Positive experiences with intraarticular infliximab have been reported in patients with rheumatoid arthritis, ankylosing spondylitis, and Behçet's disease. We used intraarticular infliximab to treat resistant knee monarthritis in a patient with spondylarthropathy. Clinical and laboratory improvement was associated with improvement in scintigraphic findings. This approach is less expensive than intravenous administration of infliximab. We suggest that selection of candidates for this innovative therapy should be guided by anti-tumor necrosis factor ␣ scintigraphy.

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The aim of our study was to evaluate the effects of intra-articular methotrexate (MTX) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Twenty-three consecutive patients, 10 with RA and 13 with PsA, with prevalent or unique arthritic involvement of one knee, were treated with intra-articular injections of MTX 10 mg every 7 days for 8 weeks. Before the beginning of the treatment and after 9 and 17 weeks, the patients underwent a clinical evaluation measuring maximal knee flexion angle, visual analog scale (VAS) and erythrocyte sedimentation rate (ESR). On the same days, an ultrasonographic examination of the involved knee was performed by two independent experienced operators. Synovial thickness in the suprapatellar bursa and the presence of joint effusion and Baker's cyst were assessed. An increase of the mean value of maximal knee flexion angle and a reduction of the mean values of ESR and VAS between TO, T9 and T17 were demonstrated. Ultrasonographic evaluation showed significant reduction of synovial thickness and joint effusion. No differences were detected for the presence of Baker's cyst. We may conclude that repeated intra-articular injections of MTX resulted in a decrease of local as well as systemic inflammatory signs. As far as we know, this is the first study that explores the effects of intra-articular MTX in RA and PsA both clinically and by ultrasonography.

Summary Sonography of the knee was performed in 28 patients with chondrocalcinosis and in 46 normal subjects. In each joint the authors examined synovial membrane, articular cartilage of femoral condyles, synovial fluid and menisci; they also searched for Baker's cysts. A significant thickening of synovial membrane was present. In 43 joints sonography showed linear hyperechoic images within condylar cartilage; they were parallel to bone surface and were interpreted as calcifications because of the coincidence with radiographic images. A significant thinning of articular cartilage was also found. Sonography of the knee is a useful method of examination for the evaluation of articular changes in chondrocalcinosis.

An ochronotic femoral head has been studied morphologically under the light and the electron microscope. Its articular cartilage showed the alterations already reported in the literature, mainly consisting of erosions of the surface, pigment accumulation in chondrocytes and intercellular matrix, chondrocyte degeneration, the formation of pigmented, calcified and uncalcified microshards, and the presence of granulation tissue with macrophagic cells. The changes in bone were less severe than those in cartilage. Pigment was present in the calcified matrix. This did not seem to disturb the organization of the bone tissue, although it was diffusely osteoporotic, perhaps because of limb disuse. The preservation of calcified matrix might depend on the fact that its collagen fibrils are encrusted by mineral substance, which avoids the dangerous effects that the deposition of ochronotic pigment induces in the fibrils of soft connective tissues. On the other hand, the newly formed osteoid matrix remains uncalcified for too short a time to be modified by the pigment. Diffuse or granular pigmentation was found in a few osteocytes, while several of them were condensed or reduced to cellular fragments. Bone resorption often occurred near these osteocytes. However, this did not seem to alter the degree of bone remodelling, possibly because of the relatively low numbers of degenerated or dead osteocytes. Pigment was also contained in the cytoplasmic vacuoles of otherwise active osteoclasts, whereas it was not found in osteoblasts. On the whole, ochronosis in bone seems to induce the same changes as in other connective tissues. However, their severity appears to be limited by calcification, which prevents modifications in collagen fibrils, and by bone remodelling, which to some extent eliminates the oldest, pigment-richest parts of the tissue.

Ultrasound detects effusion and synovial proliferation caused by synovitis. The study was undertaken to evaluate the signs of synovitis in patients with primary Sjögren's Syndrome (SS). Joint effusion was detected and synovial thickness was measured in the suprapatellar synovial bursa. Results have been compared with those obtained by sonographic assessment of knee joint in patients with secondary SS and RA. with secondary SS and connective tissue diseases, with RA, and in healthy subjects. Synovial thickening was demonstrated in all the diseases (higher grades of thickening were found in secondary SS with RA and in RA). Joint effusion was present with significantly higher frequency in secondary SS with RA and in RA. Results demonstrated signs of slight synovitis in primary SS. More severe synovitis was found both in secondary SS with RA and in RA. This is the first sonographic study demonstrating slight synovitis in primary SS.

We compared power Doppler sonography to laboratory indices of disease activity in patients with knee arthritis to determine the clinical relevance of hypervascularity. Eight healthy volunteers and 22 patients with symptoms and signs of knee arthritis were studied. Presence or absence of hypervascularity, synovial thickening, effusion, and Baker's cysts were recorded. Disease activity was measured by erythrocyte sedimentation rate, c-reactive protein, alpha2-globulins, sideremia, hemoglobinemia, and serum white cell count. Various grades of synovial hyperemia were found in 12/22 cases. Patients with and without synovial hypervascularity showed statistically significant differences in age (P=0.017), erythrocyte sedimentation rate (ESR) (P = 0.039), hemoglobinemia (P = 0.009), and sideremia (P = 0.012). Power Doppler sonography is able to demonstrate synovial hyperemia, which is correlated with some laboratory indices of inflammation.

An increased incidence of osteoarticular tuberculosis (TBC) has been reported during recent years. We report a case of TBC arthritis of the knee in which magnetic resonance tomography (MRI) provided images suggestive of this finding, in contrast to plain radiographs and joint sonography. The diagnosis was confirmed with culture for tuberculous bacilli. As far as we know, this is the first study comparing radiographs, joint sonography, and MRI.