A study of regenerated synovium after synovectomy of the knee in rheumatoid arthritis

Photodynamic therapy using talaporfin sodium for synovial membrane from rheumatoid arthritis patients and collagen-induced arthritis rats

We investigated the efficacy of photodynamic therapy (PDT) using talaporfin sodium as a new method of synovectomy for rheumatoid arthritis (RA). We first used RA synovial membrane (RASM) for in vitro and in vivo study. The RASM was obtained from patients with RA during total knee replacement. In the in vitro study, RA fibroblast-like synoviocytes (RASCs) obtained from the RASM were examined by fluorescent microscopy to measure the intracellular localization of talaporfin sodium. The cells were then subjected to PDT, and their viability was examined by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulphophenyl)-2H-tetrazolium inner salt assay. In the in vivo assay, RASM was obtained as described above, grafted onto severe combined immunodeficiency (SCID) mice and subjected to PDT. The damaged area of RASM was evaluated histologically at 1 day after PDT. Next, we performed a separate experiment using rats with collagen-induced arthritis (CIA). After intra-articular injection of talaporfin sodium, the concentration of talaporfin sodium accumulated in the CIA synovial membrane (CIASM) was compared with that in cartilage, periarticular muscle, and skin. We then performed PDT with intra-articular injection of talaporfin sodium and intra-articular irradiation. The damaged area of the CIASM was measured at 1 day after the PDT, and the articular histological and radiological changes of the ankle were observed at 56 days after the PDT. In RASM, talaporfin sodium accumulated in lysosomes in vitro, and the phototoxicity to RASCs in vitro and to RASM grafted onto SCID mice in vivo depended on the concentration of talaporfin sodium and the laser energy. In CIA rats, there was a greater accumulation of talaporfin sodium in the CIASM than in normal tissue. The CIASM was selectively damaged at 1 day after the PDT, and the bone and cartilage destruction were ameliorated at 56 days after the PDT. In conclusion, PDT using talaporfin sodium might be a new method for synovectomy in patients with RA.

Spectroscopic study of ALA-induced endogenous porphyrins in arthritic knee tissues: targeting rheumatoid arthritis PDT

The inflamed synovium of rheumatoid arthritis exhibits many features typical for neoplastic tissue implying that the photodynamic therapy might be an efficient modality for chronic poliarthritis. The accumulation of endogenously produced porphyrins after administration of exogenous 5-aminolevulinic acid (ALA) in a rabbit model of rheumatoid arthritis was evaluated by fluorescence spectroscopy. Independent of the way, intravenously or intra-articularly, in which ALA was administered to the experimental animals, the highest fluorescence intensity of endogenously produced porphyrins was detected in the tissues of the inflamed joints. Besides, the application of ALA had a systemic sensitising effect on the whole organism of rabbits. The highest amount of endogenously produced porphyrins in the inflamed joints measured from the surface of the skin above the synovium tissues was detected 1-3 h after the administration of ALA. Fluorescence measurements performed on the tissue specimens ex vivo showed the predominant accumulation of porphyrins in the synovium of the inflamed joints. The fluorescence of porphyrins was also observed in the cartilage tissues taken from knee joints. However, the fluorescence spectra features indicated that the composition of porphyrins detected in the cartilage tissues was different than that in the synovial tissues. The selective accumulation of porphyrins in the inflamed synovial tissues stands up for the application of photodynamic therapy in the treatment of rheumatoid arthritis and implies the possibility to use optical non-invasive methods based on fluorescence detection of endogenously produced porphyrins for diagnostics of inflamed tissues.

The neo-synovial membrane of patients with active rheumatoid arthritis at resynovectomy. Histomorphological and immunohistological evaluations

Neo-synovial membranes, which formed after "primary" synovectomy in 21 patients with rheumatoid arthritis (RA), were studied at resynovectomy. The clinical, histomorphological, and immunohistological data were compared with data derived from "primary" synovial membranes from RA and osteoarthritis (OA) patients. The clinical data suggest a less active rheumatoid inflammatory response after synovectomy. Histomorphologicaly, the synovitis in resynovectomized neosynovial membranes of RA revealed no qualitative differences when compared with synovitis in the "primary" synovium. However, the degree of the inflammatory rection evaluated by the different parameters was found to be distinctly lower. The immunohistological data correlated with these findings.

