Małgorzata Widuchowska

Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up

BackgroundIf anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed.The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique.MethodsFifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs.ResultsGood overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003).According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05).ConclusionsACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.

Systemic sclerosis without antinuclear antibodies or Raynaud's phenomenon: a multicentre study in the prospective EULAR Scleroderma Trials and Research (EUSTAR) database

OBJECTIVE To assess patients with SSc who present without circulating ANAs or RP. METHODS Five thousand three hundred and ninety patients who fulfilled the ACR criteria for SSc and were enrolled in the EULAR Scleroderma Trials and Research (EUSTAR) database were screened for the absence of both RP and circulating ANA. To differentiate SSc from its mimics, additional information was gathered using a standardized questionnaire. RESULTS Five thousand three hundred and seventy-eight (99.8%) of the 5390 SSc patients in the EUSTAR database had either detectable ANA or a history of RP. Twelve (0.2%) patients lacked both circulating ANA and RP. Details of the medical history could be obtained for seven patients. Three cases were compatible with ANA-negative and RP-negative SSc and were not typical of any known SSc mimic. Four patients had a malignancy: two had breast cancer, one had multiple myeloma with possible scleromyxoedema and one had bladder carcinoma. There was no temporal relationship between the onset of skin fibrosis and that of the tumour. Although no patient with confirmed nephrogenic systemic fibrosis was identified among the cases of ANA-negative and RP-negative SSc, the presentation of one patient could be compatible with that of nephrogenic systemic fibrosis other than for the absence of chronic kidney disease or of known prior gadolinium exposure. CONCLUSION We have identified a very small subgroup of SSc patients who lack both circulating ANA and RP, none of whom fulfils the diagnostic criteria for any known SSc mimic. Prospective studies are needed to elucidate the clinical presentation, evolution and outcome of such patients.

Calprotectin in rheumatic diseases: a review

Calprotectin also known as MRP8/14 or S100A8/A9 is a heterodimeric complex of two S100 calcium-binding proteins: myeloid-related protein 8 (MRP-8 or S100A8) and MRP-14 (or S100A9). At present, according to many authors, it is considered that calprotectin MRP8/14 is a potentially more sensitive biomarker of disease activity in rheumatoid disease than conventional inflammatory indices such as the erythrocyte sedimentation rate, C-reactive protein and others. A review of the literature on concentration of calprotectin in patients with some rheumatic diseases (rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still’s disease, systemic vasculitis, polymyalgia rheumatica, ankylosis spondylitis, systemic lupus erythematosus, and primary Sjögren’s syndrome) is presented.

Subacute cutaneous lupus erythematosus in the course of rheumatoid arthritis: a relationship with TNF-α antagonists and rituximab therapy?

Abstract Introduction: Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is caused by different medicines, first of all: calcium channel blockers, angiotensin converting enzyme inhibitors, thiazides, terbinafine, statins and antagonists of tumor necrosis factor-α (TNF-α). DI-SCLE does not distinguish from idiopathic form of the disease, clinically, histopathologically and immunologically. However, receding of symptoms is observed after recapture of the provoking drug. Aim: To present a patient with rheumatoid arthritis (RA), who developed SCLE after treatment with TNF-α antagonists and rituximab. Case report: In a 31-year-old woman with RA leucopenia due to treatment with etanercept and adalimumab was observed. Therefore, the treatment was changed to rituximab, but after starting the therapy, erythematous and oedematous skin lesions of an oval or annular shape appeared on the cheeks, auricles, lips and the decolette. Histopathological evaluation of the skin lesions revealed SCLE. Ro/SS-A and La/SS-B antibodies were detected in serum. Regression of skin lesions and hematologic disturbances was achieved after starting corticosteroid therapy. Conclusions: Co-existence of SCLE with RA should be considered in some patients. The role of TNF-α antagonists and rituximab therapy in induction of idiopathic form of SCLE requires further investigations.

