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ID PMID Title PublicationDate abstract
10975862 Persistent induction of the chemokine receptor CXCR4 by TGF-beta 1 on synovial T cells con 2000 Sep 15 Chemokines and their receptors determine the distribution of leukocytes within tissues in health and disease. We have studied the role of the constitutive chemokine receptor CXCR4 and its ligand, stromal-derived factor-1 (SDF-1) in the perivascular accumulation of T cells in rheumatoid arthritis. We show that synovial T cells, which are primed CD45RO+CD45RBdull cells and consequently not expected to express constitutive chemokine receptors, have high levels of the chemokine receptor CXCR4. Sustained expression of CXCR4 was maintained on synovial T cells by specific factors present within the synovial microenvironment. Extensive screening revealed that TGF-beta isoforms induce the expression of CXCR4 on CD4 T cells in vitro. Depletion studies using synovial fluid confirmed an important role for TGF-beta1 in the induction of CXCR4 expression in vivo. The only known ligand for CXCR4 is SDF-1. We found SDF-1 on synovial endothelial cells and showed that SDF-1 was able to induce strong integrin-mediated adhesion of synovial fluid T cells to fibronectin and ICAM-1, confirming that CXCR4 expressed on synovial T cells was functional. These results suggest that the persistent induction of CXCR4 on synovial T cells by TGF-beta1 leads to their active, SDF-1-mediated retention in a perivascular distribution within the rheumatoid synovium.
9301548 Detection of p53 in inflammatory tissue and lymphocytes using immunohistology and flow cyt 1997 Aug AIMS: To analyse the expression of p53 in lymphatic cells found in inflammatory tissues and the peripheral blood by immunological methods. METHODS: Immunohistological analysis of synovial tissues from patients with rheumatoid arthritis and flow cytometric analysis of peripheral blood lymphocytes were performed with anti-p53 antibodies from different sources. RESULTS: The anti-p53 antibodies PAb240, PAb421, and PAb1801 from one supplier bound to the cytoplasm of lymphocytes, fibroblasts, and endothelial cells in rheumatoid synovial tissue, while the same anti-p53 antibodies from other sources and the p53 specific antibodies PAb1620 and DO1 were negative. Using flow cytometry, the antibodies that labelled cells in inflammatory tissues were shown to bind also to peripheral lymphocytes, while the antibodies that were negative in immunohistology did not react with peripheral blood lymphocytes. p53 expression could be confirmed by western blot in rheumatoid synovial tissue, but not in peripheral blood lymphocytes using PAb421 and PAb240 antibodies from our own laboratory, which had been negative in immunohistology. CONCLUSIONS: Demonstration of p53 by western blot is more sensitive and reliable than immunohistology and flow cytometry. Western blot is the gold standard for the demonstration of p53 expression and should be used, whenever possible, to confirm p53 expression in normal tissue shown by immunohistology or flow cytometry. All other reports on p53 expression, especially those obtained using antibodies with an unusual staining pattern must be interpreted with caution.
11036825 Cyclosporin A inhibits CD69 expression induced on synovial fluid and peripheral blood lymp 2000 Oct OBJECTIVE: To study the modulation of CD69 expression on peripheral blood (PB) and synovial fluid (SF) lymphocytes by interleukin 15 (IL-15) and several other cytokines and chemokines widely detected in the rheumatoid microenvironment. The effect of cyclosporin A (CSA) or methotrexate (MTX) in the cytokine mediated regulation of CD69 was analyzed. METHODS: CD69 expression on lymphocytes was assessed by flow cytometry after incubation with different cytokines, chemokines, phorbol myristate acetate, or calcium ionophore in the presence or absence of CSA, MTX, or both. The effect of IL-15 and SF supernatants in maintaining CD69 expression on SF lymphocytes was also assessed. IL-15 levels in SF supernatants were measured by ELISA. RESULTS: IL-15 induced the greatest upregulation of CD69 expression on PB lymphocytes in a time and dose dependent manner. IL-15 was able to maintain a high CD69 expression on SF lymphocytes. SF supernatants from rheumatoid arthritis (RA), which contain significant amounts of IL-15, also reversed the CD69 downregulation of SF lymphocytes in culture. CSA, but not MTX, inhibited the CD69 upregulation mediated by IL-15 both in PB and SF lymphocytes. CONCLUSION: IL-15 appears to be responsible, at least in part, for the high CD69 expression on lymphocytes from the rheumatoid microenvironment. Consistent with the virtual absence of lymphocyte derived cytokines in RA synovium, the prevention of IL-15 mediated CD69 upregulation on lymphocytes may explain the effect of CSA in the treatment of RA.
