Roy Altman.

I met Roy Altman many years ago and had the opportunity to spend a few months working in his laboratory in the basement of the Veterans Hospital in Miami.

Italian Society for Rheumatology recommendations for the management of hand osteoarthritis.

Hand osteoarthritis (OA) is a common and potentially disabling disease, with different features from hip and knee OA so that a specific therapeutic approach is required. Evidence based recommendations for the management of hand OA were developed by the European League Against Rheumatism (EULAR) in 2006. The Italian Society for Rheumatology (SIR) aimed to update, adapt to national contest and disseminate the EULAR recommendations for the management of hand OA. The multidisciplinary group of experts included specialists involved in the management of patients with hand OA. In order to maintain consistency with EULAR recommendations, a similar methodology was utilized by the Italian group. The original propositions were reformulated in terms of a search query and for every recommendation a systematic search was conducted updating EULAR recommendations' review. The propositions were translated in Italian and reformulated basing on collected evidences and expert opinion. The strength of recommendation was measured for each proposition with the EULAR ordinal and visual analogue scales. The original 11 propositions of EULAR recommendations were translated and adapted to Italian context. Further evidences were collected about non-pharmacological therapies, local treatments, intra-articular injection with SYSADOA and corticosteroids, and surgery. The SIR has developed updated recommendations for the management of hand OA adapted to the Italian healthcare system. Their implementation in clinical practice is expected to improve the management of patients with hand OA.

Epidemiology of hip and knee pain in a community based sample of Italian persons aged 65 and older.

OBJECTIVE: To describe prevalence, characteristics and correlates of hip pain (HP) and knee pain (KP) in an Italian community based cohort aged 65 and older (65+). METHOD: Baseline survey (1998-2000), population-based study in the Chianti area (Tuscany, Italy); 1299 persons aged 65+ were selected from the city registry of Greve in Chianti and Bagno a Ripoli (multistage sampling method); 1006 participants (564 women and 442 men, age 75.2+/-7.1) provided information for this analysis. Persons reporting HP/KP in the past 4 weeks were recorded and their Western Ontario and McMaster University Osteoarthritis Index pain score (WPS-range 0-20) calculated. Potential correlates of HP/KP, including clinical, lifestyle and psycho-social features and physical measures, were tested in age- and gender-adjusted regression analyses and then entered a multivariate regression model. RESULTS: HP was reported by 11.9% participants, while 22.4% reported KP and 7.2% both conditions. Climbing/descending stairs and walking were the activities eliciting more severe pain in either condition. Average WPSs were 5.6+/-3.5 for HP and 5.4+/-10.4 for KP. Both HP and KP were related to back pain, reduced hip abduction, reduced muscle power and increased trunk flexibility. HP was also related to KP and poor self-rated health (SRH), while KP to HP, foot pain, high body mass index, reduced knee passive flexion and knee extension torque, low education. CONCLUSION: In a community sample of an Italian persons aged 65+, the prevalence of KP almost doubled that of HP. While both conditions were related to pain in other joints and specific joint impairment, only HP was related to poor SRH, and only KP to mechanical overload.

Frequency of musculoskeletal conditions among patients referred to Italian tertiary rheumatological centers.

OBJECTIVE: To describe the occurrence of different rheumatic diseases and to examine the characteristics of patients referred to six Italian rheumatological units. To compare these data with those from other countries. METHODS: Six Italian rheumatological tertiary referral centers participated in the study. Diagnoses of in- and outpatients aged over 16 years were classified according to the International Classification of Diseases, ninth revision. RESULTS: Three thousand, five hundred and thirty-seven patients with mean age 56 +/- 14.8 years, of which 2604 (73.6%) were women, were studied. Inflammatory joint and spine diseases were diagnosed in 40.4%, connective tissue diseases in 14.4%, degenerative joint and spine diseases in 21.4%, soft tissue rheumatisms in 18.5%, and metabolic bone diseases in 5.3%. There was a significant difference among centers in the frequency of most diagnoses: non-academic centers cared for more patients with arthritis and connective tissue diseases and for less patients with degenerative diseases, soft tissue rheumatisms and metabolic bone diseases. Connective tissue diseases were constantly seen more often in Italian centers, whereas soft tissue rheumatisms were seen more often abroad. CONCLUSION: Our data emphasize the great variability of the diagnostic case-mix in different centers from the same country, an observation that raises some concerns of the results of descriptive multicenter studies. Studies on the breakdown of diagnoses made in rheumatological centers could be helpful to determine the burden of rheumatic diseases on the health system, and for the planning of health interventions by both the national rheumatological societies and health authorities.

