Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial.

OBJECTIVE: To determine if visually-guided arthroscopic irrigation is an effective therapeutic intervention in patients with early knee osteoarthritis. DESIGN: Ninety patients with knee osteoarthritis were randomized in a double-blind fashion to receive either arthroscopic irrigation with 3000 ml of saline (treatment group) or the minimal amount of irrigation (250 ml) required to perform arthroscopy (placebo group). The primary outcome variable was aggregate WOMAC score. RESULTS: The study did not demonstrate an effect of irrigation on arthritis severity as measured by aggregate WOMAC scores, the primary outcome variable; the mean change in aggregate WOMAC score at 12 months was 15.5 (95% CI 7.7, 23.4) for the full irrigation group compared to 8.9 (95% CI 4.9, 13.0) for the minimal irrigation group (P=0.10). Full irrigation did have a statistically significant effect on patients' self-reported pain as measured by the WOMAC pain subscale and by a visual analog scale (VAS) (the secondary outcome variables). Mean change in WOMAC pain scores decreased by 4.2 (95% CI -0.9, 9.4) for the full irrigation group compared with a mean decrease of 2.3 (95% CI -0.1, 4.7) in the minimal irrigation group (P=0.04). Mean VAS pain scores decreased by 1.47 (95% CI -1.2, 4.1) in the full irrigation group compared to a mean decrease of 0.12 (95% CI 0.0, 0.3) in the minimal irrigation group (P=0.02). A hypothesis-generating post-hoc analysis of the effect of positively birefrigent intraarticular crystals showed that patients with and without intraarticular crystals had statistically significant improvements in pain assessments and aggregate WOMAC scores at 12 months; patients with crystals had statistically greater improvements in pain. CONCLUSIONS: Visually-guided arthroscopic irrigation may be a useful therapeutic option for relief of pain in a subset of patients with knee OA, particularly in those who have occult intraarticular crystals.

Can physical signs or magnetic resonance imaging substitute for diagnostic arthroscopy in knee osteoarthritis patients with suspected internal derangements?: a pilot study.

This pilot study was developed to compare the relative diagnostic accuracies of physical findings, magnetic resonance imaging (MRI) and arthroscopy for internal derangements in knee osteoarthritis (OA) patients. Nine patients with locking and/or giving way in 10 knees underwent MRI and arthroscopy; the relative diagnostic accuracies for meniscal tears were studied and compared with physical findings. Eleven meniscal and no cruciate ligament tears were noted by MRI and/ or arthroscopy. Using arthroscopy as the comparison standard, the sensitivity of MRI for meniscal tears was 33.3%, specificity was 96.6%, and diagnostic accuracy was 75.0%. No significant correlations between physical findings and MRI or arthroscopy findings were found. It seemed that participants with normal radiographs had false positive MRIs more frequently. These preliminary data suggest that physical findings may not be adequate for the diagnosis of meniscal tears in patients with associated knee OA. A larger study may be warranted to further test this hypothesis. Because the presence of a meniscal tear may change therapy toward specific physical therapy modalities and/or meniscal repair, knee OA patients with mechanical symptoms may require an MRI or arthroscopy to establish the presence of a meniscal tear. Further testing is required to confirm the suggestion from these cases that patients with normal or minimally abnormal radiographs may require a diagnostic arthroscopy rather than an MRI to demonstrate a meniscal tear.

In vitro regulation of B cell differentiation by interleukin-6 and soluble CD23 in systemic lupus erythematosus B cell subpopulations and antigen-induced normal B cells.

Polyreactive systemic lupus erythematosus (SLE) B cells were compared with antigen-induced SLE and normal B cells for their interleukin-6 (IL-6) and soluble CD23 requirements. Unlike normal B cells, secretion of antibody by SLE B cells in serum-free medium was not enhanced by exogenous IL-6. Anti-IL-6 antibodies inhibited immunoglobulin production in cultures of normal and SLE B cells, which suggests that IL-6 is required for B cell differentiation. SLE culture supernatants had elevated levels of IL-6, which explains the poor response of the SLE cells to exogenous IL-6. Soluble CD23 enhanced the responses of cells from normal subjects and SLE patients.