This study suggests that abnormalities of the medial perimeniscal synovium are a common feature of painful medial knee OA, associated with more severe medial chondropathy. It also suggests that an inflammatory aspect of the medial perimeniscal synovium could be considered as a predictive factor of subsequent increased degradation of medial chondropathy.

Objective. The hallmark of osteoarthritis (OA) is the loss of articular cartilage. This loss arises from an imbalance between cartilage synthesis and cartilage degradation over a variable period of time. The aims of this study were to investigate the rates of these processes in patients with knee OA using two new molecular markers and to investigate whether the combined use of these markers could predict the progression of joint damage evaluated by both radiography and arthroscopy of the joints during a period of 1 year.Methods. Seventy-five patients with medial knee OA (51 women, 24 men; mean ؎ SD age 63 ؎ 8 years, mean ؎ SD disease duration 4.8 ؎ 5.2 years) were studied prospectively. At baseline, we measured serum levels of N-propeptide of type IIA procollagen (PIIANP) and urinary excretion of C-terminal crosslinking telopeptide of type II collagen (CTX-II) as markers of type II collagen synthesis and degradation, respectively. Joint space width (JSW) on radiography and medial chondropathy at arthroscopy (assessed using a 100-mm visual analog scale [VAS]) were measured in all patients at baseline and in 52 patients at 1 year. Progression of joint destruction was defined as a decrease of >0.5 mm in JSW on radiography and as increased chondropathy (an increase in the VAS score of >8.0 units) between the baseline and 1-year evaluations.Results. At baseline, compared with 58 healthy age-and sex-matched controls, patients with knee OA had decreased serum levels of PIIANP (20 ng/ml versus 29 ng/ml; P < 0.001) and increased urinary excretion of CTX-II (618 ng/mmole creatinine [Cr] versus 367 ng/ mmole Cr; P < 0.001). The highest discrimination between OA patients and controls was obtained by combining PIIANP and CTX-II in an uncoupling index (Z score CTX-II ؊ Z score PIIANP), which yielded a mean Z score of 2.9 (P < 0.0001). Increased baseline values in the uncoupling index were associated with greater progression of joint damage evaluated either by changes in JSW (r ‫؍‬ ؊0.46, P ‫؍‬ 0.0016) or by VAS score (r ‫؍‬ 0.36, P ‫؍‬ 0.014). Patients with both low levels of PIIANP (less than or equal to the mean ؊ 1 SD in controls) and high levels of CTX-II (greater than or equal to the mean ؉ 1 SD in controls) had an 8-fold more rapid progression of joint damage than other patients (P ‫؍‬ 0.012 and P < 0.0001 as assessed by radiography and arthroscopy, respectively) and had relative risks of progression of 2.9 (95% confidence interval [95% CI] 0.80-11.1) and 9.3 (95% CI 2.2-39) by radiography and arthroscopy, respectively.Conclusion. Patients with knee OA are characterized by an uncoupling of type II collagen synthesis and degradation which can be detected by assays for serum PIIANP and urinary CTX-II. The combination of these two new markers could be useful for identifying knee OA patients at high risk for rapid progression of joint damage.

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This study supports existing data concerning the favorable symptomatic effect of intra-articular injections of Hyalgan in osteoarthritis of the knee and suggests that repeated intra-articular injections of Hyalgan might delay the structural progression of the disease. Other studies are required to confirm these results and to determine the long-term monitoring of osteoarthritic patients using such local therapy.

Objective. To evaluate the efficacy of joint lavage and intraarticular steroid injection, alone and in combination, in the treatment of patients with symptomatic knee osteoarthritis (OA).Methods. Ninety-eight patients with painful tibiofemoral OA were enrolled in a prospective, randomized, controlled, 2 ؋ 2 factorial-design trial of 6 months' duration. The 4 treatment groups consisted of 1) intraarticular placebo (1.5 ml of 0.9% normal saline), 2) intraarticular corticosteroids (3.75 mg of cortivazol in 1.5 ml), 3) joint lavage and intraarticular placebo, and 4) joint lavage and intraarticular corticosteroid. Outcome measures evaluated at baseline, week 1, week 4, week 12, and week 24 included severity of pain (100-mm visual analog scale [VAS]), global status (100-mm VAS), and Lequesne's functional index.Results. No interaction between steroid injection and joint lavage was demonstrated. Patients who had undergone joint lavage had significantly improved pain VAS scores at week 24 (P ‫؍‬ 0.020). In contrast, corticosteroid injection had no long-term effect (P ‫؍‬ 0.313); corticosteroid injection was associated with a decrease in pain only at week 1 (P ‫؍‬ 0.003) and week 4 (P ‫؍‬ 0.020). After week 4, Lequesne's functional index was not significantly improved regardless of the assigned treatment.Conclusion. Compared with placebo, both treatments significantly relieved pain but did not improve functional impairment. The effects of the 2 treatments were additive. Cortivazol provided short-term relief of pain (up to week 4). The effects of joint lavage persisted up to week 24.Osteoarthritis (OA) of the knee is one of the most common forms of arthritis and a major cause of pain and disability, particularly among the elderly (1). Intraarticular corticosteroid therapy is widely used in the treatment of OA, particularly for the knee. A recent survey of rheumatologists in the US suggested that Ͼ95% prescribe corticosteroids "at least sometimes," and 53% "frequently" (2). Such therapy is recommended in the American College of Rheumatology (ACR) guidelines for the medical management of knee OA (3), and its clinical benefit has been evaluated in several controlled studies (4-6). However, a recent systematic review of studies of intraarticular (IA) corticosteroid use in patients with knee OA (7) showed that these studies were flawed by numerous methodologic deficiencies. Two recent double-blind, placebo-controlled studies showed significantly greater decreases in pain with corticosteroid treatment than with placebo only at week 1 in 1 study and at week 3 in the other (8,9). Some authors concluded that the evidence for efficacy of IA corticosteroids in knee OA is relatively weak (10,11).The results of several studies have suggested that joint lavage, either alone or combined with arthroscopy,

No abstract

Quantification of chondropathy with MR imaging is feasible and well correlated with anatomic cartilage breakdown.

This study was undertaken to evaluate the possibility to obtain a molecular signature of rheumatoid arthritis (RA) comparatively osteoarthritis (OA), and to lay the bases to develop new diagnostic tools and identify new targets. Microarray technology was used for such an analysis. The gene expression profiles of synovial tissues from patients with confirmed RA, and patients with OA were established and compared. A set of 63 genes was selected, based, more specifically, on their overexpression or underexpression in RA samples compared to OA. Results for six of these genes have been verified by quantitative PCR using both samples identical to those used in the microarray experiments and entirely separate samples. Expression profile of the 48 known genes allowed the correct classification of additional RA and OA patients. Furthermore, the distinct expression of three of the selected genes was also studied by quantitative RT-PCR in cultured synovial cells. Detailed analysis of the expression profile of the selected genes provided evidence for dysregulated biological pathways, pointed out to chromosomal location and revealed novel genes potentially involved in RA. It is proposed that such an approach allows valuable diagnosis/prognostics tools in RA to be established and potential targets for combating the disease to be identified.