Rheumatoid Arthritis: Veigl D

Pech J, Veigl D, Dobiás J, Popelka S, Barták V. · I. ortopedická klinika 1. LF UK a FN Motol, Praha. · Acta Chir Orthop Traumatol Cech. · Pubmed #18760084 No free full text.

Abstract: PURPOSE OF THE STUDY: To present the results of total wrist replacement with a cementless prosthesis designed by us. MATERIAL AND METHODS: A group of five men and 27 women treated between 2004 and 2007 was evaluated. The average age was 51.6 years and follow-up ranged from 4 to 38 months, with an average of 9.4 months. Indications for surgery included wrist destruction due to rheumatoid arthritis, arthritis or psoriatic arthropathy. Subjective evaluation recorded satisfaction of the patients with the wrist range of motion, cosmetic appearance of the hand and pain relief. The range of motion was assessed with a goniometer at 4 months of follow-up on average. Radiographs were made immediately after surgery and then at 6 and 12 months post-operatively. RESULTS: All patients reported pain relief, 23 were satisfied with wrist mobility and hand appearance, and seven were only partly satisfied and would have preferred a greater range of motion. Two patients were dissatisfied with an ulnar deviation of the carpal axis and therefore revision arthroplasty of the radial ligamentary and tendinous structures was planned. No aseptic or septic loosening of the implant or its migration was found. DISCUSSION: The current total wrist arthroplasty has evolved from Swanson silastic implants to prostheses with a metal-on-polyethylene bearing whose active surfaces are firmly fixed in bone. In today's Europe, the most frequently used prostheses are Meuli implants or the latest modification of the Guepar implant, which is very close to the Universal 2 implant. In the USA since 1985, Professor's Beckenbaugh's BIAX implant has continuously been improved.The implant designed by us is based on all well-tired implant components and aims at being as similar to the anatomical wrist structures as possible. The socket is fixed in the distal radius. The carpal components involve the main fixation shaft for the third metacarpal and a short antirotation pin for the second metacarpal base. A metal head is assembled onto a tapered shaft extending from the carpal component transversal zone. The implant is made of titanium alloy, in some parts coated with hydroxyapatite; the sockets has a polyethylene liner. CONCLUSION: Total wrist replacement is usually preceded, particularly in surgery for rheumatoid arthritis, by operations intended to prevent or slow down gradual wrist destruction. The usual salvage procedures include surgery on soft tissues (synovectomy, tenodesis, tendon reconstruction) and/or bone (limited wrist arthrodesis, Sauve-Kapandji procedure). These procedures usually have a temporary effect and total replacement will be the next step in surgical treatment. For the most severe destruction associated with subluxation and wrist instability, total arthrodesis in a neutral wrist position still remains the method of choice. The first results with use of the implant of our design show that this total wrist replacement allows us to preserve or restore the wrist range of motion and to improved grip strength.

Hromadnikova I, Nguyen TT, Zlacka D, Sedlackova L, Popelka S, Veigl D, Pech J, Vavrincova P, Sosna A. · Department of Molecular Biology and Cell Pathology, 3rd Medical Faculty, Charles University, Ruska 87, Prague 10, 10000, Czech Republic. · Rheumatol Int. · Pubmed #18231792 No free full text.

Abstract: We examined the membrane expression of inducible Hsp70 and HSP receptors like TLR2, TLR4, CD14, CD36, CD40 and CD91 on fibroblast-like synovial cells (SC) derived from synovial tissue in 23 patients with rheumatoid arthritis (RA), who underwent synovectomy by using flow cytometric analysis. For comparison, autologous skin fibroblasts (SF) derived from the operation wound were tested. Significantly higher Hsp70 expression was found on synovial cells than on skin fibroblasts (median SC 21.4% x SF 5.0%, P < 0.001). Both synovial cells and skin fibroblasts expressed high levels of cell surface CD91 (median SC 80.2% x SF 79.2%), however, no or low levels of CD14, CD40, TLR2, TLR4 and CD36. Further, we observed high co-expression of CD91 and Hsp70 on RA synovial cells (median 18.6%), while skin fibroblasts showed only background Hsp70 expression (median 3.9%, P < 0.001). Since we demonstrated the high prevalence of inducible Hsp70 in RA synovial fluids, we speculate that Hsp70 might be captured onto the membrane of synovial cells from the extracellular space via the CD91 receptor. The significance of the Hsp70 interaction with synovial cells via CD91 remains undefined, but may mediate other non-immune purposes.

