Disease-modifying anti-rheumatic drugs for refractory severe knee synovitis in patients with peripheral spondyloarthritis: efficacy and predictors of response.

OBJECTIVES: In this study we aimed to evaluate the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) for severe knee synovitis, refractory to low-dose oral corticosteroids and/or non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroid injections, in patients with peripheral spondyloarthritis (SpA). We also examined the association between the clinical response of knee synovitis and demographic and clinical parameters of the studied patients. METHOD: Patients with SpA-related arthritis including resistant and severe knee synovitis, defined as the presence of swelling, tenderness, and a decreased range of movement on clinical examination, treated with DMARDs between January 2005 and January 2012 were studied retrospectively. No evidence of knee synovitis was considered a clinical response to DMARDs. RESULTS: Forty-five patients [mean age 41.0 ± 1.9 years; 33 (73.3%) males] were studied. In 14 (31.1%) of the patients there was a clinical response of knee synovitis, while the remaining 31 (68.9%) patients were non-responders. Response to DMARD therapy was associated with disease subtype (p = 0.011) and HLA-B27 (p = 0.023) but not with a history of psoriasis (p = 0.067) or age at disease onset (p = 0.054). However, only a history of psoriasis could independently predict the response to DMARDs [adjusted odds ratio (OR) 0.232, p = 0.049]. CONCLUSIONS: One-third of the patients with peripheral SpA and severe resistant knee synovitis had a clinical response to DMARD therapy. Disease subtype and HLA-B27 were associated with the response of knee synovitis to DMARDs, but only psoriasis could independently predict this response.

Calcitonin delays the progress of early-stage mechanically induced osteoarthritis. In vivo, prospective study.

BACKGROUND/RATIONALE: Introducing new or testing existing drugs in an attempt to modify the progress of osteoarthritis (OA) is of paramount importance. QUESTIONS/PURPOSES: This study aims to determine the effect exerted by Calcitonin on the progress of early-stage osteoarthritic lesions. METHODS: We used 18, skeletally mature, white, female, New Zealand rabbits. OA was operatively induced in the right knee of each animal by the complete dissection of the anterior cruciate ligament, complete medial meniscectomy and partial dissection of the medial collateral ligament. Postoperatively, animals were divided into two groups. Starting on the ninth postoperative day and daily thereafter, group A animals (n = 9) received 10 IU oculus dexter (o.d.) of synthetic Calcitonin IntraMuscularly (I.M.); group B animals (n = 9) received equal volume of saline o.d. Three animals from each group were sacrificed at 1, 2 and 3 months following treatment's initiation. The extent and the grade of OA were assessed macroscopically, histologically and by radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)-scans. The Osteoarthritis Research Society International (OARSI) score, incorporating histological and macroscopic information, was calculated for each knee. RESULTS: Osteoarthritic changes in group A animals were less severe and progressed less rapidly when compared with those of group B animals (sham). This difference was statistically significant in the first and second month (P = 0.05), but not in the third month (P = 0.513). CONCLUSIONS: I.M. administration of Calcitonin seems to delay the progress of early-stage osteoarthritic lesions induced by mechanical instability in a rabbit experimental model.

Simultaneous bilateral fracture-dislocation of the talus: a case report.

A bilateral talar body fracture-dislocation in a 29-year-old multitrauma patient is presented. There was a comminuted fracture associated with an ankle, subtalar and talonavicular subluxation on the right lower limb and an open fracture with complete dislocation of the body of talus on the left side. We performed a minimal invasive reduction and stabilization of the fractures with the use of K-wires, due to severe contamination of the wounds and the patient's poor general condition. After a 28-month follow-up there were signs of posttraumatic arthritis but no signs of avascular necrosis of the talus bilaterally. The range of motion in both ankle joints was limited but the patient had a satisfactory level of activity.

Supracondylar humeral osteotomy in children with severe posttraumatic cubitus varus deformity.

The authors report the results of corrective osteotomy of the humerus in 11 children with severe posttraumatic cubitus varus deformity. The average carrying angle on the affected side was -24.4 degrees, and there was an average internal rotation deformity of the distal humerus of 22 degrees. Flexion and extension of the injured elbow were severely limited. A supracondylar lateral wedge osteotomy of the humerus was performed keeping the medial cortex intact. Two K-wires served as levers to correct the angular and rotational deformity of the elbow and then as fixation material to hold the osteotomy fragments. Postoperatively we immobilized the elbows in 90 degrees flexion for 3 to 4 weeks. There was no loss of the postoperative osteotomy alignment in most cases. Recurrence of mild varus deformity (-5 degrees and -7 degrees) occurred in only two patients. At the end of the follow-up we observed excellent results in 9 patients with an average carrying angle of 7.2 degrees (range 5-10 degrees).

Functional outcome after experimental cauda equina compression.

Spinal nerve roots often sustain compression injuries. We used a Wistar rat model of the cauda equina syndrome to investigate such injuries. Rapid transient compression of the cauda equina was produced using a balloon catheter. The results were assessed by daily neurological examination and somatosensory evoked potential (SEP) recording before surgery and ten weeks after decompression. Compression of the spinal nerves induced changes in the SEP which persisted for up to ten weeks after decompression, but it had no effect on the final neurological outcome. Our study shows the importance of early surgical decompression for cauda equina syndrome.

[Fracture dislocation of the thoracic spine in ankylosing spondylitis. A case of spontaneous occurrence and an uncommon course]. / Fracture luxation du rachis thoracique au cours d'une spondylarthrite ankylosante. Un cas d'apparition spontanée et d'évolution inhabituelle.

One case of spontaneous Th 10 - Th 11 dislocation complicating ankylosing spondylitis is reported. The only functional consequences were cracks when the patient was moving. Surgical treatment was refused nevertheless after twelve year follow bone union had occurred without neurological impairment.