) ; 31(3): 32-35, set. 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1149673

RESUMO

La artritis séptica poliarticular se define como la infección de dos o más articulaciones, casi siempre de etiología bacteriana y diseminación hematógena. Es considerada una emergencia médica, lo que conlleva reconocerla precozmente, evitar la diseminación de la infección asociada con alta mortalidad y el riesgo de daño estructural articular. Presentamos tres casos de artritis séptica poliarticular, destacándose la importancia de la sospecha clínica y el estudio temprano del líquido sinovial para el diagnóstico y el tratamiento con antimicrobianos, evacuación y lavado articular.


Polyarticular septic arthritis is defined as the infection of two or more joints, almost always of bacterial etiology and hematogenous spread. It is considered a medical emergency, which should be recognized early, avoiding the spread of infection, associated with high mortality and the risk of joint structural damage. We present three cases of polyarticular septic arthritis, highlighting the importance of clinical suspicion and early synovial fluid study for diagnosis and treatment with antimicrobials, joint evacuation and joint lavage.


Assuntos
Humanos , Masculino , Artrite Reumatoide , Artrite , Líquido Sinovial , Terapêutica , Artrite Infecciosa
8.
Med. leg. Costa Rica ; 37(1): 45-53, ene.-mar. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1098371

RESUMO

Resumen La Artritis Idiopática Juvenil es la enfermedad reumática más frecuente en niños. Es una enfermedad crónica, degenerativa y de etiología desconocida; que puede dejar múltiples secuelas en la población pediátrica. Consta de siete afecciones definidas por la International League of Associations for Rheumatology del 2001: Artritis Sistémica, Oligoartritis, Artritis con Factor Reumatoide positivo o Factor Reumatoide negativo, Artritis relacionada a entesitis, Artritis psoriasica y Artritis indiferenciada; distintas tanto en el aspecto clínico, patogénico como evolutivo. Esta enfermedad se caracteriza por una alteración de la regulación del sistema inmunitario innato con una falta de linfocitos T autorreactivos y autoanticuerpos. La inflamación continua estimula el cierre rápido y prematuro del cartílago de crecimiento provocando un acortamiento óseo. Para llegar a su diagnóstico no se requiere más que una buena historia clínica y examen físico, ya que no hay laboratorios o gabinete lo bastante sensible que nos puedan ayudar. Fármacos como el metrotexate y los inhibidores del factor de necrosis tumoral han venido a modificar la evolución de la enfermedad y mejorar la calidad de vida de estos pacientes.


Abstract Juvenile idiopathic arthritis is the most common rheumatic disease in children. It is a chronic and degenerative disease, with an unknown etiology; that can leave multiple sequels in the pediatric population. There are seven conditions defined by 2001 International League of Associations for Rheumatology: Systemic Arthritis, Oligoarthritis, Arthritis with positive rheumatoid factor or negative rheumatoid factor, enthesitis-related arthritis and undifferentiated arthritis; distinct in clinical, pathogenetic and evolutionary aspects. This disease is characterized by an alteration on the regulation of the innate immune system with a lack of autoreactive lymphocytes T and autoantibodies. Continuous inflammation stimulates the rapid and premature closure of the growth cartilage causing bone shortening. To arrive at the diagnosis, it is only necessary to have a good medical history and physical exam, since there are no laboratory test sensitive enough to help us. Drugs such as methotrexate and tumor necrosis factor inhibitors have come to modify the evolution of the disease and improve the quality of life of these patients.


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Líquido Sinovial/efeitos dos fármacos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/análise , Fatores de Necrose Tumoral/uso terapêutico
9.
Adv Rheumatol ; 60: 11, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088644

RESUMO

Abstract Background: The current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis. Methods: We collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Each group included 34 patients. We compared the result of the synovial LE test with the result of the culture of each patient. Results: The mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture. Conclusion: The leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis.(AU)


Assuntos
Humanos , Artrite Reumatoide/diagnóstico , Líquido Sinovial/química , Artrite Infecciosa/diagnóstico , Contagem de Leucócitos
10.
Rev. bras. parasitol. vet ; 28(4): 779-785, Oct.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1057995

