Relationship between radiographic grading of osteoarthritis and the biochemical markers for arthritis in knee osteoarthritis

The aim of this study was to investigate the relationship between the biochemical markers of arthritis and the radiographic grading of osteoarthritis (OA) in knees. Seventy-one women aged 49–85 years with knee OA were studied. Anterior–posterior knee radiographs and hand radiographs were taken in all patients. The radiographic grading of OA in the knee was performed by using the Kellgren–Lawrence criteria and the joint space width. The 71 patients with knee OA were divided into two groups: 37 patients exhibiting generalized osteoarthritis (GOA) and 34 non-GOA patients, according to the grading of their hand radiograph. C-reactive protein (CRP), urinary pyridinoline, YKL-40, plasma matrix metalloproteinase (MMP)-3, MMP-9 and tissue inhibitor of metalloproteinases (TIMP)-1 were measured as the biochemical markers of arthritis. The radiographic grading with the Kellgren–Lawrence scale revealed a significant relationship to the joint space width (P = 0.003): the joint space width decreased with increasing Kellgren–Lawrence grade. All biochemical markers had negative correlations with the joint space width, but only urinary pyridinoline had a significant correlation (P = 0.039). Pyridinoline (P = 0.034) and TIMP-1 (P = 0.017) also exhibited a significant relationship to the Kellgren–Lawrence grade. In GOA evaluations, the joint space width did not differ between GOA and non-GOA patients. CRP, pyridinoline, YKL-40 and MMP-3 levels were significantly greater in GOA patients than in non-GOA patients. CRP, pyridinoline, YKL-40, MMP-3 and TIMP-1 levels each related to at least one of the radiographic gradings. Furthermore, pyridinoline related to every type of radiographic grading examined in the present study.

Hypothalamic digoxin and hemispheric chemical dominance--relation to the pathogenesis of senile osteoporosis, degenerative osteoarthritis, and spondylosis

The isoprenoid pathway produces three key metabolites: i) digoxin (a membrane sodium-potassium ATPase inhibitor which can regulate intracellular calcium/magnesium ratios), ii) dolichol (which regulates N-glycosylation of proteins), and iii) ubiquinone (a free radical scavenger), all of which are important in bone and joint metabolism. The pathway was assessed in senile osteoporosis, spondylosis, and osteoarthritis. Digoxin could possibly play a role in the genesis of cerebral dominance because it can regulate multiple neurotransmitter systems. The pathway was also assessed in individuals of differing hemispheric dominance for comparison and to find out the role of cerebral dominance in the pathogenesis of these diseases. The plasma/serum-activity of HMG CoA reductase, magnesium, digoxin, dolichol, ubiquinone, and tryptophan/tyrosine catabolic patterns, as well as RBC Na(+)-K+ ATPase activity, were measured in the above mentioned groups. The glycoconjugate metabolism, free radical metabolism, and membrane composition were also studied. The pathway was upregulated with increased digoxin synthesis in patients with spondylosis and osteoarthritis. In this group of patients, the glycoconjugate levels and dolichol levels were increased and lysosomal stability reduced. The ubiquinone levels were low and free radicals increased in spondylosis and osteoarthritis. On the other hand, in senile osteoporosis, the isoprenoid pathway was downregulated and digoxin synthesis reduced. The glycoconjugate and dolichol levels were low and lysosomal stability increased. The ubiquinone levels were increased and free radical production increased in senile osteoporosis. The significance of these changes in the pathogenesis of osteoarthritis, spondylosis, and osteoporosis is discussed. The hyperdigoxinemic state is seen in osteoarthritis and spondylosis and in right hemispheric dominance. The hypodigoxinemic state is seen in left hemispheric dominance and senile osteoporosis. Hemispheric dominance plays a crucial role in deciding the predisposition to bone and joint diseases. Right hemispheric chemical dominance predisposes to spondylosis and osteoarthritis. Left hemispheric chemical dominance predisposes to osteoporosis.

[Clinical study on analgesic mechanism of bitongxiao in treating neck pain due to cervical spondylitis]

OBJECTIVE

To study the analgesic mechanism of Bitongxiao (BTX, a Chinese herbal decoction) in treating neck pain due to cervical spondylitis (CS).

METHODS

BTX and Jingfukang (JFK) granule were used to treat the treated and the control group separately in 102 CS cases. Plasma leucine enkephalin (LEK), substance P (SP) and prostaglandin E2 (PGE2) before and after treatment were assayed by radioimmunoassay (RIA).

RESULTS

Twelve patients in the treated group were clinically cured, 36 markedly effectively, 3 effectively and 1 ineffectively, while in the control group they were 5, 33, 14 and 0 cases respectively. The cured and marked effective rate in the treated group was 92.3%, while that in the control group 72.0%. After treatment the pain score (VAS) of both groups were significantly reduced, but the reduction was higher in the treated group than that in the control. Before treatment, plasma LEK in all patients was abnormally low, but after treatment, it raised obviously more in the treated group than that in the control (P < 0.05). Plasma SP of both groups were obviously elevated, and PGE2 revealed unaltered after treatment.

