Introduction: Pigmented villonodular synovitis (PVNS) of the spine is a rare condition, with only a limited number of cases documented in the medical literature. In this study, we review imaging findings of two cases ...Introduction: Pigmented villonodular synovitis (PVNS) of the spine is a rare condition, with only a limited number of cases documented in the medical literature. In this study, we review imaging findings of two cases of PVNS arising in the spine. Case 1: A 52-year-old male presented with right thigh pain of unclear etiology. His condition subsequently deteriorated and he was referred to our hospital. MRI revealed a spinal tumor with high intensity on T1-weighted imaging (T1WI) and iso-intensity on T2WI in the right L2/3 intervertebral foramen. The tumor exhibited heterogeneous enhancement on contrast-enhanced MRI. Computed tomography (CT) myelography showed the presence of an epidural tumor within the right L2/3 intervertebral foramen, situated externally to the spinal canal and compressing the dura mater. Notable scalloping was observed in the posterior margin of the L2 vertebral body on CT images. Case 2: A 78-year-old male presented with a complaint of muscle weakness of the left upper limb. His gait gradually deteriorated, which led to suspicion of cervical myelopathy. A tumor was observed on plain MRI and exhibited low to iso-intensity on T1WI and high intensity on T2WI. The tumor was in the left C7/T1 intervertebral segment and the spinal cord was compressed from the left side. CT showed destruction of the medial aspect of the left C7 vertebral arch. Conclusion: In spinal PVNS, the signal intensity on MRI is dependent on the timing of hemorrhage within the tumor, and there are no distinctive features. However, if an extradural tumor is suspected and CT shows bone erosion, scalloping or osteolytic changes, PVNS should be considered as a differential diagnosis.展开更多
BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through ...BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through case reports.The inci-dence rate is now 1 in 10000 among Caucasians and 0.00144 in 10000 among Japanese.Pneumothorax occurs when gas enters the pleural cavity,typically due to lung disease or chest trauma,and is characterized as either spontaneous or traumatic.Spontaneous pneumothorax is commonly linked to congenital lung tissue abnormalities or lung conditions,such as ruptured pulmonary bullae,emphysema,and bronchial asthma.Respiratory involvement in SAPHO syn-drome has historically been noted.CASE SUMMARY We present the case of a 44-year-old male patient who had previously been diagnosed with SAPHO syndrome.Following a two-year cessation of methotrexate therapy,he experienced recurrent anterior chest wall and joint pain accompanied by dyspnea.We conducted a comprehensive examination for the patient,which included physical examination,laboratory tests,and imaging studies.The clinical presentation and treatment outcomes suggest that his pneumothorax was related to an episode of SAPHO syndrome.We performed closed thoracic drainage surgery for the patient and treated his symptoms with etoricoxib(60 mg daily).Upon discharge,methotrexate was prescribed again.In subsequent follow-ups,there was no recurrence of joint and respiratory symptoms observed in the patient.CONCLUSION SAPHO syndrome has been proposed as a transitional stage between ankylosing spondylitis and psoriatic arthritis.One study reported a 0.29%incidence of spontaneous pneumothorax in patients with ankylosing spondylitis,higher than in the general population.Additionally,30%of patients with SAPHO syndrome test positive for HLA-B27,an antigen linked to ankylosing spondylitis.Symptomatically,some patients with SAPHO syndrome meet diagnostic criteria for ankylosing spondylitis,with sternoclavicular joint involvement and paravertebral ossific-ations resembling syndesmophytes in ankylosing spondylitis.These features suggest a possible linked between SAPHO syndrome and ankylosing spondylitis.展开更多
BACKGROUND Pigmented villonodular synovitis(PVNS)is a benign proliferative disorder that affects the synovial joints,bursae,and tendon sheaths.To date,few studies have reported on the treatment of postoperative pain a...BACKGROUND Pigmented villonodular synovitis(PVNS)is a benign proliferative disorder that affects the synovial joints,bursae,and tendon sheaths.To date,few studies have reported on the treatment of postoperative pain and edema in patients with PVNS.Herein,we present the case of a woman who developed pain and edema in the left lower limb 1 wk after synovectomy and arthroscopic partial meniscectomy and was unable to walk due to limited flexion and extension of the left knee.CASE SUMMARY A 32-year-old woman underwent synovectomy and arthroscopic partial meniscectomy successively and was treated with a combination of manual lymphatic drainage(MLD)and kinesio taping(KT)in our hospital to alleviate postoperative pain and edema.The following parameters were assessed at 2 wk post-treatment and 1 wk post-discharge follow up:suprapatellar circumference,infrapatellar circumference,visual analog scale score,knee range of motion,pittsburgh sleep quality index score,hamilton anxiety rating scale(HAMA)score,and hamilton depression rating scale(HAMD)score.After treatment,the postoperative pain and edema in the patient’s left knee were effectively relieved,resulting in improved sleep quality and remarkably attenuated HAMA and HAMD scores.CONCLUSION Combined MLD and KT may be an effective approach for relieving postoperative pain and edema in patients with PVNS.展开更多
Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locall...Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locally aggressive, capable of extensive bone destruction. The disease has aggressive behavior and a high incidence of recurrence (40% - 60%). Case report: A 35 years old male presented with history of unilateral hearing loss and otalgia of six month duration. On examination, there was a soft bulge in the superior wall of external auditory canal. Contrast enhanced CT scan showed soft tissue density occupying the right external auditory canal and bulging into the middle ear cavity, displacing the intact ossicular chain medially with evidence of destruction of the posterior wall of the external auditory canal, glenoid fossa, mastoid bone and the scutum. The squamous part of the right temporal bone showed evidence of lateral bowing with discontinuity. Surgical resection was done through post aural approach. Histopathological examination revealed pigmented villonodular tenosynovitis which stained positive for CD 68. Post operatively patient was evaluated clinically and with radiological modalities which showed healthy mastoid cavity and no increase in post operative granulations on magnetic resonance imaging. Conclusion: Pigmented villonodular tenosynovitis of temporomandibular joint is a rare entity. Due to the aggressive behavior of the lesion, radical or aggressive surgical resection should be done. Long term follow up with radiological modality should be done due to the high recurrence rate.展开更多