Senolt L, Housa D, Vernerová Z, Jirásek T, Svobodová R, Veigl D, Anderlová K, Müller-Ladner U, Pavelka K, Haluzík M. · Institute of Rheumatology, 1st Medical Faculty, Charles University, Na Slupi 4, 12850 Prague 2, Czech Republic, and University Hospital Giessen, Department of Internal Medicine and Rheumatology, Germany. · Ann Rheum Dis. · Pubmed #17040961 No free full text.

Abstract: BACKGROUND: Resistin is a newly identified adipocytokine which has demonstrated links between obesity and insulin resistance in rodents. In humans, proinflammatory properties of resistin are superior to its insulin resistance-inducing effects. OBJECTIVES: To assess resistin expression in synovial tissues, serum and synovial fluid from patients with rheumatoid arthritis, osteoarthritis and spondylarthropathies (SpA), and to study its relationship with inflammatory status and rheumatoid arthritis disease activity. METHODS: Resistin expression and localisation in synovial tissue was determined by immunohistochemistry and confocal microscopy. Serum and synovial fluid resistin, leptin, interleukin (IL)1beta, IL6, IL8, tumour necrosis factor alpha, and monocyte chemoattractant protein-1 levels were measured. The clinical activity of patients with rheumatoid arthritis was assessed according to the 28 joint count Disease Activity Score (DAS28). RESULTS: Resistin was detected in the synovium in both rheumatoid arthritis and osteoarthritis. Staining in the sublining layer was more intensive in patients with rheumatoid arthritis compared with those with osteoarthritis. In rheumatoid arthritis, macrophages (CD68), B lymphocytes (CD20) and plasma cells (CD138) but not T lymphocytes (CD3) showed colocalisation with resistin. Synovial fluid resistin was higher in patients with rheumatoid arthritis than in those with SpA or osteoarthritis (both p<0.001). In patients with rheumatoid arthritis and SpA, serum resistin levels were higher than those with osteoarthritis (p<0.01). Increased serum resistin in patients with rheumatoid arthritis correlated with both CRP (r=0.53, p<0.02), and DAS28 (r=0.44, p<0.05), but not with selected (adipo) cytokines. CONCLUSION: The upregulated resistin at local sites of inflammation and the link between serum resistin, inflammation and disease activity suggest a role for resistin in the pathogenesis of rheumatoid arthritis.

Popelka S, Vavrík P, Pech J, Veigl D. · Ortopedická klinika 1. LF UK, FN Motol. · Acta Chir Orthop Traumatol Cech. · Pubmed #15002348 No free full text.

Abstract: PURPOSE OF THE STUDY: Rheumatoid arthritis affects the foot very frequently. The transversal arch of the foot gradually declines due to the inflammation, the metatarsal heads protrude in the sole of the foot which is accompanied by painful bunions and sometimes also skin necrosis. The great toe turns into a valgus position and pronation. Walking is very painful. MATERIAL: The authors evaluate a group of patients operated on for the deformities of the forefoot between 1995 and 2002. METHODS: In the deformities of the forefoot the authors use resection of the heads of II-V metatarsals. They use a plantar surgical approach during which they remove bunions under the heads of the metatarsals. Then they gradually perform resection of the heads of--V metatarsals. In case of the great toe they prefer resection after Keller. In 5 cases they used fusion of the MTP joint of the great toe. They use fusion only in cases of a marked valgus position of the great toe. Where I MTT was in a significantly varus position, they applied in 3 cases the Lapidus procedure. RESULTS: Between 1995 and 2002 they operated on 92 patients, in 38 of them the surgery was performed bilaterally. Evaluation covered 130 surgeries. In 85 cases the patients had rheumatoid arthritis, in 7 the basic diagnosis was psoriatic arthritis. The group included 72 women and 20 men. The average age at the time of surgery was 38.4 years. Eighty-two (63.1%) patients were without pain 7 (5.4%) patients had severe pain. The authors monitored the occurrence of revalgization of the great toe after Keller resection arthroplasty--of 77 patients revalgization occurred in 23 cases (29.8%). The complications included 3 times a late infect 1-2 years after the surgery after the protrated infect of the organs, 3 times a skin necrosis between the great toe and 2nd metatarsal, when prior to the surgery there was a significant valgus deformity and after the correction of the great toe there was a skin tension in this region, 6 times a delayed healing of the wound on the sole of the foot. DISCUSSION: The authors present different surgical techniques of the forefoot and the great toe of the foot used by different authors. CONCLUSION: As the patients suffer from a polyarticular affection the emphasis is put on the individual approach and a properly timed operation. In this respect of vital importance is the cooperation involving a rheumatologist, orthopaedic surgeon, physical therapist and prosthetic department. Orthopaedic insoles and orthopaedic shoes are an integral part of the comprehensive therapy. Surgical treatment is not very demanding for patients and in most cases it brings a significant relief.