Concentrations of 5 marker proteins were measured in synovial fluid and serum samples from knee effusions of 11 patients with rheumatoid arthritis and 9 with osteoarthritis. Indirect determinations of synovial plasma flow and lymphatic drainage were obtained by measuring iodide clearance (mVminute) and radioalbumin clearance (mYminute). Together with protein concentrations, these determinations allowed us to calculate: 1) the flux of each marker protein through synovial tissues (mghinute); 2) the volume of plasma cleared by synovium per unit time (mlhinute); and 3) the fractional extraction per passage through the synovial microcirculation (protein permeance). These measures differed substantially between rheumatoid arthritis and osteoarthritis patient populations and quantified the severity of the microvascular lesion in rheumatoid synovitis.Synovial microvascular permeability plays an important role in the pathophysiology of synovial effusions. Permeability changes, however, have not been easily quantified. Previous evaluations assayed marker proteins in synovial fluid (SF) and serum (S) and then used the concentration ratio (SF:S) to charFrom the Departments of Medicine and Radiology, University of Washington, Seattle.Supported in part by NIH grants AM-22186, AM-32811, AM-07108, and RR-37, and by a Clinical Research Center grant from the Arthritis Foundation.acterize the "leakiness" of the synovial tissue barrier (1,2). Such studies provided support for the view that rheumatoid synovial tissues are more permeable than are osteoarthritic synovial tissues. The regression lines created by plotting SF:S versus protein molecular size have also been useful in determining whether specific proteins are consumed or synthesized within the articular compartment (1-3).Unfortunately, SF:S protein ratios reflect not only the permeability of synovial microvessels, but also the kinetics of plasma delivery to and lymphatic removal from synovial tissues. The contributions of these kinetic factors must be resolved in order to specifically assess microvascular permeability. In addition, net intraarticular synthesis or catabolism must be considered (4). Since the SF:S ratio fails to distinguish the several factors contributing to protein delivery and removal, it remains an inadequate measure of synovial microvascular permeability (5).Evidence from studies of animals indicates that protein traffic across the synovium is unidirectional, with proteins delivered to articular tissues by the microcirculation and removed by lymphatic drainage (6,7). Three groups of investigators have found that radiolabeled proteins of widely different molecular radius are removed from human articular tissues at identical rates (8-10). A shared rate suggests that proteins are not cleared by diffusion (in which case, the removal of different proteins would be inversely drainage.We have recently introduced a method for deriving the articular clearance of radiolabeled albumin (RISA) from human synovial effusions (11). Be-98195.
First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. The term is derived from the Latin word gutta (or 'drop'), and referred to the prevailing medieval belief that an excess of one of the four 'humors' – which in equilibrium were thought to maintain health – would, under certain circumstances, 'drop' or flow into a joint, causing pain and inflammation. Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. Although there is evidence that colchicine, an alkaloid derived from the autumn crocus (Colchicum autumnale), was used as a powerful purgative in ancient Greece more than 2000 years ago, its first use as a selective and specific treatment for gout is attributed to the Byzantine Christian physician Alexander of Tralles in the sixth century AD. Uricosuric agents were first used at the end of the 19th century. In the modern era, nonsteroidal anti-inflammatory drugs are usually the drugs of choice for treating acute gout. Perhaps the most important historical advance in the treatment of hyperuricemia was the development of xanthine oxidase inhibitors, which are effective in reducing plasma and urinary urate levels and have been shown to reverse the development of tophaceous deposits.
Objective. To report our experience with the efficacy and safety of anakinra for acute gouty arthritis in medically complex hospitalized patients. Methods. We reviewed the hospital charts of 26 patients treated with anakinra for crystal-induced arthritis since 2007. Demographics, comorbid conditions, reason for anakinra use, response to treatment, and any adverse outcomes were recorded. Results. Twenty-six patients received 40 courses of anakinra therapy. In 67% of patients, pain improved significantly within 24 hours, and complete resolution of signs and symptoms of gout occurred by day 5 in 72.5% of patients. Seven patients received multiple courses with no decrement in response with repeated treatments. Anakinra was well tolerated and no adverse outcomes were attributed to the medication. Only 1 patient appeared to be refractory to this form of interleukin-1 inhibition. Conclusion. Anakinra is an effective and safe alternative treatment for acute gouty arthritis in medically complex hospitalized patients who fail or cannot undergo more conventional therapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.