First in man study of [18F]fluoro-PEG-folate PET: a novel macrophage imaging technique to visualize rheumatoid arthritis.

Non-invasive imaging of arthritis activity in rheumatoid arthritis (RA) patients using macrophage PET holds promise for early diagnosis and therapeutic response monitoring. Previously obtained results with macrophage tracer (R)-[11C]PK11195 were encouraging, but the imaging signal could be further improved by reduction of background uptake. Recently, the novel macrophage tracer [18F]fluoro-PEG-folate was developed. This tracer showed excellent targeting of the folate receptor ß on activated macrophages in synovial tissue in a preclinical arthritic rat model. We performed three substudies to investigate the biodistribution, potential for imaging arthritis and kinetic properties of [18F]fluoro-PEG-folate in RA patients. Firstly, biodistribution demonstrated fast clearance of [18F]fluoro-PEG-folate from heart and blood vessels and no dose limiting uptake in organs. Secondly, [18F]fluoro-PEG-folate showed uptake in arthritic joints with significantly lower background and hence significantly higher target-to-background ratios as compared to reference macrophage tracer (R)-[11C]PK11195. Lastly, dynamic scanning demonstrated fast tracer uptake in affected joints, reaching a plateau after 1 minute, co-existing with a rapid blood clearance. In conclusion, this first in man study demonstrates the potential of [18F]fluoro-PEG-folate to image arthritis activity in RA with favourable imaging characteristics of rapid clearance and low background uptake, that allow for detection of inflammatory activity in the whole body.

Gouty tophi caused limited knee range of motion: a case report.

BACKGROUND: Gout is a disease of purine metabolism characterized by monosodium urate crystal deposition. Gouty tophi can mimic many conditions such as infection or neoplasm. OBJECTIVE: We descriptively presented a case of a 29-year-old male with gouty toph. Data was obtained from patient chart. This patient presented with limited knee joint range of motion after sport injury. Arthroscopic examination was performed in order to confirm the diagnosis of the meniscal injury. RESULTS: The result showed the synovium with white toothpaste-like chalky urate crystals in the joint cartilage. CONCLUSION: An atypical presentation of gouty tophi can sometime mislead to diagnose an internal derangement of the knee.

[Synovial chondromatosis in the temporomandibular joint: analysis of 5 cases].

Five patients with synovial chondromatosis in the temporomandibular joint were treated in our hospital between August, 2011 and August, 2014. All the patients underwent preoperative imaging examinations for clinical diagnosis and determining the involvement of the lesions. Surgeries were performed and the lesions were confirmed as synovial chondromatosis by pathological diagnosis. The clinical manifestations, imaging features, diagnosis and treatment results were analyzed. All the 5 patients had pain in the joint region, 3 had limited mouth opening, and 3 had swelling in the joint region. X-ray film showed widening of the joint space in all the 5 cases and radiographic findings showed space-occupying lesions in the intra-articular space. Open joint surgeries was performed and completed successfully in all the cases. The postoperative imaging showed no residual lesions in the surgical area. As a rare clinical entity, synovial chondromatosis in the temporomandibular joint was poorly documented without specific clinical manifestations. The diagnosis of synovial chondromatosis relies on imaging, arthroscopic and pathological findings. Corpus liberum is an important feature of the disease occurring frequently in the joint cavity. Surgical intervention is the primary choice for treatment of synovial chondromatosis in the temporomandibular joint, in which the corpus liberum and the affected synovial membrane shall be removed after joint incision.

CERVICAL SPINE LESIONS IN RHEUMATOID ARTHRITIS PATIENTS.

AIM OF THE STUDY: to gather clinical and laboratory data on rheumatoid arthritis patients with cervical spine damage (incidence and prevalence, correlation between duration of disease and the time of lesion onset, to assess signs and symptoms and the role of laboratory investigations). The spine is an axial organ with an important role in support and resistance. It is a pillar with a very complex morphological and functional structure. The vertebral column is crossed by many kinematic chains. The main problem of the cervical spine caused by rheumatoid arthritis is cervical instability which describes all cervical lesions that can lead to neurovascular damage or major disturbance of pain generating statics at movement. The evolving disease shows chronic inflammation of the synovium, which is a self-maintained process and an immunologically induced phenomenon. The chronic inflammation of the synovium forms granulation tissue that invades peripheral joints towards the center and causes ligament cartilage and bone damage. MATERIAL AND METHODS: The present paper investigated cervical spine lesions in 107 rheumatoid arthritis patients who were admitted to the 1st Rheumatology Clinic of Iasi Rehabilitation Hospital between January 2013 and December 2014. Our study focused on assessing signs and symptoms seen in spine affected by rheumatic disease. RESULTS AND DISCUSSIONS: the disease causes destructive lesions due to granulomatous infiltration of rachidian structures and medullary sheaths. These lesions lead to damaged discs and instability that produces subluxations and dislocations. The suboccipital region is most affected; in other regions of the spine, high lesions of C4-C5 prevail, where osteolysis damage of spinal apophyses are found. In atlas and axis joints, rheumatoid arthritis causes the inflammation of bursa, synovium and joint capsule and leads to synovial pannus formation. This causes the destruction of cartilage and subchondral bone. Atlantoaxial dislocation is caused by erosive synovitis of atlanto-epistrophic joint, atlanto-odontoid joint and serous bursitis separating the odontoid process from the transverse ligament. CONCLUSIONS: The dominant symptom of cervical spine damage was pain associated with stiffness and limited joint mobility, muscle stiffness, poor posture.

