[Functional and morphologic changes in the tendons and multimicrovacuolar collagen absorbing system of the three-phalanx fingers in disorder of arterial inflow].

Taking into account the fact, that unsatisfactory results of treatment of the thumbs traumatic damage are significantly caused by presence of anatomic disruption of the thumbs palm's own arteries with chronic tissue ischemia occurrence. One of consequences of damage of the three-phalanx thumbs interphalanx joints and the thumbs palm's own arteries is a formation of quickly progressing secondary flexing contracture of proximal interphalanx joints (PIPHJ). In the investigations accomplished there was established, that the changed tissues of the flexors tendons and their sheaths, forming cicatricial blockade distally to the primary trauma site, are taking part in a PIPHJ contracture development while arterial perfusion presence.The tissues damage severity, as well as a severity of clinical features of the tendons and their sheaths damage, depends on a degree of an arterial perfusion disorder present,

Dynamic optical imaging of vascular and metabolic reactivity in rheumatoid joints.

Dynamic optical imaging is increasingly applied to clinically relevant areas such as brain and cancer imaging. In this approach, some external stimulus is applied and changes in relevant physiological parameters (e.g., oxy- or deoxyhemoglobin concentrations) are determined. The advantage of this approach is that the prestimulus state can be used as a reference or baseline against which the changes can be calibrated. Here we present the first application of this method to the problem of characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system together with previously implemented model-based iterative image reconstruction schemes, we have performed initial dynamic imaging case studies on a limited number of healthy volunteers and patients diagnosed with RA. Focusing on three cases studies, we illustrated our major finds. These studies support our hypothesis that differences in the vascular reactivity exist between affected and unaffected joints.

Expression of long non­coding RNAs in chondrocytes from proximal interphalangeal joints.

Osteoarthritis (OA) of hand is a common disease, resulting in disability of the hands. The pathogenesis of hand (H) OA remains to be elucidated, and findings from knee and hip joints cannot be simply applied to HOA. To improve knowledge on the specific biology and pathobiology of HOA, the present study performed bioinformatics analyses to analyze the long non­coding (lnc) RNA expression profile in human chondrocytes of proximal interphalangeal (PIP) finger joints and knee joints. Gene expression data were downloaded from the Gene Expression Omnibus database, and PIP and knee chondrocytes were analyzed (n=3/group). Probes of the Affymetrix Human Gene 2.0 ST Microarray were annotated to obtain information about lncRNA expression profile. Compared with chondrocytes from knee joints, chondrocytes derived from PIP joints had significantly different lncRNA expression profiles, and 1,172 lncRNAs were differentially expressed. Compared with chondrocyte from knee joints, 534 lncRNAs were upregulated and 638 lncRNAs were downregulated in chondrocytes from PIP joints. A co­expression network was constructed to analyze the correlation between lncRNAs and protein­coding genes. Function annotation analyses suggested that protein­coding genes that are co­expressed with lncRNAs are enriched in the biological processes of bone morphogenesis, bone development and cartilage development. In conclusion, the present study demonstrated that chondrocytes derived from PIP joints exhibit a significant difference in lncRNA expression compared with chondrocytes derived from knee joints.

Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid.

