Rheumatoid Arthritis: Lemaire R

Solau-Gervais E, Zerimech F, Lemaire R, Fontaine C, Huet G, Flipo RM. · Department of Rheumatology, Roger Salengro Hospital, Lille, France. · Scand J Rheumatol. · Pubmed #17963167 No free full text.

Abstract: OBJECTIVE: To compare the activities of cathepsin B (EC 3.4.22.1) and L (EC 3.4.22.15), calpain (EC 3.4.22.17), and dipeptidyl peptidase (EC 3.4.14.5 or DPP IV or CD26) in synovial membrane from patients with rheumatoid arthritis (RA), osteoarthritis (OA), and post-traumatic joint injury (PT). METHODS: Forty RA patients were divided into two groups on the basis of surgical procedure: the RAs group comprised 18 patients requiring surgical synovectomy; the RAr group comprised 22 patients requiring a total joint replacement or arthrodesis. A third group (the OA group) comprised 19 OA patients while six patients with post-traumatic joint injury were included in the fourth group (the PT group). Cathepsin and calpain activity was assessed using a Cobas Fara II centrifugal analyser. DPP IV activity was determined kinetically using a fluorogenic substrate. RESULTS: RAs patients were significantly younger than RAr patients, and the mean duration of RA was shorter in the RAs group than in the RAr group. Cathepsin and calpain activity in synovial membrane was higher in RA and OA patients than in the control group, but no statistical difference was observed between RA and OA. However, cathepsin, calpain, and DPP IV synovial activity was significantly higher in the RAs group than in either the OA or the PT group. CONCLUSION: Our results show that proteinase activity tends to be higher in joints with early synovitis in RA, and suggest that these enzymes are not all involved at the same stage of the disease.

Popovic N, Lemaire R. · Orthopaedic Department, University Hosptital, Liège, Belgium. · J Arthroplasty. · Pubmed #12820079 No free full text.

Abstract: Femoropatellar problems have been reported with some designs of posterior-stabilized knee prostheses with fixed bearings; we report similar findings with a posterior-stabilized mobile-bearing prosthesis. A review of 184 patients (193 knees) who underwent placement of a Rotaglide (Corin, Cirencester, UK) posterior-stabilized prosthesis with patellar resurfacing showed that only 33 knees (17%) had complete absence of femoropatellar complaints after at least 1 year of follow-up evaluation. Femoropatellar grinding was noted in the other 160 knees; 65 were asymptomatic, 78 were mildly symptomatic, and 17 were severely symptomatic. Two patients refused secondary treatment; 15 underwent arthroscopic debridement. The only abnormal finding was intra-articular fibrosis surrounding the patellar implant. After arthroscopic debridement of the fibrosis, all patients reported immediate relief of their symptoms followed by recurrence within 6 to 9 months. Inappropriate trochlear design of the femoral implant appears to be the main determinant of femoropatellar problems in these patients. Encroachment on the trochlea by a broad intercondylar box with a sharp anterior edge appears detrimental to function irrespective of the presence or absence of bearing mobility.