Psoriatic arthritis - new perspectives.

Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and sciatic pain. In most patients with PsA, pharmacologic treatment with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologic agents is effective. However, when pharmacological treatment fails, patients with PsA may benefit from orthopedic surgery, which can improve both joint function and quality of life. Total hip arthroplasty, total knee arthroplasty, and arthroscopic synovectomy of the knee are the most common surgical procedures offered to patients with PsA. The management of PsA requires the care of a multidisciplinary team, which should include dermatologists, rheumatologists, physiotherapists, and orthopedic surgeons.

An assessment of natural concentrations of selected metals in the bone tissues of the femur head.

The study was aimed at assessing the natural concentrations of copper, iron, potassium, lead and cadmium in the femur head using regression analysis. The material was collected during the operation of total hip arthroplasty from patients of southern and central Poland suffering from diagnosed coxarthrosis. In total, 197 samples were collected, including 68 samples of spongious bone, 59 samples of cortical bone and 70 samples of cartilage surface. After wet microwave digestion, the metal content in the samples was measured by atomic absorption spectrophotometry. The average concentrations of metals in the femur head were 67.30 microgFe/g, 760.58 microgK/g, 0.07 microgCd/g, 0.81 microgCu/g and 2.76 microgPb/g. A comparison of metal concentrations in bone tissues assessed by regression analysis to the findings of other authors revealed that the technique can be used to assess the natural concentration of elements in tissues and the results may provide a basis for the evaluation of metal concentrations in the human organism.

Lead content in the femoral heads of inhabitants of Silesia (Poland).

Lead content was evaluated in spongious and cortical bone as well as in cartilage surface of human femoral heads obtained during hip arthroplasty from 45 inhabitants (11 males and 34 females) of the industrial region of Upper Silesia. The average age of this group was 63.9+/-14.4 years. Lead content was assessed using microwave mineralization with the graphite furnace atomic absorption spectrometry (GFAAS) method. The average lead content in the specimens from spongious bone was 2.56 microg/g, 3.05 microg/g in cortical bone and 3.53 microg/g in cartilage surface. The calculated average Pb/Ca ratio was 1783x10(-8) in spongious bone, 1623x10(-8) in cortical bone, and 2512x10(-8) in the cartilage. Both lead concentration and Pb/Ca ratio increased with the age of the patients. Higher lead content was found in the specimens from male hips and in the group of cigarette smokers.

Metal content in femoral head spongious bone of people living in regions of different degrees of environmental pollution in Southern and Middle Poland.

The content of calcium, phosphorus, magnesium, potassium, iron, zinc, copper, lead, cadmium, arsenic, and silver was evaluated in femoral head spongious bone of inhabitants of southern (Silesia, n = 13; Cracow, n = 13) and middle Poland (Lodz, n = 12). A total of 38 persons (29 females and 9 males) were included in the study. The average age in the Silesian group was 68 +/- 9.9 years old, in the group from Cracow 69.2 +/- 9.6 years old, and 68.3 +/- 7.3 years old for the inhabitants of Lodz. The AAS method was used to determine the femoral heads metal content after microwave mineralization. A similar content of calcium (av 18.4% dry weight), phosphorus (av 6.8%), magnesium (av 1883.5 microg/g), potassium (av 598.1 microg/g), iron (av 59.5 microg/g), zinc (av 90.1 microg/g), copper (av 90.1 microg/g), arsenic (av 0.3 microg/g), and silver (av 0.03 microg/g) was found in every group. Specimens from different regions differed in lead and cadmium content, illustrating the differences in environmental pollution exposure.

[Early results of surgical treatment of dysplastic hip arthrosis with CDH prosthesis]. / Wczesne wyniki protezoplastyki CDH w leczeniu dysplastycznej koksartrozy.

The paper presents the early results of surgical treatment of osteoarthritis secondary to hip dysplasia with CDH hip prosthesis. Between 2001 and 2002 fourteen cases of hip arthritis secondary to dysplasia were treated with CDH prosthesis. Surgery was performed in women, age ranging from 22 to 52 years (average age: 40 years). In 8 cases a cementless CDH femoral component was used. In all cases cementless Taperloc (Biomet) acetabulum components were used. Weight-bearing was allowed 7-14 days post-op. Final patient assessment was done 6-26 months post-op, using the Merle d'Aubigne classification. Patient satisfaction was also taken into account. Functional assessment using this classification yielded 7 points (range: 5-9 points) pre-op, and 11 points post-op (range: 10-12 points). In the post-op assessment, patients reported less pain and an increased range of motion of the hip. No infections were noted. In 1 case deep rein irritation was noted on the second day post-op. In 10 cases there was no limb length discrepancy post-op, while in 4 cases it ranged from 1.5 cm to 3.0 cm. CDH prosthesis allows secure hip replacement procedure, especially in cases with narrow femoral canals.

Arsenic content in the femur head of the residents of southern and central Poland.

Arsenic content was assayed in the samples of the femur head of the people living in southern and central Poland (Kraków, n=13; Silesian region, n=13; Lódz, n=12). The average age being 68.7+/-8.7 yr. Arsenic content in the femur head was determined applying the hydride generation atomic absorption spectrometry (HG-AAS) method after microwave mineralization. The average arsenic contents in the femur head of the residents of the Lódz, Kraków, and Silesian regions were 0.41 microg/g, 0.37 microg/g, and 0.18 microg/g, respectively. No correlation has been found between arsenic content in the femur head and the content of other metals. Neither the age nor sex of the people tested affected the arsenic content in the femur head.

Possibilities of surgical treatment of bone metastases to the proximal epiphysis of the femur: a review of the literature and own experience.

Background. The most common complication of bone metastases to the hip is pathological fracture of the proximal epiphysis. The present study presents the indications and contraindications for surgery and the choice of particular surgical techniques, based on the literature and the authors' own experience.
Material and methods. In the period 1992-2002 we treated 25 patients with bone metastases to the proximal epiphysis of the femur. All had suffered pathological fractures. Various surgical procedures were used, depending on the indications. In two cases we used pallative treatment.
Results. There were no intraoperative or immediate post-operative deaths. In all cases but one we observed reduced pain after surgery. 23 patients recovered hip mobility. 22 patients could walk with elbow crutches after surgery. A functional evaluation performed on day 14 post-surgery produced an average score of 13.2, which on Merle d'Aubigne's scale is a "good" outcome. The survival time ranged from 6 weeks to 4 years (average 13.5 months).
Conclusions. Surgical treatment is essential, both in existing and imminent pathological fractures of the proximal epiphysis of the femur, in order to provide relief from persistent pain and enable independent movement. A patient with advanced neoplastic disease and bone metastases to the hip should be operated even before a pathological fracture occurs, which enables the use of a less invasive surgical technique and prevents immobility and worsening of the patient's physical and mental status.