10381062 Complete heart block as a rare complication of treatment with chloroquine. 1999 Jun Antimalarials are well established disease modifying antirheumatic drugs. A rare and underappreciated treatment difficulty is cardiac complication, in particular conduction disturbances. We describe 2 more patients that developed complete heart block after high dose, longterm treatment. Patient 1, a 73-year-old woman with longstanding rheumatoid arthritis, had taken chloroquine (250 mg/day) for 12 years when she developed complete heart block requiring a permanent pacemaker. Patient 2, a 40-year-old woman with discoid lupus erythematosus, was taking chloroquine from 1979 until 1996. Depending on the clinical disease activity, she intermittently increased the dose from 250 to 750 mg/day. In 1994, she developed complete heart block and a permanent pacemaker had to be implanted. Intensive investigations in both cases did not reveal another underlying cause for conduction disturbances; the atrioventricular block was probably due in both cases to chloroquine related cardiac toxicity. This toxicity seems to be restricted to longterm, high dose treatment; however, it should be kept in mind in patients with preexisting conduction disturbances during longterm treatment.
9620192 Continuous passive motion following metacarpophalangeal joint arthroplasty. 1998 May To determine whether a postoperative rehabilitation protocol incorporating continuous passive motion would increase the total range of motion obtained 6 months following silicone interposition arthroplasty of the metacarpophalangeal joints in patients with rheumatoid arthritis, a prospective trial randomizing patients to receive either continuous passive motion or the standard dynamic splint protocol (modified Madden protocol) was undertaken. Fifteen hands (60 joints) were treated with the modified Madden protocol and 10 hands (40 joints) had continuous passive motion. The mean 6-month postoperative range of motion was 7 degrees in the modified Madden cohort compared with 39 degrees in the continuous passive motion cohort, representing an improvement of 22 degrees in the modified Madden cohort compared with an improvement of only 5 degrees in the continuous passive motion cohort. Residual ulnar deviation 8 degrees vs 12 degrees and grip strength (2.3 kgf v 3.7 kgf) were both lower in the continuous passive motion cohort. Incorporation of the continuous passive motion machine in the postoperative rehabilitation protocol does not offer sufficient advantages to justify the added costs.
10861584 Follicular dendritic cells share a membrane-bound protein with fibroblasts. 2000 Jun The expression of a fibroblast antigen (AS02) on a proportion of CD21+ follicular dendritic cells (FDCs) provides evidence in support of their fibroblastic reticular origin. This antigen is expressed on the membrane of tissue fibroblasts but is absent from lymphocytes, macrophages or granulocytes. The distribution of AS02 in conjunction with other FDC markers (DRC-1, RFD3, CD23, IgM, and vitronectin) showed six types of FDCs. AS02 is present in the outer layers of primary and secondary follicles, but gradually decreases and disappears in the centre of germinal centres. In contrast, there is a progressive up-regulation of the other FDC markers. AS02 is re-expressed in involuting FDCs. Intermediate forms from fibroblastic to dendritic appearance are also apparent and occasionally FDC processes contain collagen type I and IV fibres, a characteristic feature of fibroblasts. In pathological follicles the normal differentiation pattern is disrupted, with persistence of the fibroblast marker, possibly due to altered interactions between FDCs and disrupted lymphocytic patterns. These findings provide new evidence for a local differentiation pathway of fibroblasts to mature FDCs.
