Joint Space (joint + space)

Distribution by Scientific Domains

Terms modified by Joint Space

  • joint space narrowing
  • joint space width

  • Selected Abstracts

    An evaluation of European air pollution regulations for particulate matter monitored from a heterogeneous network

    ENVIRONMETRICS, Issue 8 2009
    Sujit K. Sahu
    Abstract Statistical methods are needed for evaluating many aspects of air pollution regulations increasingly adopted by many different governments in the European Union. The atmospheric particulate matter (PM) is an important air pollutant for which regulations have been issued recently. A challenging task here is to evaluate the regulations based on data monitored on a heterogeneous network where PM has been observed at a number of sites and a surrogate has been observed at some other sites. This paper develops a hierarchical Bayesian joint space,time model for the PM measurements and its surrogate between which the exact relationship is unknown, and applies the methods to analyse spatio -temporal data obtained from a number of sites in Northern Italy. The model is implemented using MCMC techniques and methods are developed to meet the regulatory demands. These enablefull inference with regard to process unknowns, calibration, validation, predictions in time and space and evaluation of regulatory standards. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    A cranial intercondylar arthroscopic approach to the caudal medial femorotibial joint of the horse

    T. Muurlink
    Summary Reason for performing study: Current noninvasive techniques for imaging the soft tissue structures of the stifle have limitations. Arthroscopy is commonly used for the investigation and treatment of stifle pain. Cranial and caudal arthroscopic approaches to the femorotibial joints are used. However, complete examination of the axial aspect of the medial femorotibial joint (MFTJ) is not possible currently. Objective: To develop a cranial approach to the caudal pouch of the MFTJ and to assess whether it would allow a more complete examination of the compartment and facilitate the caudomedial approach. Method: The regional anatomy was reviewed and the technique developed on cadavers. A series of nonrecovery surgeries were performed to evaluate the procedure, which was then used in 7 clinical cases. Advantages compared to existing techniques and complications encountered were recorded. Results: Successful entry into the caudal pouch of the MFTJ was achieved in 20 of 22 cadaver legs, 8 of 8 joints of nonrecovery surgery horses and 6 of 7 clinical cases operated. The caudal ligament of the medial meniscus could be visualised, along with other axial structures of the caudal joint pouch. The technique was used to facilitate a caudomedial approach and allowed better triangulation within the joint space. Complications were minor and included puncture of the caudal joint capsule and scoring of the axial medial femoral condyle. Conclusions and potential relevance: It is possible to access the caudal pouch of the MFTJ arthroscopically using a cranial intercondylar approach. The technique has advantages when compared to existing techniques and is associated with few significant complications. A cranial approach to the caudal pouch of the MFTJ could complement existing techniques and be useful clinically. [source]

    Morphine modulation of temporomandibular joint-responsive units in superficial laminae at the spinomedullary junction in female rats depends on estrogen status

    A. Tashiro
    Abstract The influence of analgesic agents on neurons activated by stimulation of the temporomandibular joint (TMJ) region is not well defined. The spinomedullary junction [trigeminal subnucleus caudalis (Vc)/C1,2] is a major site of termination for TMJ sensory afferents. To determine whether estrogen status influences opioid-induced modulation of TMJ units, the classical opioid analgesic, morphine, was given to ovariectomized (OvX) rats and OvX rats treated for 2 days with low-dose (LE2) or high-dose (HE2) 17,-estradiol-3-benzoate. Under thiopental anesthesia, TMJ units in superficial and deep laminae at the Vc/C1,2 junction were activated by injection of ATP (1 mm) directly into the joint space. In superficial laminae, morphine inhibited evoked activity in units from OvX and LE2 rats in a dose-related and naloxone-reversible manner, whereas units from HE2 rats were not inhibited. By contrast, in deep laminae, morphine reduced TMJ-evoked unit activity similarly in all groups. Morphine reduced the background activity of units in superficial and deep laminae and resting arterial pressure similarly in all groups. Morphine applied to the dorsal surface of the Vc/C1,2 junction inhibited all units independently of E2 treatment. Quantitative polymerase chain reaction and immunoblots revealed a similar level of expression for ,-opioid receptors at the Vc/C1,2 junction in LE2 and HE2 rats. These results indicated that estrogen status differentially affected morphine modulation of TMJ unit activity in superficial, but not deep, laminae at the Vc/C1,2 junction in female rats. The site(s) for estrogen influence on morphine-induced modulation of TMJ unit activity was probably outside the medullary dorsal horn. [source]

    The impact of joint bleeding and synovitis on physical ability and joint function in a murine model of haemophilic synovitis