Serum human cartilage glycoprotein-39 in patients with systemic sclerosis: relationship to skin and articular manifestation

Human cartilage glycoprotein-39 (HC gp-30) is a secretory protein of several types of cells including chondrocytes. It has been suggested to be a laboratory index of joint damage. Thirty-two patients with systemic sclerosis (SSc) and 22 age-matched controls were investigated. An increased serum HC gp-39 level was shown in SSc patients and was found to correlate with inflammatory indices. There was no correlation with modified Rodnan score, joint involvement, or duration of symptoms of SSc. The obtained results indicate for possible relationship of HCgp-39 to inflammation but do not suggest determination of HC gp-39 as clinically applicable index of articular involvement in SSc patients.

Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

Background Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Material/Methods Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul’s method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. Results The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score – UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Conclusions Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

Opinion of patients with ankylosing spondylitis on risk factors impairing their quality of life

We studied 54 patients with ankylosing spondylitis with questionnaire in order to determine their view on threat to quality of their life related to the disease. We have show that pain and significant disability are the main threats associated with the disease in view of the patients. Social aspects (losing of job or decreasing of income) are also important for the patients, while management of the disease is not considered as arduous. The results of patients’ opinion may be helpful in designing of educational programs for them.

Serum cystatin C level in patients with rheumatoid arthritis after single infusion of infliximab

Rheumatoid arthritis (RA) is a chronic inflammatory disease that often leads to impairment of the kidney function. Cystatin C might be used as marker of early renal dysfunction; moreover, it correlates better with GFR than serum creatinine level [1]. Mannge et al. [2] reported that in a group of 56 patients with RA in 60% of patients, serum cystatin C level was increased while only in 3 patients serum creatinine level was increased. The present study was designed to evaluate the effect of infliximab, anti-TNF-a antibody therapy on serum cystatin C level and its association with changes in creatinine, GFR, inflammatory indices (ESR, CRP) and DAS 28 in patients with RA with initially normal creatinine level. Ten RF positive, postmenopausal, no smoking, without diabetes mellitus and hypertension women with RA aged 50.8 ± 5.96 years were investigated. Patients met the 1987 American College of Rheumatology (ACR) criteria for RA. Duration of RA 7.08 ± 1.2 years. All patients were treated with infliximab (3 mg/kg of body mass). Patients were also given prednisone in an unchanged dose of 7.5 ± 1.16 mg/ day and methotrexate in a dose of 15 mg/week. Some authors indicate [3] that change of the steroids dose might influence the serum cystatin C level. Blood samples were obtained at 8:00 AM after overnight fasting, before and one day after the first infusion of infliximab. Serum cystatin C was assayed with ELISA (Human Cystatin C ELISA, Bio Vendor Laboratory Medicine, Inc.) before and after single infusion of infliximab. ESR, CRP, serum creatinine concentration (before and after treatment) were assayed with routine methods. DAS 28 was calculated with commonly used formula; glomerular filtration rate (GFR) was estimated by the Cockroft-Gault (CG) formula. The characteristics of the patients (ESR, CRP, DAS 28, serum creatinine level and GFR) before and after the infusion of infliximab are shown in Table 1. The results were expressed as mean ± standard deviation (SD). Differences were tested for significance using the Student’s t-test or the Wilcoxon test where appropriate. Correlations were assessed using Spearman’s rank correlation. The results are shown in Table 1. After one dose of infliximab, there was a significant increase in mean cystatin C level. Creatinine level and GFR did not change significantly. There was a significant decrease in the disease activity (ESR, CRP, DAS 28). There was no statistical correlation between the evaluated parameters. In the currently published literature, the opinions on influence of inflammatory state on serum cystatin level are controversial. Karstila et al. [4] did not find any influence of inflammatory parameters (CRP, ESR) on cystatin C levels. Knight et al. [1] shown that higher serum CRP levels are associated with higher serum cystatin C levels. In contrast, Bokarewa et al. [5] proved that in patients with RA, there is relationship between serum cystatin C level and serum amyloid A level (SAA), an acute phase reactant. Cystatin C is thought to bind SAA and therefore its serum level might be decreased in patients with active RA. Probably the increase in serum cystatin C level in patients with RA after one dose of infliximab in this study is caused by the decrease in serum SAA, as a result of decrease in the inflammatory process [5] and is not dependent on the renal function. However, there was no statistically significant correlation between serum cystatin M. Kopec-Medrek (&) M. Widuchowska A. Kotulska E. Zycinska-Dębska E. J. Kucharz Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland e-mail: magda.kopec@gazeta.pl