Chondrocyte physiopathology and drug efficacy.

After a brief exposition on the physiopathology of cartilage, and characteristic features of chondrocytes and proteoglycans (PGs) in osteoarthritis (OA), it is underlined how different molecules of GAGs and aggregated PGs added to the culture media can prevent damage and reduction of GAGs and fibril production in chondrocytes cultured with NSAIDs and corticosteroids. In animal models of OA, the local or general administration of GAGPS reduces the proteinase activity, the level of uronic acid in synovial fluid and the number of inflammatory cells in synovia. In the Pond-Nuki dog, GAGPS improves the cartilage surface. These favourable events can also occur in human OA, where it is, moreover, difficult to monitor the patients. For this purpose, patients must be selected in the first two stages of primary OA, and followed using NMR, the only device able to scan cartilage and subchondral bone, to determine their consistency and thickness, and to provide information on water content.

[Association between serum amyloid A (SAA) in salivary glands and high levels of circulating beta 2-microglobulin in patients with Sjögren syndrome]. / Associazione fra presenza di Serum Amyloid A (SAA) nelle ghiandole salivari e alti livelli circolanti di beta 2-microglobulina in pazienti affetti da sindrome di Sjögren.

OBJECTIVES: The presence of secondary amyloidosis is a complication of different rheumatic diseases. We investigated the presence of Serum Amyloid A (SAA), marker of secondary amyloidosis, in salivary glands of patients (pts) with Sjögren Syndrome (SS) and correlated it to biohumoral parameters. MATERIALS AND METHODS: 141 pts with sicca syndrome who fulfilled 3 items of the European Criteria for SS by Vitali et al underwent biopsies of labial salivary glands, that were scored according to Chisholm and Mason index and evaluated for the presence of SAA. All pts were evaluated for ANA, ENA, rheumatoid factor, gamma-globulins, IgA, IgG, IgM, C3, C4, beta 2-microglobulin, erythrosedimentation rate, C reactive protein. RESULTS: Forty out of 141 pts, showed sialoadenitis (SL) with focus score 3-4 (definite SS), and 101 pts showed SL with focus score 1-2. Fourteen out of 101 pts (13.8%) with score 1-2 and 12/40 pts (30%) with definite SS were positive for SAA, respectively. SS pts were further divided in group A (positive for SAA) and group B (negative for SAA). These groups were compared to detect if differences could exist in biohumoral parameters: group A showed higher levels of biohumoral parameters than group B, but the difference was significant only for beta 2-microglobulin: 2653+610 ng/ml versus 1848+440 ng/ml; p< 0.025. CONCLUSION: Secondary amyloidosis is a complication of SS. In pts with SAA in salivary glands were detected high levels of beta 2-microglobulin, that could be considered a factor predicting the development of amyloidosis in SS.

[Italian consensus on Eular 2003 recommendations for the treatment of knee osteoarthritis]. / Consensus italiana sulle raccomandazioni dell'EULAR 2003 per il trattamento dell'artrosi del ginocchio.

The recommendations for the management of osteoarthritis (OA) of the knee firstly proposed by the EULAR in 2000, have been updated in 2003. One of the most important objectives of the expert charged to provide these recommendations was their dissemination. Thus, the information generated may be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. The Italian Society of Rheumatology (SIR) and the Italian League against Rheumatism (LIMAR) have organised a Consensus on the EULAR recommendations 2003 with the aim to analyse their acceptability and applicability according to our own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that specialists involved in the management of knee OA strongly encourage the dissemination of the EULAR 2003 recommendations also in Italy.

Plasminogen activator and receptor in osteoarthritis.

Evidence indicates that breakdown of articular cartilage resulting in the loss of normal joint function is the distinctive feature of osteoarthritis. Degradation of cartilage extracellular matrix components involves the action of at least 2 classes of proteinases: serine proteinases and metalloproteinases. Receptors have been described on a wide range of cell lines for many such proteinases [urokinase-type plasminogen activator (u-PA), plasminogen/plasmin, collagenase], which subsequently activate each other on the solid phase of the cell surface, leading to cartilage destruction. We review the leading role of u-PA and its receptor (u-PAR) in cartilage degradation.

Laser Doppler velocimetry with a compact disc pickup.