9585927 [Ankle prostheses. Mid-term results after Thompson-Richards and STAR prostheses]. 1998 Mar Thirty-seven patients with 20 cemented Thompson-Richards prostheses and 19 cementless S.T.A.R. prostheses (2 bilateral cases) were followed up after 1-12 years. Rheumatoid arthritis was the main diagnosis in both populations, with females dominating. The investigation was based on the Kofoed ankle score. At follow-up the total scoring improved to 86.9 pts. in S.T.A.R. and to 77.7 pts. in T.R.P. replacement. The radiological examination showed a high rate of radiolucency for the tibial component (53.3%) in cemented T.R.P.; subsidence of talar component was seen in 3 cases with T.R.P. In cementless S.T.A.R. prothesis only 3 cases showed small radiolucent lines of the flat tibial component. Talar subsidence was not seen at all. In T.R.P. we had two revisions due to prothesis loosening and one maleollar fracture, giving a cumulative estimated survival rate of 87% at 12 years. In the S.T.A.R. prosthesis group two revisions had to be performed because of one meniscal breakage and correction of meniscal height. The estimated survival rate at 6 years was 94.3%.
10546617 Total condylar knee arthroplasty. 16- to 21-year results. 1999 Oct This study presents long term results of arthroplasty with posterior cruciate retention using the Total Condylar Knee implant. From 1976 to 1982, 139 patients had 159 knee arthroplasties using Total Condylar Knee prostheses. Sixty-three patients (72 knees) were available for followup at a minimum of 16 years (range, 16-21 years). The average age of the patients at the time of surgery was 61 years. There were 21 men and 42 women. Patients with 68 knees had osteoarthrosis, three had rheumatoid arthritis and one had posttraumatic arthritis. There were five delayed complications. One patient (one knee) underwent revision surgery and two patients (two knees) declined revision surgery because they were considered to be high surgical risks, as determined by their internists. The average preoperative score was 40.3 points and improved to 88.4 points at followup. Eighty-seven percent of the patients had a score equal to or more than 85 points at last evaluation. Prosthesis survivorship at 20 years was 98.6% for patients who had revision surgery. No femoral components were revised for aseptic loosening. Retention of the posterior cruciate in Total Condylar Knee prosthesis produces results comparable with the results of the original Total Condylar Knee prosthesis with cruciate sacrifice.
10688908 Expression and function of wingless and frizzled homologs in rheumatoid arthritis. 2000 Mar 14 Rheumatoid arthritis (RA) is accompanied by synovial inflammation, proliferation, and cartilage destruction. The reasons the activation of synovial fibroblasts often persists despite antiinflammatory therapy are not known. One possibility is that the synovial membrane becomes gradually repopulated with immature mesenchymal and bone marrow cells with altered properties. To explore this hypothesis, we have investigated the expression in RA synovial tissues of various embryonic growth factors from the wingless (wnt) and frizzled (fz) families, which have been implicated in cell-fate determination in both bone marrow progenitors and limb-bud mesenchyme. Reverse transcriptase-PCR analysis revealed expression of five wnt (wnt1, 5a, 10b, 11, and 13) and three fz (fz2, 5, and 7) isoforms in RA synovial tissues. Osteoarthritis synovial tissues expressed much less wnt5a and fz5. Northern blotting confirmed the overexpression of wnt5a and fz5 in RA synovial tissues, in comparison to a panel of normal adult tissues. Compared with normal synovial fibroblasts, cultured RA fibroblast-like synoviocytes expressed higher levels of IL-6, IL-8, and IL-15. Transfection of normal fibroblasts with a wnt5a expression vector reproduced this pattern of cytokine expression and stimulated IL-15 secretion. These results suggest that the unusual phenotypic properties of RA fibroblasts may be attributable partly to their replacement with primitive fibroblast-like synoviocytes with characteristics of immature bone marrow and mesenchymal cells. Clear delineation of the signaling pathway(s) initiated by the wnt5a/fz5 ligand-receptor pair in the RA synovium may yield new targets for therapeutic intervention.
10504165 Outer causes inner conflicts: environment and autoimmunity. 1999 Oct Autoimmune diseases are some of the most common yet least understood maladies in medicine today. Some estimates place the number of sufferers of such diseases as high as 20% of the U.S. population, most of them women. The disorders involved range from the familiar to the relatively uncommon to the obscure. What these disorders have in common is that they cause the immune system to attack the body's own tissues. Uncertainty in the field of autoimmune disease extends even to the fundamental questions of what an autoimmune disease is and how many people are affected; identifying specific environmental risk factors for autoimmune diseases is still highly speculative. To gain some sense of direction, scientists are looking at a few documented environmental exposures that have led to autoimmune syndromes, as well as some animal models that exhibit autoimmune syndromes similar to those seen in humans. At a September 1998 NIEHS workshop on environmental links to autoimmune diseases, participants prioritized research needs in five main categories, a step that should help scientists develop strategies for investigating this family of diseases.