RESUMO

Abstract A free-living, adult male maned wolf (Chrysocyon brachyurus) was referred to the Governador "Laudo Natel" - FCAV/Unesp veterinary hospital after being found with skin lesions and a fracture on the right pelvic limb, which had to be amputated due to compromised integrity. Around 20 days later, bilateral accentuated swollen on humerus-radius-ulna articulation was observed. The synovial liquid was drained and sent to the laboratory for synovial cytology with Rosenfeld staining that revealed predominantly degenerated neutrophils with karyolytic chromatin associated with intracellular inclusions suggestive of Hepatozoon sp. gametocytes. Blood and synovial liquid samples were submitted to molecular analysis, aiming to amplify the Hepatozoon spp. 18S rRNA gene fragment. Despite the positioning of the found Hepatozoon sequence together with Hepatozoon canis previously detected in domestic carnivores, the BLAST analysis showed only 98% identity with H. canis. To the best of the authors' knowledge, this is the first time a Hepatozoon was detected in the synovial liquid by clinical pathology and molecular analyses.


Resumo Um lobo guará (Chrysocyon brachyurus) adulto, macho, de vida livre foi encaminhado para atendimento no hospital veterinário Governador "Laudo Natel" - FCAV/Unesp após ser encontrado com lesões de pele e fratura em membro pélvico direito, sendo amputado devido a comprometimento da integridade do membro. Aproximadamente 20 dias após a chegada ao hospital, foi notado acentuado aumento de volume bilateral em região de articulação úmero-rádio-ulnar. O líquido sinovial foi drenado e enviado para análise citológica com coloração de Rosenfeld, revelando a presença de neutrófilos degenerados com cromatina cariolítica associados a inclusões intracelulares sugestivas de gametócitos de Hepatozoon sp. Amostras de sangue e líquido sinovial foram submetidas a análises moleculares visando amplificar um fragmento do gene 18S rRNA de Hepatozoon spp. Apesar da sequência de Hepatozoon detectada se posicionar filogeneticamente no mesmo clado que H. canis previamente detectado em carnívoros domésticos, o resultado da análise do BLAST mostrou somente 98% de identidade com H. canis. De acordo com o conhecimento dos autores, esta é a primeira vez que Hepatozoon foi detectado no líquido sinovial por meio de patologia clínica e análises moleculares.


Assuntos
Animais , Masculino , Infecções por Protozoários/parasitologia , Líquido Sinovial/parasitologia , Apicomplexa/genética , Canidae/parasitologia , Filogenia , Brasil , RNA Ribossômico 18S/genética , Apicomplexa/isolamento & purificação , Achados Incidentais
11.
Pesqui. vet. bras ; 39(6): 388-392, June 2019. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1012759

RESUMO

The aim of the study was to determine the concentration pattern of intra-articular acute phase proteins (APPs) and immunoglobulins in healthy crossbred cattle. Synovial fluid (SF) samples were collected from the radiocarpal joint of 25 heifers and 25 steers. Concentrations of APPs were measured by SDS-PAGE. The results were submitted to analysis of variance using the SAS statistical program, and means were compared by the Student-Newman-Keuls test (P<0.05). Thirty-seven proteins with molecular weights ranging from 7 to 37kDa were identified in SF of all animals. Eight were nominally identified with immunoglobulin A (IgA) and G (IgG), ceruloplasmin (Cp), transferrin (Tf), albumin (Ab), α1-antitripsin (AAT), α1-acid glycoprotein (AGP), and haptoglobin (Hp). The α1-antitripsin was only identified in the Sf of the heifers. The SF values of Cp, Hp, AGP and IgA were significantly higher in heifers than in steers. In sera, 34 proteins with molecular weights between 7 and 244kDa were identified in heifers and steers. Similar proteins were nominally identified in the sera, however the α1-antitrypsin was identified only in SF. The serum values Tf, AGP and IgG were significantly higher in heifers compared with steers. In conclusion, the physiological acute-phase proteins concentrations in synovial fluid of healthy ruminants can be useful in the interpretation of samples from animals with joint diseases. The SF electrophoretic profile of healthy ruminants differs depending on gender. Similar proteins were nominally identified in the sera, but only the SF of α1-antitrypsin.(AU)