CONCLUSION

BTX has strong, fast-acting and long-lasting analgesic effect with no side-effects, it could elevate the lowered plasma LEK level in cervical spondylitis patients and increase plasma SP level. The analgesic mechanism of BTX might be associated with its effect on LEK, SP or other endorphins, directly acting on the pain modulation system.

Influence of osteoarthritis on serum marker levels of bone formation and resorption in patients with benign prostatic hypertrophy

BACKGROUND

The aim of this study was to investigate the influence of osteoarthritis of lumbar vertebrae on serum bone formation and resorption marker levels of patients with benign prostatic hypertrophy (BPH).

METHODS

Serum levels of carboxyterminal propeptide of type I procollagen (PICP), alkaline phosphatase (ALP), carboxyterminal telopeptide of type I collagen (ICTP), and prostate-specific antigen (PSA) were examined in 40 patients with BPH, and the presence of osteoarthritis at the lumbar vertebrae of the patients was evaluated by plain x-ray-p.

RESULTS

Findings of osteoarthritis were observed in 23 of the 40 patients (58%), and 10 of the patients had severe osteoarthritis (involving at least 2 lumbar vertebral bodies). The serum levels of PICP, ALP, ICTP, and PSA of the patients without osteoarthritis findings were not different from those of the patients with osteoarthritis or severe osteoarthritis.

CONCLUSION

The influence of osteoarthritis on serum bone formation and resorption marker levels of patients with BPH appears to be rather slight, if there is any influence at all.

Effect of massotherapy on the in vivo free radical metabolism in patients with prolapse of lumbar intervertebral disc and cervical spondylopathy

The endogenous free radical scavenger superoxide dismutase (SOD) and blood catalase (CAT) in 2 groups of patients with prolapse of lumbar intervertebral disc and cervical spondylopathy were lower than that of the healthy control group, while the -SH reflecting the metabolic disturbance of free radical was higher. After massotherapy, blood SOD and CAT were increased, while lipid peroxide (LPO), -SH in urine were decreased, demonstrating that there are distinct parallel relationships existing in the changes of these enzymes in blood and urine.

Preliminary study of an increase of a plasma apolipoprotein E variant associated with peripheral nerve damage. A finding in patients with chronic spinal pain

STUDY DESIGN

This two-dimensional gel electrophoretic study analyzed the plasma of six groups of patients to determine the association of an elevated apolipoprotein E variant with peripheral nerve damage (PND).

OBJECTIVES

To find a statistically significant plasma protein alteration in patients with PND including chronic spinal pain.

SUMMARY OF BACKGROUND DATA

A twofold to fivefold increase in human plasma apolipoprotein E may be a physiologic response to PND as a 250-fold local increase in apolipoprotein E was reported in experimental PND studies in mammals.

METHODS

A total of 36 patients with chronic lumbar pain, 28 normal control subjects, and 33 patients with other conditions were studied. Venipuncture was performed and plasma was studied using the technique of two-dimensional gel electrophoresis. Chi-square analysis was used to evaluate results.

RESULTS

A statistically significant (P < 0.005) elevation of the plasma apolipoprotein E variant was found in patients with chronic lumbar pain. It also was elevated in patients with chronic cervical pain, extraspinal pain with PND, and chronic inflammatory diseases; but not in extraspinal pain without PND, or asymptomatic biomechanically deficient lumbar spines.

CONCLUSIONS

This quantitative protein alteration, although not specific for PND, may prove useful in the treatment of conditions with this disorder, including chronic spinal pain.

Increase of serum growth hormone-binding protein in patients with ossification of the posterior longitudinal ligament of the spine

Serum growth hormone-binding protein (GHBP) was measured in 26 patients with ossification of the posterior longitudinal ligament of the spine (OPLL) and 19 age-matched controls. Serum GHBP level was significantly higher in the OPLL group than in the controls, whereas there was no statistical difference between the two groups in serum level of growth hormone, insulin-like growth factor (IGF)-1, and IGF-2. These results, taken together with the hypothesis that serum GHBP reflects the number of GH receptors in tissue, suggest that GH receptors are increased in patients with OPLL.

[Clinical research on the treatment of cervical spondylosis with jingtongning granule]

The authors treated 102 cervical spondylosis patients with jing tong ning granule that made of herbs according to the TCM principle of promoting blood circulation to remove blood stasis. The 9 hemorheological indexes before and after treatment were observed. 15 patients of all were also observed the changes of eyeground microangium. Moreover, the animal experiments were taken in order to test and verify the effects further. The results revealed that the total effective rate was 96.1%. The main hemorheological indexes (eg. blood viscosity and plasma viscosity) showed significant difference in statistics before and after treatment (P less than 0.05, P less than 0.01). The changes of eyeground microangium had significant difference too, (P less than 0.01). The animal experimental results were the same as the clinical ones. Hence, the authors consider that jing tong ning granule had the effects to decrease the blood viscosity, improve microcirculation and accelerate blood flow.