11060790 Immunoadsorption, current status and future developments. 2000 Sep The association of abnormalities in the cellular and humoral immune system with various autoimmune diseases provides the rationale for apheresis technologies. While plasmapheresis or plasma exchange is limited by its non-selective removal of all plasma components, modern apheresis techniques aim to provide more specific elimination according to clinical needs and avoid plasma product replacement. However, the commercialisation has not met the expectations in the early 80's and the number of patients treated by extracorporeal immunoadsorption remains small due to a lack of well-defined controlled trials and limited reimbursement. This review highlights the immunological and technical basis for extracorporeal immunoadsorption, as well as its current status in the treatment of immunologically-mediated diseases.
11672959 The 3-week sulphasalazine syndrome strikes again. 2001 Nov 1 A 34-year-old lady developed a constellation of dermatitis, fever, lymphadenopathy and hepatitis, beginning on the 17th day of a course of oral sulphasalazine for sero-negative rheumatoid arthritis. Cervical and inguinal lymph node biopsies showed the features of severe necrotising lymphadenitis, associated with erythrophagocytosis and prominent eosinophilic infiltrates, without viral inclusion bodies, suggestive of an adverse drug reaction.A week later, fulminant drug-induced hepatitis, associated with the presence of anti-nuclear autoantibodies (but not with other markers of autoimmunity), and accompanied by multi-organ failure and sepsis, supervened. She subsequently died some 5 weeks after the commencement of her drug therapy.Post-mortem examination showed evidence of massive hepatocellular necrosis, acute hypersensitivity myocarditis, focal acute tubulo-interstitial nephritis and extensive bone marrow necrosis, with no evidence of malignancy. It is thought that the clinico-pathological features and chronology of this case bore the hallmarks of the so-called "3-week sulphasalazine syndrome", a rare, but often fatal, immunoallergic reaction to sulphasalazine.
11296546 Differential regulation of interleukin-1 beta-induced cyclooxygenase-2 gene expression by 2001 Osteoarthritic (OA) human synovial fibroblasts (HSF) in culture were treated with the preferential COX-2 inhibitors nimesulide or NS-398, the non-specific COX-1/COX-2 inhibitor naproxen, or dexamethasone, in the presence or absence of IL-1 beta or LPS. Nimesulide or NS-398 inhibited IL-1 beta-induced PGE2 production at all concentrations tested, and in addition they suppressed IL-1 beta-induced COX-2 mRNA expression and protein synthesis. These suppressive effects were most evident at therapeutic levels of the drugs. Mechanistic studies revealed that the drug-induced inhibition of COX-2 expression and synthesis was not promoter-based, but may be associated with the blockade of IL-1 beta-dependent calcium flux and increased cellular calcium levels.
10788537 Radiographic joint space in rheumatoid glenohumeral joints. A 15-year prospective follow-u 2000 Mar OBJECTIVE: To evaluate radiographically the glenohumeral (GH) joint space in patients with long-term rheumatoid arthritis (RA). METHODS: A cohort of 74 patients with RA were followed prospectively for 15 yr. At the end point, 148 shoulders were radiographed using a standard method. The GH joint space was examined from the radiographs using a method developed previously for population studies; the joint space was measured at three different sites and the average of the three measurements, the integral space, was calculated. Destruction of the GH joints was assessed with the Larsen method on a scale of 0-5 and compared with the joint space measurements. RESULTS: The mean GH joint space in RA patients was 3. 1 (S.D. 3.3), range -17.3 to 5.7 mm; 2.7 mm (S.D. 4.5) in men and 3. 2 mm (S.D. 2.8) in women. The mean of the affected joints (Larsen grades 2-5), 1.7 mm (S.D. 4.5), was notably narrower than the mean 4. 4 mm (S.D. 0.6) of the non-affected (Larsen grades 0-1) joints. Pathological GH joint space, less than 2 mm, was found in five (15%) of 36 joints in men and in 14 (13%) of 112 joints in women. All the joints graded as Larsen 4 and 5 (n = 17) fulfilled this pathological criterion. Joint space narrowing was associated [r = - 0.66, 95% confidence interval (CI): -0.56 to -0.75] with increasing destruction (Larsen grading) of the joint. The narrowing was significant between non- (Larsen 0, 1), moderately (Larsen 2, 3) and severely (Larsen 4, 5) affected joints (P < 0.001). However, a remarkable step in this process occurred between Larsen grades 3 and 4 when the mean joint space diminished from 3.1 to 0.3 mm. CONCLUSIONS: Joint space narrowing is a frequent consequence of GH joint rheumatoid affection. However, joint space narrowing is a late phenomenon occurring not until after marked erosive destruction, which should be noted when using the Larsen method for GH joints.
