An update on the study of synovial fluid in the geriatric patient.

BACKGROUND: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.

Antiphagocytic Properties of Polygallic Acid with Implications in Gouty Inflammation.

Polygallic acid (PGAL) has been used in vitro to protect synoviocytes from monosodium urate (MSU) crystals due to its anti-inflammatory properties. However, MSU crystals can also activate other cells of the synovial fluid (SF). We studied the impact of PGAL on the phagocytosis of MSU crystals, inflammation, and oxidative stress using an in vitro model with SF leukocytes and THP-1 monocyte cells. SF leukocytes were stimulated with PGAL and MSU crystals, proinflammatory cytokines and phagocytosis were assessed. In THP-1 cells, the effect of PGAL on the phagocytosis of MSU crystals and the levels of IL-1ß, IL-6, TNF-α, and reactive oxygen species (ROS) was evaluated. PGAL was added to THP-1 cultures 24 h before MSU crystal addition as a pre-treatment, and IL-1ß was measured. One-way ANOVA with Tukey's post hoc test was performed, and a P value < 0.05 was considered statistically significant. PGAL (100 µg/mL) decreased phagocytosis in SF leukocytes by 14% compared to cells exposed to crystals without PGAL. In THP-1 cells, 100 and 200 µg/mL PGAL reduced phagocytosis by 17% and 15%, respectively. In SF cells, there was a tendency to decrease IL-1ß and IL-6. In THP-1 cells, decreases in IL-1ß and TNF-α, as well as a slight decrease in ROS, were identified. PGAL pre-treatment resulted in a reduction of IL-1ß. PGAL inhibits MSU phagocytosis by exerting an anti-inflammatory effect on cells exposed to crystals. The use of PGAL before an acute attack of gout suggests an important protective factor to control the inflammation.

Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution.

INTRODUCTION/OBJECTIVES: Few studies have addressed the detection and clinical impact of different crystals in patients with diverse rheumatologic diagnoses in Latin America. The aim of this study was to assess the consistency between the clinical referring diagnosis and the identification of crystals, such as monosodium urate (MSU) and calcium pyrophosphate (CPP), in the synovial fluid (SF) of patients from a Mexican tertiary care institution. METHODS: We reviewed the results of 264 SF analyses to identify any changes in diagnosis upon SF analysis. We reported patient medical file data on sex, age, diagnosis, and microscopic SF analysis results. We performed consistency analyses between referring diagnoses and SF findings with McNemar's test. RESULTS: The prevalence of MSU crystals in SF was noted in 89.1% of gout cases and 9.09% of cases of calcium pyrophosphate disease (CPPD). CPP crystals were present in 54.5% of CPPD cases, 42.9% of osteoarthritis (OA) cases, and 7.27% of gout cases. Calcium hydroxyapatite (HA) crystals were identified in 5.45% of gout cases, 33.3% of rheumatoid arthritis (RA) cases, 57.1% of OA cases, and 63.6% of CPPD cases. Cholesterol and lipid crystals were present in small proportions in RA cases. Glucocorticoid crystals were observed in 1.85% of gout cases, 44.4% of RA cases, and 42.9% of OA cases. We observed an association of MSU identification with clinical suspicion of gout (P = 0.08), CPP with OA (P = 0.26) and CPPD (P = 0.50). An association was noted between HA and the diagnosis of CPPD (P = 0.84) and OA (P > 0.99). The number of initial diagnoses that changed upon SF analysis was 14.3%. CONCLUSIONS: SF analysis has major diagnostic value regarding MSU crystals and gout. Our findings underscore the importance of SF crystal analysis in identifying the prevalence of crystals in the Mexican population. SF analysis provides for better diagnosis of crystal arthropathies and improves the quality of the medical care that the patient receives. Key Points • Synovial fluid analysis in laboratories from developing countries has been scarce. • In some cases, the initial diagnosis is modified after of synovial fluid analysis. • This study confirmed that synovial fluid analysis exhibits major diagnostic value for urate crystals and gout.

Impact of cadmium toxicity on cartilage loss in a 3D in vitro model.

Osteoarthritis (OA) is the gradual loss of articular cartilage and decrease in subchondral space. One of the risk factors Exposure to cadmium (Cd) through tobacco smoke has been identified as a major OA risk factor. There are no reports addressing the role of Cd in OA progression at the molecular level. Our findings revealed that Cd can promote the activation of metalloproteinases (MMP1, MMP3, MMP9 y MMP13), affecting the expression of COL2A1 and ACAN, and decreasing the presence of glycosaminoglycans and proteoglycans through an inflammatory response related to IL-1ß y a IL-6, as well as oxidative by producing ROS like O2-• and H2O2. In conclusion, our findings suggest a cytotoxic role of Cd in the articular cartilage, which could affect OA development.

