Macrophage colony-stimulating factor (M-CSF) is a cytokine involved in the development and proliferation of the monocyte/macrophage lineage cells. M-CSF has also been reported to participate in the induction of osteoclasts, and may be important in the destruction of bone and cartilage and the periarticular osteoporotic changes seen in patients with rheumatoid arthritis (RA). We developed a new ELISA technique to measure M-CSF levels in synovial fluid with high sensitivity and reproducibility. The mean M-CSF level in the synovial fluid of patients with RA was 1.38 +/- 0.56 ng/ml, and that of patients with osteoarthritis (OA) was 0.67 +/- 0.13 ng/ml. In contrast, serum levels of M-CSF in patients with RA and in normal controls were 1.32 +/- 0.50 ng/ml and 0.90 +/- 0.09 ng/ml, respectively. These differences were both statistically significant. Since serum M-CSF levels correlate with inflammatory signs obtained from examination of blood, they indicate the general condition of patients with RA. Synovial fluid M-CSF levels increase even in the early phase of RA and remain high despite drug therapy, which suggests that they reflect the condition of affected joints including joint spaces and inflamed synovia more directly than do the levels of serum M-CSF. Measurement of the M-CSF level in the synovial fluid may be useful in the diagnosis, clinical evaluation, and assessment of the effects of treatment in patients with RA.
Although rheumatoid involvement of the lumbar spine is relatively rare, we report a patient with rapidly progressing cauda equina symptoms due to rheumatoid diskitis. A 72-year-old woman was admitted to our hospital because of motor weakness below the iliopsoas muscle and sensory disturbance beneath the level of L2. Plain X-ray films, computed tomography, and magnetic resonance imaging demonstrated destruction of the L2/3 intervertebral disc and endplates with subluxation of the facet joints. The dural sac was compressed. Based on a diagnosis of spinal canal stenosis due to rheumatoid diskitis, we performed partial laminectomy and posterolateral fusion with pedicle screws. The neurological deficits improved immediately. The mechanism of intervertebral disc destruction in this case is thought to be rheumatoid nodes or enthesitis. Destruction of the facet joints and the intervertebral disc might have led to severe instability and spinal canal stenosis.
We retrospectively compared two groups of patients with hip fractures and severe complications. One group had been treated surgically; the other group had been treated conservatively to prevent worsening of general status, with transfer to wheelchair as soon as possible. This study aimed to determine if early prognosis after conservative treatment would be worse than that following surgical treatment.
Materials and Methods:Subjects were patients (n=230) with hip fracture who had been admitted and treated at our hospital from 1993 through 2006. Patients' medical records were retroactively investigated to obtain information on age, sex, complications, type of fracture, and course of subsequent hospitalizations. Additional information for conservatively treated patients included reasons for avoiding surgery and time-to-transfer to wheelchair. In case of death, the cause and timing of death were investigated.
Results:Of the 230 patients, 22 (mean age, 83.5 years) were treated conservatively. Complications at admission included cardiac disease, respiratory disease, malignancy, renal disease, dementia, and other conditions. Multiple complications were commonly seen. The reasons for selecting conservative treatment were cardiac function disturbance in 13 cases and decision of patients' families in 9 cases. Almost all patients were able to transfer to wheelchair. A total of 9 patients died in the hospital: 8 were in the surgical treatment group and 1 was in the conservative treatment group. The patients who died in the surgical treatment group had a mean age of 80.3 years, and pneumonia was the main cause of death.The timing of death ranged from 12 to 129 days after surgery. The number of perioperative deaths was 3 (1.4%).
Discussion and Conclusion:This study showed that in patients with hip fractures, severe complications, and poor general conditions, early prognosis after conservative treatment aiming for early transfer to wheelchair is no worse than that following surgical treatment. Thus, conservative treatment should be considered for patients with poor ability for activities of daily living. (J Nippon Med Sch 2016; 83: 2 5)
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