Quantitative measurement and visual assessment of ileal Crohn's disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein.

BACKGROUND: Few studies have correlated computed tomography (CT) enterography findings with endoscopic severity and C reactive protein (CRP) concentrations. AIM: To examine whether small bowel inflammation at CT enterography correlates with endoscopic severity and CRP in patients with Crohn's disease (CD). METHODS: CT enterography datasets from 143 CD patients undergoing ileoscopy were examined for three different CT parameters: CT bowel enhancement, as defined by the ratio of terminal ileal versus control ileal loop attenuation; vascular enlargement of the vasa recta ("the comb sign"); and mesenteric fat density. Correlations between CT scan parameters, endoscopy, and histology severity scores, and CRP were assessed using Spearman's rank correlation and logistic regression. RESULTS: Endoscopic score was significantly correlated with CT bowel enhancement, comb sign, and fat density (Spearman correlation coefficients 0.33-0.39; p<0.001). Correlations with histological inflammation were strongest for bowel enhancement (r = 0.34-0.38; p<0.001). CRP was elevated in patients with increased fat density versus those with increased bowel enhancement only (median 0.96 v 0.23, p = 0.002). CRP did not differ significantly between patients without evidence of active Crohn's and those with bowel enhancement and endoscopic inflammation not involving the perienteric tissues by CT (median 0.24 v 0.36; p = 0.38). CONCLUSION: Quantitative measures of bowel enhancement at CT enterography correlate with endoscopic and histological severity. CRP correlates with radiological findings of perienteric inflammation (increased fat density), but not of inflammation limited to the small bowel wall, underscoring the potential role of perienteric inflammation in CRP response in CD.

Cartilage metabolism in osteoarthritis and the influence of viscosupplementation and steroid: a review.

Osteoarthritis (O.A.) is the most common type of articular disease. This is an idiopathic joint disease characterized by an imbalance between synthesis and degradation of articular cartilage and subchondral bone accompanied by capsular fibrosis, osteophyte formation and variable grade of inflammation of synovial membrane. Joint lubrication is naturally provided by Hyaluronic acid in syovial fluid. Hyaluronan is present in abundance in normal young and healthy joints. In degenerative O.A. Hyaluronan is smaller in size, molecular weight and diminished in concentration. This decrease in joint lubrication and shock absorbing mechanism in O.A. can be remedied by intraarticular viscosupplementation. Alternatively the pain and secondary inflammation in O.A. can be relieved by intraarticular injection of steroids and long acting local anesthetics. Promt and effective reduction in local inflammation occurs after intra-articular injection of corticosteriod. This article reviews the cartilage metabolism in O.A., discusses the pros and cons of these treatments and provides a literature review of the studies which compare benefits and adverse reactions of viscosupplementation vs. intraarticular steroids with placebo treatment.