BACKGROUND: Digital myxoid cysts are a relatively common pathology in the skin, representing a ganglion of the adjacent distal interphalangeal joint. Success of treatment is largely proportional to the destructiveness of the therapy and postoperative morbidity. We studied an effective, minimally traumatic surgical treatment in which tissue is not removed and morbidity is low. DESIGN: Open, nonrandomized trial of therapy. Methylene blue dye was injected into the distal interphalangeal joint. A skin flap was designed around the cyst and raised to identify the dye-filled communication between joint and cyst. The communication was sutured and the flap was replaced with no tissue excision. SETTING: Two university dermatology departments. PATIENTS: Fifty-four subjects with 47 cysts involving fingers or thumbs and 7 involving toes. Previous therapies in 37 patients had resulted in relapse. MAIN OUTCOME MEASURES: Clinical assessment at 2 and 8 months. RESULTS: We treated 34 women and 20 men (mean age, 60.4 years; range, 45-83 years). Communication between cyst and joint was identified by means of methylene blue injection in 48 patients (89%). At 8 months, 48 patients remained cured with no visible scarring. Of these, nail dystrophy associated with the cyst preoperatively (n = 35) resolved in all but 1 patient (97%). Six patients had relapses (5 within 4 months). Of these, 3 were on the toes. Cure rate on toes was 4 of 7 (57%) and on fingers, 44 of 47 (94%). In 2 patients, pain persisted for 4 months and then resolved. Limitation of joint mobility resolved after 2 months in 1 subject. CONCLUSIONS: Ligature of myxoid cyst origin at the joint capsule is an effective treatment and does not require excision. Myxoid cysts on toes are more likely to relapse than those on fingers.

Mechanical properties of the scapholunate ligament correlate with bone mineral density measurements of the hand.

The mechanical properties of the scapholunate ligament have been previously examined in small sample sizes, with ultimate load and occasionally stiffness reported. The present study examined 16 scapholunate ligaments in uniaxial extension at two rates and determined stiffness, ultimate load, and stress relaxation properties. Mean stiffness values of 66.4+/-28.6 N/mm at an elongation rate of 50 mm/min and 94.5+/-44.4 N/mm at an elongation rate of 100 mm/min were found. Relaxation behavior, determined by the percent load remaining after 100 s, was found to be 68.1+/-12%. Mean ligament ultimate loads were 357+/-110 N (n = 8). In eight specimens, failure occurred in bone. Positive correlations were observed between bone mineral density of the hand and ligament stiffness, ligament ultimate load, and bone ultimate load. No correlation was observed between bone mineral density and ligament load relaxation behavior. The results provide a comprehensive understanding of scapholunate ligament biomechanics and demonstrate a relationship between bone and ligament properties.

Late presentation and microcrystalline arthropathy in primary hyperoxaluria.

A 66 year-old woman was referred in 1981 because of renal insufficiency and pronounced nephrocalcinosis. The urinary oxalate excretion was elevated. Secondary hyperoxaluria was excluded. End-stage renal disease necessitated hemodialysis from late in 1982 up to her death in 1986, at the age of 71 years. During the course of the disease, an aggressive arthropathy developed in the fingers. Classical signs of oxalosis were found: deposits of calcium oxalate crystals in bone tissue, the pancreas, myocardium, subcutaneous tissue and especially in the kidneys. This rare case documents the possible occurrence of late clinical presentation and long survival in primary oxalosis.

Calcific periarthritis of the finger verified by X-ray diffraction of apatite.

The authors describe a 24-year-old woman presenting with swelling and pain of several finger joints. Roentgenograms showed periarticular, calcific deposits at all locations of swelling. One such deposit revealed the presence of hydroxyapatite crystals on X-ray diffraction. After two injections of corticosteroids in and around one deposit its size and density diminished rapidly, whereas the uninjected corresponding site of the other hand showed no initial improvement; after two years no difference was discernible. Under systemic and topic NSAIDs, pain and swelling improved similarly in all joints. In conclusion, periarthritis of the fingers associated with radiopaque deposits responded favourably to NSAID therapy, while local corticosteroid injections showed no additional benefit.

[Flexion contractures of the PIP joints: pathogenesis, classification and results following arthrolysis]. / Beugekontrakturen der Mittelgelenke: Pathogenese, Klassifikation und Ergebnisse nach Arthrolysen.