Asociación entre elevación sérica de gamma-glutamil transpeptidasa y riesgo aumentado de evento vascular cerebral isquémico en población mexicana / Relation between serum elevation of gamma-glutamyl transpeptidase and increased risk of ischemic stroke in Mexican population

Resumen: ANTECEDENTES: Las concentraciones elevadas de gamma-glutamil transpeptidasa (GGT) se han asociado con el riesgo de enfermedad coronaria isquémica, diabetes mellitus tipo 2 y evento vascular cerebral. OBJETIVO: Determinar mediante métodos estadísticos estandarizados que la elevación sérica de gamma-glutamil transpeptidasa es predictor temprano de evento vascular cerebral en la población mexicana. MATERIAL Y MÉTODO: Estudio tipo casos y controles, con medición de GGT sérica en pacientes con enfermedades crónico-degenerativas en control y pacientes crónicos con un evento cardiovascular adverso, en este caso, un evento vascular cerebral de tipo isquémico (EVC), efectuado de mayo de 2016 a julio de 2017. RESULTADOS: Se incluyeron 74 pacientes; los pacientes con EVC tuvieron, en pro- medio, 17.81 U/L de GGT más que los controles ajustado por edad, con diferencia estadísticamente significativa (p = 0.038, IC95% 1.04-34.57). CONCLUSIONES: Las concentraciones de gamma-glutamil transpeptidasa se correlacionan de manera directamente proporcional con el riesgo cardiovascular, lo que tiene gran importancia debido a que se ha demostrado que sus concentraciones séricas pueden disminuirse con medidas como dieta y ejercicio, por lo que se abre un amplio panorama para posteriores estudios que puedan reafirmar la validez de éste y hacer otros con un enfoque preventivo.

Abstract: BACKGROUND: Elevated levels of gamma-glutamyl transpeptidase (GGT) have been associated with the risk of ischemic heart disease, diabetes mellitus and stroke. OBJECTIVE: To determine, by means of standardized statistical methods, that the serum elevation of GGT is an early predictor of ischemic stroke in the Mexican population. MATERIAL AND METHOD: A case-control study was conducted with measurement of serum GGT in patients with chronic-degenerative diseases without cardiovascular events and chronic patients with an adverse cardiovascular event, in this case, an ischemic stroke, done from May 2016 to June 2017. RESULTS: A total of 74 patients were analyzed; patients with ischemic stroke presented, on average, 17.81 U/L of GGT more than controls adjusted for age, with a statistically significant difference (p = 0.038, 95%CI 1.04- 34.57). CONCLUSIONS: GGT levels correlated directly with cardiovascular risk, which is of great importance, since it has been shown that serum levels can be reduced with measures such as diet and exercise, so that a broad panorama opens up for further studies that can reaffirm the validity of this study and do others with a preventive approach.

Prevalence of chondrocalcinosis in a Mexican tertiary care institution of musculoskeletal disorders.

INTRODUCTION/OBJECTIVES: The prevalence of chondrocalcinosis (CC) was reported as variable according to the geographic populations. However, there are no data regarding its prevalence in Mexico. Thus, we decided to investigate the Mexican prevalence of CC in a cohort of patients from a tertiary health care institution. METHODS: A retrospective analysis of radiographs of knees and wrists from our institution was performed. Inclusion criteria included patients > 50 years old having radiographs of knees and wrists. Radiographic presence of CC was classified according to a dichotomous evaluation assayed by two rheumatologists experts on the area. RESULTS: A total of 3.350 radiographs from 1.602 patients were evaluated. Forty-seven patients showed calcifications in at least one knee or wrist for an overall prevalence of 3%, of which 23.4% were men and 76.6% women. The knee was more commonly affected than the wrist (85.1% and 14.9% respectively). The prevalence according to gender was 2.9% in women, whereas, it was 3.2% in men. Only two patients (4.3%) showed a contemporaneous presence of CC in both hands and both knees. At knee level, the prevalence was 2.7%, whereas at the wrist, we reported a prevalence of 4.9%. CONCLUSIONS: The prevalence of CC for Mexican population had not been reported so far. This a starting point to break the silence and encourage the knowledge of how this disease is associated with possible risk factors in Mexican population. Key Points •The prevalence of chondrocalcinosis in Mexico was 3%. •The prevalence of knee chondrocalcinosis increases according to the age in women's. •The nixtamalized meals could be a protective factor for CC in Mexican population.