Increasing evidence shows that adipokines play a vital role in the development of rheumatoid arthritis(RA).Fatty acid-binding protein 4(FABP4),a novel adipokine that regulates inflammation and angiogenesis,has been ex...Increasing evidence shows that adipokines play a vital role in the development of rheumatoid arthritis(RA).Fatty acid-binding protein 4(FABP4),a novel adipokine that regulates inflammation and angiogenesis,has been extensively studied in a variety of organs and diseases.However,the effect of FABP4 on RA remains unclear.Here,we found that FABP4 expression was upregulated in synovial M1-polarized macrophages in RA.The increase in FABP4 promoted synovitis,angiogenesis,and cartilage degradation to exacerbate RA progression in vivo and in vitro,whereas BMS309403(a FABP4 inhibitor)and anagliptin(dipeptidyl peptidase 4 inhibitor)inhibited FABP4 expression in serum and synovial M1-polarized macrophages in mice to alleviate RA progression.Further studies showed that constitutive activation of mammalian target of rapamycin complex 1(mTORC1)by TSC1 deletion specifically in the myeloid lineage regulated FABP4 expression in macrophages to exacerbate RA progression in mice.In contrast,inhibition of mTORC1 by ras homolog enriched in brain(Rheb1)disruption specifically in the myeloid lineage reduced FABP4 expression in macrophages to attenuate RA development in mice.Our findings established an essential role of FABP4 that is secreted by M1-polarized macrophages in synovitis,angiogenesis,and cartilage degradation in RA.BMS309403 and anagliptin inhibited FABP4 expression in synovial M1-polarized macrophages to alleviate RA development.Hence,FABP4 may represent a potential target for RA therapy.展开更多
BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel the...BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.展开更多
We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bi...We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen-B7 antigen was positive. Moreover, matrix metalloproteinase 3(MMP-3) was high. She was diagnosed with RS3 PE syndrome, and treatment with prednisolone(15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3 PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3 PE syndrome symptoms.展开更多
BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS coul...BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.展开更多
AIM To investigate the reliability of the established and new scoring methods for Hoffa's fat pad synovitis using magnetic resonance imaging(MRI).METHODS A total of 139 knees of 115 patients who underwent MRI of t...AIM To investigate the reliability of the established and new scoring methods for Hoffa's fat pad synovitis using magnetic resonance imaging(MRI).METHODS A total of 139 knees of 115 patients who underwent MRI of the knee with and without gadolinium contrast were enrolled in this study. Proton density(PD)-weighted, PD-weighted fat-suppressed(PD-FS), and postcontrast T1-weighted fat-suppressed(T1CE) images were used for evaluation. Using contrast and noncontrast images, our grading method for synovitis was performed to measure synovial thickness and signal intensity changes of the fat pad [Synovial membrane(SM) score], which was compared with the established methods,including MRI Osteoarthritis Knee Score(MOAKS), parapatellar synovitis score,Whole-Organ Magnetic Resonance Imaging Score(WORMS), and suprapatellar effusion diameter. Intraclass correlation coefficients(ICC) for intra and interobserver reproducibility and Spearman correlation coefficients(r) were calculated for the parapatellar synovitis score and each scoring method.RESULTS All of the scores presented substantial to almost perfect intrareliability. Among three readers, effusion diameter had substantial to almost perfect interreliability(ICC = 0.68-0.81) and WORMS had substantial interreliability(ICC = 0.61-0.70).For two out of three readers, there was substantial interreliability for the thickness score in T1CE(ICC = 0.55-0.69), SM scores in T1CE(ICC = 0.56-0.78)and PD-FS(ICC = 0.51-0.79), and parapatellar synovitis score in T1CE(ICC =0.53-0.72). The parapatellar synovitis score was significantly correlated with the thickness score in T1CE(r = 0.70) and the SM score in T1CE(r = 0.81) and PD-FS(r = 0.65).CONCLUSION The newly proposed quantitative thickness score on T1CE and the semiquantitative SM score on T1CE and PD-FS can be useful for Hoffa's fat pad synovitis.展开更多
Objective:To evaluate the efficacy of synovectomy combined with postoperative radiotherapy in the treatment of pigmented villonodular synovitis compared with only synovectomy in knee. Methods:The related references we...Objective:To evaluate the efficacy of synovectomy combined with postoperative radiotherapy in the treatment of pigmented villonodular synovitis compared with only synovectomy in knee. Methods:The related references were searched from SinoMed,CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and Web of Science from date of databases establishment to October 2020,and the studies of synovectomy combined with postoperative radiotherapy were screened. According to the type of research,the corresponding evaluation methods were selected for quality evaluation of the literature. RevMan 5.3 software was used for meta-analysis. The primary outcome was recurrence,while the secondary outcomes included complications,excellent and good rate of function of knee,range of motion of knee,Lysholm score,and IKDC score of knee etcetera. Results:A total of 11 articles were included in meta-analysis,with 510 cases,280 in the combined group and 230 in the control group. The results of meta-analysis showed that:(1)The recurrence rate in the combination group was significantly lower than that in the control group,[OR=0.33,95%CI(0.20,0.55),P<0.000 1];(2)The complications in the combined group were higher than that in the control group[OR=2.70,95%CI(1.16,6.31),P=0.02];(3)The excellent and good rate of the combined group was significantly better than that of the control group[OR=2.86,95%CI(1.23,6.64),P=0.01],and it also may be the result of different evaluation criteria of each study;(4)There was no significant difference range of motion[MD=2.96,95%CI(-0.54,6.47),P=0.10],Lysholm score[MD=3.22,95%CI(-0.51,6.96),P=0.09],or IKDC score[MD=2.88,95%CI(-1.07,6.82),P=0.15]in knee between the two groups. Conclusion:The meta-analysis shows that synovectomy combined with radiotherapy can reduce the recurrence rate of pigmented villonodular synovitis in knee,but compared with only operation,there are higher complications. However,the above conclusions need to be verified by long-term follow-up of more high-quality clinical studies.展开更多
Objective:Based on the technology and method of network pharmacology,to explore the active components and specific mechanism of Simiao powder in the treatment of synovitis.Methods:by using tcmsp database,the potential...Objective:Based on the technology and method of network pharmacology,to explore the active components and specific mechanism of Simiao powder in the treatment of synovitis.Methods:by using tcmsp database,the potential active components and related target proteins of Simiao powder were screened.Genecards and digenet database were used to predict the target of synovitis.UniProt database was used to query the corresponding gene names.The compound synovitis target network and protein of Simiao powder were constructed by using Cytoscape and string software In R language,bio conductor data package was used to analyze the enrichment of go biological function and KEGG pathway,and the effective components and targets of Simiao powder in the treatment of synovitis were obtained.Results:64 key active components of Simiao powder were screened out from tcmsp database,71 of them were involved in the interaction of main chemical components of Simiao powder-chemical components and synovitis treatment target-synovitis.95 PPI core genes were obtained,and 90 go biological enrichment processes were obtained by go enrichment analysis.The results of network pharmacology indicate that Simiaosan can regulate 32 signaling pathways in the treatment of synovitis,including IL-17 signaling pathway,TNF signaling pathway,T cell receptor signaling pathway and toll like receptor signaling pathway.Conclusion:the treatment of synovitis with Simiao powder is a complex process of multi-component,multi-target and multi-channel,which is related to the coordinated regulation of multiple targets and signal pathways.展开更多