Synovial proliferative disorders: role of synovectomy

Synovectomy is an effective procedure in many of the synovial proliferative diseases. It is the treatment of choice in pigmented villonodular synovitis and synovial chondromatosis. In addition, it may be a useful adjunct to treatment in carefully selected patients with rheumatoid arthritis and hemophilia. Synovectomy can now be accomplished effectively with arthroscopic techniques, and this has greatly diminished the previous morbidity and cost associated with open synovectomy. However, the indications for synovectomy remain the same, regardless of the technique.

Consequences of synovectomy of the knee joint: clinical, histopathological, and enzymatic changes and changes in 2 components of complement

The state of 36 knee joints of 32 rheumatic patients was evaluated after surgical synovectomy, the follow-up period varying from 2 to 39 months. Synovitis was suspected by arthroscopy in 67% and verified histologically in 52%, although in a milder form than at the time of synovectomy. The regenerated synovial tissue was less permeable to serum proteins and contained lower activities of lysosomal enzymes than the excised synovial tissue. Although the number of leucocytes decreased in the joint fluid after synovectomy, the activities of lysosomal enzymes were lowered only slightly, and there was no change in the amount of C3 and C4 components of complement pathway.

99mTc-pertechnetate uptake after total knee replacement in rheumatoid arthritis

In 6 out of 48 non-hinged knee joint replacements in 35 patients, 99mTc04- uptake values were clearly increased compared with a control group. Measurements were performed an average of 3 years (range 9 months - 4 1/2 years) after operation. Four of the six cases showed loosening of the prosthesis at arthrotomy and one showed an infection. Tests for hypersensitivity to the different components of the prosthesis and cement were normal. Histology and immunofluorescence of the synovial membrane obtained at arthrotomy in the four operated patients showed no recurrence of the synovitis. This study indicates that there is no recurrence or only a slight recurrence of rheumatoid synovitis after total knee joint replacement of the geometric type.

Experience with knee synovectomy in Norwich, 1964-1973

Thirty-six patients (43 knees) who underwent anterior synovectomy for rheumatoid disease between 1964 and 1973 have been personaly reviewed. The notes and X-rays of a further seven patients (10 knees) have been examined. Twenty-five per cent of the knees were failures at the time of review, but only two were failures from the outset. The indications for the operation and also the contraindications are described and evaluated. It is concluded that: 1. In the rheumatoid knee, anterior synovectomy is a pain relieving operation. 2. The indications are wider than classically stated, and can include knees with full thickness cartilage destruction, and flexion deformities up to 20 degrees. 3. The majority of knees fail because of secondary degenerative change, and this is manifested by pain rather than stiffness. 4. Postoperative manipulation does not prejudice the final result. 5. Associated popliteal cysts (five in this series) can be cured by anterior synovectomy.

Follow-up study of synovectomies of the knee joint in patients suffering from rheumatoid arthritis

Synovectomies of the knee joint that were performed during the years 1960-65 at the Rheumatism Foundation Hospital because of rheumatoid arthritis have been re-examined after the lapse of 9.5 years in 156 patients and 202 knee joints and 110 non-operated knee joints of the same patients. Track of motion was helped both in synovectomized and in control knees. Deficiency of extension decreased only in the synovectomized knees; track of motion of the knee was improved by the operation. Swelling and pain appeared less often in operated than in control knees. The patient's own assessment of the operating results was good in 71% and poor in 12% of the cases. Radiological deterioration continued during the follow-up period both in the operated and in the control knees, though it was more severe in the latter. There is a distinct negative correlation between severity of disease and the patients's ability to work. Within the limits of this survey it is not possible to prove that synovectomy halts the radiological destruction of the knee joint; it is mainly a question of a measure that retards the rate of deterioration. One of the chief advantages of synovectomy of the knee is that it helps the patient to live a normal life and makes it possible for him to participate in working life.

Role of early synovectomy of the knee joint in rheumatoid arthritis

The prospective study of 32 knees in 26 patients with rheumatoid arthritis was carried out with an average followup of 3 years. Relief of pain and control of inflammation locally were obtained in 22 of 32 knees (69%). Articular cartilage was preserved in 20 of 28 knees (71%) and the synovitis recurred in 9 knees (28%), 7 of which showed progressive loss of cartilage. Therefore, it appears that synovectomy, if performed at a stage in which articular cartilage is still normal and after medical therapy has failed, is a very effective method for preserving articular cartilage and controlling inflammation locally. However, with a longer followup the disease with loss of articular cartilage will recur in a large number of cases. In patients whose disease progresses rapidly, no form of therapy effectively controls joint destruction.