    HAEMOPHILIA, Issue 1 2008
    Summary., Haemophilia is a congenital disorder that commonly results in musculoskeletal bleeding and orthopaedic complications. After an acute joint haemorrhage, an increase in intra-articular pressure and inflammation cause pain, swelling and limited motion. Blood in the joint space provokes a proliferative disorder known as haemophilic synovitis. Overgrowth of the synovial membrane causes mechanical dysfunction. Eventually, there is destruction of the articular surface and underlying bone. The aim of this project was to test the hypothesis that a minimum number of haemarthroses negatively impacts on joint function and that this would be reflected by decreased physical performance of experimental animals. Mice deficient in factor VIII coagulant activity were trained to ambulate on a rotating rod then injured three times at weekly intervals. Their ability to walk was then compared to a group of uninjured mice. Cohorts of mice were killed after 1, 2 or 3 months and the knee joints examined by gross and histological methods. The results supported the following conclusions: (i) haemophilic mice can be trained to ambulate on a rotating rod; (ii) acute hemarthrosis temporarily impairs their ability to ambulate and (iii) following recovery from acute injury, mice developing synovitis demonstrated inferior physical ability compared to mice not developing synovitis. This is the first description of a quantitative assay to monitor joint function in experimental animals and should be useful to evaluate the efficacy of new therapies developed to prevent and treat bleeding and to test strategies to counter the devastating effects of synovitis. [source]

    Destructive arthritis in Behçet's disease: a report of eight cases and literature review

    Abstract Behçet's disease (BD) is a multisystemic disease with typically non-erosive and non-deforming joint manifestations. The occurrence of destructive arthritis in Behçet's disease has rarely been reported. Here we attempt to define the epidemiological, clinical and radiological features of this unusual type of osteoarticular manifestation of BD. We retrospectively reviewed the medical records of 553 patients with Behçet's disease seen over 25-year period in our department of Internal Medicine (Sfax-Tunisia). All the patients fulfilled The International Study Group of Behçet's Disease criteria. Patients with destructive arthritis (defined by radiological changes: erosions and/or geodes and/or global narrowing of the joint space and/or ankylosis) were included in this study. Rheumatologic manifestations were observed in 71.1% patients. Eight patients (1.4% overall, 2% among patients with rheumatologic manifestations) had presented with destructive arthritis. The joint symptoms involved the knee in two cases, the wrist in one case, the elbow (one case), the sternoclavicular joint in two cases, the foot in one case and the tarsal scaphoïd in one case. There was recurrent arthritis at the same joint in the majority of cases. X-ray examinations revealed radiological changes: global narrowing of the joint in one case (knee), narrowing of the joint with geodes in three cases (knee, sternoclavicular), isolated geodes in two cases (tarsal scaphoid, foot) and severe lesions with ankylosis in two cases (two elbows, right wrist). Joint manifestations are common in patients with BD, but destructive arthritis is rare. [source]

    In vitro degradation of articular cartilage: does trypsin treatment produce consistent results?

    JOURNAL OF ANATOMY, Issue 2 2006
    H. R. Moody
    Abstract It is common practice in laboratories to create models of degraded articular cartilage in vitro and use these to study the effects of degeneration on cartilage responses to external stimuli such as mechanical loading. However, there are inconsistencies in the reported action of trypsin, and there is no guide on the concentration of trypsin or the time to which a given sample can be treated so that a specific level of proteoglycan depletion is achieved. This paper argues that before any level of confidence can be established in comparative analysis it is necessary to first obtain samples with similar properties. Consequently, we examine the consistency of the outcome of the artificial modification of cartilage relative to the effects of the common enzyme, trypsin, used in the process of in vitro proteoglycan depletion. The results demonstrate that for a given time and enzyme concentration, the action of trypsin on proteoglycans is highly variable and is dependent on the initial distribution and concentration of proteoglycans at different depths, the intrinsic sample depth, the location in the joint space and the medium type, thereby sounding a note of caution to researchers attempting to model a proteoglycan-based degeneration of articular cartilage in their experimental studies. [source]

    Sonography of the normal scapholunate ligament and scapholunate joint space

    James Francis Griffith FRCR
    Abstract Purpose The aims of this study were to assess the visibility of the normal scapholunate ligament on sonography and to establish the normal scapholunate joint space width in the neutral position and radial and ulnar deviation. Methods Two hundred normal wrists in 100 subjects (55 men and 45 women; mean age, 40 years; range, 19,83 years) were examined with high-resolution sonography (5,12-MHz linear-array transducer). The visibility and thickness of the scapholunate ligament were recorded. The width of the scapholunate joint space, or interval, was measured in the neutral position and radial and ulnar deviation. The width of the distal radius was recorded as a comparative standard for the patients' body habitus. Results The dorsal scapholunate ligament was completely (100%) visible in 95 wrists (48%), partially (, 50%) visible in 60 (30%), barely (< 50%) visible in 15 (8%), and not visible in 30 (15%). The volar scapholunate ligament was completely visible in 13 wrists (7%), partially visible in 17 (9%), barely visible in 15 (8%), and not visible in 151 (76%). The proximal component of the ligament was not visible in any subject. Measurement of the scapholunate interval was limited by the lack of identifiable anatomic marks for reference. The mean width of the dorsal scapholunate interval was 4.2 mm (range, 2.3,6.3 mm) in the neutral position. The interval did not differ more than 2.5 mm between the left and right wrists. No predictable change in width on ulnar or radial deviation was evident. The mean scapholunate intervals and mean distal radial width were significantly wider in men than in women and on the right side than on the left side. Conclusions The dorsal scapholunate ligament is completely or partially visible in 78% of normal wrists. Its detection following injury may help to exclude the possibility of scapholunate dissociation. There is a quite wide variation in scapholunate interval widths on sonography and an unpredictable response with stress testing. The absence of a visible scapholunate ligament on sonography does not indicate injury. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:223,229, 2001. [source]