Objective:To observe therapeutic effect of sodium aescinate Tablets on knee osteoarthritis complicated with synovitis.Methods:86 patients with knee osteoarthritis combined with synovitis treated in the Honghui Hospita...Objective:To observe therapeutic effect of sodium aescinate Tablets on knee osteoarthritis complicated with synovitis.Methods:86 patients with knee osteoarthritis combined with synovitis treated in the Honghui Hospital Affiliated to Xi’an Jiaotong University from January 2018 to December 2019 were randomly divided into control group and intervention group,with 43 cases in each group.The control group was given routine treatment,and the intervention group was given sodium aescinate Tablets orally on the basis of routine treatment,twice a day,2 tablets each time.The curative effect was evaluated after 2 weeks of treatment.The knee pain and joint function of the two groups were evaluated by Visual Analogue Scale(VAS)and Western Ontario and McMaster Universities Arthritis Index(WOMAC),and the clinical effects of the two groups were compared.Results:Before treatment,there was no significant difference in general information,VAS and WOMAC scores between the two groups(P>0.05).After treatment,the VAS and WOMAC scores of the two groups were both lower than those before treatment,and the difference was statistically significant(P<0.05).The vas and WOMAC scores of the intervention group were lower than those of the control group(VAS,1.87±0.79 vs 3.38±0.81).In this study,sodium aescinate tablets were applied to the treatment of KOA combined with synovitis.The results showed that the intervention group was better than the control group in alleviating knee pain,improving joint function and improving clinical efficacy,and the difference was statistically significant.The total effective rate of the intervention group was higher than that of the control group(100%vs 86.05%),and the difference was statistically significant(P<0.05).Conclusion:Sodium aescinate tablet in the treatment of knee osteoarthritis combined with synovitis can effectively alleviate knee pain,improve joint function and improve clinical efficacy.展开更多
Purpose:To investigate the pathological changes of the synovium in mice with post-traumatic osteoarthritis(PTOA)treated with 4-octyl itaconate(4-OI)and evaluate the therapeutic effects of 4-OI.Methods:In the phenotypi...Purpose:To investigate the pathological changes of the synovium in mice with post-traumatic osteoarthritis(PTOA)treated with 4-octyl itaconate(4-OI)and evaluate the therapeutic effects of 4-OI.Methods:In the phenotypic validation experiment,the mice were randomly divided into 3 groups:wildtype(WT)group,sham group,and destabilization of the medial meniscus(DMM)group.Through MRI,micro-CT,and histological analysis,it was determined that the DMM surgery induced a mouse PTOA model with significant signs of synovitis.At 12 weeks post-DMM surgery,synovial tissues from the DMM group and WT group mice were collected for ribonucleic acid sequencing analysis.In the 4-OI treatment experiment,mice were randomly divided into the sham group,DMM group,DMM+4-OI(50 mg/kg)group,and DMM+4-OI(100 mg/kg)group.Von Frey tests and open field tests were conducted at intervals during the 12 weeks following the DMM surgery.After 12 weeks of surgery,the efficacy of 4-OI treatment on PTOA in mice was evaluated using MRI,micro-CT,histological analysis,and quantitative real-time polymerase chain reaction.Finally,we utilized network pharmacology analysis to predict the mechanism of 4-OI in treating PTOA synovitis and conducted preliminary validation.Statistical analysis was performed using one-way ANOVA and the Kruskal-Wallis test.Difference was considered statistically significant at p<0.05.Results:The DMM surgery effectively induced a PTOA mouse model,which displayed significant symptoms of synovitis.These symptoms included a notable increase in both the number of calcified tissues and osteophytes(p<0.001),an enlargement of the calcified meniscus and synovial tissue volume(p<0.001),and thickening of the synovial lining layer attributable to M1 macrophage accumulation(p=0.035).Additionally,we observed elevated histological scores for synovitis(p<0.001).Treatment with 4-OI inhibited the thickening of M1 macrophages in the synovial lining layer of PTOA mice(p<0.001)and reduced fibrosis in the synovial stroma(p=0.004).Furthermore,it reduced the histological scores of knee synovitis in PTOA mice(p=0.006)and improved the inflammatory microenvironment associated with synovitis.Consequently,this treatment alleviated pain in PTOA mice(p<0.001)and reduced spontaneous activity(p=0.003).Bioinformatics and network pharmacology analyses indicated that 4-OI may exert its therapeutic effects by inhibiting the differentiation of synovial Th17 cells.Specifically,compared to the lipopolysaccharide stimulation group,4-OI reduced the levels of positive regulatory factors of Th17 cell differentiation(IL-1:p<0.001,IL-6:p<0.001),key effector molecules(IL-17A:p<0.001,IL-17F:p=0.004),and downstream effector molecules in the IL-17 signaling pathway(CCL2:p<0.001,MMP13:p<0.001).Conclusion:4-OI is effective in inhibiting synovitis in PTOA,thereby alleviating the associated painful symptoms.展开更多
Background Functional magnetic resonance is a non-invasive method that can examine brain activity and has been widely used in various fields including jaw movement and pain processing. Temporomandibular disorder （TMD...Background Functional magnetic resonance is a non-invasive method that can examine brain activity and has been widely used in various fields including jaw movement and pain processing. Temporomandibular disorder （TMD） is one of the most frequent facial pain problems. The objective of this study was to investigate the brain activities using functional magnetic resonance imaging （fMRI） during unilateral maximal voluntary clenching tasks in the TMD synovitis patients with biting pain.Methods Fourteen TMD synovitis patients with unilateral biting pain and 14 controls were included in the study.Contralateral biting pain was defined as right molar clenching causing left temporomandibular joint （TMJ） pain. Ipsilateral biting pain was defined as right molar clenching causing right TMJ pain. Symptom Check List-90 （SCL-90） was administered to the patients and controls. Independent sample t-test was used to compare the SCL-90 subscales between the two groups. Unilateral clenching tasks were performed by the patients and controls. Imaging data were analyzed using SPM99.Results Patients were divided into contralateral TMD biting pain group （n=8） and ipsilateral TMD biting pain group （n=6）. The SCL-90 subscales were significantly different between the two groups for somatization, depression, anxiety,phobic anxiety, and paranoid ideation. Group analysis of the controls demonstrated brain activations in the inferior frontal gyrus, precentral gyrus, middle frontal gyrus, superior temporal gyrus, and insular. The areas of activation were different between right and left clenching task. In TMJ synovitis patients with contralateral or ipsilateral biting pain, the group analysis showed activations in the inferior frontal gyrus, superior temporal gyrus, medium frontal gyrus, precentral gyrus,and anterior cingulate cortex.Conclusions The inferior frontal gyrus and precentral gyrus play essential roles during the unilateral clenching task.Activation of anterior cingulate cortex in the synovitis patients with biting pain was associated with higher levels of psychological distress.展开更多