The most frequent cause of flexion contracture is immobilization, which may occur with or without trauma. Posttraumatic flexion contracture mainly develops from direct injury, intraarticular fluid and the physiological muscle balance. Nontraumatic post-immobilisation stiffness is due to biochemical and biomechanic changes as well as processes, which are determined by the metabolic activities of tissue and the lack of stress. Because of the variable and the changing anatomical substrates, and owing to different prognostic factors, it is necessary to subdivide the group of flexion contractures with regard to their prognostic factors. Thus, we recommend to differentiate between simple periarticular contractures, complex periarticular contractures with tenodesis and/or contractures caused by scars, as well as a corresponding classification of corresponding treatment procedures. The results in the literature will then be categorized accordingly within a metaanalysis. With regard to the reduction of flexion contractures and the range of motion, the group of simple periarticular arthrolysis shows better results than the group of complex periarticular arthrolysis. The mediolateral approach is preferred in the first group.

[Therapeutic effect of hemodialysis on gouty arthritis and tophi in 2 patients with chronic renal failure].

Therapeutic effect of hemodialysis on gouty arthritis and tophi in 2 patients with chronic renal failure (CRF) is described. One patient was 74-year-old man with CRF due to benign nephrosclerosis, and had severe secondary gout. There were many tophi in metatarsophalangeal joints of the fingers and toes. Another patient was 44-year-old man with CRF probably due to familial gout. He had many tophi in elbows, knees, wrists, fingers and toes. In both cases initiation of hemodialysis treatment, at first temporally exacerbated gouty arthritis, but thereafter gradually eliminated the tophi. From these results, dialysis treatment is considered to be quite efficient method of treatment for gouty arthritis and tophi in patient with CRF. Gouty arthritis in CRF patient, which does not respond to the conservative therapy, should be considered to be one of the indices for commencement of hemodialysis.

Associations between biomarkers of joint metabolism, hand osteoarthritis, and hand pain and function: the Johnston County Osteoarthritis Project.

OBJECTIVE: To determine the associations between joint metabolism biomarkers and hand radiographic osteoarthritis [(rOA), based on Kellgren Lawrence (KL) grade ≥ 2], symptoms, and function. METHODS: Cross-sectional data were available for 663 participants (mean age 63 yrs, 63% white, 49% women). Three definitions of hand rOA were considered: (1) a composite measure involving at least 3 hand joints distributed bilaterally with 2 of 3 in the same joint group, including ≥ 1 distal interphalangeal joint, without metacarpophalangeal (MCP) swelling; (2) rOA in at least 1 joint of a group; and (3) number of joints with KL ≥ 2. We assessed hand symptoms and the 15-item Australian Canadian Hand Osteoarthritis Index (AUSCAN; Likert format). We measured serum cartilage oligomeric matrix protein (sCOMP), hyaluronic acid (sHA), carboxy-terminal propeptide of type II collagen, type II collagen degradation product, urinary C-terminal crosslinked telopeptide of type II collagen, and urinary N-terminal crosslinked telopeptide. Linear regression models were performed to assess associations between each biomarker with hand rOA, AUSCAN, and symptoms, adjusting for age, sex, race, current smoking/drinking status, body mass index, and hip and knee rOA. RESULTS: In adjusted analyses, MCP (p < 0.0001) and carpometacarpal rOA (p = 0.003), and a higher number of hand joints with rOA (p = 0.009), were associated with higher levels of sHA. Positive associations were seen between AUSCAN and hand symptoms and levels of sCOMP (p ≤ 0.003) and sHA (p ≤ 0.048). CONCLUSION: Hand symptoms and higher AUSCAN scores were independently associated with higher levels of both sCOMP and sHA; hand rOA was associated only with sHA levels.

