Significance of xenon‐133 clearance rate from canine and human joints

Phelps, Paulding; Steele, A. Dean; McCarty, Daniel J.

doi:10.1002/art.1780150407

Cited by 35 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypoxia within the diarthrodial joint may result from decreased 0, levels in arterial blood, impaired synovial membrane permeability (7), diminished effective synovial blood flow (8,9), and/or increased 0, utilization by metabolism of capsular and intrasynovial tissues (4,lO). A prior study assumed arterial Po, levels of 80-120 mm Hg (2).…”

Section: Discussionmentioning

confidence: 99%

Reciprocal relationship of synovial fluid volume and Oxygen tension

Richman

1981

Arthritis & Rheumatism

View full text Add to dashboard Cite

To investigate the impact of synovial fluid volume on oxygen tension (Po,) and other metabolic correlates, 24 specimens of synovial fluid from the knees of 22 patients were analyzed for volume, number of leukocytes (WBC), pH, PO,, Pco,, glucose, protein, and complement (CH50) levels. Concurrent arterial blood samples were obtained in 21 instances. Synovial fluid Po, values varied inversely with volumes of synovial fluid (r = -0.54, P < 0.01), but when patients with rheumatoid arthritis were excluded, the correlation was more significant (r = -0.76, P c 0.001). When synovial fluid Po, dropped below 45 mm Hg, intraarticular acidosis resulted. The decrease in pH (r = 0.93, P < 0.001), the lowering of glucose values (r = 0.89, P < 0.001), and the rise in PCO, (r = -0.79, P < 0.01) can be explained by a shift toward anaerobic metabolism coupled with the impaired elimination of its products. Systemic acidosis and hypoxia were not found. Intraarticular hypoxia most likely represents circulatory imbalance at the level of the synovial membrane, although an inverse relationship of synovial fluid PO, and WBC was also noted. Complement and protein levels had no correlation with volume, pH, or respiratory gas tensions of synovial fluids. Our data support the importance of the effective blood Address reprint requests to George Ho, Jr., MD, Veterans Administration Medical Center, Davis Park, Providence, Rhode Island 02908.Submitted for publication July 8, 1980; accepted in revised form November 25, 1980 flow to the joint in maintaining homeostasis. The volume of synovial effusion and the compliance of the joint c a p sule appear to be important determinants of the articular blood supply.The study of synovial fluid respiratory gases began when easily reproducible measurements of pH, Po,, Pco2, and HCO, by blood gas analyzers became available. Several studies examined the diagnostic specificity of synovial fluid respiratory gases and their metabolic and histologic correlates (1-3). Most have shown that progressive hypoxia was associated with increased glucose consumption leading to lactate accumulation, bicarbonate consumption, acidosis, and hypercapnia. The lowest PO, and pH levels with the highest Pco2 and lactate levels were usually found in synovial fluids from adults with rheumatoid arthritis who had the most advanced histopathologic changes (2). The precise mechanism of intraarticular hypoxia is unknown, but a "circulatory-metabolic" imbalance was proposed and investigated by Goetzl et a1 in 1971 (4). The present study was undertaken to confirm the profound metabolic consequences of intraarticular hypoxia and to examine the influence of synovial fluid volume on respiratory gases in joint effusions of various causes. MATERIALS AND METHODSTwenty-four specimens of synovial fluid from 23 knee joints of 22 patients were obtained during diagnostic or therapeutic arthrocentesis. All patients were supine with the knee in maximal extension. The initial 2-3 ml were aspirated into a heparinized syringe and the remainder was remove...

show abstract

Section: Discussionmentioning

confidence: 99%

Reciprocal relationship of synovial fluid volume and Oxygen tension

Richman

1981

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…In rheumatoid subjects IAP increased to 103 mm Hg (92-118) during exercise (p < 0 01); no significant change was seen in normal subjects. After the addition of intraarticular saline to normal joints, resting and exercise related IAP increased to 18 mm Hg (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and 75 mm Hg (60-117) respectively (both p < 005) (fig 1).…”

Section: Mcp Jointrsmentioning

confidence: 99%

Intra-articular pressure changes in rheumatoid and normal peripheral joints.

