症状性膝骨关节炎的结构相关性。

Structural associations of symptomatic knee osteoarthritis.

机构信息

Arthritis Research UK Pain Centre and University of Nottingham, Nottingham, UK.

出版信息

Arthritis Rheumatol. 2014 Nov;66(11):3018-27. doi: 10.1002/art.38778.

DOI:10.1002/art.38778

PMID:25049144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4309484/

Abstract

OBJECTIVE

Structural changes of osteoarthritis (OA) may occur in the absence of pain. In this study, we aimed to identify histopathologic features that are associated with symptomatic knee OA.

METHODS

Medial tibial plateaus and synovium samples were obtained at the time of total knee replacement (TKR) surgery for OA (advanced OA group) or were obtained postmortem from subjects who had not sought medical attention for knee pain during the last year of life (non-OA control group). To identify features of OA, we compared the patients with advanced OA with the age-matched non-OA controls (n = 26 per group). To identify OA features associated with symptoms, we compared two additional groups of subjects who were matched for severity of chondropathy (n = 29 per group): patients undergoing TKR for symptomatic OA (symptomatic chondropathy group) and postmortem subjects with similar severity of chondropathy who were asymptomatic during the last year of life (asymptomatic chondropathy group). The histologic features of the samples were graded, and immunoreactivities for macrophages (CD68) and nerve growth factor (NGF) in the synovium were quantified. The cellular localization of synovial NGF was determined by double immunofluorescence analysis.

RESULTS

Advanced OA cases displayed more severe changes in the synovium (synovitis, increased synovial NGF, and CD68-immunoreactive macrophages) and cartilage (loss of cartilage surface integrity, loss of proteoglycan, tidemark breaching, and alterations in chondrocyte morphology) than did the non-OA controls. Synovial NGF was localized predominantly to fibroblasts and to some macrophages. The symptomatic chondropathy group displayed greater levels of synovitis, synovial NGF, and loss of cartilage integrity, in addition to alterations in chondrocyte morphology, than did the asymptomatic chondropathy group (P < 0.05 for each comparison).

CONCLUSION

Synovitis, increased synovial NGF, alterations in chondrocyte morphology, and loss of cartilage integrity are features of knee OA that may be associated with symptoms.

摘要

目的

骨关节炎（OA）的结构变化可能在没有疼痛的情况下发生。本研究旨在确定与症状性膝 OA 相关的组织病理学特征。

方法

在全膝关节置换术（TKR）时，从 OA 患者（晚期 OA 组）的内侧胫骨平台和滑膜中获取样本，或从在生命的最后一年中未因膝关节疼痛寻求医疗帮助的患者（非 OA 对照组）死后获取样本。为了确定 OA 的特征，我们将晚期 OA 患者与年龄匹配的非 OA 对照组进行了比较（每组 26 例）。为了确定与症状相关的 OA 特征，我们将两组另外的患者进行了匹配，以匹配软骨病的严重程度（每组 29 例）：患有症状性 OA 并接受 TKR 的患者（症状性软骨病组）和死后患有类似严重程度的软骨病且在生命的最后一年无症状的患者（无症状软骨病组）。对样本的组织学特征进行分级，并对滑膜中的巨噬细胞（CD68）和神经生长因子（NGF）的免疫反应性进行定量。通过双重免疫荧光分析确定滑膜 NGF 的细胞定位。

结果

与非 OA 对照组相比，晚期 OA 病例的滑膜（滑膜炎、滑膜 NGF 增加和 CD68-免疫反应性巨噬细胞）和软骨（软骨表面完整性丧失、糖胺聚糖丧失、潮线破裂和软骨细胞形态改变）的变化更严重。滑膜 NGF 主要定位于成纤维细胞和一些巨噬细胞。与无症状软骨病组相比，症状性软骨病组的滑膜炎、滑膜 NGF 和软骨完整性丧失程度更高，此外还存在软骨细胞形态改变（每种比较均 P <0.05）。