Periarticular bone gain at proximal interphalangeal joints and changes in bone turnover markers in response to tumor necrosis factor inhibitors in rheumatoid and psoriatic arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are characterized by periarticular bone erosion; periarticular bone formation is a feature in PsA. The effect of anti-tumor necrosis factor-α (TNF-α) on periarticular bone remodeling is unclear in both diseases. Our aim was to assess the response of bone turnover markers (BTM) and hand bone mineral density (BMD) to anti-TNF over 3 years in RA and PsA. METHODS: We measured serum bone-specific alkaline phosphatase (bone ALP), procollagen type-I N-propeptide (PINP), intact osteocalcin, C-terminal cross-linking telopeptides (CTX-I), urinary N-terminal cross-linking telopeptide of type-I collagen (NTX-I), and free deoxypyridinoline crosslinks (fDPD) at baseline, 1, 12, and 36 months. BMD measurements (hands/spine/hip) were obtained at 3 timepoints. RESULTS: We recruited 62 patients (RA 35; PsA 27). BTM correlated significantly with hand BMD but not with central BMD. Low hand BMD was associated with RA and increased BTM. Following anti-TNF therapy, hip BMD declined while spine and hand BMD were unchanged. Periarticular BMD at proximal interphalangeal (PIP) joints increased while it decreased at metacarpophalangeal joints. Bone ALP increased steadily and was always higher in PsA. PINP and intact osteocalcin increased to a lesser extent, but resorption markers did not change. CONCLUSION: At baseline, hand BMD was inversely associated with BTM. Bone formation rather than resorption markers better showed the bone response to anti-TNF. Despite a lack of effect on central BMD, the modest effect of anti-TNF on PIP BMD may provide evidence that BTM reflect specifically bone remodeling activity at periarticular sites of inflammation in RA and PsA.

Serum levels of tissue inhibitor of metalloproteinase-1 and periarticular bone loss in early rheumatoid arthritis.

We investigated the relationship between disease activity, serum biological mediators of joint damage, and periarticular bone loss in inflammatory arthritis. Patients with early inflammatory arthritis were recruited from a dedicated early arthritis clinic. At the time of recruitment, all had clinical evidence of synovitis. Patients were assessed at baseline and at 1-year follow-up. Periarticular and axial bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum levels of matrix metalloproteinase 1 and tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by enzyme-linked immunosorbent assay. A total 38 patients were included in the study. Twenty had rheumatoid arthritis (RA) and 18 had a seronegative spondylarthropathy (SpA). At baseline, periarticular hand BMD measurements were similar in RA and SpA. At 1 year, the mean periarticular hand BMD was significantly lower in RA (p < 0.05). Significant inverse correlations between both the Ritchie articular index and C-reactive protein levels and the change in periarticular hand BMD at 1 year were observed in RA (r = -0.792, p < 0.001 and r = -0.478, p = 0.045, respectively). Baseline TIMP-1 levels correlated with the change in periarticular hand BMD at 1 year in RA (r = 0.519, p = 0.02). At 1 year, radiographic measures of joint damage were highest in RA. Inverse correlations between the change in periarticular hand BMD and the changes in erosion score (r = -0.90, p = 0.04) were observed in patients demonstrating significant periarticular bone loss. Persistent disease activity was associated with increased periarticular bone loss in the hands in patients with RA, consistent with synovitis-mediated periarticular bone loss. The correlation between baseline TIMP-1 levels and periarticular bone loss over 1 year suggests that TIMP-1 may have utility as a biomarker of periarticular bone loss in early RA.

Articular cartilage metabolism in patients with Kashin-Beck Disease: an endemic osteoarthropathy in China.