    Inverse Velocity and Singularity Analysis of Low-DOF Serial Manipulators

    Yuefa Fang
    This paper presents a method for exact inverse velocity analysis of low-DOF (degrees of freedom n<6) serial manipulators. For a low-DOF serial manipulator, the number of independently controllable variables in the Cartesian space is equal to the number of joint variables in the joint space, and the remaining 6,n variables are linearly dependent on these independent variables. This paper employs the theory of reciprocal screws to determine a mapping between the independent velocity components in the Cartesian space and the joint rates in the joint space. It is shown that singular conditions of a low-DOF manipulator depend on choice of independent variables. A 5-DOF and a 4-DOF manipulator are analyzed, and a numerical example in which the end effector of a 4-DOF manipulator is commanded to follow a straight line is used to demonstrate the methodology. © 2003 Wiley Periodicals, Inc. [source]

    Association between condylar position, joint morphology and craniofacial morphology in orthodontic patients without temporomandibular joint disorders

    K. Kikuchi
    summary, The present study investigated condylar position and joint morphology in adolescent patients and elucidated the possible association between the joint structure and condylar position, and craniofacial morphology. Sixty-five adolescent patients were selected as subjects and their tomograms and lateral cephalograms were analysed. No significant differences in joint spaces were found between the right and left temporomandibular joints. Both the condyles in this population were located slight anteriorly in the glenoid fossa. With respect to the association between condylar position, joint morphology and craniofacial morphology, the ramus plane angle also exhibited significant negative correlations with posterior, lateral and medial joint spaces. Furthermore, there was a significant negative correlation between the gonial angle and the anterior joint space. These findings imply that the condyle was likely to show more posterior position in the glenoid fossa when the mandible exhibited clockwise rotation. In conclusion, the condyle in the adolescent subjects showed a symmetrical anterior position relative to the glenoid fossa. In addition, the joint spaces and it ratios were significantly related to the craniofacial morphology associated with vertical dimension. It is suggested that the condylar position may be affected by craniofacial growth pattern. [source]

    Effect of oral diacerein (DAR) in an experimental hip chondrolysis model

    Humberto Ken Kitadai
    Abstract We aimed to reproduce the articular cartilage structural changes in a joint exposed to a metallic implant as in the adolescent pinned hip with persistent joint penetration and secondly, to test the effect of an interleukin inhibitor, diacerein (DAR) in the ensuing articular cartilage lesion. Twenty immature beagles were submitted to a surgical K-wire implantation in the hip with the material left in the joint space for 6 months. Twelve animals were sacrificed for histological and biochemical tests. Eight animals were sacrificed at 10 months (half of them treated with DAR) and analyzed by scanning electron microscopy (SEM) and biochemistry of the articular cartilage. Preoperative and monthly C3 and C4 complement and immunoglobulins serum levels were determined. The histological and the electrophoretic profile changes were significative at 6 months. At 10 months the migration profile (CaCl2) recovered to normal levels in the operated hip and the SEM scores for the acetabulum were similar to the non operated control hip after treatment. The serum level of IgA was elevated at the 4th and 6th month postoperatively. The persistence of a metallic implant resulted in degenerative changes parallel to that described for hip chondrolysis as a complication of in-situ pinning; and the cartilage lesion improved with DAR treatment. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:1240,1248, 2006 [source]

    Intra-articular depot formulation principles: Role in the management of postoperative pain and arthritic disorders

    Claus Larsen
    Abstract The joint cavity constitutes a discrete anatomical compartment that allows for local drug action after intra-articular injection. Drug delivery systems providing local prolonged drug action are warranted in the management of postoperative pain and not least arthritic disorders such as osteoarthritis. The present review surveys various themes related to the accomplishment of the correct timing of the events leading to optimal drug action in the joint space over a desired time period. This includes a brief account on (patho)physiological conditions and novel potential drug targets (and their location within the synovial space). Particular emphasis is paid to (i) the potential feasibility of various depot formulation principles for the intra-articular route of administration including their manufacture, drug release characteristics and in vivo fate, and (ii) how release, mass transfer and equilibrium processes may affect the intra-articular residence time and concentration of the active species at the ultimate receptor site. © 2008 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 97:4622,4654, 2008 [source]

    Evaluation of elbow incongruency using reconstructed CT in dogs suffering fragmented coronoid process