O objetivo do estudo foi determinar o padrão de concentração de proteínas de fase aguda e de imunoglobulinas intra-articulares (APPs) em bovinos mestiços saudáveis. As amostras de fluido sinovial (SF) foram coletadas da articulação radiocárpica de 25 novilhas e 25 novilhos. As concentrações de APPs foram mensuradas por SDS-PAGE. Os resultados foram submetidos à análise de variância usando o programa estatístico SAS, e os meios foram comparados pelo teste Student-Newman-Keuls (P<0,05). Trinta e sete proteínas com pesos moleculares variando de 7 a 37kDa foram identificadas no SF de todos os animais. Oito foram nominalmente identificadas como imunoglobulina A (IgA) e G (IgG), ceruloplasmina (Cp), transferrina (Tf), albumina (Ab), a1-antitripsina (AAT), glicoproteína a1-ácido (AGP) e haptoglobina (Hp). A α1-antitripsina foi identificada apenas no SF das novilhas. Os valores de Cp, Hp, AGP e IgA no SF foram significativamente maiores em novilhas do que em novilhos. No soro, 34 proteínas com pesos moleculares entre 7 e 244kDa foram identificadas nas novilhas e novilhos. Proteínas similares foram identificadas nos soros, mas apenas o SF das novilhas apresentou a α1-antitripsina. Os valores séricos de Tf, AGP e IgG foram significativamente maiores em novilhas em relação aos novilhos. Conclui-se que a mensuração das concentrações das proteínas da fase aguda no líquido sinovial de animais saudáveis pode ser útil na avaliação de amostras oriundas de bovinos com afecções articulares. O perfil eletroforético do SF de ruminantes saudáveis difere em função do gênero e as diferenças devem ser levadas em consideração na interpretação dos achados.(AU)


Assuntos
Animais , Bovinos , Líquido Sinovial , Imunoglobulinas/análise , Proteínas de Fase Aguda/análise , Bovinos/sangue
12.
Acta ortop. mex ; 33(2): 127-135, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1248647

RESUMO

Resumen: Actualmente contamos con diversos métodos de laboratorio para el diagnóstico de las infecciones periprotésicas, algunos ampliamente probados y otros en estudio. Han aparecido nuevos biomarcadores después del Consenso de Filadelfia, por tal motivo, nos planteamos hacer una revisión acerca de qué hay de nuevo para su diagnóstico después del Consenso y cuáles podrían ser los más útiles para el trabajo clínico diario. Material y métodos: Se revisaron artículos publicados entre 2013-2017 en cinco revistas de alto impacto. Las variables fueron: tipo de biomarcador, cifras de corte, sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, área bajo la curva, razón de momios diagnósticos y cocientes de probabilidad positivos y negativos. Se calificó nivel de evidencia. Resultados: Los resultados se agruparon en Tablas. Se encontraron 54 artículos, de los cuales 31 no se ajustaban a los criterios de inclusión y fueron excluidos; sólo se incluyeron 23. Se encontraron 19 biomarcadores, cinco de los cuales no habían sido reportados hasta antes de 2013: La α defensina sinovial 1, la β defensina humana 3, el lactato sinovial y los receptores tipo Toll 1 y Toll 6. Conclusión: Los biomarcadores que ofrecen mayor utilidad clínica para el diagnóstico de IAP son: la proteína C reactiva, la esterasa leucocitaria, la interleucina-6, la interleucina-1β, la α-defensina y la interleucina-17. Detectamos cinco nuevos marcadores. Los estudios analizados muestran heterogeneidad en sensibilidad, especificidad y en sus cifras de corte. En la mayoría no usan aplicaciones estadísticas avanzadas que los harían más confiables.


Abstract: We now have a great variety of laboratory diagnostic tools, for the detection of PJI, some of them widely used and others under study. After the Philadelphia Consensus, they have emerged some new biomarkers. Because of that, we consider useful to review which new biomarkers we have for the diagnosis of PJI after the Consensus and which of them could be more useful in daily clinic work. Material and methods: We searched for articles published from 2013 to 2017 in 5 high impact journals. The analized variables were: biomarker type, cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio. We value their evidence level. Results: Results were grouped in Tables. They were found 54 articles, 31 of them didn't meet the inclusion criteria so they were excluded; 23 studies were included in the revision. We found a total of 19 biomarkers studies, 5 of them weren't reported before 2013: Sinovial α defensin 1, human β defensin-3, sinovial lactate and Toll-like receptors 1 and 6. Conclusion: Of all the markers reviewed for the diagnosis of PJI, C reactive protein, esterase test strip, interleukin-6, interleukin-1 β, α defensin and interleukin-17 show the highest diagnostic utility. We found 5 new markers. The articles studies show high heterogeneity in their reported sensitivity, specificity and cutoff values. In most of them were not used advanced statistical tools which could make them more reliable.