OBJECTIVE: The objective of this study was to investigate CD44 and proteoglycan metabolism in patients suffering from Kashin-Beck Disease (KBD), an endemic osteoarthropathy that affects 2.5 million of 30 million people living in the KBD regions of China. METHODS: Immunohistochemical analyses of cluster of differentiation-44 (CD44), BC-13 and 3-B-3(-) expression were performed in cartilage sections harvested from KBD and normal patients. In addition, the serum levels of soluble CD44 (sCD44), interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and matrix metalloproteinase-1 were determined using a sandwich enzyme linked immunosorbent assay. RESULTS: Hematoxylin & eosin and toluidine blue staining indicated that there was cell necrosis and proteoglycan loss in cartilage from both KBD children and adult cartilage. Strong immunohistochemical staining for CD44, BC-13 and 3-B-3(-) occurred in the majority of adult KBD patients and most KBD children. Furthermore, statistically significant elevated levels of sCD44, IL-1beta and TNF-alpha were found in the sera of both adult and child KBD patients when compared to the levels of normal adult and child controls. Interestingly, IL-1beta and TNF-alpha serum levels were all high in normal children from KBD regions when compared to normal children from non-KBD regions suggesting that unidentified factors (e.g., a genetic predisposition) may protect some people from KBD pathology. CONCLUSION: Our results demonstrate that altered CD44, IL-1beta and TNF-alpha metabolism occurs in the pathogenesis of KBD and there is an increased aggrecanase-generated proteoglycan loss from KBD adult and child cartilage. These primary metabolic changes are likely to be significant contributing factor causing pathological joint formation and instability that leads to secondary osteoarthritis in KBD patients.

Do metabolic factors add to the effect of overweight on hand osteoarthritis? The Rotterdam Study.

BACKGROUND: As hand joints are non-weight bearing, the association between overweight and hand osteoarthritis (HOA) is critical to understanding how overweight may associate with osteoarthritis (OA) apart from axial load. Overweight might be associated with the occurrence of OA through other metabolic factors. AIM: To evaluate the role of overweight in HOA, cross-sectional data of a population-based study were used (> or =55 years, n = 3585). The role of diabetes, hypertension and total cholesterol:high-density lipoprotein (HDL)-cholesterol ratio on HOA, and whether they play an intermediate role in the association of overweight/HOA was investigated. Furthermore, the prevalence of HOA in the concurrent presence of overweight and other metabolic factors was evaluated. RESULTS: Independently of other metabolic factors, overweight (body mass index (BMI) >27.4 kg/m(2)) showed a significant association with HOA (OR 1.4, 95% CI 1.2 to 1.7). The association between diabetes and HOA was only present in people aged 55-62 years (OR 1.9, 95% CI 1.0 to 3.8), but was absent in the total population or in other age groups. The association of hypertension with HOA was weak, and disappeared after adjustment for BMI. The total/HDL cholesterol ratio showed no significant association with HOA. The concurrent presence of overweight, diabetes and hypertension resulted in an even higher prevalence of HOA (OR 2.3, 95% CI 1.3 to 3.9) compared with subjects with none of these characteristics; this prevalence increased further in the younger age group (OR 3.2, 95% CI 1.1 to 8.8). CONCLUSION: No intermediate effect of metabolic factors on the association of overweight with HOA was found. An increase in the prevalence of HOA, however, seems to be present when overweight occurs together with hypertension and diabetes especially at a relatively young age.

Periarticular hand hydroxyapatite deposition after corticosteroid injections.

Four cases of periarticular calcifications chronologically related to deposteroid injections of small joints of the hands are presented. The calcifications were excised and documented to contain hydroxyapatite by x-ray diffraction analysis.

Metabolic activity of erosions in rheumatoid arthritis.

The hands of 10 patients with rheumatoid arthritis were investigated with diphosphonate scanning and radiology. Increased uptake of isotope can be associated with some erosions but not all and also reflects other processes more linked to acute inflammatory areas unassociated with the development of erosions. If the latter are the hallmark of active rheumatoid arthritis then bone scans are not.

Distribution of collagens and glycosaminoglycans in the joint capsule of the proximal interphalangeal joint of the human finger.