Objective:To compare the efficacy of different treatment protocols in treating transient synovitis of the hip(TSH)in children and to optimize the clinical treatment strategy for this condition.Methods:Ninety kids with...Objective:To compare the efficacy of different treatment protocols in treating transient synovitis of the hip(TSH)in children and to optimize the clinical treatment strategy for this condition.Methods:Ninety kids with TSH were divided into a control group,a chiropractic group and a chiropractic plus foot bath group using the random number table method,with 30 cases in each group.The control group was treated with conventional traction;the chiropractic group was given chiropractic treatment based on the control group;the chiropractic plus foot bath group was given Chinese medicine foot bath based on the chiropractic group.Traction and foot bath were conducted once daily while chiropractic was done once every other day,all with 14 d as a treatment course for a total of two courses.Changes in the visual analog scale(VAS)score and range of motion(ROM)of the hip joint in the three groups were observed,and the efficacy was compared.Results:The total effective rate was 93.3%in the chiropractic plus foot bath group,versus 76.7%in the chiropractic group and 66.7%in the control group,and the total effective rate was notably higher in the chiropractic plus foot bath group than in the other two groups(both P<0.05).Respectively after the first and second treatment course,the VAS score decreased significantly in each of the three groups compared with that before treatment(all P<0.01),and the ROM of the hip joint in flexion increased significantly(all P<0.01).After two treatment courses,the VAS score was lower in the chiropractic plus foot bath group than in the other two groups(both P<0.05),and its ROM of the hip joint in flexion was larger than that in the other two groups(both P<0.05).Conclusion:Based on traction,chiropractic plus Chinese medicine foot bath can effectively reduce pain and improve motor function of the hip joint in treating TSH.展开更多
Background Diffusion-weighted imaging(DWI)of synovitis has been suggested as a possible non-invasive alternative to contrast-enhanced T1w imaging(ce-T1w).We aimed to study DWI for diagnosing synovitis in the knee join...Background Diffusion-weighted imaging(DWI)of synovitis has been suggested as a possible non-invasive alternative to contrast-enhanced T1w imaging(ce-T1w).We aimed to study DWI for diagnosing synovitis in the knee joint of pediatric patients,to quantify inter-observer agreement on DWI and ce-T1w and to calculate quantitative measures of synovial diffusivity and conspicuity.Methods Forty consecutive patients with known or suspected arthritis of the knee(25 girls,median age 12 years)underwent routine 1.5T MRI with ce-T1w and transverse DWI with b values 50 and 800 s/mm2.Mean apparent diffusion coefficient(ADC)values and signal intensity of inflamed synovium,joint effusion and muscle were measured with regions of interest retrospectively.Post-contrast T1 w images(diagnostic standard)and diffusion-weighted images at b=800 s/mm2 with ADC map were separately rated by three independent and blinded readers with different levels of expertise for the presence and degree of synovitis along with the level of diagnostic confidence.Results Thirty-one(78%)patients showed at least some synovial contrast enhancement,17(43%)children were diagnosed with synovitis on ce-T1w.Ratings by the 1st reader on ce-T1w and on DWI for synovitis showed very good agreement(kappa=0.90).Inter-observer agreement on DWI ranged from moderate to substantial with kappa values between 0.68 and 0.79(all P<0.001).Agreement and diagnostic confidence were generally lower in patients with mild and without synovial enhancement,compared to patients with synovitis.DWI yielded higher signal of inflamed synovium vs.muscle tissue,but lower signal vs.joint effusion,compared to ce-T1 w(all P<0.001).Conclusions Diffusion-weighted imaging is a promising,though reader-dependent alternative to contrast-enhanced imaging in patients with arthritis of the knee,based on our preliminary findings.It holds potential for increasing patient safety and comfort.展开更多
IntroductionSynovitis,Acne,Pustulosis,Hyperostosis and Osteitis (SAPHO) syndrome is a rare clinical entity characterized by a wide range of dermatological and musculoskeletal manifestations.This condition has a hetero...IntroductionSynovitis,Acne,Pustulosis,Hyperostosis and Osteitis (SAPHO) syndrome is a rare clinical entity characterized by a wide range of dermatological and musculoskeletal manifestations.This condition has a heterogeneous presentation,at times chronic and relapsing,which results in diagnostic difficulties and delays as well as therapeutic challenges.展开更多
Introduction: Joint manifestations are common in systemic lupus, affecting multiple joints or just one. These manifestations are present in 95% of patients. Pseudo-septic arthritis is a subset of systemic lupus that m...Introduction: Joint manifestations are common in systemic lupus, affecting multiple joints or just one. These manifestations are present in 95% of patients. Pseudo-septic arthritis is a subset of systemic lupus that mimics septic arthritis caused by the deposition of lipid droplets in the joint. We present the case of a patient hospitalized for mono-arthritis, which revealed systemic lupus. Observation: The patient is a 19-year-old woman, single, without children, and with no previous medical history, who was hospitalized for fever and inflammatory polyarthralgia. The clinical examination revealed an inflammatory swelling of the right knee with patellar ballottement, yellow citrine synovial fluid, an inflammatory tumor on the left arm, which was round, mobile, and fluctuating with purulent content, edema of the lower limbs, and facial puffiness, along with a systemic inflammatory response syndrome. Paraclinical examination showed hyperleukocytosis with neutrophil predominance, microcytic anemia, thrombocytopenia, antistreptolysin O (ASLO) 3, suggesting inflammatory arthritis. Bacteriological tests did not isolate any pathogens. An arthrotomy with synovial biopsy was performed, and the histopathological examination supported non-specific synovitis. A joint ultrasound showed signs of arthritis with a septic appearance. During the third hospitalization for persistent fever, she presented with facial puffiness, anemia syndrome, systemic inflammatory response syndrome, and a malar rash across the bridge of the nose. Antinuclear antibodies returned positive with a titer of 1280 and a speckled fluorescence pattern, and anti-native DNA antibodies were positive at 60.1 (normal Conclusion: Pseudo-septic arthritis is a feature of lupus that can mimic septic arthritis. Monoarticular involvement is rare but possible. The absence of pathogens and the inflammatory nature of the synovial fluid should prompt consideration of a lupus-related etiology.展开更多
Objective To observe influence of moxibustion at ＂Shenshu＂ （肾俞BL 23） and ＂Zusanli＂ （足三里 ST 36） on proteins expression of Ras, ERKI/2, and Raf in synovial tissues in rats with rheumatoid arthritis （RA） t...Objective To observe influence of moxibustion at ＂Shenshu＂ （肾俞BL 23） and ＂Zusanli＂ （足三里 ST 36） on proteins expression of Ras, ERKI/2, and Raf in synovial tissues in rats with rheumatoid arthritis （RA） to elucidate molecular mechanisms of moxibustion on treating RA. Methods Thirty Wistar rats were randomly divided into a normal control group （Group Cont）, a model group （Group Mod） and a moxibustion group （Group Mox） with 10 rats in each group. The model was established by using both environmental factors such as wind, cold and damp and a biological factor （Freund＇s complete adjuvant）. Suspended moxibustion was applied at bilateral BL 23 and ST 36 for 20 min, applied once daily for 15 days, starting from the 3rd day after modeling. Volumes of metaleg digiti pedis on the right side were measured before, after and 15 days after modeling. Protein expressions of Ras, ERK 1/2, p-ERKI/2 and Raf in synovium tissues were detected by western blot. Results After modeling, volumes of metaleg digiti pedis on the right side were significantly enlarged, compared with those of rats in Group Cont （P〈0.01）. After treatment by moxibustion for 15 days, the metatarsale girth of metaleg digiti pedis on the right side in Group Mox was significantly reduced, compared with that in Group Mod （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mod were significantly increased, compared with those in Group Cont （P〈0.01） and Group Mox （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mox were significantly lowered, compared with those in Group Mod （all P〈0.01）. Conclusions Moxibustion can suppress excessive protein expressions of Ras, Raf and ERK1/2 in synovium tissues of rats with experimental RA to inhibit abnormal activation of Ras-MAPK signal Pathway, which may be one of the molecular mechanisms of moxibustion in alleviating synovitis.展开更多