Assuntos
Humanos , Biomarcadores/análise , Infecções Relacionadas à Prótese/diagnóstico , Líquido Sinovial , alfa-Defensinas/análise , Consenso
13.
Rio de Janeiro; s.n; 2019. 103 p.
Tese em Português | LILACS, Coleciona SUS | ID: biblio-1179008

RESUMO

A infecção articular periprotética (IAP) é uma das complicações mais frequentes e graves da artroplastia total de quadril (ATQ). A presença de IAP requer a adoção de medidas terapêuticas específicas, frequentemente havendo necessidade de cirurgia de revisão. O diagnóstico preciso e o tratamento adequado são imprescindíveis para evitar a perda funcional e a evolução para infecção sistêmica. Entretanto, o diagnóstico correto da IAP é um desafio, uma vez que ainda não há um método diagnóstico padrão ouro, e os critérios diagnósticos existentes se baseiam em achados cirúrgicos e testes sorológicos, histológicos e microbiológicos, que são imprecisos e demorados. Entre os exames preconizados, a pesquisa de esterase leucocitária (PEL) tem as vantagens de fornecer resultados rápidos, "à beira do leito" ("point of care"), e ser de baixo custo, além de apresentar boa acurácia, de acordo com estudos internacionais. Seu desempenho na população brasileira, no entanto, é pouco conhecido. Dessa forma, este estudo se propõe a avaliar o desempenho da PEL para identificação da IAP pós ATQ nos pacientes submetidos à cirurgia de revisão da ATQ no INTO. Foram incluídos os pacientes nos quais foi possível coletar líquido sinovial (LS) durante o procedimento cirúrgico. Para diagnóstico de IAP foram utilizados os critérios preconizados pela Sociedade de Infecção Musculoesquelética. O valor diagnóstico da PEL foi comparado aos exames de cultura microbiológico, avaliação histopatológica da membrana periprotética, velocidade de hemossedimentação, quantificação de proteína C reativa no plasma, contagem de células brancas no LS e percentual de polimorfonucleares no LS. Foram incluídos no estudo 53 pacientes, sendo 25 (54,3%) homens e 21 (45,6%) mulheres. Dezessete pacientes tiveram diagnóstico de IAP confirmado, dos quais quinze tiveram crescimento de microrganismos na cultura do tecido periprotético. Foi possível realizar a PEL em 42 pacientes, 15 do grupo infecção e 27 do grupo não infecção. A PEL do líquido sinovial apresentou valores de sensibilidade e especificidade de 53% e 100%, respectivamente. A sensibilidade da PEL foi inferior apenas à sensibilidade do teste microbiológico. A baixa sensibilidade encontrada sugere que a PEL não deve ser utilizada como exame de triagem de IAP, já que seu valor preditivo negativo baixo (79,4%) não permite que o resultado negativo seja utilizado para excluir a hipótese de infecção. A especificidade e o valor preditivo positivo alto, aliados à rapidez, baixo custo e possibilidade de ser utilizada no intra-operatório, faz da PEL um exame bastante útil dentro do arsenal diagnóstico da IAP. Quando positiva, a PEL confirma o diagnóstico de infecção, sendo, portanto, capaz de mudar a conduta do cirurgião durante uma cirurgia de revisão classificada inicialmente como asséptica, de acordo com a avaliação pré-operatória. Desta forma recomendamos o uso rotineiro da PEL em todas as revisões aparentemente assépticas de quadril


