Evaluation of Selected Parameters of Lipid Peroxidation and Paraoxonase Activity in Blood of Patients with Joint Osteoarthritis.

BACKGROUND: Oxidative stress constitutes an important risk factor for tissue/cell damage and is involved in the occurrence and progression of Osteoarthritis (OA). OBJECTIVE: The aim of this study was to evaluate the concentration of Malondialdehyde (MDA) in Synovial Fluid (SF) and blood as well as the activity of serum and SF paraoxonase (PON1) of patients with OA. Our study aimed to assess local and systemic responses to oxidative stress. METHODS: The study included 43 subjects with OA qualified to total joint replacement. The control group consisted of 58 subjects with no musculoskeletal disorders. The malondialdehyde level were measured in venous blood plasma, erythrocytes (MDAe) and Synovial Fluid (SF) while PON1 activities were estimated in serum and SF. RESULTS: No differences in MDA concentrations in erythrocytes and blood plasma between healthy subjects and OA patients were observed. The significant higher level of MDA in SF compared with blood serum was seen in both genders (in woman about 46.2%, in men - 75.0%) and in both assessed joints (in hip about 53.8%, in knee - 115.9%). Total protein concentration and PON1 activity in serum were significantly higher in OA patients (about 14.6% and 87.9% respectively). The systemic response to osteoarthritis (serum PON1 activity) was higher about 33.6% in men than women and not dependent on affected joint. CONCLUSION: The changes observed in osteoarthritic SF show that the process of antioxidant enzymatic defence is intensified locally, not systemically. The lipid hydroperoxides elimination may lead to restore joints homeostasis.

Hyaluronic acid and phospholipid interactions useful for repaired articular cartilage surfaces-a mini review toward tribological surgical adjuvants.

This mini review is focused on the emerging nexus between the medical device and pharmaceutical industries toward the treatment of damaged articular cartilage. The physical rationale of hyaluronic acid and phospholipid preparations as tribological surgical adjuvants for repaired articular cartilage surfaces is explored, with directions for possible new research which have arisen due to the therapeutic advance of the physiochemical scalpel. Because synovial joint lubrication regimes become dysfunctional at articular cartilage lesion sites as a result of the regional absence of the surface active phospholipid layer and its inability to reform without surgical repair, hyaluronic acid and phospholipid intra-articular injections have yielded inconsistent efficacy outcomes and only short-term therapeutic benefits mostly due to non-tribological effects. Parameters for hydrophobic-polar type interactions as applied to the lubricating properties of normal and osteoarthritic synovial fluid useful for repaired articular cartilage surfaces are discussed.

Deep venous thrombosis in patients with chronic spinal cord injury.

CONTEXT/OBJECTIVE: Deep venous thrombosis (DVT) is a well-known complication of an acute spinal cord injury (SCI). However, the prevalence of DVT in patients with chronic SCI has only been reported in a limited number of studies. The aim of our study was to examine the prevalence of DVT in patients with SCI beyond three months after injury. DESIGN: Cross-sectional study. SETTING: Rehabilitation Department at the Bydgoszcz University Hospital in Poland. PARTICIPANTS: Sixty-three patients with SCI that were more than 3 months post injury. The patients, ranging in age from 13 to 65 years, consisted of 15 women and 48 men; the mean age of the patients was 32.1 years. The time from injury varied from 4 to 124 months. OUTCOME MEASURES: Clinical assessment, D-dimer and venous duplex scan. RESULTS: The venous duplex scan revealed DVT in 5 of the 63 patients. The post-injury time in four of the patients varied between 4 and 5 months; one patient was 42 months post-injury. CONCLUSION: DVT occurred in patients with chronic SCI, mainly by the 6th post injury month.

Lysosomal enzymes in serum and synovial fluid in patients with osteoarthritis.

OBJECTIVE: To assess the activity of arylsulfatase (AS), acid phosphatase (ACP), cathepsin D (CAT-D) and alpha-1 antitrypsin (AAT) in blood serum and synovial fluid (SF) of patients with hip or knee osteoarthritis (OA). METHODS: The study included 43 subjects with OA (35 hip OA, 8 knee OA), submitted total joint replacement. The control group consisted of 58 subjects with no past history of musculoskeletal disorders. RESULTS: The OA blood serum samples showed a significantly higher level of lysosomal enzymes activity than in the control group (AS by 17.8%, AAT by 42.4%); only the CAT-D activity decreased by 50%). AS, ACP and CAT-D activities were about two-fold higher in SF when compared with blood of OA patients. The differences between the genders were visible in the SF: Total protein concentration, activity of ACP (both higher in OA men) and activity of CAT-D (higher in OA women). Between the involved hip and knee, there were no significant differences in all estimated parameters in the blood serum of the OA group. In regard to the SF, only ACP activity was significantly higher in patients with a hip involved. CONCLUSIONS: The osteoarthritic SF enzymatic profile differs from that in normal joints. The OA in joints is not reflected in the systemic response. Our preliminary results suggest further studies on role of lysosomal enzymes (ACP and AS) as biomarkers for the detection of osteoarthritis.