Gaffney

Williams

Jolliffe

et al. 1995

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

Objective-To investigate the intraarticular pressure (IAP) dynamics of a spectrum of joints in rheumatoid and normal subjects in order to determine whether a reperfusion event is likely to occur at these sites. Methods-IAP was measured in the metacarpophalangeal (MCP) (n = 8), wrist (n = 8), ankle (n = 4), and elbow joints (n = 4) of rheumatoid subjects, in addition to the MCP (n = 8), wrist (n = 6), and ankle joints (n = 1) of normal healthy controls, using the hand held portable 295-1 IntraCompartmental Pressure Monitor System (Stryker, UK). Results-Resting IAP was positive in all rheumatoid joints, and subatmospheric or weakly atmospheric in normal subjects (p < 0.01). Exercise produced an increase in IAP in rheumatoid subjects only (p < 0.01). The addition ofsaline to normal joints mimiicked the IAP changes seen in the rheumatoid group. Conclusion-These observations suggest that increased resting IAP is a marker for chronic joint inflammation. The IAP increase seen in the rheumatoid group during exercise supports the concept of hypoxic reperfusion mediated joint injury.

show abstract

“…The effects of vehicle components on the synovial lining cells may be limited by their rapid removal from the joint space. In diseased joints containing tense effusions, or in poorly vascularized sites or synovial cysts into which these corticosteroid suspensions may be injected, the effects of MGP and polysorbate 80 could be more sustained (30).…”

Section: Discussionmentioning

confidence: 99%

Suppression of hyaluronic acid synthesis in synovial organ cultures by corticosteroid suspensions

Myers

1985

Arthritis & Rheumatism

View full text Add to dashboard Cite

The effects of sparingly soluble corticosteroid suspensions prepared for intraarticular therapy, of their vehicles, and of hydrocortisone on synovial hyaluronic acid (HA) synthesis were compared in organ cultures of normal canine villous synovium. Both hydrocortisone and the corticosteroid suspensions suppressed HA synthesis, as did 2 vehicle components, polysorbate 80 and myristyl-gamma-picrolinium chloride. Cultures of synovium from joints of dogs which, 1 day previously, had been injected with methylprednisolone acetate suspension synthesized less HA than did control cultures from noninjected joints of the same animals. The results indicate that suppression of HA synthesis is a mechanism by which these drugs can act to reduce joint HA content and promote resolution of synovial effusions.Suspensions of microcrystalline corticosteroids, which can be injected into joints or periarticular tissues, have become important clinical tools for the physician. The soluble corticosteroids first used for intraarticular therapy had beneficial, but transient, effects. The subsequent availability of chemically modilhed and relatively insoluble corticosteroids, such as miethylprednisolone acetate, hydrocortisone tebutate, prednisolone tebutate, and triamcinolone The site of action of these drugs appears to be the synovium, but their effects there have not been well defined. Estimates of the relative efficacy and duration of action of the available formulations have been based on clinical experience gained in treating patients with arthritis (2). Customary doses have been derived empirically, with little information available regarding the joint space bioavailability or half-life of the drugs (1).A satisfactory clinical response to intraarticular corticosteroid treatment usually includes a reduction in the volume of synovial fluid. Several observations suggest that this reflects reduced synovial blood flow, which is produced either by a direct corticosteroid effect on synovial blood vessels or by effects on mediators of vascular resistance or permeability, such as prostaglandins or histamine (3,4). The concentration of hyaluronic acid (HA) in synovial effusions is lower than that in normal joint fluid (3, but large effusions indicate an increase in the total HA content of the joint.It was speculated 30 years ago that corticosteroids might decrease HA synthesis by synovial lining cells and thus reduce the amount of HA present in the joint (6). This hypothesis is consistent with the results of experiments in which hydrocortisone (lo-' to 10-7M) inhibited synthesis of HA and sulfated glycosaminoglycans (GAG) in synovial cell cultures (7,8). Other in vitro studies have demonstrated a suppressive effect of hydrocortisone, dexamethasone, or prednisolone on synthesis of DNA, proteoglycans, prostaglandins, collagen, collagenase, proteoglycanase, catabolin, and other proteins (8-12). There

show abstract

Significance of xenon‐133 clearance rate from canine and human joints

Cited by 35 publications

References 11 publications

Reciprocal relationship of synovial fluid volume and Oxygen tension

Reciprocal relationship of synovial fluid volume and Oxygen tension

Intra-articular pressure changes in rheumatoid and normal peripheral joints.

Suppression of hyaluronic acid synthesis in synovial organ cultures by corticosteroid suspensions

Contact Info

Product

Resources

About