    T. J. Gemmill
    Objectives: A retrospective study was undertaken to evaluate elbow joint congruency in dogs suffering fragmented coronoid process (FCP). METHODS: Based on clinical, radiographic and computed tomographic (CT) examinations, elbows were divided into control and FCP groups. Standardised CT reconstructions were formatted in the frontal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from the images and incongruencies were calculated by comparing the two measurements. Results: Forty-two FCP and 29 control elbows were identified. No incongruencies were noted at the coronoid base. At the level of the coronoid apex, FCP elbows exhibited a significant radioulnar incongruency compared with controls (P<0·0001), though incongruency was not identified in all cases. Comparing FCP and control elbows at the level of the apex, the humeroradial joint space was increased in FCP elbows (P=0·0006) whereas no difference was noted in the humeroulnar space. Clinical Significance: This study supports the hypothesis that joint incongruency is associated with FCP in dogs, though is not present in every case at the time of diagnosis. The precise mechanism of development of this incongruency cannot be determined from these data. [source]

    Osteosarcoma near joints: Assessment and implications

    Gerald M.Y. Quan MBBS
    Abstract Background The choice of performing surgery when tumors encroach onto joints remains a challenging and controversial issue. Pre-operative assessment by magnetic resonance imaging (MRI) is of critical importance in dictating surgical management and subsequent functional outcome. Methods We examined archival samples from 27 patients with osteosarcoma, adjacent to synovial joints for the incidence and mechanism of osteosarcoma extension into the joint space. Histopathologic findings were correlated with pre-operative MRI findings and choice of operation. Results There was no evidence of penetration across the entire thickness of articular cartilage into the joint cavity in all of the 27 cases. When pre-operative MRI confidently excluded joint involvement by tumor, enabling an intra-articular surgical approach, histopathologic correlation confirmed the absence of joint involvement in all cases. The low incidence of joint involvement was despite the presence of extensive bone and soft tissue involvement in most cases, a tendency for peripheral extension of tumor around the articular margin of the bone, and evidence of joint effusions pre-operatively in more than one-third of cases. Conclusions Joint involvement by osteosarcoma is uncommon, with articular cartilage being a relative barrier to tumor invasion. If pre-operative MRI does not show definite evidence of intra-articular tumor involvement, it is likely to be safe to proceed with intra-articular resection. J. Surg. Oncol. 2005;91:159,166. © 2005 Wiley-Liss, Inc. [source]

    In vivo high-resolution synchrotron radiation imaging of collagen-induced arthritis in a rodent model

    Chang-Hyuk Choi
    In vivo microstructures of the affected feet of collagen-induced arthritic (CIA) mice were examined using a high-resolution synchrotron radiation (SR) X-ray refraction technique with a polychromatic beam issued from a bending magnet. The CIA models were obtained from six-week-old DBA/1J mice that were immunized with bovine type II collagen and grouped as grades 0,3 according to a clinical scoring for the severity of arthritis. An X-ray shadow of a specimen was converted into a visual image on the surface of a CdWO4 scintillator that was magnified using a microscopic objective lens before being captured with a digital charge-coupled-device camera. Various changes in the joint microstructure, including cartilage destruction, periosteal born formation, articular bone thinning and erosion, marrow invasion by pannus progression, and widening joint space, were clearly identified at each level of arthritis severity with an equivalent pixel size of 2.7,µm. These high-resolution features of destruction in the CIA models have not previously been available from any other conventional imaging modalities except histological light microscopy. However, thickening of the synovial membrane was not resolved in composite images by the SR refraction imaging method. In conclusion, in vivo SR X-ray microscopic imaging may have potential as a diagnostic tool in small animals that does not require a histochemical preparation stage in examining microstructural changes in joints affected with arthritis. The findings from the SR images are comparable with standard histopathology findings. [source]

    Morphological differences in the temporomandibular joints in asymmetrical prognathism patients

    M Kawakami
    Structured Abstract Authors ,, Kawakami M, Yamamoto K, Inoue M, Kawakami T, Fujimoto M, Kirita T Objective ,, To investigate the morphology of the temporomandibular joints (TMJ) in skeletal asymmetry with prognathism. Design ,, Three-group observational clinical study. Setting and Sample Population ,, University setting. Thirty-five patients undergoing orthognathic surgery without signs and symptoms of TMJ disorder were assigned to three groups (right deviation, n = 11; left deviation, n = 14; and non-deviation; n = 10) based on anteroposterior cephalometric analysis. Outcome Measure ,, Positional and morphological differences of the TMJs were evaluated using a total of 70 bilateral sagittal TMJ magnetic resonance images. Results ,, In both the right and left deviation groups, the TMJ on the deviated side showed a significantly steeper eminence than that on the non-deviated side (p < 0.05). The anterior joint space was narrower on the deviated side than on the non-deviated side whereas the posterior joint space did not differ markedly, indicating an anterior position of the condyle in the glenoid fossa of the TMJ on the deviated side. Disk displacement comparisons revealed no significant differences between left and right sides in the symmetry or asymmetry group. Conclusion ,, Asymmetrical prognathism patients exhibit significant morphological differences between the right and left TMJs concerning the slope of the articular eminence, which correspond to facial asymmetry. [source]

    Knockdown of Fc, receptor III in an arthritic temporomandibular joint reduces the nociceptive response in rats