A laser Doppler velocimeter employing a compact disc pickup for both fringe projection and signal detection is described. The spectrum of the recorded signal gives the information about the speed of the object. The device takes advantage of the Talbot effect to project the grating contained in the pickup onto a moving target, so that no imaging system is required. The peculiar imaging technique allows for the exploitation of several optical configurations and permits the manipulation of the intensity profile of the projected grating. The instrument was used to measure the velocity of dust particles on a solid substrate in the 1-m/s range but could also find an application to the study of liquid flow.

High-resolution angular and displacement sensing based on the excitation of surface plasma waves.

The possibility of building angular and displacement sensors based on the phenomenon of attenuated total reflection (ATR) is explored both numerically and experimentally. ATR occurs when a surface wave is excited by an incoming TM electromagnetic wave through a resonant phase-matching process, as in the Kretschmann coupling scheme. The reflected intensity strongly depends on the angle of incidence of the beam. We first show some computations of the sensitivity and the linearity of an ATR-based sensor, then proceed to the experiment, illustrating how an angular resolution of the order of 0.1 arc sec can be obtained with moderate effort. Finally we show how the sensor, combined with a simple optical arrangement, can be used to detect and measure nanometric displacements, as those provided by piezoelectric actuators.

Correlation optical velocimetry with a compact disk pickup.

The compact disk pickup is a consumer electronics component that can be purchased for a low price owing to the great number of units produced every year. A typical three-beam head contains, enclosed in a tiny case, a quite complete sample of what can be found in an optoelectronics laboratory: a coherent source, a grating, a polarizing beam splitter, a fourth-wave plate, solid-state detectors, and much more. Exploiting the unique features of such a device for scientific aims is intriguing from many points of view. We present a straightforward application of a compact disk pickup to optical correlation velocimetry and show how a rather complicated discrete setup can be replaced successfully by this highly integrated component.

Multiple scattering from Chebyshev particles: Monte Carlo simulations for backscattering in lidar geometry.

Lidar measurements are often interpreted on the basis of two fundamental assumptions: absence of multiple scattering and sphericity of the particles that make up the diffusing medium. There are situations in which neither holds true. We focus our interest on multiply-scattered returns from homogeneous layers of monodisperse, randomly oriented, axisymmetric nonspherical particles. T(2) Chebyshev particles have been chosen and their single-scattering properties have been reviewed. A Monte Carlo procedure has been employed to calculate the backscattered signal for several fields of view. Comparisons with the case of scattering from equivalent (equal-volume) spheres have been carried out (narrow polydispersions have been used to smooth the phase functions' oscillations). Our numerical effort highlights a considerable variability in the intensity of the multiply-scattered signal, which is a consequence of the strong dependence of the backscattering cross section on deformation of the particles. Even more striking effects have been noted for depolarization; peculiar behavior was observed at moderate optical depths when particles characterized by a large backscattering depolarization ratio were employed in our simulations. The sensitivity of depolarization to even small departures from sphericity, in spite of random orientation of the particles, has been confirmed. The results obtained with the Monte Carlo codes have been successfully checked with an analytical formula for double scattering.

Optomechanics with LEGO.

The basic elements of a fairly complete optomechanical kit based on the use of LEGO are presented. Taking advantage of the great variety of standard LEGO elements, and adding a few custom components made of Plexiglas, we show how most of the mechanical parts of an optical setup can be built with little effort and at an extremely reduced cost. Several systems and experiments are presented, mainly in the fields of optical filtering and interferometry, to show that the proposed mounts are excellent for didactic purposes and often perfectly suitable even in applied research.

The effects of methotrexate on normal and osteoarthritic lapine articular cartilage.

OBJECTIVE: The effects of methotrexate (MTX) on articular cartilage and its influence on the development of osteoarthritis (OA) lesions were tested in a lapine partial medial meniscectomy model. METHOD: Animals were divided into groups consisting of unoperated and operated rabbits that either received or did not receive MTX treatment. After 8 weeks knee articular condylar cartilage was examined for gross and histologic anatomy, active and total neutral metalloproteinases, tissue inhibitor of metalloproteinase (TIMP), DNA, uronic acid and hydroxyproline content. RESULTS: Carbon black retention and histologic scores revealed moderately severe changes in the OA animals with a tendency to less severe changes in OA animals receiving MTX. Unoperated animals receiving MTX had abnormal cartilage that displayed pitting and elevations in histologic score. Active and total neutral metalloproteinase and TIMP were elevated in both untreated and treated OA animals when compared to either unoperated or unoperated and treated animals. CONCLUSION: Articular cartilage with lesser amounts of neutral metalloproteinase and high amounts of TIMP levels often seen with other therapeutic modalities for OA, were not observed with MTX therapy. Our data suggest that MTX may have limited value in the treatment of OA.