Periprosthetic Joint Infection (PJI) is one of the most frequent and severe complications of total hip arthroplasty (THA). The presence of PJI requires the adoption of specific therapeutic measures, often requiring revision surgery. Accurate diagnosis and adequate treatment are essential to restore patient function and inhibit evolution to systemic infection. However, the correct diagnosis of PJI is challenging, since there is not such a gold standard, highly accurate, diagnostic method for this disease. PJI diagnosis is currently based on the combination of surgical findings and serological, histological and microbiological tests that are imprecise and time consuming. Among the exams recommended, the test of leukocyte esterase (TLE) has the advantages of providing quick results, at bed side ("point of care"), with low cost, besides having good accuracy, according to international studies. Its performance in the Brazilian population, however, is unknown. Thus, this study proposes to evaluate the performance of the TLE for the identification of the PJI post THA in patients submitted to revision surgery of THA, treated at INTO. Patients in whom was possible to collect synovial fluid (SF) during the surgical procedure were included. The criteria recommended by the Musculoskeletal Infection Society were used for the diagnosis of PJI. The diagnostic value of TLE was compared to microbiological culture, histopathological evaluation of periprosthetic membrane, erythrocyte sedimentation rate, plasma C-reactive protein quantification, white cell count in SF and percentage of polymorphonuclear in SF. The study included 53 patients, of which 25 (54.3%) were men and 21 (45.6%) were women. Seventeen patients had the diagnosis of infection confirmed, of which fifteen had growth of microorganisms in the periprosthetic tissue culture. It was possible to perform TLE in 42 patients, 15 of the infection group and 27 of the non-infection group. The TLE presented values of sensitivity and specificity of 57% and 100%, respectively. The sensitivity of TLE was significantly reduced in comparison to sensitivity of microbiological test. The low sensitivity suggests that TLE should not be used as an IAP screening test, since its low negative predictive value (79.4%) does not allow that the negative result lead to the exclusion of the hypothesis of infection. However, specificity and high positive predictive value, combined with the rapidity, low cost and possibility of being used intraoperatively, make TLE a very useful exam within the diagnostic arsenal of PJI. When positive, TLE confirms the diagnosis of infection and is, therefore, able to change the surgeon's behavior during revision surgery initially classified as aseptic, according to the preoperative evaluation. In this way, we recommend the routine use of TLE in all apparently aseptic hip revisions


Assuntos
Reoperação , Líquido Sinovial , Artroplastia de Quadril
14.
Rev. colomb. reumatol ; 25(4): 271-286, oct.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-990959

RESUMO

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.


Assuntos
Artrite Reumatoide , Líquido Sinovial , Doenças Periodontais , Membrana Sinovial , Líquido do Sulco Gengival
15.
Int. j. morphol ; 36(1): 297-302, Mar. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-893226

RESUMO

RESUMEN: El objetivo de este estudio fue realizar una revisión de la literatura respecto de la importancia del líquido sinovial en la articulación temporomandibular y sus implicancias en la patología articular. El líquido sinovial corresponde a un fluido viscoso y filante de color amarillento claro, compuesto principalmente por proteínas plasmáticas, componentes celulares, moléculas lubricantes, citoquinas, factores de crecimiento y enzimas. Es producido por la membrana sinovial y se encuentra en relación directa con las superficies articulares y la membrana sinovial, mediando las interacciones entre los tejidos de las articulaciones sinoviales. En la articulación temporomandibular desempeña un papel fundamental en el mantenimiento y regulación de la fisiología, a través de funciones lubricantes, reguladoras y metabólicas, disminuyendo el roce de las superficies articulares durante todos sus movimientos. En los trastornos temporomandibulares, la composición y función del líquido sinovial se puede ver alterada por cambios en los tejido de la articulación temporomandibular, estos cambios pueden resultar en una disminución en la capacidad de lubricar las superficies articulares y generar un ambiente catabólico en el interior de la articulación, contribuyendo conjuntamente al deterioro de éstas.


SUMMARY: The aim of this study was to conduct a review of the literature on the value of synovial fluid in the temporomandibular joint and its implications in joint pathology. The synovial fluid is a viscous and filamentous fluid of a light yellow color, composed mainly of plasma proteins, cellular components, lubricating molecules, cytokines, growth factors and enzymes. It is produced by the synovial membrane and is in direct relation with the joint surfaces and the synovial membrane, mediating the interactions between the tissues of the synovial joints. In the temporomandibular joint it plays a fundamental role in the maintenance and regulation of physiology, through lubricating, regulating and metabolic functions, decreasing the friction of the joint surfaces during all its movements. In temporomandibular disorders, synovial fluid function can be altered by changes in the tissues of the temporomandibular joint, these changes can result in a decrease in the ability to lubricate the joint surfaces and generate a catabolic environment inside the joint, contributing together to the deterioration of these.