The retention and distribution in the rabbit knee of a radionuclide complexed with a lipophilic chelator in liposomes.

The application of radiosynovectomy to patients with rheumatoid arthritis has been severely restricted by the difficulty of preventing leakage of the radioisotope from the joint cavity. We have synthesised a lipophilic chelator, 3-cholesteryl 6-[N'-iminobis(ethylenenitrilo)-tetraacetic acid]hexyl ether (Chol-DTTA) which can complex with a variety of beta-emitting radionuclides and is incorporated into the lipid phase of liposomes. The retention in the synovial cavities of rabbit knees of liposomes containing Chol-DTTA, complexed with the gamma-emitting tracer 51Cr, has been measured over a period of 21 days and compared with colloidal and water-soluble preparations. The distribution of the radionuclide between the tissues of the joint was also examined. Results show retention of 51Cr delivered in chelator liposomes to be greater than 99% after 24 h. At this time, over 93% of the radioactivity had become associated with the synovium. We conclude that chelator liposomes offer considerable promise as vehicles for radioisotopes in radiosynovectomy.

Partial hemiarthroplasty for the treatment of osteonecrosis of the femoral head. An experimental study in the dog.

The use of a composite osteochondral device for simulating partial hemiarthroplasty was examined. The device was composed of a polyvinyl alcohol hydrogel and a titanium fibre mesh, acting as artificial cartilage and as porous artificial bone, respectively. The titanium fibre mesh was designed to act as an interface material, allowing firm attachment to both the polyvinyl alcohol gel (through injection moulding) and the femoral joint surface (through bony ingrowth). We implanted 22 of these devices into canine femoral heads. Histological findings from the acetabular cartilage and synovial membrane, as well as the attachment of the prosthesis to bone, were examined up until one year after operation. No marked pathological changes were found and firm attachment of the device to the underlying bone was confirmed. The main potential application for this device is for partial surface replacement of the femoral head after osteonecrosis. Other applications could include articular resurfacing and the replacement of intervertebral discs.

Sonography of the temporomandibular joint from 60 examinations and comparison with MRI and axiography.

BACKGROUND AND OBJECTIVE: Establishing a diagnosis of temporomandibular joint disorder is mainly based on clinical assessment, functional examination, nuclear magnetic resonance imaging (MRI) and axiography. Sonographic examination was compared with MRI and axiography in assessing temporomandibular joint (TMJ) function in 55 patients. PATIENTS AND METHODS: Fifty-five patients with different TMJ problems were examined clinically, by means of axiography, sonography and some also by MRI. The range of motion was measured by sonography and axiography and the results compared using Student's t-test. Anatomical details diagnostic for disc-displacement were tested by sonography and MRI. RESULTS: The average time required for sonography was 2 min and for axiography 20 min. The mean measurement differences for condylar movement in maximal mouth opening was 1.7 mm, for protrusion 1.6 mm and for mediotrusion 2.5 mm. The range of condylar movement as measured by sonography and axiography coincided for opening and for protrusion (statistically significant). No significance was found for lateral excursions. The concordance in diagnosis of disc dislocation, hypermobility and impaired range of motion when comparing ultrasound with MRI was 83%. All sonographic examinations were performed by one person only. Sixty repeat examinations in patients produced no complaints and showed an absolute range of difference of 0.6 mm, with a relative range of 7%. Student's t-test was significant (p<0.05) (two repetitive measurements). CONCLUSION: Sonography proved to be a fast and reliable method for evaluating the range of movement of the TMJ. The lateral joint capsule, lateral disc, and upper condyle could be demonstrated. Pathological processes such as anterior or lateral disc displacement, disc perforation, seroma following contusion, capsular fibrosis, crystalline structures in the synovia and fracture dislocation of the condyle could be diagnosed with considerable reliability when compared with MRI. However, the medial aspect of the joint, medial disc dislocation and the angulation of the condylar slope could not be seen.