    ARTHRITIS & RHEUMATISM, Issue 10 2010
    Phillip R. Kramer
    Objective Fc, receptor III (Fc,RIII; CD16) is a receptor expressed on immune cells that selectively binds IgG molecules. IgG binding results in cellular activation and cytokine release. IgG is an important factor in arthritis and can be found in the arthritic temporomandibular joint (TMJ). We undertook this study to test the hypothesis that a reduction in Fc,RIII expression in TMJ tissues would reduce the nociceptive and inflammatory responses in an inflamed joint. Methods Small interfering RNA (siRNA), either naked or complexed with linear polyethyleneimine, was injected into the superior joint space of the TMJ in rats. After administration of siRNA the joint was injected with saline or with Freund's complete adjuvant to induce arthritis. Nociceptive responses were quantitated in the rat by measuring the animal's meal duration. Fc,RIII expression in the TMJ tissue was assayed by immunocytochemistry or Western blotting. Cleavage of Fc,RIII transcript was then assayed by 5, rapid amplification of complementary DNA ends. Interleukin-1, (IL-1,) and IgG content was measured in the TMJ tissue by enzyme-linked immunosorbent assay. Results Injection of Fc,RIII siRNA reduced the amount of Fc,RIII in the TMJ tissues, and the transcript was cleaved in a manner consistent with an RNA interference mechanism. Moreover, injection of Fc,RIII siRNA reduced the nociceptive response of rats with an arthritic TMJ and reduced the amount of the proinflammatory cytokine IL-1,. Conclusion Fc,RIII contributes to the pain resulting from inflammatory arthritis of the TMJ, and siRNA has the potential to be an effective treatment for this disorder. [source]

    Changes in proximal femoral mineral geometry precede the onset of radiographic hip osteoarthritis: The study of osteoporotic fractures

    ARTHRITIS & RHEUMATISM, Issue 7 2009
    M. K. Javaid
    Objective Radiographic hip osteoarthritis (RHOA) is associated with increased hip areal bone mineral density (aBMD). This study was undertaken to examine whether femoral geometry is associated with RHOA independent of aBMD. Methods Participants in the Study of Osteoporotic Fractures in whom pelvic radiographs had been obtained at visits 1 and 5 (mean 8.3 years apart) and hip dual x-ray absorptiometry (DXA) had been performed (2 years after baseline) were included. Prevalent and incident RHOA phenotypes were defined as composite (osteophytes and joint space narrowing [JSN]), atrophic (JSN without osteophytes), or osteophytic (femoral osteophytes without JSN). Analogous definitions of progression were based on minimum joint space and total osteophyte score. Hip DXA scans were assessed using the Hip Structural Analysis program to derive geometric measures, including femoral neck length, width, and centroid position. Relative risks and 95% confidence intervals for prevalent, incident, and progressive RHOA per SD increase in geometric measure were estimated in a hip-based analysis using multinomial logistic regression with adjustment for age, body mass index, knee height, and total hip aBMD. Results In 5,245 women (mean age 72.6 years), a wider femoral neck with a more medial centroid position was associated with prevalent and incident osteophytic and composite RHOA phenotypes (P < 0.05). Increased neck width and centroid position were associated with osteophyte progression (both P < 0.05). No significant geometric associations with atrophic RHOA were found. Conclusion Differences in proximal femoral bone geometry and spatial distribution of bone mass occur early in hip OA and predict prevalent, incident, and progressive osteophytic and composite phenotypes, but not the atrophic phenotype. These bone differences may reflect responses to loading occurring early in the natural history of RHOA. [source]

    Defining incident radiographic hip osteoarthritis for epidemiologic studies in women

    ARTHRITIS & RHEUMATISM, Issue 4 2009
    Nigel K. Arden
    Objective To evaluate definitions of radiographic hip osteoarthritis (RHOA) for use in longitudinal epidemiologic studies of disease incidence in women. Methods We studied 5,839 women from the Study of Osteoporotic Fractures who had had serial pelvic radiographs obtained (mean of 8.3 years apart) and who were followed up (mean followup 7.1 years from the time of the second radiograph) for evaluation of clinical outcomes. Definitions of RHOA were assessed for construct validity (association with symptoms and signs at the time of the second radiograph) and predictive validity (association with total hip replacement [THR] and signs and symptoms a mean of 7.1 years later). Odds ratios (ORs) and 95% confidence intervals were calculated to assess the strength of association using logistic regression. Results The cumulative incidence of RHOA ranged from 2.2% to 11.7%. All definitions displayed significant construct validity; the most consistent was found for composite definitions that required the concurrent presence of 2 or more individual radiographic features and definitions based on stringent criteria for joint space narrowing. All definitions except minimum joint space ,2.5 mm displayed consistent predictive validity. Composite definitions had the strongest associations with THR (OR 10.5,18.5) and hip pain (OR 2.6,2.9). The hips identified as having OA by each definition varied, with especially small overlap between findings using definitions based on osteophytes and those using definitions based on joint space narrowing alone. Conclusion Most definitions of incident RHOA display good construct and predictive validity. Composite definitions have the best overall performance, and definitions requiring the presence of both osteophytes (in particular, femoral osteophytes) and joint space narrowing would be recommended for most epidemiologic and genetic studies. [source]