10498346 The effect of a joint protection education programme for people with rheumatoid arthritis. 1999 Oct OBJECTIVE: To evaluate the effects of an education programme in improving adherence with joint protection by people with rheumatoid arthritis (RA). DESIGN: A repeated measures design. Subjects were assessed at six weeks and one week before and six and twelve weeks after education. SETTING: Rheumatology unit in a large district general hospital. SUBJECTS: Twenty-one people diagnosed with RA (mean age 48.95 years (SD 12.54) and disease duration of 6.43 years (SD 7.7) ). INTERVENTION: An 8-hour arthritis education programme delivered over four sessions, including two hours of joint protection education designed to be typical of current UK practice. MAIN OUTCOME MEASURES: The Joint Protection Behaviour Assessment (JPBA), an observational assessment of hand joint protection methods used during kitchen activities, to measure adherence with education. Other assessments included a joint protection knowledge questionnaire, hand joint counts, hand pain visual analogue scale, the Health Assessment Questionnaire (HAQ) and HAQ Pain scale to identify any short-term changes in hand pain, pain on activity and functional status. At the beginning and end of the study subjects were interviewed to obtain their self-report of joint protection behaviours and reasons for following or not following the advice given. RESULTS: Median JPBA scores did not improve pre- to posteducation (18.4% to 23.7%; p = 0.65) and neither did hand joint count, hand pain, HAQ and HAQ Pain scores. However, joint protection knowledge improved significantly (p = 0.01) and the majority of people believed joint protection to be a beneficial strategy. Reasons for not changing behaviour included problems recalling information; joint protection being considered inappropriate as 'hands were not that bad yet'; lack of skill; and difficulties changing habits. CONCLUSION: The joint protection education programme improved knowledge but not use of taught methods. Educational strategies being used by therapists need to be focused on enhancing adherence.
10949717 Colour Doppler ultrasonography to detect pannus in knee joint synovitis. 2000 Jul OBJECTIVE: To determine if colour Doppler ultrasonography can characterise the nature of intraarticular echogenic structures and synovial villi more precisely than conventional ultrasonography. METHODS: This is a prospective study on 20 patients--10 with rheumatoid arthritis and 10 with osteoarthritis. Colour Doppler ultrasonography of the knee joints was performed prior to total prosthetic replacement. Two independent, trained physician ultrasonographers examined the knee to be replaced with different ultrasound equipment using colour Doppler and power Doppler ultrasonography. The existence and extent of pannus were then assessed surgically and histologically. RESULTS: All 9 patients with histologically detected pannus had perfused, echogenic, intraarticular structures (ultrasonographer 2; ultrasonographer 1: 8 out of 9 patients). Sparse perfusion was detected in 1 patient (investigator 1) and in 5 patients (investigator 2) with extensive non-destructive synovial proliferation. Colour Doppler and power Doppler ultrasonography were equivalent in detecting small intraarticular vessels. CONCLUSION: Colour Doppler ultrasonography improves the differentiation of intraarticular structures compared to conventional ultrasonography.
9418630 Cost effectiveness and quality of life in knee arthroplasty. 1997 Dec Few studies quantitate the cost of a quality well being as produced by arthroplasty surgery. The objective was to use the Quality of Well Being Index to calculate the cost per quality of well year in knee arthroplasty surgery. The difference in Quality of Well Being Index scores before and after the intervention was calculated and multiplied by the patient's life expectancy. The procedure cost was divided by this quantity resulting in the cost of a quality well year. One hundred patients underwent a primary knee arthroplasty. There were 30 males (average age, 62 years old) and 70 females (average age, 64 years old). The calculated costs per a quality well year were $30,695 (standard deviation $90,883) at 3 months, $17,804 (standard deviation $25,888) at 6 months, $11,560 (standard deviation $11,874) at 1 year, and $6656 (standard deviation $3567) at 2 years postsurgery. Health economists consider an intervention costing less than $30,000 per quality of well year a bargain to society. Cost effectiveness of knee arthroplasty surgery compares favorably with other surgical interventions such as coronary artery bypass surgery ($5000 per quality of well year) and extremely favorable with medical treatments such as renal dialysis ($50,000.00 for the quality well year). Knee arthroplasty is a cost effective procedure and should be considered an appropriate investment by society.