Prevalence of symptomatic hand osteoarthritis in community-dwelling older persons: the ICARe Dicomano study. Insufficienza Cardiaca negli Anzizni Residenti a Dicomano.

OBJECTIVE: To assess whether the American College of Rheumatology (ACR) classification criteria for hand osteoarthritis (OA) may be used successfully to detect hand OA in population-based studies and to estimate the prevalence of hand OA in an elderly italian population. DESIGN: This study was part of a cross-sectional population-based survey on heart failure in the elderly (ICARe Dicomano study). All community-dwelling citizens aged >65 were considered eligible and screened by expert geriatricians for the presence of major chronic conditions, including hip, knee and hand OA, using custom-made algorithms based on standard criteria. Those subjects who screened positively were subsequently assessed by a rheumatologist. RESULTS: Six hundred and ninety-seven subjects (80% of the eligible population) underwent a general examination by a geriatrician. One hundred and thirty-nine of these met the ACR criteria for hand OA at screening: 22 subjects with isolated first carpometacarpal (CMC) joint OA and 117 with generalized nodal OA. 74.2% of the diagnoses were confirmed in the 101 participants re-examined in a second phase by a rheumatologist (19 subjects presented with isolated thumb-base OA and 56 with nodal OA). The estimated prevalence in the cohort was 14.9%. CONCLUSIONS: The ACR clinical criteria for hand OA may be used in population studies, especially when the burden of this disease is evaluated.

Control of the chondrocyte fibrinolytic balance by the drug piroxicam: relevance to the osteoarthritic process.

OBJECTIVE: Since the plasminogen activator [PA/plasminogen activator inhibitor (PAI) system is believed to be involved in a breakdown of articular cartilage in osteoarthritis (OA), we studied the modulation of single components of the fibrinolytic system (urokinase-type plasminogen activator, u-PA; plasminogen activator inhibitor-1, PAI-1; the surface receptor for u-PA, u-PAR) in human chondrocytes in the presence of piroxicam. METHODS: The drug was added to the chondrocyte culture medium either directly or by supplementing chondrocyte cultures with synovial fluid (SF) from patients with OA treated with piroxicam. We have shown u-PAR M(r) 55000 Da on human chondrocytes in suspension culture by cross linking chondrocyte lysates with 125I-labelled amino-terminal fragment (ATF) of human u-PA, which frames the sequence that specifically interacts with u-PAR. RESULTS: Such receptors decrease upon incubation of chondrocytes with piroxicam or with SF from patients treated with piroxicam. The culture medium of treated chondrocytes showed decreased fibrinolytic activity when compared with untreated controls, while PAI activity was increased in both SF chondrocyte culture medium following piroxicam treatment. At the same time, internalization of u-PA/u-PAR complexes increased after incubation of chondrocytes with piroxicam or PAI-1 rich SF. CONCLUSION: Our results indicate that the drug induces the surface clearance u-PAR by internalization of u-PA/PAI-/u-PAR complexes. Thus piroxicam reduces both the soluble fibrinolytic activity of human chondrocytes (increase of PAI activity and decrease of released u-PA) and the cell associated u-PA activity (clearance of u-PAR by internalization). The drug dependent changes in the fibrinolytic system suggest that piroxicam may be useful in preventing or limiting perilacunar cartilage damage in OA.

Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy.

OBJECTIVES: To assess the prevalence of hand, hip, and knee osteoarthritis (OA) in an older Italian community dwelling population and its association with disability. METHOD: A cross sectional survey of the whole community aged 65 years and over, was carried out in Dicomano, a small rural town in Tuscany, Italy. Subjects were screened by geriatricians for major chronic conditions, including hip, knee, and hand OA, using diagnostic algorithms based on the American College of Rheumatology (ACR) clinical criteria. A rheumatologist examined subjects who screened positive. Disability was assessed by a World Health Organisation questionnaire. RESULTS: 697 of 864 eligible subjects (81% of the eligible population) were screened. OA of the knee, hand, or hip was identified by clinical ACR criteria respectively in 159, 139, and 81 subjects, and was confirmed by the rheumatologist in 158/182 (87%), 75/101 (74%), and 63.2% of cases. The estimated prevalence was 29.8%, 14.9%, and 7.7%, respectively. Only hip OA was significantly associated with disability in basic activities of daily living. CONCLUSIONS: About one third of community dwelling older people are affected by symptomatic peripheral OA. Hip OA was strongly associated with disability.