    A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis,

    ARTHRITIS & RHEUMATISM, Issue 4 2007
    Kristin Baker
    Objective In uncontrolled studies, a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis (OA). The aim of this study was to test the efficacy of this simple, low-cost intervention for pain in patients with medial knee OA. Methods We conducted a double-blind, randomized, crossover trial designed to detect a small effect of treatment. Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Participants were randomized to receive a 5° lateral-wedge insole or a neutral insole for 6 weeks. Following a 4-week washout period, participants crossed over to the other treatment for 6 weeks. Knee pain, the primary outcome, was assessed by the WOMAC pain scale (visual analog scale version). Secondary outcomes included the WOMAC disability subscale, overall knee pain, 50-feet walk time, chair-stand time, and use of medications for knee pain. Results Ninety patients were randomized. The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale (95% confidence interval ,3.9, 31.4 [P = 0.13]). We observed similar small effects for the secondary outcomes. Conclusion The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinically important. [source]

    Change in joint space width: Hyaline articular cartilage loss or alteration in meniscus?

    ARTHRITIS & RHEUMATISM, Issue 8 2006
    D. J. Hunter
    Objective To explore the relative contribution of hyaline cartilage morphologic features and the meniscus to the radiographic joint space. Methods The Boston Osteoarthritis of the Knee Study is a natural history study of symptomatic knee osteoarthritis (OA). Baseline and 30-month followup assessments included knee magnetic resonance imaging (MRI) and fluoroscopically positioned weight-bearing knee radiographs. Cartilage and meniscal degeneration were scored on MRI in the medial and lateral tibiofemoral joints using a semiquantitative grading system. Meniscal position was measured to the nearest millimeter. The dependent variable was joint space narrowing (JSN) on the plain radiograph (possible range 0,3). The predictor variables were MRI cartilage score, meniscal degeneration, and meniscal position measures. We first conducted a cross-sectional analysis using multivariate regression to determine the relative contribution of meniscal factors and cartilage morphologic features to JSN, adjusting for body mass index (BMI), age, and sex. The same approach was used for change in JSN and change in predictor variables. Results We evaluated 264 study participants with knee OA (mean age 66.7 years, 59% men, mean BMI 31.4 kg/m2). The results from the models demonstrated that meniscal position and meniscal degeneration each contributed to prediction of JSN, in addition to the contribution by cartilage morphologic features. For change in medial joint space, both change in meniscal position and change in articular cartilage score contributed substantially to narrowing of the joint space. Conclusion The meniscus (both its position and degeneration) accounts for a substantial proportion of the variance explained in JSN, and the change in meniscal position accounts for a substantial proportion of change in JSN. [source]

    Radiologic features in juvenile idiopathic arthritis: A first step in the development of a standardized assessment method

    ARTHRITIS & RHEUMATISM, Issue 2 2003
    Marion A. J. Van Rossum
    Objective To describe radiologic features of patients with juvenile idiopathic arthritis (JIA) in a standardized manner, to test the reliability and feasibility of this description, and to correlate these features with clinical signs as a first step in the development of a standardized assessment method. Methods The placebo-controlled study of sulfasalazine in patients with oligoarticular, extended oligoarticular, and polyarticular JIA performed by the Dutch Juvenile Idiopathic Arthritis Study Group yielded the data for this study. All trial entry radiographs (clinically involved joints and contralateral joints) were scored (in consensus by a skeletal radiologist and pediatric rheumatologist) for the presence of swelling, osteopenia, joint space narrowing, growth abnormalities, subchondral bone cysts, erosions, and malalignment. Results Data on 67 of 69 patients were analyzed. The mean age was 9.1 years (range 2.5,17.6 years), and the median disease duration was 24 months (range 5,176 months). Thirteen percent of the patients were IgM rheumatoid factor (IgM-RF) positive, and 16% were HLA,B27 positive. All 68 clinically evaluated joints were included in the maximum of 19 radiographed joints (or joint groups) per patient. The mean number of radiographed joints per patient was 7 (range 2,15); knees, hands, ankles, and feet were most frequently affected. Fifty-eight patients (87%) had radiologic abnormalities in at least one joint (soft-tissue swelling in 63% of patients, growth disturbances in 48%, joint space narrowing in 28%, and erosions in 15%). In total, half of the radiographs of the clinically involved joints showed radiologic abnormalities, including two-thirds of the radiographs of the clinically affected hands and knees. Univariate analysis revealed a good correlation between the overall articular (clinical) severity and the presence of radiologic abnormalities (odds ratio [OR] 1.38, P < 0.0001). Multivariate analysis showed increased ORs for the presence of radiologic abnormalities and IgM-RF positivity (OR 4.6, P = 0.005) or HLA,B27 positivity (OR 3.0, P = 0.004). In general, reproducibility of the radiologic scoring method was good (mean kappa coefficient of 0.74 [range 0.40,0.86]), although there were scoring discrepancies for swelling, osteopenia, and growth disturbances. The scoring took 10,20 minutes per patient. Conclusion Our model of describing and scoring radiologic abnormalities of radiographed joints in JIA was feasible, mostly reproducible, correlated well with the overall articular severity score, and added substantial new information not available on clinical examination. [source]