文摘Introduction: Pigmented villonodular synovitis (PVNS) of the spine is a rare condition, with only a limited number of cases documented in the medical literature. In this study, we review imaging findings of two cases of PVNS arising in the spine. Case 1: A 52-year-old male presented with right thigh pain of unclear etiology. His condition subsequently deteriorated and he was referred to our hospital. MRI revealed a spinal tumor with high intensity on T1-weighted imaging (T1WI) and iso-intensity on T2WI in the right L2/3 intervertebral foramen. The tumor exhibited heterogeneous enhancement on contrast-enhanced MRI. Computed tomography (CT) myelography showed the presence of an epidural tumor within the right L2/3 intervertebral foramen, situated externally to the spinal canal and compressing the dura mater. Notable scalloping was observed in the posterior margin of the L2 vertebral body on CT images. Case 2: A 78-year-old male presented with a complaint of muscle weakness of the left upper limb. His gait gradually deteriorated, which led to suspicion of cervical myelopathy. A tumor was observed on plain MRI and exhibited low to iso-intensity on T1WI and high intensity on T2WI. The tumor was in the left C7/T1 intervertebral segment and the spinal cord was compressed from the left side. CT showed destruction of the medial aspect of the left C7 vertebral arch. Conclusion: In spinal PVNS, the signal intensity on MRI is dependent on the timing of hemorrhage within the tumor, and there are no distinctive features. However, if an extradural tumor is suspected and CT shows bone erosion, scalloping or osteolytic changes, PVNS should be considered as a differential diagnosis.
基金Supported by The National Natural Science Foundation of China,No.82074246.
文摘BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through case reports.The inci-dence rate is now 1 in 10000 among Caucasians and 0.00144 in 10000 among Japanese.Pneumothorax occurs when gas enters the pleural cavity,typically due to lung disease or chest trauma,and is characterized as either spontaneous or traumatic.Spontaneous pneumothorax is commonly linked to congenital lung tissue abnormalities or lung conditions,such as ruptured pulmonary bullae,emphysema,and bronchial asthma.Respiratory involvement in SAPHO syn-drome has historically been noted.CASE SUMMARY We present the case of a 44-year-old male patient who had previously been diagnosed with SAPHO syndrome.Following a two-year cessation of methotrexate therapy,he experienced recurrent anterior chest wall and joint pain accompanied by dyspnea.We conducted a comprehensive examination for the patient,which included physical examination,laboratory tests,and imaging studies.The clinical presentation and treatment outcomes suggest that his pneumothorax was related to an episode of SAPHO syndrome.We performed closed thoracic drainage surgery for the patient and treated his symptoms with etoricoxib(60 mg daily).Upon discharge,methotrexate was prescribed again.In subsequent follow-ups,there was no recurrence of joint and respiratory symptoms observed in the patient.CONCLUSION SAPHO syndrome has been proposed as a transitional stage between ankylosing spondylitis and psoriatic arthritis.One study reported a 0.29%incidence of spontaneous pneumothorax in patients with ankylosing spondylitis,higher than in the general population.Additionally,30%of patients with SAPHO syndrome test positive for HLA-B27,an antigen linked to ankylosing spondylitis.Symptomatically,some patients with SAPHO syndrome meet diagnostic criteria for ankylosing spondylitis,with sternoclavicular joint involvement and paravertebral ossific-ations resembling syndesmophytes in ankylosing spondylitis.These features suggest a possible linked between SAPHO syndrome and ankylosing spondylitis.
基金Shanghai Municipal Health Commission,No.20214Y0078and The Key Discipline Construction Project,No.SHXHZDXK202321.
文摘BACKGROUND Pigmented villonodular synovitis(PVNS)is a benign proliferative disorder that affects the synovial joints,bursae,and tendon sheaths.To date,few studies have reported on the treatment of postoperative pain and edema in patients with PVNS.Herein,we present the case of a woman who developed pain and edema in the left lower limb 1 wk after synovectomy and arthroscopic partial meniscectomy and was unable to walk due to limited flexion and extension of the left knee.CASE SUMMARY A 32-year-old woman underwent synovectomy and arthroscopic partial meniscectomy successively and was treated with a combination of manual lymphatic drainage(MLD)and kinesio taping(KT)in our hospital to alleviate postoperative pain and edema.The following parameters were assessed at 2 wk post-treatment and 1 wk post-discharge follow up:suprapatellar circumference,infrapatellar circumference,visual analog scale score,knee range of motion,pittsburgh sleep quality index score,hamilton anxiety rating scale(HAMA)score,and hamilton depression rating scale(HAMD)score.After treatment,the postoperative pain and edema in the patient’s left knee were effectively relieved,resulting in improved sleep quality and remarkably attenuated HAMA and HAMD scores.CONCLUSION Combined MLD and KT may be an effective approach for relieving postoperative pain and edema in patients with PVNS.
文摘Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locally aggressive, capable of extensive bone destruction. The disease has aggressive behavior and a high incidence of recurrence (40% - 60%). Case report: A 35 years old male presented with history of unilateral hearing loss and otalgia of six month duration. On examination, there was a soft bulge in the superior wall of external auditory canal. Contrast enhanced CT scan showed soft tissue density occupying the right external auditory canal and bulging into the middle ear cavity, displacing the intact ossicular chain medially with evidence of destruction of the posterior wall of the external auditory canal, glenoid fossa, mastoid bone and the scutum. The squamous part of the right temporal bone showed evidence of lateral bowing with discontinuity. Surgical resection was done through post aural approach. Histopathological examination revealed pigmented villonodular tenosynovitis which stained positive for CD 68. Post operatively patient was evaluated clinically and with radiological modalities which showed healthy mastoid cavity and no increase in post operative granulations on magnetic resonance imaging. Conclusion: Pigmented villonodular tenosynovitis of temporomandibular joint is a rare entity. Due to the aggressive behavior of the lesion, radical or aggressive surgical resection should be done. Long term follow up with radiological modality should be done due to the high recurrence rate.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81772406,81974341,81991511,81625015,and 81902268)the Natural Science Foundation of Guangdong Province(2020A1515010207 and 2022A1515010431)the China Postdoctoral Science Foundation(2019M663264 and 2019TQ0385).