The activity of cathepsin D and alpha-1 antitrypsin in hip and knee osteoarthritis.

The progress of cartilage decay during joint degeneration is not well monitored with biochemical methods. The role of cathepsin D (CAT-D) in articular cartilage deterioration remains unclear. The aim of this study is to assess the activity of CAT-D and alpha-1 antitrypsin (AAT) in blood in patients with hip or knee osteoarthritis. The activity of CAT-D and AAT in blood serum of 40 women and 21 men with hip or knee osteoarthritis was determined before total joint replacement, on the tenth day after surgery, and once in 54 healthy patients. The preoperative activity of CAT-D in patients with osteoarthritis was lower by 53.6% (11.00 ± 4.54 10(-2) nM released tyrosine/mg protein/min, P < 0.001) and after surgery by 55.0% (10.67 ± 4.64 10(-2) nM released tyrosine/mg protein/min, P < 0.001) when compared to its activity in healthy patients. There was no significant statistical difference between CAT-D activity before the surgery and its activity on the tenth day after it in the analyzed group (P< 0.496). Simultaneously, the preoperative activity of AAT in the OA (osteoarthritis) patients was by 25.5% (0.93 ± 0.32 mg inhibited trypsin/ml blood serum, P < 0.001) and postoperative was by 44.9% higher (1.26 ± 0.36 mg inhibited trypsin/ml blood serum, P < 0.001) than in healthy patients. The low CAT-D activity in osteoarthritis of big joints is associated with a decrease of cartilage cells during the degenerative process. The higher activity of acute phase protein AAT in OA patients' blood serum confirms the inflammatory component in the osteoarthritis process.

Microarchitecture parameters describe bone structure and its strength better than BMD.

INTRODUCTION AND HYPOTHESIS: Some papers have shown that bone mineral density (BMD) may not be accurate in predicting fracture risk. Recently microarchitecture parameters have been reported to give information on bone characteristics. The aim of this study was to find out if the values of volume, fractal dimension, and bone mineral density are correlated with bone strength. METHODS: Forty-two human bone samples harvested during total hip replacement surgery were cut to cylindrical samples. The geometrical mesh of layers of bone mass obtained from microCT investigation and the volumes of each layer and fractal dimension were calculated. The finite element method was applied to calculate the compression force F causing ε = 0.8% strain. RESULTS: There were stronger correlations for microarchitecture parameters with strength than those for bone mineral density. The values of determination coefficient R(2) for mean volume and force were 0.88 and 0.90 for mean fractal dimension and force, while for BMD and force the value was 0.53. The samples with bigger mean bone volume of layers and bigger mean fractal dimension of layers (more complex structure) presented higher strength. CONCLUSION: The volumetric and fractal dimension parameters better describe bone structure and strength than BMD.

Early diagnostic procedures in primary care and hospital for children with a painful hip. A prospective study.

OBJECTIVES: To evaluate the current practice in the approach to the painful hip in children. To determine the superiority of ultrasonographic techniques over plain X-ray and to provide guidance to primary care. METHODS: We carried out a prospective cohort study of 55 patients with a painful hip. The management leading up to admission and diagnostic procedures were examined. We carried out ultrasound of all affected hips and repeated the scan every three days. Effusion on ultrasound was noted and was correlated to the symptoms. RESULTS: In total 29/55 patients had plain X-rays taken before or at the initial presentation. No abnormalities were found. Ultrasound showed effusion in 48/55 children. The reduction of the effusion correlated with the improvement in symptoms. An effusion persisting longer than 26 days correlated well to those patients who went on to be diagnosed with a chronic condition (3/4 patients). CONCLUSIONS: At present many practitioners use plain X-ray in the initial diagnosis. Ultrasound should be the initial diagnostic tool of choice. Repeat ultrasound at one month may be of use to determine if the child is likely to develop a chronic condition.

Complete rupture of the peroneus longus tendon secondary to injection.

Rupture of the peroneal tendons is rare, particularly rupture of peroneus longus. We report a case of a peroneus longus rupture following repeated steroid injection for chronic pain.