Assuntos
Humanos , Líquido Sinovial/fisiologia , Articulação Temporomandibular/fisiologia , Transtornos da Articulação Temporomandibular/fisiopatologia
16.
Acta ortop. mex ; 31(6): 319-327, nov.-dic. 2017. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-949788

RESUMO

Resumen: En la degradación del cartílago articular, la limitación funcional y el dolor se asocian a la alteración cuantitativa y cualitativa del ácido hialurónico en un proceso fisiopatológico sobre el que influye una amplia variedad de factores cuyo impacto agrava la enfermedad y disminuye la calidad de vida del paciente. El manejo farmacológico convencional para la osteoartritis es a menudo insuficiente. Por fortuna, en el mundo actual se cuenta con viscosuplementos capaces de mejorar, restituir y promover la producción endógena del ácido hialurónico degradado en los cuadros de osteoartritis. El uso de estos compuestos exige el apego a un conjunto de técnicas específicas, diseñadas para la correcta infiltración intraarticular del viscosuplemento sin necesidad de infligir una carga traumática adicional al paciente; estas técnicas -con referencia especial al paciente afectado por la osteoartritis de rodilla (gonartritis)- se describen en el presente artículo, en el que además se destacan los criterios para la elección del viscosuplemento idóneo, el más semejante al ácido hialurónico nativo de personas jóvenes y sanas y aquel cuyo uso terapéutico reporta mayores beneficios clínicos a corto y a largo plazo.


Abstract: In the degradation of articular cartilage, functional limitation and pain -cardinal signs of osteoarthritis- underlies, as a central factor, the quantitative and qualitative alteration of hyaluronic acid, the main component of synovial fluid and cartilage, in a pathophysiological process influenced by a wide variety of risk factors whose impact complicates the disease and radically reduces the quality of life of the patient. Conventional pharmacological management for osteoarthritis is often insufficient. Fortunately, in our days, there are viscosupplements capable of improving, replacing and promoting the endogenous production of degraded hyaluronic acid in osteoarthritis. The use of these compounds requires the adherence to a set of specific techniques, designed for the correct intra-articular infiltration of the viscosupplement without the need to inflict an additional traumatic load on the patient; these techniques -with special reference to the patient affected by knee osteoarthritis (gonarthritis)- are described in this article, which also highlights the criteria for choosing the ideal viscosupplement, the one most similar to hyaluronic acid native in healthy young people, and one whose therapeutic use reports greater clinical benefits in the short and long term.


Assuntos
Humanos , Líquido Sinovial , Osteoartrite do Joelho/terapia , Osteoartrite do Joelho , Injeções Intra-Articulares
18.
Braz. j. med. biol. res ; 50(11): e6485, 2017. tab
Artigo em Inglês | LILACS | ID: biblio-888949

RESUMO

Osteoarthritis (OA) is the main cause of disability worldwide, due to progressive articular cartilage loss and degeneration. According to recent research, OA is more than just a degenerative disease due to some metabolic components associated to its pathogenesis. However, no biomarker has been identified to detect this disease at early stages or to track its development. Metabolomics is an emerging field and has the potential to detect many metabolites in a single spectrum using high resolution nuclear magnetic resonance (NMR) techniques or mass spectrometry (MS). NMR is a reproducible and reliable non-destructive analytical method. On the other hand, MS has a lower detection limit and is more destructive, but it is more sensitive. NMR and MS are useful for biological fluids, such as urine, blood plasma, serum, or synovial fluid, and have been used for metabolic profiling in dogs, mice, sheep, and humans. Thus, many metabolites have been listed as possibly associated to OA pathogenesis. The goal of this review is to provide an overview of the studies in animal models and humans, regarding the use of metabolomics as a tool for early osteoarthritis diagnosis. The concept of osteoarthritis as a metabolic disease and the importance of detecting a biomarker for its early diagnosis are highlighted. Then, some studies in plasma and synovial tissues are shown, and finally the application of metabolomics in the evaluation of synovial fluid is described.


Assuntos
Humanos , Animais , Metabolômica/tendências , Osteoartrite/diagnóstico , Osteoartrite/metabolismo , Biomarcadores/metabolismo , Diagnóstico Precoce , Espectroscopia de Ressonância Magnética/métodos , Espectrometria de Massas/métodos , Metabolômica/métodos , Osteoartrite/fisiopatologia , Líquido Sinovial/metabolismo
19.
Acta ortop. mex ; 30(6): 302-306, nov.-dic. 2016. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-949768

RESUMO

Resumen: Antecedentes: La infección articular es un reto ortopédico por su complejidad diagnóstica y efectos devastadores al no tratarse oportunamente. Contamos con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren de infraestructura compleja. En este estudio determinamos la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. Material y métodos: Durante Noviembre de 2015 a Abril de 2016, se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante, y de otros sin infección, con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos; se determinó positivo para infección con dos cruces; el resto de la muestra fue enviado a cultivo. Resultados: Realizamos el test en 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad de 100%, especificidad de 88.24%, VPP de 68.42% y VPN de 100%; índice de Kappa de .753. Conclusiones: La esterasa leucocitaria es una prueba eficaz para detectar un proceso infeccioso contra uno inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia Kappa de 0.753, con lo que demostró ser reproducible, por lo que recomendamos implementarlo en los servicios de urgencias a nivel nacional.