Early and late occurrences of destructive spondyloarthropathy in haemodialysed patients

In a series of 100 patients dialysed for 3 months to 17 years destructive spondyloarthropathy was diagnosed in 11 cases. Lower cervical spine was involved in ten and dorsal spine in one. When compared to patients without arthropathy, spinal involvement was associated with longer duration of dialysis and greater prevalence of parathyroidectomy. The patients with destructive spondyloarthropathy were divided into two groups: Group 1, four patients, in whom arthropathy occurred within the first 41 months of dialysis, and Group 2, seven patients, in whom arthropathy occurred after 106 months of dialysis. Group 1 was associated with greater age, chondrocalcinosis (2 of 4), absence of overt osteoarticular bone defects, and absence of carpal-tunnel syndrome. Parathyroidectomy (PTx) was performed in one patient. Amyloidosis was not found in one patient who came to autopsy. Group 2 was associated with presence of shoulder pain (6 of 7), juxtaarticular bone cysts (6 of 7) and CTS (6 of 7), and absence of radiological chondrocalcinosis. PTx was performed in six of seven patients and amyloidosis was found in three. In conclusion, destructive spondyloarthropathy may be seen early in the course of dialysis, apart from general amyloid involvement of accelereted hyperparathyroidism. A specific finding of this study was the discovery of radiological chondrocalcinosis in association with early arthropathy, which is a well-recognised feature in non-uraemic subjects.

[Plasma levels of vitamins A and E in hyperostosis, ankylosing spondylarthritis and rheumatoid polyarthritis]

In animal and man, chronic intoxication with vitamin A or retinoids may be responsible for vertebral hyperostosis and periosteal appositions. Vertebral hyperostosis is found in hyperostotic disease but also in the course of ankylosing spondylarthritis. Therefore, we felt it would be interesting to study blood retinol levels in 22 patients with hyperostotic disease, 29 patients with ankylosing spondylarthritis, 18 patients with rheumatoid polyarthritis and 21 reference patients. The Kurskal-Wallis test has demonstrated a significant difference of blood retinol levels between these four groups (p less than 0.0001). The blood retinol level was more elevated during hyperostotic disease (3.63 +/- 1.13 mumol/l) than in the reference group (2.94 +/- 0.76) and was, on the contrary, lower during ankylosing spondylarthritis (2.57 +/- 0.66) and rheumatoid polyarthritis (2.32 +/- 0.64). This study confirms the elevation of blood retinol during the course of hyperostotic disease; such a abnormality was not demonstrated in the course of ankylosing spondylarthritis, and on the contrary, suggest that a decreased blood retinol level may be observed during chronic inflammatory rheumatic diseases such as rheumatoid polyarthritis or ankylosing spondylarthritis.

Impaired fibrinolytic activity in defined chronic back pain syndromes

Fibrinolytic activity was studied in 34 patients who had chronic low-back pain of defined types (spondylosis, post-laminectomy and postmyelography-proven arachnoiditis, postlaminectomy and postmyelography-possible arachnoiditis, chronic prolapsed intervertebral disc (PID), spinal stenosis, and nonspecific low-back pain). Fibrinolysis was significantly impaired in the back pain patients as a whole compared with matched controls. Similar changes were observed in all the different back pain syndromes. In the smaller subgroups, these did not reach significance but were significant in spondylosis, proven arachnoiditis, and nonspecific back pain. It is suggested that the abnormal persistence of a defect in fibrinolytic activity, leading to fibrin deposition and chronic inflammation, may be an important factor in the chronicity of many back pain syndromes.

Comparative investigations on vitamin A level of plasma in some rheumatic diseases

The vitamin A levels in the plasma of patients suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis, ankylosing hyperostosis (whether or not connected with diabetes) were investigated. Somatically healthy neurotic patients and patients suffering from diabetes without rheumatological problems served as controls. It was found that the retinol level of plasma decreased in patients of both sexes suffering from rheumatoid arthritis and clinically active ankylosing spondylitis, but increased in female patients suffering from ankylosing hyperostosis connected with diabetes, and also in the diabetes group. The retinyl-esters content of plasma decreased in the rheumatoid arthritis group and increased in female patients suffering from spondylosis and in the clinically inactive ankylosing spondylitis group. The total vitamin A content changed only in the rheumatoid arthritis group where a lower level was found compared to a somatically healthy control group.

Obesity and joint disease

In male mice of strain C57Bl, obesity caused by intraperitoneal administration of aurothioglucose failed to alter the course of spontaneous osteoarthrosis. The distribution of osteoarthrosis of the knee joint and of spondylosis of the thoracic and lumbar spine was haphazard in regard to body weight, and levels of plasma and hepatic lipids. It is concluded that the arthrosis-promoting effects of fat-enriched diets are not mediated by the simultaneously occurring obesity.