文摘Increasing evidence shows that adipokines play a vital role in the development of rheumatoid arthritis(RA).Fatty acid-binding protein 4(FABP4),a novel adipokine that regulates inflammation and angiogenesis,has been extensively studied in a variety of organs and diseases.However,the effect of FABP4 on RA remains unclear.Here,we found that FABP4 expression was upregulated in synovial M1-polarized macrophages in RA.The increase in FABP4 promoted synovitis,angiogenesis,and cartilage degradation to exacerbate RA progression in vivo and in vitro,whereas BMS309403(a FABP4 inhibitor)and anagliptin(dipeptidyl peptidase 4 inhibitor)inhibited FABP4 expression in serum and synovial M1-polarized macrophages in mice to alleviate RA progression.Further studies showed that constitutive activation of mammalian target of rapamycin complex 1(mTORC1)by TSC1 deletion specifically in the myeloid lineage regulated FABP4 expression in macrophages to exacerbate RA progression in mice.In contrast,inhibition of mTORC1 by ras homolog enriched in brain(Rheb1)disruption specifically in the myeloid lineage reduced FABP4 expression in macrophages to attenuate RA development in mice.Our findings established an essential role of FABP4 that is secreted by M1-polarized macrophages in synovitis,angiogenesis,and cartilage degradation in RA.BMS309403 and anagliptin inhibited FABP4 expression in synovial M1-polarized macrophages to alleviate RA development.Hence,FABP4 may represent a potential target for RA therapy.
文摘BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.
文摘We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen-B7 antigen was positive. Moreover, matrix metalloproteinase 3(MMP-3) was high. She was diagnosed with RS3 PE syndrome, and treatment with prednisolone(15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3 PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3 PE syndrome symptoms.
文摘BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.
文摘AIM To investigate the reliability of the established and new scoring methods for Hoffa's fat pad synovitis using magnetic resonance imaging(MRI).METHODS A total of 139 knees of 115 patients who underwent MRI of the knee with and without gadolinium contrast were enrolled in this study. Proton density(PD)-weighted, PD-weighted fat-suppressed(PD-FS), and postcontrast T1-weighted fat-suppressed(T1CE) images were used for evaluation. Using contrast and noncontrast images, our grading method for synovitis was performed to measure synovial thickness and signal intensity changes of the fat pad [Synovial membrane(SM) score], which was compared with the established methods,including MRI Osteoarthritis Knee Score(MOAKS), parapatellar synovitis score,Whole-Organ Magnetic Resonance Imaging Score(WORMS), and suprapatellar effusion diameter. Intraclass correlation coefficients(ICC) for intra and interobserver reproducibility and Spearman correlation coefficients(r) were calculated for the parapatellar synovitis score and each scoring method.RESULTS All of the scores presented substantial to almost perfect intrareliability. Among three readers, effusion diameter had substantial to almost perfect interreliability(ICC = 0.68-0.81) and WORMS had substantial interreliability(ICC = 0.61-0.70).For two out of three readers, there was substantial interreliability for the thickness score in T1CE(ICC = 0.55-0.69), SM scores in T1CE(ICC = 0.56-0.78)and PD-FS(ICC = 0.51-0.79), and parapatellar synovitis score in T1CE(ICC =0.53-0.72). The parapatellar synovitis score was significantly correlated with the thickness score in T1CE(r = 0.70) and the SM score in T1CE(r = 0.81) and PD-FS(r = 0.65).CONCLUSION The newly proposed quantitative thickness score on T1CE and the semiquantitative SM score on T1CE and PD-FS can be useful for Hoffa's fat pad synovitis.
基金General Project of National Natural Science Foundation of China(No.81873327)Youth Project of National Natural Science Foundation of China(No.81904226)。
文摘Objective:To evaluate the efficacy of synovectomy combined with postoperative radiotherapy in the treatment of pigmented villonodular synovitis compared with only synovectomy in knee. Methods:The related references were searched from SinoMed,CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and Web of Science from date of databases establishment to October 2020,and the studies of synovectomy combined with postoperative radiotherapy were screened. According to the type of research,the corresponding evaluation methods were selected for quality evaluation of the literature. RevMan 5.3 software was used for meta-analysis. The primary outcome was recurrence,while the secondary outcomes included complications,excellent and good rate of function of knee,range of motion of knee,Lysholm score,and IKDC score of knee etcetera. Results:A total of 11 articles were included in meta-analysis,with 510 cases,280 in the combined group and 230 in the control group. The results of meta-analysis showed that:(1)The recurrence rate in the combination group was significantly lower than that in the control group,[OR=0.33,95%CI(0.20,0.55),P<0.000 1];(2)The complications in the combined group were higher than that in the control group[OR=2.70,95%CI(1.16,6.31),P=0.02];(3)The excellent and good rate of the combined group was significantly better than that of the control group[OR=2.86,95%CI(1.23,6.64),P=0.01],and it also may be the result of different evaluation criteria of each study;(4)There was no significant difference range of motion[MD=2.96,95%CI(-0.54,6.47),P=0.10],Lysholm score[MD=3.22,95%CI(-0.51,6.96),P=0.09],or IKDC score[MD=2.88,95%CI(-1.07,6.82),P=0.15]in knee between the two groups. Conclusion:The meta-analysis shows that synovectomy combined with radiotherapy can reduce the recurrence rate of pigmented villonodular synovitis in knee,but compared with only operation,there are higher complications. However,the above conclusions need to be verified by long-term follow-up of more high-quality clinical studies.
基金Liaoning Province TCM rehabilitation discipline construction project(No.10010239a00175)。
文摘Objective:Based on the technology and method of network pharmacology,to explore the active components and specific mechanism of Simiao powder in the treatment of synovitis.Methods:by using tcmsp database,the potential active components and related target proteins of Simiao powder were screened.Genecards and digenet database were used to predict the target of synovitis.UniProt database was used to query the corresponding gene names.The compound synovitis target network and protein of Simiao powder were constructed by using Cytoscape and string software In R language,bio conductor data package was used to analyze the enrichment of go biological function and KEGG pathway,and the effective components and targets of Simiao powder in the treatment of synovitis were obtained.Results:64 key active components of Simiao powder were screened out from tcmsp database,71 of them were involved in the interaction of main chemical components of Simiao powder-chemical components and synovitis treatment target-synovitis.95 PPI core genes were obtained,and 90 go biological enrichment processes were obtained by go enrichment analysis.The results of network pharmacology indicate that Simiaosan can regulate 32 signaling pathways in the treatment of synovitis,including IL-17 signaling pathway,TNF signaling pathway,T cell receptor signaling pathway and toll like receptor signaling pathway.Conclusion:the treatment of synovitis with Simiao powder is a complex process of multi-component,multi-target and multi-channel,which is related to the coordinated regulation of multiple targets and signal pathways.