Cambios electrocardiográficos en pacientes con VIH con y sin inhibidores de proteasa vs NNRTI / Differences in electrocardiographic changes in HIV patients with and without treatment with protease inhibitors vs NNRTI

Resumen ANTECEDENTES La infección por el virus de inmunodeficiencia humana (VIH) incrementa la prevalencia de prolongación del intervalo QT corregido (QTc), lo que es un factor independiente de eventos de enfermedad cardiovascular en esta población. En la bibliografía mundial se asocia este cambio con la administración de los antirretrovirales inhibidores de proteasa y efavirenz. Sin embargo, no se conocen datos de estos cambios en la población mexicana. MATERIAL Y MÉTODO Estudio prospectivo observacional en el que se seleccionaron expedientes de marzo de 2015 a mayo de 2016 de la consulta externa del Instituto Nacional de Enfermedades Respiratorias (INER); se dividieron en dos grupos: sin tratamiento, por reciente diagnóstico, y con tratamiento antirretroviral. Se registraron datos clínicos, tratamiento farmacológico, electrocardiograma y química sanguínea. RESULTADOS No se encontraron diferencias entre ambos grupos respecto a edad ni electrólitos séricos. Tampoco se encontró relación entre la prolongación del QTc con efavirenz o los inhibidores de proteasa. Raltegravir disminuyó la duración del QTc (p = 0.001) mientras que la coinfección por molusco contagioso se asoció con prolongación del QTc (p = 0.02). CONCLUSIÓN En nuestro estudio no logramos demostrar en población mexicana relación de la prolongación del QTc con los antirretrovirales de primera ni segunda línea. Se requieren más estudios para determinar la importancia clínica del efecto de raltegravir y molusco contagioso en el QTc.

Abstract BACKGROUND Human immunodeficiency virus (HIV) infection increases the prevalence of QTc prolongation (QTc), which is an independent factor of cardiovascular disease events in this population. In the world literature this change is associated with the use of the protease inhibitors and efavirenz antiretrovirals. However, no data are available on these changes in the Mexican population. MATERIAL AND METHOD A prospective observational study was done selecting records from March 2015 to May 2016 of the external consultation of the National Institute of Respiratory Diseases (INER), Mexico City; they were divided into two groups, those without treatment, because recent diagnosis, and with antiretroviral treatment. We recorded clinical data, pharmacological treatment, electrocardiogram and blood chemistry. RESULTS We found no differences between the two groups regarding age or serum electrolytes. We found no association between QTc prolongation and efavirenz or protease inhibitors. Raltegravir decreased QTc duration (p = 0.001) while molluscum contagiosum coinfection was associated with QTc prolongation (p = 0.02). CONCLUSION In our study, we failed to demonstrate in Mexican population association of QTc prolongation with first- and second-line antiretrovirals. More studies are needed to determine the clinical significance of the effect of raltegravir and molluscum contagiosum on QTc.

[Validation of diagnosis scales for differencing hemorrhagic from ischemic cerebral vascular disease]. / Escalas clínicas para diferenciar enfermedad vascular cerebral hemorrágica de isquémica.

BACKGROUND: differentiating hemorrhagic from ischemic cerebral vascular disease (CVD) is the starting point for the treatment. The aim was to compare the diagnostic accuracy of the scales that differentiate hemorrhagic from ischemic stroke. METHODS: we applied the scale of Siriraj Stroke Score (SSS) and Greek Stroke Score (GSS) to patients with stroke. The results were described as means and frequencies. For significant variables odds ratio was calculated. We calculated the validity of both scales compared to the head computed tomography. RESULTS: ninety one patients had ischemic stroke and 28 were hemorrhagic. The mean systolic blood pressure in ischemic stroke was 138.94 mmHg (SD ± 26.90) and hemorrhagic was 165.55 mmHg (SD ± 36.40) p = 0.0007. The atherogenic index (AT) in ischemic stroke was 4.52 (SD ± 1.52) and in hemorrhagic was 4.84 (SD ± 2.01) p = 0.87. The specificity of the SSS for hemorrhagic stroke is 85.5 % and 96.7 % for the GSS. CONCLUSIONS: the GSS has a high specificity for hemorrhagic stroke.