    Inhibition of insulin-like growth factor binding protein 5 proteolysis in articular cartilage and joint fluid results in enhanced concentrations of insulin-like growth factor 1 and is associated with improved osteoarthritis

    ARTHRITIS & RHEUMATISM, Issue 3 2002
    David R. Clemmons
    Objective The complement component C1s is present in dog joint fluid in an activated state. Since C1s degrades insulin-like growth factor binding protein 5 (IGFBP-5), we undertook to determine whether inhibiting C1s in joint fluid would result in an increase in the amount of intact IGFBP-5 and IGF-1 in cartilage and joint fluid, and whether C1s inhibition would be associated with a reduction in cartilage destruction during the development of osteoarthritis (OA). Methods Twenty-two dogs were randomized to 3 treatment groups. All dogs underwent anterior cruciate ligament transection and were exercised. Dogs received 1 of 3 treatments: buffer alone (controls; n = 6); PB-145, a peptide derived from the sequence of antithrombin III (n = 9); and pentosan polysulfate (PPS; n = 7). PB-145 or saline was injected into the joint space 3 times per week for 3 weeks. PPS was injected intramuscularly weekly for 3 weeks. Results Joint histology showed preservation of chondrocytes and a smooth joint surface in the animals treated with PB-145 and PPS. Mankin scoring showed statistically significant reductions in joint destruction with PB-145 and PPS treatments (P < 0.01) compared with buffer control. Mean active collagenase concentrations were decreased by these two treatments. Immunoblotting of joint fluid showed that both treatments increased concentrations of intact IGFBP-5. Direct analysis of IGFBP-3 and IGFBP-5 protease activity showed that IGFBP-5 was degraded more rapidly and that PB-145 and PPS inhibited the degradation of both proteins. Total IGF-1 concentrations in joint fluid were increased 5.6,5.8-fold by these two treatments. Analysis showed that C1s was being activated in joint fluid and that its activation was inhibited by the addition of PB-145 or PPS. Conclusion The findings suggest that direct inhibition of the serine protease C1s results in increased concentrations of intact IGFBP-5 and that proteolysis of IGFBP-3 is also inhibited, probably by the inhibition of some other protease. This increase in concentrations of intact IGFBP-3 and IGFBP-5 leads to an increase in IGF-1 which is associated with an improvement in joint architecture during the development of OA. [source]

    Models for Estimating Bayes Factors with Applications to Phylogeny and Tests of Monophyly

    BIOMETRICS, Issue 3 2005
    Marc A. Suchard
    Summary Bayes factors comparing two or more competing hypotheses are often estimated by constructing a Markov chain Monte Carlo (MCMC) sampler to explore the joint space of the hypotheses. To obtain efficient Bayes factor estimates, Carlin and Chib (1995, Journal of the Royal Statistical Society, Series B57, 473,484) suggest adjusting the prior odds of the competing hypotheses so that the posterior odds are approximately one, then estimating the Bayes factor by simple division. A byproduct is that one often produces several independent MCMC chains, only one of which is actually used for estimation. We extend this approach to incorporate output from multiple chains by proposing three statistical models. The first assumes independent sampler draws and models the hypothesis indicator function using logistic regression for various choices of the prior odds. The two more complex models relax the independence assumption by allowing for higher-lag dependence within the MCMC output. These models allow us to estimate the uncertainty in our Bayes factor calculation and to fully use several different MCMC chains even when the prior odds of the hypotheses vary from chain to chain. We apply these methods to calculate Bayes factors for tests of monophyly in two phylogenetic examples. The first example explores the relationship of an unknown pathogen to a set of known pathogens. Identification of the unknown's monophyletic relationship may affect antibiotic choice in a clinical setting. The second example focuses on HIV recombination detection. For potential clinical application, these types of analyses must be completed as efficiently as possible. [source]

    The management of inhibitors in haemophilia A: introduction and systematic review of current practice

    HAEMOPHILIA, Issue 4 2003
    S. Paisley
    Summary., Haemophilia is the commonest bleeding disorder in the UK, affecting approximately 5400 people, almost all of them male. In haemophiliacs, reduced levels, or absence, of factor VIII (FVIII) cause bleeding episodes, typically into joint spaces or muscles. Haemophilia is generally treated with exogenous FVIII. However, in some haemophiliacs, therapeutically administered FVIII comes to be recognized as a foreign protein, stimulating the production of antibodies (inhibitors), which react with FVIII to render it ineffective. Alternative treatment strategies then have to be used to manage bleeding episodes. In addition, strategies have been developed to attempt to abolish inhibitor production through the induction of immune tolerance. A systematic review was undertaken of current international practice for the clinical management of haemophilia A patients with inhibitors to FVIII, concentrating on literature published from 1995 onwards. Although it can be difficult to determine what constitutes current practice, current guidelines indicate that immune tolerance induction is seen as desirable, with the choice of regimen dependent on patient characteristics, familiarity with regimens and cost. Various approaches, based on similar factors, are used to control bleeding episodes. [source]

