Bone change after surgical treatment of mucous cyst at the interphalangeal joint of the great toe in a patient with rheumatoid arthritis.

Digital mucous cysts are a type of benign cysts of the digits, typically located at the distal interphalangeal joints or in the proximal nail fold, which usually occur on the hands. The diagnosis of digital mucous cysts is relatively easy because of its light-transmitting property, but the treatment is often difficult because of complications including recurrence, infection, diminished range of motion, and nail deformity. We report a case of rheumatoid arthritis (RA) showing good course after surgical treatment of mucous cyst at the interphalangeal joint of the great toe. In a case of RA, combination of synovectomy with surgical treatment of mucous cyst might be effective.

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis combined with bony ankylosis of the acromioclavicular joint and ossification of the coracoclavicular ligament.

Sternocostoclavicular hyperostosis (SCCH) has been reported in patients with pustulotic arthro-osteitis, but there are few reports of marked ossification of the lateral part of the clavicle. Here, we report a case of stress fracture in a patient with SCCH with marked ossification of the lateral part of the clavicle. In this case, the clavicular fracture was proximal and no dislocation. Conservative treatment with a clavicle band and the administration of corticosteroids resulted in rapid symptom improvement. Eight months later, the patient had no difficulty in daily life, but X-rays showed that bone fusion was not complete. Therefore, it is necessary to carefully follow-up such patients for any recurrence of symptoms and radiographic changes.

CD14+ Dendritic-Shaped Cells Functioning as Dendritic Cells in Rheumatoid Arthritis Synovial Tissues.

OBJECTIVE: We previously reported that CD14+ dendritic-shaped cells exhibit a dendritic morphology, engage in pseudo-emperipolesis with lymphocytes, and express CD90 in the perivascular areas of rheumatoid arthritis (RA) synovial tissues. However, it remains unclear whether these CD14highCD90intermediate(int) cells function as dendritic cells. In this study, we investigated the dendritic cell-differentiation potential of CD14highCD90int cells. METHODS: The localization and number of CD14highCD90int cells in RA synovial tissues and peripheral blood were examined. The dendritic cell-differentiation potential of CD14highCD90int cells was examined by measuring interleukin-6 and tumor necrosis factor-α levels in the supernatant and CD83 and human leukocyte antigen (HLA)-DR expression in the cells after induction of dendritic cell differentiation. Synovial cells were co-cultured with lymphocytes, and the activation of these cells was examined. RESULTS: CD14highCD90int cells were abundant in RA synovial tissues, including the sublining layer and the pannus areas. Patients with untreated and active RA had significantly higher percentages of CD14highCD90int cells in the peripheral blood and synovial tissues. In RA synovial cells, inflammatory cytokine levels increased with dendritic cell-differentiation culture, but CD83 and HLA-DR expression were significantly increased in the CD14highCD90int cell group. When co-cultured with lymphocytes, cell numbers and inflammatory cytokine levels significantly increased in both groups of synovial cells after dendritic cell induction. CONCLUSION: CD14+ cells migrate and spread from the circulating blood to RA synovial tissues while expressing CD90, and CD14highCD90int cells in contact with lymphocytes differentiate into HLA-DR+ dendritic cells, which contribute to chronic inflammation in RA.

A Case of Elderly Rheumatoid Arthritis with Fracture Cascade Triggered by Worsening Disease Activity.

Introduction: Patients with rheumatoid arthritis (RA) have generalized bone loss and deterioration of bone quality, leading to a relatively higher risk of vertebral and non-vertebral fractures. It has been previously reported that patients who cause fragility fractures such as vertebral fractures, had statistically higher scores of RA disease activity, but there are no case reports. Case Report: The case described in this report is an elderly woman with RA who was receiving treatment including glucocorticoids. Her state of RA activity had been in remission for a long time, and she was also receiving treatment to prevent osteoporosis. However, the worsening of the disease activity triggered a fracture cascade starting from a vertebral fracture and her activities of daily living deteriorated rapidly. Conclusion: This report highlights the difficulties in treating osteoporosis and preventing fragility fractures in an elderly patient with RA and the importance of managing RA disease activity.

Association of CD90 Expression by CD14+ Dendritic-Shaped Cells in Rheumatoid Arthritis Synovial Tissue With Chronic Inflammation.