BACKGROUND: The capsule of the proximal interphalangeal joint consists of the central slip of the extensor tendon dorsally, the collateral ligaments at the sides and the palmar ligament ventrally. Fibrocartilaginous menisci have been reported extending into the joint cavity and the central slip has a sesamoid fibrocartilage articulating with the proximal phalanx. This study relates ECM composition in the joint capsule to function. METHODS: Each part of the capsule from 24 fingers amputated because of trauma, carcinoma, isthaemia, fixed-flexion deformities or Dupuytren's contracture, was dissected out. Sections were prepared for routine histology or immunolabelled with a panel of monoclonal and polyclonal antibodies against collagens and glycosaminoglycans using the avidin/biotin/peroxidase procedure. RESULTS: All parts of the capsule consistently labelled for types I, III and VI collagens and for dermatan and keratan sulphate, though labelling was more pericellular in fibrocartilaginous regions. In contrast, only certain regions of the capsule in some fingers labelled for type II collagen, chondroitin 4 or 6 sulphate. The sesamoid fibrocartilage in the central slip showed the greatest degree of fibrocartilage differentiation, especially in fixed-flexion deformity fingers, and the palmar ligament the least. CONCLUSIONS: The immunolabelling patterns suggest that there is an ordered sequence of matrix changes accompanying fibrocartilage differentiation. Chondroitin sulphate-containing proteoglycans accumulate first, and type II collagen appears later. The presence or absence of type II collagen probably relates to different levels of compressive loading. No fibrocartilaginous menisci were found in normal joints and those described previously are regarded as synovial folds.

Genome scan for predisposing loci for distal interphalangeal joint osteoarthritis: evidence for a locus on 2q.

The genetic contribution to common forms of osteoarthritis (OA) is well established but poorly understood. We performed a genome scan, using 302 markers for loci predisposing to distal interphalangeal joint (DIP) OA. To minimize genetic heterogeneity in our study sample, we identified siblings with a severe, radiologically defined phenotype from the nationwide registers of Finland. In the initial genome scan, linkage analysis in 27 sibships gave a pairwise LOD score (Z) >1.00 with nine of the screening markers. In the second stage, additional markers and family members were genotyped in these chromosomal regions. On 2q12-q13, IL1R1 resulted in Z=2.34 at recombination fraction (theta) 0, allowing a dominant mode of inheritance. Association analysis of markers D2S2264, IL1R1, D2S373, and D2S1789 jointly provided some evidence for a shared haplotype among the affected individuals (P value of.012). Also, multipoint nonparametric linkage analysis yielded a P value of.0001 near the locus IL1R1 and P=.0007 approximately 20 cM telomeric near marker D2S1399, which, in two-point analysis, gave Z=1.48 (straight theta=. 02). This chromosomal region on 2q harbors the interleukin 1 gene cluster and, thus, represents a good candidate region for inflammatory and autoimmune disorders. Three additional chromosomal regions-4q26-q27, 7p15-p21, and Xcen-also provided some evidence for linkage, and further analyses would be justified to clarify their potential involvement in the genetic predisposition to DIP OA.

Absence of linkage or association for osteoarthritis with the vitamin D receptor/type II collagen locus: the Framingham Osteoarthritis Study.

OBJECTIVE: Studies have suggested that polymorphisms or mutations either in the COL2A1 or VDR gene. both on chromosome 12q, are associated with the occurrence of osteoarthritis (OA). We examined linkage and association between the VDR/COL2A1 locus and hand/knee OA in the Framingham Osteoarthritis Study (FOS). METHODS: Hand and knee joints were characterized radiographically in the FOS. An overall score for OA using the standard Kellgren and Lawrence grading scheme was determined, as well as scores for individual features of OA including osteophytes and joint space narrowing. For linkage studies, polymorphic microsatellite markers near the VDR-COL2AI genes on chromosome 12 were tested in a collection of 296 of the largest Framingham Heart Study families and the results analyzed using variance component linkage (SOLAR). For association studies, we characterized the allele status of a subset of subjects at the BsmI site of the VDR gene. RESULTS: Overall, we found no linkage or association between OA and the COL2A1/VDR locus for either knee or hand OA, nor did we find an association or linkage between COL2AI or VDR with any individual radiographic features of OA. CONCLUSION: Despite studies suggesting associations of OA with both COL2A1 and VDR loci, our results suggest that mutations at the COL2A1/VDR locus do not play an important role as a cause of common OA in the population at large.