Arthroscopy of the temporomandibular joint. A comparative study of arthroscopic and tomographic findings.

Established radiographic criteria of temporomandibular joint osteoarthrosis were evaluated by comparison of arthroscopic and tomographic findings in the superior compartment. 34 joints of 30 patients with long-standing chronic pain and/or functional impairment were investigated according to standardized techniques. Agreement was found between arthroscopy and corrected sagittal tomography regarding diagnosis of osteoarthrosis in all advanced cases. Diagnostic accuracy as regards slight changes was, however, lower. At tomographic examination, the sensitivity was slightly higher than specificity, i.e., pathological changes were more frequently identified than normality. No radiographic sign of osteoarthrosis could be specifically associated with arthroscopic features of osteoarthrosis or synovitis. Predominant location of osteoarthrosis at both arthroscopy and tomography was the posterior slope of the eminence (latero-central part). Osteoarthrosis was more widespread in the fibrocartilage than in the subchondral bone.

Preserving the posterior superior synovial recess during allograft TMJ diskal condylar transplantation in the adult goat.

OBJECTIVE: The purpose of the study was to test the hypothesis that sparing the posterior superior synovial recess during the resection of temporomandibular joint condyle and disk would maintain a critical mass of synovium necessary to predictably achieve a successful allograft joint reconstruction. STUDY DESIGN: A group of 15 adult goats underwent unilateral resection of their temporomandibular condyle and meniscus. The fossa and posterior superior synovial recess were left intact. They were immediately reconstructed with cryogenically preserved allograft mandibular condyles and temporomandibular joint disk harvested from 15 adult donor goats. The animals were evaluated clinically and radiographically at 6 and 12 months and histologically at 12 months. RESULTS: Of the 15 animals, 13 met all the criteria to be declared a success and retained the posterior superior synovial recess. CONCLUSION: Immediate joint reconstruction using cryogenically preserved mandibular condyles and temporomandibular joint disk can have a high rate of success if the native posterior superior synovial recess remains intact.

Is high-resolution ultrasonography suitable for the detection of temporomandibular joint involvement in children with juvenile idiopathic arthritis?

OBJECTIVES: The purpose of this study was to determine the potential of high-resolution ultrasonography for the detection of temporomandibular joint (TMJ) changes in children with juvenile idiopathic arthritis (JIA). METHODS: We investigated prospectively 20 children (17 female and 3 male; mean age 11.06 years, standard deviation 3.43 years) with TMJ disorders caused by JIA, over a period of 16 months. Using a 12 MHz array transducer, four images in each TMJ (160 images) were acquired. Each image was analysed with regard to five different aspects (condylar erosion, thickness of the condylar disc, synovial thickness, joint effusion and enlargement of the intra-articular space). RESULTS: Diagnosis of JIA was ensured for every child and involvement of the TMJ was proven by MRI. Overall 287 changes (35.9%) were detected by using high-resolution ultrasonography. On 124 images (77.5%) condylar erosions were diagnosed; on 55 images (34.4%) synovial thickness was abnormal; on 48 images (30%) we could see higher thickness of the condylar disc; on 40 images (25%) irregularities of the bony surface were detected; and on 20 images (12.5%) we found joint effusion. CONCLUSION: High-resolution ultrasonography could be a sufficient diagnostic method, especially for the detection of condylar involvement in children with JIA, even if not all parts of the TMJ are visible for ultrasonography. High-resolution ultrasonography is a valuable tool in particular situations: (i) when MRI examination is not available; (ii) when children fear MRI examination; (iii) in more advanced stages of JIA; and (iv) for monitoring the progression of TMJ involvement and response of therapy.

Vacuum phenomenon in the temporomandibular joint: a clinical, computed tomography and magnetic resonance case report.

A 28-year-old woman presented with a history of clicking and mandibular clenching. She was studied clinically and with axial and coronal CT. The patient was going through a tense emotional period and reported tightening of her teeth (clenching); she was under psychological and neurological treatment for depression including pharmacological therapy. She presented slight pain only at maximum mouth opening at the right temporomandibular joint (TMJ) and in the lateral pole on palpation; there was no coincidence between initial and maximal interocclusal contacts because of premature dental contacts. She showed occlusal group function in the right side and canine guidance in the left side with a right contact of balance, local muscular pain in the right deep masseter muscle and in the superior and middle portion of the right trapezium on palpation. On CT, a spherical area of 3 mm diameter with an average density of -647 HU (SD+/-4.7) was found in the upper and posterior area of the lower space of the right TMJ, together with a thicker lower synovial tissue. This observation was confirmed by MRI. Like other joints, the TMJ could present vacuum phenomenon images inside synovial tissue in the presence of degenerative disease. It is important for radiologists to recognize this rare entity.

