Book•
Diagnosis of Bone and Joint Disorders
01 Dec 1987-
TL;DR: This book discusses Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases and their applications in Musculoskeletal Diseases.
Abstract: Volume I: Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases. Imaging of the Postoperative Patient . Volume II: Basic Sciences of Musculoskeletal Diseases. Rheumatoid Arthritis and Related Diseases. Connective Tissue Diseases . Volume III: Degenerative Diseases. Crystal-Induced and Related Diseases. Temporomandibular Manifestations of Articular Diseases. Target Area Approach to Articular Diseases. Volume IV: Metabolic Disease. Endocrine Diseases. Diseases of the Hematopoietic System. Infectious Diseases. Volume V: Traumatic, Iatrogenic and Neurogenic Diseases. Osteonecrosis and Osteochondrosis. Volume VI: Tumours and Tumor-Like Diseases. Congenital Diseases. Miscellaneous Diseases
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729 citations
TL;DR: Results suggest a model for understanding the pathogenesis of aggressive bone erosions in PsA, where OCPs arise from TNF-alpha-activated PBMCs that migrate to the inflamed synovium and subchondral bone, where they are exposed to unopposed RANKL and T NF-alpha.
Abstract: Psoriatic arthritis (PsA) is an inflammatory joint disease characterized by extensive bone resorption. The mechanisms underlying this matrix loss have not been elucidated. We report here that blood samples from PsA patients, particularly those with bone erosions visible on plain radiographs, exhibit a marked increase in osteoclast precursors (OCPs) compared with those from healthy controls. Moreover, PsA PBMCs readily formed osteoclasts in vitro without exogenous receptor activator of NF-kappaB ligand (RANKL) or MCSF. Both osteoprotegerin (OPG) and anti-TNF antibodies inhibited osteoclast formation. Additionally, cultured PsA PBMCs spontaneously secreted higher levels of TNF-alpha than did healthy controls. In vivo, OCP frequency declined substantially in PsA patients following treatment with anti-TNF agents. Immunohistochemical analysis of subchondral bone and synovium revealed RANK-positive perivascular mononuclear cells and osteoclasts in PsA specimens. RANKL expression was dramatically upregulated in the synovial lining layer, while OPG immunostaining was restricted to the endothelium. These results suggest a model for understanding the pathogenesis of aggressive bone erosions in PsA. OCPs arise from TNF-alpha-activated PBMCs that migrate to the inflamed synovium and subchondral bone, where they are exposed to unopposed RANKL and TNF-alpha. This leads to osteoclastogenesis at the erosion front and in subchondral bone, resulting in a bidirectional assault on psoriatic bone.
581 citations
TL;DR: Two complementary approaches underlie the study of evolutionary morphology—one a direct result of the Darwinian revolution, the other with roots that can be traced back to pre-Darwinian times.
Abstract: Two complementary approaches underlie the study of evolutionary morphology—one a direct result of the Darwinian revolution, the other with roots that can be traced back to pre-Darwinian times. The former focuses on the issue of diversity and the origin of adaptation. Morphological change is depicted as a chronological progression of various combinations of adaptations and preadaptations (e.g., Bock, 1977). To define a morphological adaptation one has to focus on the relationships between form and function, i.e., on the selective pressures that fuel evolutionary change. This approach is dominated by an attempt to characterize the organism-environment interrelationship via the concept of natural selection as the driving force for morphological diversification. Conversely, the second approach, adopted in this work, seeks the structural and morphogenetic unity within diverse forms irrespective of the functional or adaptive differences between them. Essentially typological, its method goes back to the ideas of the German Naturphilosophie and French transcendental schools of morphology (Russell, 1916), and it addresses the ordered diversity of forms from the perspective of internal organization.
562 citations
TL;DR: Investigation of human cadaveric spinal motion segments found that segmental motion increased with increasing severity of disc degeneration up to Grade IV, but decreased in both genders when theDisc degeneration advanced to Grade V, and the effects of Disc degeneration on the motion were similar between genders.
Abstract: STUDY DESIGN A biomechanical and imaging study of human cadaveric spinal motion segments. OBJECTIVE To investigate the effect of both disc degeneration and facet joint osteoarthritis on lumbar segmental motion. SUMMARY OF BACKGROUND DATA Spinal degeneration includes the osteoarthritic changes of the facet joint as well as disc degeneration. Disc degeneration has been reported to be associated with spinal motion. The association of facet joint osteoarthritis with lumbar segmental motion characteristics and the combined influence of disc degeneration and facet osteoarthritis has not yet been investigated. METHODS A total of 110 lumbar motion segments (52 female, 58 male) from 44 human lumbar spines were studied (mean age = 69 years). Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the osteoarthritic changes in the facet joints in terms of cartilage degeneration, subchondral sclerosis, and osteophytes. Disc height, endplate size, and facet joint orientation and width also were measured from the computed tomographic images. Rotational movements of the motion segment in response to the flexion, extension, lateral bending, and axial rotational moments were measured using a three-dimensional motion analysis system. RESULTS Female motion segments showed significantly greater motion (lateral bending: P < 0. 001, flexion: P < 0.01, extension: P < 0.05) and smaller endplate size (P < 0.001) than male ones. The segmental motion increased with increasing severity of disc degeneration up to Grade IV, but decreased in both genders when the disc degeneration advanced to Grade V. In male segments, the disc degeneration-related motion changes were significant in axial rotation (P < 0.001), lateral bending (P < 0.05), and flexion (P < 0.05), whereas female segments showed significant changes only in axial rotation (P < 0.001). With cartilage degeneration of the facet joints, the axial rotational motion increased, whereas the lateral bending and flexion motion decreased in female segments. In male segments, however, motion in all directions increased with Grade 3 cartilage degeneration and decreased with Grade 4 cartilage degeneration. Subchondral sclerosis significantly decreased the motion (female: axial rotation, P < 0. 05; extension, P < 0.05 vs.- male:flexion,P < 0.05). Severity of osteophytes had no significant association with the segmental motion. CONCLUSION Axial rotational motion was most affected by disc degeneration, and the effects of disc degeneration on the motion were similar between genders. Facet joint osteoarthritis also affected segmental motion, and the influence differed for male and female spines. Further studies are needed to clarify whether the degenerative process of facet joint osteoarthritis differs between genders and how facet joint osteoarthritis affects the stability of the spinal motion segment.
558 citations
Cites background from "Diagnosis of Bone and Joint Disorde..."
...and decreased range of motion of the joint.(45) The facet joints are one of the main structures for the stability of the spinal motion segment....
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TL;DR: Methodology and techniques for the evaluation of new agents for OA have been refined dramatically over the last decade and studies are needed to validate surrogate markers of disease activity, since they may help shorten Phase 2 structure modifying drug trials.
545 citations