文摘Objective:To observe therapeutic effect of sodium aescinate Tablets on knee osteoarthritis complicated with synovitis.Methods:86 patients with knee osteoarthritis combined with synovitis treated in the Honghui Hospital Affiliated to Xi’an Jiaotong University from January 2018 to December 2019 were randomly divided into control group and intervention group,with 43 cases in each group.The control group was given routine treatment,and the intervention group was given sodium aescinate Tablets orally on the basis of routine treatment,twice a day,2 tablets each time.The curative effect was evaluated after 2 weeks of treatment.The knee pain and joint function of the two groups were evaluated by Visual Analogue Scale(VAS)and Western Ontario and McMaster Universities Arthritis Index(WOMAC),and the clinical effects of the two groups were compared.Results:Before treatment,there was no significant difference in general information,VAS and WOMAC scores between the two groups(P>0.05).After treatment,the VAS and WOMAC scores of the two groups were both lower than those before treatment,and the difference was statistically significant(P<0.05).The vas and WOMAC scores of the intervention group were lower than those of the control group(VAS,1.87±0.79 vs 3.38±0.81).In this study,sodium aescinate tablets were applied to the treatment of KOA combined with synovitis.The results showed that the intervention group was better than the control group in alleviating knee pain,improving joint function and improving clinical efficacy,and the difference was statistically significant.The total effective rate of the intervention group was higher than that of the control group(100%vs 86.05%),and the difference was statistically significant(P<0.05).Conclusion:Sodium aescinate tablet in the treatment of knee osteoarthritis combined with synovitis can effectively alleviate knee pain,improve joint function and improve clinical efficacy.
基金supported by the Foundation of Chongqing Talents(grant no.CQYC2021059825).
文摘Purpose:To investigate the pathological changes of the synovium in mice with post-traumatic osteoarthritis(PTOA)treated with 4-octyl itaconate(4-OI)and evaluate the therapeutic effects of 4-OI.Methods:In the phenotypic validation experiment,the mice were randomly divided into 3 groups:wildtype(WT)group,sham group,and destabilization of the medial meniscus(DMM)group.Through MRI,micro-CT,and histological analysis,it was determined that the DMM surgery induced a mouse PTOA model with significant signs of synovitis.At 12 weeks post-DMM surgery,synovial tissues from the DMM group and WT group mice were collected for ribonucleic acid sequencing analysis.In the 4-OI treatment experiment,mice were randomly divided into the sham group,DMM group,DMM+4-OI(50 mg/kg)group,and DMM+4-OI(100 mg/kg)group.Von Frey tests and open field tests were conducted at intervals during the 12 weeks following the DMM surgery.After 12 weeks of surgery,the efficacy of 4-OI treatment on PTOA in mice was evaluated using MRI,micro-CT,histological analysis,and quantitative real-time polymerase chain reaction.Finally,we utilized network pharmacology analysis to predict the mechanism of 4-OI in treating PTOA synovitis and conducted preliminary validation.Statistical analysis was performed using one-way ANOVA and the Kruskal-Wallis test.Difference was considered statistically significant at p<0.05.Results:The DMM surgery effectively induced a PTOA mouse model,which displayed significant symptoms of synovitis.These symptoms included a notable increase in both the number of calcified tissues and osteophytes(p<0.001),an enlargement of the calcified meniscus and synovial tissue volume(p<0.001),and thickening of the synovial lining layer attributable to M1 macrophage accumulation(p=0.035).Additionally,we observed elevated histological scores for synovitis(p<0.001).Treatment with 4-OI inhibited the thickening of M1 macrophages in the synovial lining layer of PTOA mice(p<0.001)and reduced fibrosis in the synovial stroma(p=0.004).Furthermore,it reduced the histological scores of knee synovitis in PTOA mice(p=0.006)and improved the inflammatory microenvironment associated with synovitis.Consequently,this treatment alleviated pain in PTOA mice(p<0.001)and reduced spontaneous activity(p=0.003).Bioinformatics and network pharmacology analyses indicated that 4-OI may exert its therapeutic effects by inhibiting the differentiation of synovial Th17 cells.Specifically,compared to the lipopolysaccharide stimulation group,4-OI reduced the levels of positive regulatory factors of Th17 cell differentiation(IL-1:p<0.001,IL-6:p<0.001),key effector molecules(IL-17A:p<0.001,IL-17F:p=0.004),and downstream effector molecules in the IL-17 signaling pathway(CCL2:p<0.001,MMP13:p<0.001).Conclusion:4-OI is effective in inhibiting synovitis in PTOA,thereby alleviating the associated painful symptoms.
文摘Background Functional magnetic resonance is a non-invasive method that can examine brain activity and has been widely used in various fields including jaw movement and pain processing. Temporomandibular disorder （TMD） is one of the most frequent facial pain problems. The objective of this study was to investigate the brain activities using functional magnetic resonance imaging （fMRI） during unilateral maximal voluntary clenching tasks in the TMD synovitis patients with biting pain.Methods Fourteen TMD synovitis patients with unilateral biting pain and 14 controls were included in the study.Contralateral biting pain was defined as right molar clenching causing left temporomandibular joint （TMJ） pain. Ipsilateral biting pain was defined as right molar clenching causing right TMJ pain. Symptom Check List-90 （SCL-90） was administered to the patients and controls. Independent sample t-test was used to compare the SCL-90 subscales between the two groups. Unilateral clenching tasks were performed by the patients and controls. Imaging data were analyzed using SPM99.Results Patients were divided into contralateral TMD biting pain group （n=8） and ipsilateral TMD biting pain group （n=6）. The SCL-90 subscales were significantly different between the two groups for somatization, depression, anxiety,phobic anxiety, and paranoid ideation. Group analysis of the controls demonstrated brain activations in the inferior frontal gyrus, precentral gyrus, middle frontal gyrus, superior temporal gyrus, and insular. The areas of activation were different between right and left clenching task. In TMJ synovitis patients with contralateral or ipsilateral biting pain, the group analysis showed activations in the inferior frontal gyrus, superior temporal gyrus, medium frontal gyrus, precentral gyrus,and anterior cingulate cortex.Conclusions The inferior frontal gyrus and precentral gyrus play essential roles during the unilateral clenching task.Activation of anterior cingulate cortex in the synovitis patients with biting pain was associated with higher levels of psychological distress.