11242480 Divergent changes in serum sterols during a strict uncooked vegan diet in patients with rh 2001 Feb The effects of a strict uncooked vegan diet on serum lipid and sterol concentrations were studied in patients with rheumatoid arthritis. The subjects were randomized into a vegan diet group (n 16), who consumed a vegan diet for 2-3 months, or into a control group (n 13), who continued their usual omnivorous diets. Serum total and LDL-cholesterol and -phospholipid concentrations were significantly decreased by the vegan diet. The levels of serum cholestanol and lathosterol also decreased, but serum cholestanol:total cholesterol and lathosterol:total cholesterol did not change. The effect of a vegan diet on serum plant sterols was divergent as the concentration of campesterol decreased while that of sitosterol increased. This effect resulted in a significantly greater sitosterol:campesterol value in the vegan diet group than in the control group (1.48 (SD 0.39) v. 0.72 (SD 0.14); P < 0.001). A higher concentration of campesterol compared with sitosterol is normal in omnivorous subjects and can be explained by lower absorption and esterification rates of sitosterol. Our results suggest that a strict uncooked vegan diet changes the relative absorption rates of these sterols and/or their biliary clearance.
10488741 HLA-DR polymorphism influences T-cell precursor frequencies to Epstein-Barr virus (EBV) gp 1999 Aug To study whether HLA-DR haplotypes associated with susceptibility to develop rheumatoid arthritis (RA) may influence T-cell responses to the Epstein-Barr virus (EBV) gp110 (a protein of the late replicative cycle of EBV), we evaluated the frequency in peripheral blood of T cells capable to proliferate to EBV gp110 by direct limiting dilution analysis in 50 HLA-DR-typed healthy subjects. NVe found that HLA-DRB1*07, an allele associated with reduced risk to develop RA, is associated with the highest frequencies of T cells specific for gp110 in peripheral blood. In contrast, HLA-DRB1*0404, one of the susceptibility alleles is associated with the lowest frequencies of gp110 specific T cells. Finally, people expressing both HLA-DRB1*07 and HLA-DRB1*0404 display low precursor frequencies to EBV gp110.
11710705 Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive de 2001 Nov OBJECTIVE: To evaluate and characterize magnetic resonance imaging (MRI) findings in the metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients macroscopically, using miniarthroscopy (MA; needle arthroscopy). METHODS: The second MCP joint of the dominant hand of 22 RA patients (13 with various RA activities/stages; 9 with early RA [< or = 1.5 years' duration]) was examined by MRI followed by MA. Findings were evaluated by standardized semiquantitative measures of synovial and bony pathologic changes of the MCP joint, and were compared with the clinical and conventional radiologic findings. RESULTS: Erosions and pre-erosions were detected in 17 of 22 patients by MRI; 2 of the other 5 patients (all early RA) displayed bony changes on MA. All 10 joints with pre-erosions on MRI (grade I bony alterations on MRI) exhibited significant cartilaginous and bony pathology on MA. Synovial membrane pathology was detected in all but 1 patient by MRI and in all patients by MA, although findings of plain radiography were normal in 6 of the 22 patients and another 9 patients had a Larsen score of 1. Semiquantitative analysis of synovial findings of MRI revealed gadolinium diethylenetriaminepentaacetic acid enhancement as a significant marker of macroscopically varied synovial vascularity and hyperemia, both of which strongly correlated with clinical activity (as measured by the Disease Activity Score). The extent of synovitis/synovial proliferation shown by MA and MRI were significantly correlated with each other, but not with any other activity or damage parameter analyzed. CONCLUSION: In RA, both MRI and MA findings support early detection and staging of synovial changes. Ongoing longitudinal studies are aimed at evaluating the value of synovial proliferation as visualized by both methods.