Vascular aspects of degenerative joint disorders a synthesis

Arnoldi, Carl C.

doi:10.3109/17453679409155226

Cited by 24 publications

(22 citation statements)

References 147 publications

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“…It is beyond the scope of this paper to validate the model further. Our interpretation of the Brix model is consistent with many other observations proposing a vascular component of OA 34–38. These studies focused on venous outflow obstruction as a key pathological observation.…”

Section: Discussionsupporting

confidence: 91%

Subchondral fluid dynamics in a model of osteoarthritis: use of dynamic contrast-enhanced magnetic resonance imaging

Lee

Dyke

Ballon

et al. 2009

Osteoarthritis and Cartilage

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Summary Objective The hypothesis of this study is that changes in fluid dynamics in subchondral bone bear a functional relationship to bone remodeling and cartilage breakdown in osteoarthritis (OA). We have utilized dynamic contrast-enhanced magnetic resonance imaging (MRI) to extract kinetic parameters of bone perfusion at various stages in the development of OA in the Dunkin-Hartley guinea pig. Design of four different ages (6, 9, 12 and 15 months), representing various stages in the development of OA, were studied. All animals underwent dynamic contrast-enhanced (DCE) MRI and perfusion data were analyzed based on the Brix two compartment pharmacokinetic model. Regions of interest were studied at the medial and lateral tibial plateaus and compared to histological/histochemical scores of articular cartilage and subchondral bone plate thickness. Results A decrease in perfusion as well as outflow obstruction was observed in animals between 6 and 9 months of age, only in the medial tibial plateau subchondral bone. The eventual cartilage and bone lesions of OA occurred also in the medial tibia. Changes in perfusion occurred in the lateral tibia but not until OA lesions were established. Kinetic parameters of inflow were unchanged in both the medial and lateral plateaus. Conclusions Dynamic contrast-enhanced MRI can be used to extract kinetic information on bone perfusion in an animal model of OA. The signal enhancement in subchondral bone temporally precedes and spatially localizes at the same site of the eventual bone and cartilage lesions. Time-intensity curves suggest outflow obstruction as an underlying mechanism.

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Section: Discussionsupporting

confidence: 91%

Subchondral fluid dynamics in a model of osteoarthritis: use of dynamic contrast-enhanced magnetic resonance imaging

Lee

Dyke

Ballon

et al. 2009

Osteoarthritis and Cartilage

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“…The elevated signal enhancement patterns seen on DCE‐MRI during the clearance phase suggest the presence of venous outflow obstruction and venous stasis. Previously, intraosseous venography has demonstrated markedly delayed venous drainage and occlusion of retinacular veins in OA of the hip with drainage of the proximal femur through diaphyseal intramedullary veins . In physiologic and anatomic studies of established human OA, circulatory alterations consisting of decreased venous drainage, venous outflow obstruction, and venous stasis have been reported, associated with intraosseous hypertension, reductions in perfusion, and relative hypoxia .…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms exist that could suggest a functional , rather than structural , increase in venous outflow resistance. Venous stasis could have been produced by increased intraosseous extravascular pressure or extraosseous venous shunting, both of which have been demonstrated in OA . Bone venous vasculature is relatively more sensitive to vasoconstricting agents and are responsive to a number of cytokines resident in bone particularly endothelin, a vasoconstricting agent that is released from endothelial cells by hypoxia …”

Section: Discussionmentioning

confidence: 99%

Characterization of bone perfusion by dynamic contrast‐enhanced magnetic resonance imaging and positron emission tomography in the Dunkin–Hartley guinea pig model of advanced osteoarthritis

Dyke

Synan

Ezell

et al. 2014

Journal Orthopaedic Research

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Purpose This study characterizes changes in subchondral bone circulation in OA and examines relationships to bone structure and cartilage degeneration in Dunkin-Hartley guinea pigs. Methods We have used dynamic contrast-enhanced MRI (DCE-MRI) and PET, with pharmacokinetic modeling, to characterize subchondral bone perfusion. Assessments are made of perfusion kinetics and vascular permeability by MRI, and blood volume and flow, and radionuclide incorporation into bone, by PET. These parameters are compared to cartilage lesion severity and bone histomorphometry. Assessments of intraosseous thrombi are made morphologically. Results Prolonged signal enhancement during the clearance phase of MRI correlated with OA severity and suggested venous stasis. Vascular permeability was not increased indicating that transvascular migration of contrast agent was not responsible for signal enhancement. Intraosseous thrombi were not observed. Decreased perfusion associated with severe OA was confirmed by PET and was associated with reduced radionuclide incorporation and osteoporosis. Discussion MRI and PET can be used to characterize kinetic parameters of circulation in OA and correlate them with subchondral bone metabolism of interest to the pathophysiology of OA. The significance of these observations may lie in alterations induced in the expression of cytokines by OA osteoblasts that are related to bone remodeling and cartilage breakdown.

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“…One likely source that remains underexplored is that of intra-osseous hypertension. The pathophysiology remains unclear, although phlebographic studies in OA indicate impaired vascular clearance from bone and raised intra-osseous pressure in the bone marrow near the painful joint (31–34). What may subsequently cause pain is as yet unknown.…”

Section: Local Tissue Pathologymentioning

confidence: 99%

The Symptoms of Osteoarthritis and the Genesis of Pain

Hunter

McDougall

Keefe

2008

Rheumatic Disease Clinics of North America

331

201

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Symptomatic osteoarthritis (OA) causes substantial physical and psychosocial disability. This article delineates the characteristic symptoms and signs associated with OA and how they can be used to make the clinical diagnosis. The predominant symptom in most patients is pain. The remainder of the article focuses on what is known about the causes of pain in OA and factors that contribute to its severity. Much has been learned during recent years, but much of this puzzle remains unexplored or inadequately understood.

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Vascular aspects of degenerative joint disorders a synthesis

Cited by 24 publications

References 147 publications

Subchondral fluid dynamics in a model of osteoarthritis: use of dynamic contrast-enhanced magnetic resonance imaging

Subchondral fluid dynamics in a model of osteoarthritis: use of dynamic contrast-enhanced magnetic resonance imaging

Characterization of bone perfusion by dynamic contrast‐enhanced magnetic resonance imaging and positron emission tomography in the Dunkin–Hartley guinea pig model of advanced osteoarthritis

The Symptoms of Osteoarthritis and the Genesis of Pain

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