Synovial accumulation of technetium labelled liposomes in rheumatoid arthritis.

Technetium labelled, negatively charged, unilamellar liposomes were given by intravenous injection to patients with rheumatoid arthritis and the joints scanned 20-22 hours later. Positive scintigraphy was obtained in all six patients with active disease, and, with the exception of the small interphalangeal joints, all clinically involved joints could be visualised.

Rheumatoid arthritis of the craniocervical region: assessment and characterization of inflammatory soft tissue proliferations with unenhanced and contrast-enhanced CT.

The aim of this study was to depict and characterize inflammatory soft tissue proliferations caused by rheumatoid arthritis (RA) in the craniocervical region by unenhanced and contrast-enhanced CT. Computed tomography of the craniocervical region was performed in 35 patients in the axial plane before and after the i.v. administration of contrast material. According to the densities and contrast enhancement of the inflammatory soft tissue proliferations, four groups were classified. Ancillary findings, such as a compression of the dural sac or spinal cord, erosions of the bony structures, and atlantoaxial subluxation, were also evaluated. Inflammatory soft tissue proliferations were depicted in 28 of 35 patients and could be differentiated by unenhanced and contrast-enhanced CT according to the above defined criteria: effusion in 6 patients (17%); hypervascular pannus in 8 (23%); hypovascular pannus in 5 (14%); and fibrous tissue in 9 patients (26%). A compression of the dural sac was seen in 11 (31%) patients; 3 of these had neurological symptoms. Erosions of the odontoid process were found in 20 (57%) patients; 16 (80%) of these also showed erosions of the atlas. Atlantoaxial subluxation was seen in 11 (31%) patients. Inflammatory soft tissue proliferations in the craniocervical region caused by RA can be reliably demonstrated and classified by unenhanced and contrast-enhanced CT, which can differentiate between joint effusion and various forms of pannus and depict ancillary findings. Computed tomography is an alternative method for patients unable to undergo an MRI examination.

The radiologic findings in synovial chondromatosis (chondrometaplasia) of the temporomandibular joint.

Synovial chondromatosis or chondrometaplasia is a rare disease in which foci of cartilage may develop in the synovial membrane, usually of the large diarthroidal joints. However, the temporomandibular joint may be affected, with less than 15 such cases documented. It is the purpose of this presentation to define the radiologic findings in synovial chondromatosis of the temporomandibular joint, not previously recorded, which allow for definitive diagnosis. These radiologic findings are: 1) widening of the joint space; 2) limitation of motion; 3) irregularity of joint surfaces; 4) presence of calcified loos bodies (cartilage); and 5) sclerosis of the glenoid fossa and mandibular condyle.

A biochemical, histologic, and immunohistologic analysis of membranes obtained from failed cemented and cementless total knee arthroplasty.

Biochemical, histologic, and immunohistochemical analyses were performed on 34 interface membranes obtained from 33 patients during revision total knee arthroplasty. The membranes had surrounded components of cementless (n = 11) and cemented (n = 23) knee prostheses that were aseptically loose. None of these implant failures was caused by catastrophic polyethylene erosion leading to metal-to-metal contact. The histologic findings were similar in the membranes from cemented and cementless knee components: small polyethylene debris within macrophages and large birefringent polyethylene debris within foreign-body giant cells. Metallic debris was seen in membranes from both groups, but cemented membranes had more polymethylmethacrylate particles and more hyalinization. Intracytoplasmic asteroid bodies were observed in several foreign-body giant cells in both types of membranes. No significant differences were found between the two groups in levels of collagenase, prostaglandin E2 (PGE2), interleukin-1 (IL-1), interleukin-6 (IL-6), or tumor necrosis factor-alpha (TNF-alpha), nor in the population of inflammatory cells stained with IL-1, IL-6, and TNF-alpha antibodies. Membranes that had surrounded components with radiographic evidence of diffuse or localized periprosthetic bone loss released significantly more collagenase, IL-1, IL-6, and TNF than did membranes from components without bone loss. These two groups, however, did not have significantly different PGE2 levels. These findings suggest that polyethylene and metal debris may play a role in macrophage activation and the release of mediators of bone resorption in the membranes surrounding failed cemented and cementless total knee implants.

[Indications for imagery in dysfunctional temporomandibular pathology]. / Indications de l'imagerie en pathologie temporo-mandibulaire dysfonctionnelle.

Cranio-mandibular disorders include muscular and articular signs. Articular pathology is the only one that need to be structurally studied. Paraclinic indications are based upon physical examination. Bone structure can be explored with tomography or CT scan and intra-articular structures can be explored with M.R.I. or arthrography. Two pathologies have then been found with an excessive frequency, disc displacements and juvenile osteoarthrosis.