OBJECTIVE: CD14+ dendritic-shaped cells show a dendritic morphology under the electron microscopy and engage in a pseudoemperipolesis phenomenon with lymphocytes. CD90 has been used as a marker of a major subset of fibroblast-like synoviocytes in rheumatoid arthritis (RA). In this study, we investigated the significance of CD90 expression in CD14+ dendritic-shaped cells and its correlation with RA chronic inflammation. METHODS: Double immunofluorescence staining for CD14 and CD90 was performed in the collected tissues, including 12 active RA synovial tissues. The localization of CD14+ CD90+ cells, the percentages of CD14+ CD90+ cells and vascular areas, the degree of synovitis, and clinical data were investigated. Furthermore, CD14+ CD90+ cells analyzed by flow cytometry (CD14high CD90intermediate (int) cells) were sorted from RA synovial cells, and we examined their potential to differentiate into dendritic cells. RESULTS: Double immunofluorescence staining showed that CD14+ CD90+ cells were abundant in RA synovial tissues. The percentages of CD14+ CD90+ cells and vascular areas correlated with some of the Krenn synovitis scores, but neither showed a strong correlation with RA disease activity parameters. Flow cytometry analysis indicated that CD14high CD90int cells were more abundant in both peripheral blood samples and synovial tissues in patients with active RA. CD14high CD90int cells were more likely to differentiate into dendritic cells in vitro. CONCLUSION: CD14+ dendritic-shaped cells expressed CD90 in the perivascular areas of RA synovial tissues. These findings suggest that CD14+ CD90+ dendritic-shaped cells migrate from the peripheral blood to the synovial tissue, the site of inflammation, and may contribute to the chronic inflammation of RA as dendritic progenitor cells.

Possibility of inhibiting arthritis and joint destruction by SSEA-3 positive cells derived from synovial tissue in rheumatoid arthritis.

AIM: Joint destruction progresses irreversibly once they occur in rheumatoid arthritis (RA), even with the recent development of anti-rheumatic drugs. Cells positive for stage-specific embryonic antigen-3 (SSEA-3), a marker of human embryonic stem cell, act as stem cells in the blood. The aim of this study is to investigate the effectiveness of SSEA-3 positive cells for the treatment for RA. METHODS: Synovial tissues were harvested at the time of joint surgery in RA patients. Cultured synovial cells were sorted by anti-SSEA-3 antibody using flow cytometry and were analyzed in in vitro. To investigate inhibitory effects on arthritis by SSEA-3 positive cells, collagen antibody-induced arthritis (CAIA) mice were used and transplanted with labeled cells intravenously. RESULTS: Presence of SSEA-3 positive cells was confirmed with approximately 1% in RA synovial cells. SSEA-3 positive cells were negative for CD34 and positive for CD44, CD90 and CD105. Multipotency of SSEA-3 positive cells was higher than that of SSEA-3 negative cells. Arthritis of the group transplanted with SSEA-3 positive cells in CAIA mice decreased over time. CONCLUSIONS: SSEA-3 positive cells derived from RA synovial tissue might have the inhibitory effect on arthritis and would be one of cell source for new RA treatment.

Pathological findings from synovium of early osteoarthritic knee joints with persistent hydrarthrosis.

AIM: Nonspecific chronic synovitis of the knee joint was reported by Pollard in 1962 and its pathogenesis is considered to be a physiological reaction to intra-articular disease. In this study, we evaluated the pathological findings of the synovium of early osteoarthritis (OA)-affected knee joints with hydrarthrosis in comparison to typical OA. METHODS: Synovial tissues were harvested from early OA knee joints with hydrarthrosis graded 0-2 according to the Kellgren and Lawrence classification and examined by histopathology. RESULTS: The synovial tissues showed proliferation of fibroblast-like synoviocytes (FLS) as if in rheumatoid arthritis (RA), and were immunohistochemically positive for matrix metalloproteinase 3, tumor necrosis factor α and interleukin 6. CONCLUSIONS: The histology of RA is characterized by marked proliferation of FLS. In this study, the synovial tissues of early OA with hydrarthrosis showed moderate FLS proliferation. They also expressed the cytokines that are detected in the synovial tissues of RA. We suggest long-term follow-up is needed because early OA with hydrarthrosis might progress to overt RA.

Characterization of human synovial fluid cells of 26 patients with osteoarthritis knee for cartilage repair therapy.

AIM: To investigate the possibility of chondrogenic differentiation and cartilage repair of synovial fluid cells of osteoarthritis (OA) knee. METHODS: Synovial fluids from 26 patients with OA knee were aspirated from each knee joint and cultured in vitro. The morphology of cultured synovial fluid cells, cell proliferation rate, the phenotype, and chondrogenic differentiation were analyzed in in vitro. Also, human autologous synovial fluid cells were transplanted to OA cartilage, and the cells were traced in ex vivo. RESULTS: In 19 of 26 materials, the cells proliferated satisfactorily. The cell proliferation in six materials was very slow and one material contaminated. Culture-expanded synovial fluid cells had a fibroblastic morphology and the phenotype was negative for CD10, CD14, and CD45, and positive for CD13, CD44, and CD105. Pellet culture of synovial fluid cells showed chondrogenic differentiation. In the ex vivo study, autologous transplanted synovial fluid cells were observed in repaired or enhanced regenerative cartilage areas and showed a tendency to infiltrate the original degenerative cartilage of OA. CONCLUSIONS: This study proved the possibility of chondrogenic differentiation of synovial fluid cells of OA knee joints despite the pathologic environment within a diseased joint. Synovial fluid cells were actually heterogeneous cells but they showed chondrogenic differentiation, similar to that of bone marrow-derived mesenchymal progenitor cells (BMMPCs). The Ex vivo study suggested that synovial fluid cells had a tendency to adhere to OA degenerative cartilage in humans.