Perioperative management of patients with inflammatory rheumatic diseases : Updated recommendations of the German Society for Rheumatology.

Background: Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014.

Methods: After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added.

[Perioperative management of treatment of patients with inflammatory rheumatic diseases : Updated recommendations of the German Society of Rheumatology].

Background: Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014.

Methods: After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added.

A novel micromotion measurement method to gain instructive insight into the acetabular bone-implant interface.

In total hip arthroplasty insufficient primary stability with excessive bone-implant micromotion is a major reason for aseptic loosening at the acetabular cup implant. In the literature, several methods were proposed for in vitro micromotion measurement, but none is capable of six degrees of freedom measurement at a large number of measuring points over the entire acetabular bone-implant interface, which was the aim of the current scientific work. A pin-sleeve sensor system was developed and an appropriate installing technique was incorporated.

Calcium-sensing receptor-mediated NLRP3 inflammasome response to calciprotein particles drives inflammation in rheumatoid arthritis.

Increased extracellular Ca concentrations ([Ca]) trigger activation of the NLRP3 inflammasome in monocytes through calcium-sensing receptor (CaSR). To prevent extraosseous calcification in vivo, the serum protein fetuin-A stabilizes calcium and phosphate into 70-100 nm-sized colloidal calciprotein particles (CPPs). Here we show that monocytes engulf CPPs via macropinocytosis, and this process is strictly dependent on CaSR signaling triggered by increases in [Ca].

Effects of various anchoring components and loading conditions on primary stability of acetabular revision implant.

Purpose: In revision total hip arthroplasty, until today, orthopaedic surgeons are missing evidence-based guidelines on cementless acetabular cup fixation.

Methods: 5 finite element models were generated featuring the following anchorage strategies: 1 short peg, 1 long peg, 2 long screws, 3 short screws and zero anchoring components for reference. The micromotions at the implant-bone interface were analyzed for 3 different loadcases, "Seated leg-crossing" (joint force 940 N, impingement force 750 N), "Normal gait" (joint force 1820 N), and "Stumbling" (joint force 4520 N).

Shear stress and von Mises stress distributions in the periphery of an embedded acetabular cup implant during impingement.

As literature implies, daily activities of total hip arthroplasty (THA) patients may include movements prone to implant-implant impingement. Thus, high shear stresses may be induced at the acetabular implant-bone interface, increasing the risk of implant loosening. The aim of the current study is to determine whether or not impingement events may pose an actual risk to acetabular periprosthetic bone.

Latent Cytomegalovirus Infection in Rheumatoid Arthritis and Increased Frequencies of Cytolytic LIR-1+CD8+ T Cells.

Objective: Leukocyte immunoglobulin-like receptor 1 (LIR-1) is up-regulated by cytomegalovirus (CMV), which in turn, has been associated with premature aging and more severe joint disease in patients with rheumatoid arthritis (RA). The aim of this study was to investigate the expression and functional significance of LIR-1 in CMV-positive RA patients.

Methods: We determined the phenotype, cytolytic potential, CMV-specific proliferation, and HLA-G-triggered, LIR-1-mediated inhibition of interferon-γ secretion of LIR-1+ T cells in RA patients and healthy controls.

[Surgical treatment of tibialis anterior tendon rupture].

Introduction: Tibialis anterior tendon rupture is rare, with only a few cases and small series having been reported in the literature. In this article, cases reported in the literature from 1997-2012 are reviewed and patients treated by the author are presented.

Materials: Cases published from 1997-2012 needing surgical treatment for tibialis anterior tendon rupture were retrospectively reviewed.

Peripheral CD4CD8 double positive T cells with a distinct helper cytokine profile are increased in rheumatoid arthritis.

Peripheral CD4CD8 double positive (DP) T cells have been reported to play a role in several autoimmune diseases, virus infections and cancer. In rheumatoid arthritis (RA), both CD4 and CD8 single positive (SP) T cells are known to be involved in the pathogenesis, but the role of peripheral CD4CD8 DP T cells has not been investigated in detail. Anti cyclic citrullinated antibodies (ACPA) positive and ACPA negative RA patients, patients with systemic lupus erythematodes (SLE) and age matched healthy donors (HD) were enrolled in the analysis.

Ethanol and formaldehyde fixation irreversibly alter bones' organic matrix.

Introduction: Biomechanical tests on bones are frequently accomplished in anatomically fixed tissues. The effects of ethanol or formaldehyde based fixation in bone material properties are subject to controversial discussions, regarding their appropriateness and usability to answer clinical questioning or biomechanical issues. We hypothesized that ethanol and formaldehyde irreversibly change bone material properties, and that this effect is mainly related to the bone's organic matrix.

Validation of density-elasticity relationships for finite element modeling of human pelvic bone by modal analysis.

In total hip arthroplasty and particularly in revision surgery, computer assisted pre-operative prediction of the best possible anchorage strategy for implant fixation would be a great help to the surgeon. Computer simulation relies on validated numerical models. In the current study, three density-elasticity relationships (No.

Tumor necrosis factor receptor type I expression of CD4+ T cells in rheumatoid arthritis enables them to follow tumor necrosis factor gradients into the rheumatoid synovium.