文摘Objective:To compare the efficacy of different treatment protocols in treating transient synovitis of the hip(TSH)in children and to optimize the clinical treatment strategy for this condition.Methods:Ninety kids with TSH were divided into a control group,a chiropractic group and a chiropractic plus foot bath group using the random number table method,with 30 cases in each group.The control group was treated with conventional traction;the chiropractic group was given chiropractic treatment based on the control group;the chiropractic plus foot bath group was given Chinese medicine foot bath based on the chiropractic group.Traction and foot bath were conducted once daily while chiropractic was done once every other day,all with 14 d as a treatment course for a total of two courses.Changes in the visual analog scale(VAS)score and range of motion(ROM)of the hip joint in the three groups were observed,and the efficacy was compared.Results:The total effective rate was 93.3%in the chiropractic plus foot bath group,versus 76.7%in the chiropractic group and 66.7%in the control group,and the total effective rate was notably higher in the chiropractic plus foot bath group than in the other two groups(both P<0.05).Respectively after the first and second treatment course,the VAS score decreased significantly in each of the three groups compared with that before treatment(all P<0.01),and the ROM of the hip joint in flexion increased significantly(all P<0.01).After two treatment courses,the VAS score was lower in the chiropractic plus foot bath group than in the other two groups(both P<0.05),and its ROM of the hip joint in flexion was larger than that in the other two groups(both P<0.05).Conclusion:Based on traction,chiropractic plus Chinese medicine foot bath can effectively reduce pain and improve motor function of the hip joint in treating TSH.
基金This study was supported by the German Research Foundation(DFG)(No.NE1953/1-1).
文摘Background Diffusion-weighted imaging(DWI)of synovitis has been suggested as a possible non-invasive alternative to contrast-enhanced T1w imaging(ce-T1w).We aimed to study DWI for diagnosing synovitis in the knee joint of pediatric patients,to quantify inter-observer agreement on DWI and ce-T1w and to calculate quantitative measures of synovial diffusivity and conspicuity.Methods Forty consecutive patients with known or suspected arthritis of the knee(25 girls,median age 12 years)underwent routine 1.5T MRI with ce-T1w and transverse DWI with b values 50 and 800 s/mm2.Mean apparent diffusion coefficient(ADC)values and signal intensity of inflamed synovium,joint effusion and muscle were measured with regions of interest retrospectively.Post-contrast T1 w images(diagnostic standard)and diffusion-weighted images at b=800 s/mm2 with ADC map were separately rated by three independent and blinded readers with different levels of expertise for the presence and degree of synovitis along with the level of diagnostic confidence.Results Thirty-one(78%)patients showed at least some synovial contrast enhancement,17(43%)children were diagnosed with synovitis on ce-T1w.Ratings by the 1st reader on ce-T1w and on DWI for synovitis showed very good agreement(kappa=0.90).Inter-observer agreement on DWI ranged from moderate to substantial with kappa values between 0.68 and 0.79(all P<0.001).Agreement and diagnostic confidence were generally lower in patients with mild and without synovial enhancement,compared to patients with synovitis.DWI yielded higher signal of inflamed synovium vs.muscle tissue,but lower signal vs.joint effusion,compared to ce-T1 w(all P<0.001).Conclusions Diffusion-weighted imaging is a promising,though reader-dependent alternative to contrast-enhanced imaging in patients with arthritis of the knee,based on our preliminary findings.It holds potential for increasing patient safety and comfort.
文摘IntroductionSynovitis,Acne,Pustulosis,Hyperostosis and Osteitis (SAPHO) syndrome is a rare clinical entity characterized by a wide range of dermatological and musculoskeletal manifestations.This condition has a heterogeneous presentation,at times chronic and relapsing,which results in diagnostic difficulties and delays as well as therapeutic challenges.
文摘Introduction: Joint manifestations are common in systemic lupus, affecting multiple joints or just one. These manifestations are present in 95% of patients. Pseudo-septic arthritis is a subset of systemic lupus that mimics septic arthritis caused by the deposition of lipid droplets in the joint. We present the case of a patient hospitalized for mono-arthritis, which revealed systemic lupus. Observation: The patient is a 19-year-old woman, single, without children, and with no previous medical history, who was hospitalized for fever and inflammatory polyarthralgia. The clinical examination revealed an inflammatory swelling of the right knee with patellar ballottement, yellow citrine synovial fluid, an inflammatory tumor on the left arm, which was round, mobile, and fluctuating with purulent content, edema of the lower limbs, and facial puffiness, along with a systemic inflammatory response syndrome. Paraclinical examination showed hyperleukocytosis with neutrophil predominance, microcytic anemia, thrombocytopenia, antistreptolysin O (ASLO) 3, suggesting inflammatory arthritis. Bacteriological tests did not isolate any pathogens. An arthrotomy with synovial biopsy was performed, and the histopathological examination supported non-specific synovitis. A joint ultrasound showed signs of arthritis with a septic appearance. During the third hospitalization for persistent fever, she presented with facial puffiness, anemia syndrome, systemic inflammatory response syndrome, and a malar rash across the bridge of the nose. Antinuclear antibodies returned positive with a titer of 1280 and a speckled fluorescence pattern, and anti-native DNA antibodies were positive at 60.1 (normal Conclusion: Pseudo-septic arthritis is a feature of lupus that can mimic septic arthritis. Monoarticular involvement is rare but possible. The absence of pathogens and the inflammatory nature of the synovial fluid should prompt consideration of a lupus-related etiology.
基金Supported by Naional Key Basic Research Program(973, No. 2009 CB 522905)
文摘Objective To observe influence of moxibustion at ＂Shenshu＂ （肾俞BL 23） and ＂Zusanli＂ （足三里 ST 36） on proteins expression of Ras, ERKI/2, and Raf in synovial tissues in rats with rheumatoid arthritis （RA） to elucidate molecular mechanisms of moxibustion on treating RA. Methods Thirty Wistar rats were randomly divided into a normal control group （Group Cont）, a model group （Group Mod） and a moxibustion group （Group Mox） with 10 rats in each group. The model was established by using both environmental factors such as wind, cold and damp and a biological factor （Freund＇s complete adjuvant）. Suspended moxibustion was applied at bilateral BL 23 and ST 36 for 20 min, applied once daily for 15 days, starting from the 3rd day after modeling. Volumes of metaleg digiti pedis on the right side were measured before, after and 15 days after modeling. Protein expressions of Ras, ERK 1/2, p-ERKI/2 and Raf in synovium tissues were detected by western blot. Results After modeling, volumes of metaleg digiti pedis on the right side were significantly enlarged, compared with those of rats in Group Cont （P〈0.01）. After treatment by moxibustion for 15 days, the metatarsale girth of metaleg digiti pedis on the right side in Group Mox was significantly reduced, compared with that in Group Mod （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mod were significantly increased, compared with those in Group Cont （P〈0.01） and Group Mox （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mox were significantly lowered, compared with those in Group Mod （all P〈0.01）. Conclusions Moxibustion can suppress excessive protein expressions of Ras, Raf and ERK1/2 in synovium tissues of rats with experimental RA to inhibit abnormal activation of Ras-MAPK signal Pathway, which may be one of the molecular mechanisms of moxibustion in alleviating synovitis.