    Juvenile psoriatic arthritis with nail psoriasis in the absence of cutaneous lesions

    Carola Duran-McKinster MD
    A 4-year-old white boy without a significant family history had morning stiffness and painful swelling of his left knee and ankle, right elbow, and dorsolumbar region of 2 months' evolution. The following laboratory studies were within normal limits: complete blood cell count, C-reactive protein (CRP), latex, antistreptolysin, and antinuclear antibodies. Rheumatoid factor was negative and an increase in the erythrocyte sedimentation rate (ESR) was detected (56 mm/h). The pediatric department made an initial diagnosis of juvenile rheumatoid arthritis, and treatment with acetylsalicylic acid at 100 mg/kg/day and naproxen at 10 mg/kg/day was started. A thick, yellowish toenail was diagnosed as onychomycosis. No mycologic investigations were performed. Intermittent episodes of painful arthritis of different joints were present. The radiographic features of the peripheral joints included: narrow joint spaces, articular erosions, soft tissue swelling, and diffuse bony demineralization. Characteristic bilateral sacroiliitis and a swollen tendon sheath on the left ankle were detected. At 11 years of age the nail changes had extended to five other toenails and to four fingernails, were yellow,brown in color, and showed marked subungual hyperkeratosis ( Figs 1, 2). The rest of the nails showed significant nail pitting. Trials of griseofulvin alternated with itraconazole in an irregular form for five consecutive years resulted in no clinical improvement, which prompted a consultation to our dermatology department. On three different occasions, KOH nail specimens were negative for fungus, but the presence of parakeratotic cells aroused the suspicion of psoriasis. A complete physical examination was negative for psoriatic skin lesions. A nail bed biopsy specimen was characteristic of nail psoriasis ( Fig. 3). Figure 1. Thickened nails with severe subungual hyperkeratosis in five fingernails Figure 2. Secondary deformity of nail plate. No "sausage" fingers were observed Figure 3. Light microscopic appearance of a nail biopsy specimen showing parakeratotic hyperkeratosis, elongation of interpapillary processes, and Munroe abscess (arrow) (hematoxylin and eosin stain, ×40) The following human leukocyte antigens (HLAs) were positive: A9, A10, B12, B27, Cw1, Bw4, DR6, DR7, DQ1, DQ2, and DR53. A diagnosis of juvenile psoriatic arthritis associated with nail psoriasis was made. Toenail involvement became so painful that walking became very difficult. Occlusive 40% urea in vaseline applied to the affected toenails for 48 h resulted in significant improvement. Currently, the patient is 20 years old with nail involvement, but no psoriatic skin lesions have ever been observed. [source]

    Association between condylar position, joint morphology and craniofacial morphology in orthodontic patients without temporomandibular joint disorders

    K. Kikuchi
    summary, The present study investigated condylar position and joint morphology in adolescent patients and elucidated the possible association between the joint structure and condylar position, and craniofacial morphology. Sixty-five adolescent patients were selected as subjects and their tomograms and lateral cephalograms were analysed. No significant differences in joint spaces were found between the right and left temporomandibular joints. Both the condyles in this population were located slight anteriorly in the glenoid fossa. With respect to the association between condylar position, joint morphology and craniofacial morphology, the ramus plane angle also exhibited significant negative correlations with posterior, lateral and medial joint spaces. Furthermore, there was a significant negative correlation between the gonial angle and the anterior joint space. These findings imply that the condyle was likely to show more posterior position in the glenoid fossa when the mandible exhibited clockwise rotation. In conclusion, the condyle in the adolescent subjects showed a symmetrical anterior position relative to the glenoid fossa. In addition, the joint spaces and it ratios were significantly related to the craniofacial morphology associated with vertical dimension. It is suggested that the condylar position may be affected by craniofacial growth pattern. [source]

    Healing of dorsal pancarpal arthrodesis in the dog

    U. Michal
    The purpose of this study was to assess radiographically the healing process in dogs which had undergone dorsal pancarpal arthrodesis with autologous cancellous bone grafting. The medical records of 17 dogs that had undergone dorsal pancarpal arthrodesis with complication-free dynamic compression plate fixation were reviewed. Postoperative healing was evaluated radiographically. It started five weeks after surgery and progressed for six to 12 weeks in all dogs. After this time period no further progression of healing was observed. Between weeks 6 and 8, bony fusion progressed significantly more rapidly in the intercarpal joint than in the radiocarpal joint. The following criteria had no influence on healing time: gender, age, bodyweight, and immediate versus delayed surgery after trauma. The major difficulties noted with respect to the interpretation of postoperative radiographs were irregular bony bridging, mainly caused by inadequate palmar curettage, and oblique projection of articular surfaces resulting in superimposition of joint spaces and solid bone. [source]