Abstract: Background: Articular infection is an orthopedic challenge due to its difficult diagnosis and devastating results. Various diagnostic studies exist: culture, ESR, CRP, count of leukocytes, among others, but none is specific, they all take more than 30 minutes to complete, and require complex infrastructure. In this study, we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. Material and methods: During November 2015 to April 2016, we obtained synovial fluid from two groups of patients: one with a diagnosis of synovial joint infection with or without implant, and the control group, without infection but with degenerative pathology of the knee. We evaluated the sample using the leukocyte esterase test COMBI-SCREEN 11SYS with colorimetric reading at two minutes; two crosses determined positive for infection; the remainder of the sample was sent for culture. Results: We performed the test in 64 samples of synovial fluid, 19 diagnosed with articular infection and 45 without it. We obtained a sensitivity of 100%, specificity of 88.24%, PPV of 68.42%, and NPV of 100%; Kappa index of .753. Conclusions: Leukocyte esterase is an effective test to detect an infectious process against an inflammatory one with a high probability of success. This study presented an index of agreement Kappa of 0.753, proving to be reproducible.


Assuntos
Humanos , Líquido Sinovial/química , Hidrolases de Éster Carboxílico/análise , Infecções Relacionadas à Prótese/diagnóstico , Biomarcadores/análise
20.
Rev. bras. reumatol ; 56(5): 451-457, Sept.-Oct. 2016. tab
Artigo em Inglês | LILACS | ID: lil-798098

RESUMO

ABSTRACT A better understanding of the inflammatory mechanisms of rheumatoid arthritis and the development of biological therapy revolutionized its treatment, enabling an interference in the synovitis – structural damage – functional disability cycle. Interleukin 33 was recently described as a new member of the interleukin-1 family, whose common feature is its pro-inflammatory activity. Its involvement in the pathogenesis of a variety of diseases, including autoimmune diseases, raises the interest in the possible relationship with rheumatoid arthritis. Its action has been evaluated in experimental models of arthritis as well as in serum, synovial fluid and membrane of patients with rheumatoid arthritis. It has been shown that the administration of interleukin-33 exacerbates collagen-induced arthritis in experimental models, and a positive correlation between cytokine concentrations in serum and synovial fluid of patients with rheumatoid arthritis and disease activity was found. This review discusses evidence for the role of interleukin-33 with a focus on rheumatoid arthritis.


RESUMO A melhor compreensão dos mecanismos inflamatórios da artrite reumatoide e o desenvolvimento da terapia biológica revolucionaram o tratamento da doença, permitindo uma interferência no ciclo sinovite–dano estrutural–incapacidade funcional. A interleucina 33 foi recentemente descrita como um novo membro da família da interleucina 1, cuja característica comum é a atividade pró-inflamatória. Por estar envolvida na patogênese de uma grande variedade de doenças, incluindo doenças autoimunes, a interleucina 33 começa a ser estudada na doença reumatoide. Ela tem sido avaliada em modelos experimentais de artrite, no soro, no líquido e membrana sinoviais de pacientes com artrite reumatoide. Demonstrou-se que a administração da interleucina 33 exacerba a artrite induzida por colágeno em modelos experimentais, e concentrações dessa citocina no soro e no líquido sinovial de pacientes com artrite reumatoide correlacionaram-se positivamente com a atividade da doença. Esse manuscrito apresenta a interleucina 33 e discute as evidências do seu papel em diferentes doenças, com ênfase na artrite reumatoide.


Assuntos
Humanos , Animais , Artrite Experimental/imunologia , Artrite Reumatoide/patologia , Interleucina-33/imunologia , Interleucina-33/sangue , Artrite Experimental/patologia , Artrite Experimental/sangue , Artrite Reumatoide/imunologia , Artrite Reumatoide/sangue , Líquido Sinovial , Sinovite , Interleucinas
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