Objective: The cytokine tumor necrosis factor (TNF) plays a central role in the pathogenesis of rheumatoid arthritis (RA), but its disease-specific effector mechanisms have not been fully elucidated. This study was undertaken to investigate the role of TNF in T cell accumulation and migration in the synovitic joints of RA patients.

Methods: Vital tissue sections from rheumatoid synovium were generated using a horizontally oscillating microtome and were coincubated with fluorescence-labeled CD4+ T cells.

Experimental evidence of impingement induced strains at the interface and the periphery of an embedded acetabular cup implant.

After total hip arthroplasty, impingement of implant components may occur during every-day patient activities causing increased shear stresses at the acetabular implant-bone interface. In the literature, impingement related lever-out moments were noted for a number of acetabular components. But there is little information about pelvic load transfer.

Identification and evaluation of novel synovial tissue biomarkers in rheumatoid arthritis by laser scanning cytometry.

Introduction: Suitable biomarkers are essential for therapeutic strategies in personalized medicine in terms of diagnosis as well as of prognosis. With highly specific biomarkers, it is possible, for example, to identify patients with poor prognosis, which enables early intervention and intensive treatment. The aim of this study was to identify and validate biomarkers and possible combinations for a prospective use in immunoscintigraphy, which may improve diagnosis of rheumatoid arthritis (RA) patients with consideration of inflammatory activity in the affected joints.

Association of anticytomegalovirus seropositivity with more severe joint destruction and more frequent joint surgery in rheumatoid arthritis.

Objective: Expansion of autoreactive CD4+CD28(null) T cells is associated with extraarticular disease manifestations, including rheumatoid vasculitis, and it has recently been demonstrated that expansion of these T cells is associated with anticytomegalovirus (anti-CMV) seropositivity. This study was undertaken to investigate a possible link between latent CMV infection and rheumatoid arthritis (RA).

Methods: In a retrospective analysis, anti-CMV antibodies and clinical, serologic, and radiologic parameters of joint destruction were examined in 202 RA patients and 272 healthy controls.

Combined multi-body and finite element investigation of the effect of the seat height on acetabular implant stability during the activity of getting up.

An important question in assessing the stability of a total hip arthroplasty is the effect of daily physical activities of patients. The aim of this study is to examine these effects when standing up from three different seat heights. A musculoskeletal body model has been modified to simulate the three different seat heights.

Accuracy and reliability of different methods to evaluate the acetabular cup version from plain radiographs.

Purpose: The purpose of this study was to compare different methods of evaluating the version of a metallic acetabular cup from plain radiographs and to compare them regarding their accuracy, inter- and intra-observer reliability.

Methods: Conventional anterior-posterior radiographs were taken of a phantom-model at different defined ante- and retroversion angles of the acetabular cup. The version angles of the acetabular cup were derived according to four different established methods from the radiographs by five independent examiners.

Finite element analysis of shear stresses at the implant-bone interface of an acetabular press-fit cup during impingement.

After total hip replacement (THR) impingement of the implant components causes shear stresses at the acetabular implant-bone interface. In the current study the finite element method (FEM) was applied to analyse the shear stresses at a fully bonded implant-bone interface assuming total ingrowth of the cup. The FE model of a press-fit acetabular component and the proximal part of the femoral component incorporates non-linear material and large sliding contact.

The contact-mediated response of peripheral-blood monocytes to preactivated T cells is suppressed by serum factors in rheumatoid arthritis.

Stimulation of monocytes/macrophages after cell contact with preactivated T cells has been suggested to contribute to the excessive TNF-alpha production in rheumatoid arthritis (RA). In this study, T cell-contact-dependent TNF-alpha production by peripheral-blood monocytes in vitro was investigated and found to be significantly lower in treated and untreated patients with RA than in healthy controls. This suppression was not due to a general deficiency of monocytes to respond, because responses to lipopolysaccharide were comparable in patients and controls.

The influence of head and neck geometry on stability of total hip replacement: a mechanical test study.

Background: Dislocation after replacement may be caused by poor implant design or positioning, or by the surgical approach taken. We evaluated the influence of head and neck design on range of motion and stability (with respect to risk of dislocation) in total hip endoprostheses.

Material And Methods: Using a test device, we determined the stability afforded by different head sizes and neck geometries for various implant positions.

Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement.

After total hip replacement an insufficient range of motion (ROM) can lead to contact between femoral neck and rim of the cup (= impingement) causing dislocation and consecutive material failure. The purpose of this study was to analyse the influence of different wear couples on the ROM and stability against dislocation. By means of a special testing device the ROM until impingement, the ROM until dislocation as well as the resisting moment against levering the head out of the cup were experimentally determined.

High CXCR3 expression in synovial mast cells associated with CXCL9 and CXCL10 expression in inflammatory synovial tissues of patients with rheumatoid arthritis.

To improve our knowledge on the pathophysiology of rheumatoid arthritis (RA), we investigated gene expression patterns in synovial tissue from RA and osteoarthritis (OA) patients. DNA oligonucleotide microarray analysis was employed to identify differentially expressed genes in synovial tissue from pathologically classified tissue samples from RA (n = 20) and OA patients (n = 10). From 7131 gene sets displayed on the microarray chip, 101 genes were found to be upregulated and 300 genes to be downregulated in RA as compared with OA.