Junichi Nishioka

Immunohistochemical study of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 human intervertebral discs.

Study Design. Immunohistologic staining of human intervertebral discs collected at the time of surgery (100 intervertebral discs from 80 patients) and 10 discs collected from 7 cadavers within 12 hours of death was performed using antimatrix metalloproteinase‐3 monoclonal antibody and antitissue inhibitor of metalloproteinase‐1 monoclonal antibody. Objectives. To examine the relationship between matrix destruction and staining for matrix metalloproteinase‐3 and tissue inhibitor of metalloproteinase‐1 in intervertebral disc degeneration. Summary of Background Data. Matrix metalloproteinase‐3, which decomposes aggregating proteoglycans, has attracted research attention as a substance contributing to matrix destruction in the articular cartilage and intervertebral disc. However, except for a few in vitro studies, the relationship between matrix destruction of the intervertebral disc and matrix metalloproteinase‐3 has been little studied. Methods. Immunohistologic staining was performed to examine the relationship between matrix metalloproteinase‐3 and tissue inhibitor of metalloproteinase‐1 in the intervertebral disc, and the relationship of these two agents to magnetic resonance imaging, radiographic, and surgical findings. Results. Those cases testing positive for matrix metalloproteinase‐3 and negative for tissue inhibitor of metalloproteinase‐1 accounted for most of the surgical specimens. The matrix metalloproteinase‐3‐positive cell ratio was significantly correlated with the magnetic resonance imaging grade of intervertebral disc degeneration, and the matrix metalloproteinase‐3‐positive cell ratio observed in prolapsed lumbar intervertebral discs was significantly higher than that in nonprolapsed discs. In cervical intervertebral discs, the matrix metalloproteinase‐3‐positive cell ratio and staining of cartilaginous endplate were correlated with the size of osteophyte formation. Conclusions. These findings suggested that intervertebral disc degeneration is caused by disturbance in the equilibrium of matrix metalloproteinase‐3 and tissue inhibitor of metalloproteinase‐1, and that matrix metalloproteinase‐3 contributes to degeneration of the cartilaginous endplate.

Association of oestrogen receptor gene polymorphisms with age at onset of rheumatoid arthritis

OBJECTIVE In view of the possible role of oestrogens in the pathogenesis of rheumatoid arthritis (RA), this study investigated the association between oestrogen receptor (OR) gene polymorphisms and RA. METHODS Pvu II and Xba I restriction fragment length polymorphisms of the OR gene were analysed in 70 male and 240 female patients with RA, and in 300 male and 350 female controls. The absence or presence of restriction sites were represented as P, p (Pvu II ) or X, x (Xba I ). The distribution of OR genotypes was compared between the RA and control subjects by sex. RA patients were divided into subgroups according to their OR genotypes, then the age at onset, seropositivity, and rheumatoid nodule positivity were compared between the subgroups. RESULTS The OR genotype frequency of distribution did not have significant differences between the male RA and male controls nor between the female RA and female controls. In women with RA, there was a significant difference of age at onset between the subgroups (uncorrected p=0.047, corrected p=0.94). Female patients with the OR genotype PPxx (homozygote of Px) tended to have developed RA at a younger age, whereas those with PPXX and ppxx (lack of Px haplotype) developed RA at an older age. In men with RA, there was no association between the OR genotype and age at onset. In seropositivity and rheumatoid nodule positivity, there was no significant difference between subgroups for either sex. CONCLUSIONS Some variants of the OR gene are related to the onset of RA in women in certain age periods, suggesting the role of the interaction between the OR gene and serum concentrations of oestrogen at the onset of the disease.

Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty.

In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA.

Older age onset rheumatoid arthritis with or without osteoarthritis

The clinical features of a group of 79 patients with older age onset rheumatoid arthritis (ORA) were compared with those of a group of 414 patients with younger age onset rheumatoid arthritis. The ORA group contained approximately equal numbers of men and women, were less rheumatoid factor positive, had a raised erythrocyte sedimentation rate, lower HLA-DR4 positivity, and a tendency towards larger joint involvement at the onset of the disease. These features have been reported by many authors except for the lower DR4 positivity. Of these features, the lower prevalence of rheumatoid factor positivity and the tendency towards larger joint involvement at the onset were characteristic of a subset of patients with ORA who had had osteoarthritis before the onset of rheumatoid arthritis. It is suggested that osteoarthritic large joints may be susceptible to the occurrence of rheumatoid synovitis at the onset of the disease, but that the osteoarthritis inducing factor may be negatively related to the progression of rheumatoid arthritis.

Rupture of the Achilles tendon in rheumatoid arthritis with histologic evidence of enthesitis. A case report.

Spontaneous Achilles tendon rupture occurred in a 60-year-old man with a two-year history of sero-positive rheumatoid arthritis (RA). Histologic section of the ruptured Achilles tendon revealed the existence of rheumatoid granulation that consisted of lymphocytes, histiocytes, and small vascular proliferation within the tendon tissue. The enthesis of the tendon to the calcaneus also revealed lymphocyte infiltration in the bone marrow and rheumatoid granulation within the tendon. Throughout the course of his disease, the patient had not been treated with corticosteroids. These facts suggested that enthesis (attachment of tendon to bone) was one of the extraarticular sites of the rheumatoid inflammation and that enthesitis was a possible cause of Achilles tendon rupture in this RA patient.

Intramedullary fibular graft for supracondylar fracture of the femur following total knee arthroplasty

We describe a successful treatment, intramedullary fibular grafting, for a patient with a supracondylar fracture of the femur following total knee arthroplasty in which the fracture region was comminuted and a segmental large bone defect was present. Free autogenous fibular was inserted into the medullary cavity from the intercondylar region and fixed to the proximal fragment of the femur with augmented fixation using a small plate and screws. Our procedure makes it easy to perform large segmental bone grafting and internal fixation at the same time for such a condition.

Increased rate of hysterectomy in women undergoing surgery for osteoarthritis of the knee

We performed a case-controlled study to determine whether previous gynecological surgery is associated with severe osteoarthritis (OA) of the knee, the hip or the spine, as well as mild OA of the knee. Patients who underwent surgical treatment for OA were defined as having severe OA. Patients with knee pain and radiographic grade 2 OA in a tibiofemoral joint on the Kellgren and Lawrence scale were defined as having mild knee OA. An increased rate of hysterectomy was observed in the severe knee OA group after adjustment for age and number of children, or even after adjustment for body mass index. Hysterectomy in this group was most often performed for myoma uteri. Patients with mild knee OA tended to have previous hysterectomy. From the results, we speculate that certain subsets of OA which often take a progressive course might be related to hysterectomy.

Cervical myelopathy caused by calcium pyrophosphate dihydrate crystal deposition in facet joints. A case report.

Study Design This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically. Objectives To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patients surgery. Summary of Background Data Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur. Methods Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically. Results The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals. Conclusions The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.