The authors report the results of the use of autologous growth factors in a patient affected by systemic sclerodermia. Two total hip prostheses were implanted in this woman. Because of the delayed wound healing in this patient, either because of the long-term corticosteroid therapy or the basic connective dissease, she decided not to have surgery. Some time later the patient decided positively for surgery, as her condition was becoming serious. Therefore, as part of a pre-operative protocol, she discontinued corticosteroids for 8 months beforehand and increased pharmacological therapy to improve blood perfusion in soft tissues. During surgery, we injected in the periprosthetic zone and in both sides of the surgical wound. Our patient had a normal period of healing and after 2 weeks the result was so good that we were able to remove the skin suture easily.

Rheumatoid arthritis (RA) is an autoimmune disease that involves T and B cells and their reciprocal immune interactions with proinflammatory cytokines. T cells, an essential part of the immune system, play an important role in RA. T helper 1 (Th1) cells induce interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), and interleukin (IL)-2, which are proinflammatory cytokines, leading to cartilage destruction and bone erosion. Th2 cells primarily secrete IL-4, IL-5, and IL-13, which exert anti-inflammatory and anti-osteoclastogenic effects in inflammatory arthritis models. IL-22 secreted by Th17 cells promotes the proliferation of synovial fibroblasts through induction of the chemokine C-C chemokine ligand 2 (CCL2). T follicular helper (Tfh) cells produce IL-21, which is key for B cell stimulation by the C-X-C chemokine receptor 5 (CXCR5) and coexpression with programmed cell death-1 (PD-1) and/or inducible T cell costimulator (ICOS). PD-1 inhibits T cell proliferation and cytokine production. In addition, there are many immunomodulatory agents that promote or inhibit the immunomodulatory role of T helper cells in RA to alleviate disease progression. These findings help to elucidate the aetiology and treatment of RA and point us toward the next steps. Cite this article: Bone Joint Res 2022;11(7):426–438

Rheumatoid arthritis (RA) is an autoimmune disease characterized by symmetrical and chronic polyarthritis. Fibroblast-like synoviocytes are mainly involved in joint inflammation and cartilage and bone destruction by inflammatory cytokines and matrix-degrading enzymes in RA. Approaches that induce various cellular growth alterations of synoviocytes are considered as potential strategies for treating RA. However, since synoviocytes play a critical role in RA, the mechanism and hyperplastic modulation of synoviocytes and their motility need to be addressed. In this review, we focus on the alteration of synoviocyte signalling and cell fate provided by signalling proteins, various antioxidant molecules, enzymes, compounds, clinical candidates, to understand the pathology of the synoviocytes, and finally to achieve developed therapeutic strategies of RA. Cite this article: Bone Joint Res 2021;10(4):285–297

Aims. The purpose of this study was to validate our hypothesis that centrifugation may eliminate false-positive leucocyte esterase (LE) strip test results caused by autoimmune diseases in the diagnosis of knee infection. Methods. Between January 2016 and May 2019, 83 cases, including 33 cases of septic arthritis and 50 cases of aseptic arthritis, were enrolled in this study. To further validate our hypothesis, another 34 cases of inflammatory arthritis from the Department of Rheumatology of our institution were also included. After aspiration, one drop of synovial fluid was applied to LE strips before and after centrifugation. The results were recorded after approximately three minutes according to the different colour grades on the colour chart. The differences of LE results between each cohort were analyzed. Results. Before centrifugation, 46% (23/50) of the LE strip tests in the aseptic arthritis group were false-positives. Most of the false-positive results were due to inflammatory arthritis; after centrifugation, 78.3% (18/23) of the tests yielded negative results. Similar results were observed in cases from the Department of Rheumatology. The sensitivity of the centrifuged LE strip test was 0.818 (0.639 to 0.924), which is still an acceptable level compared with the uncentrifuged results, which yielded a sensitivity of 0.909 (0.745 to 0.976). However, the specificity was increased from 0.540 (0.395 to 0.679) to 0.900 (0.774 to 0.963) after centrifugation. Conclusion. Although inflammatory arthritis can yield a false-positive LE strip test result in the diagnosis of knee infection, centrifugation may eliminate these false-positive results. Cite this article: Bone Joint Res. 2020;9(5):236–241

Aim. Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic prophylaxis (EOAP) has become increasingly popular in the United States following a highly publicized study (Inabathula et al) from a single center demonstrating a significant protective effect (81% reduction) against PJI in ‘high-risk’ patients. However, these results have not been reproduced elsewhere and EOAP use directly conflicts with current antibiotic stewardship efforts. In order to study the role of EOAP in PJI prevention, consensus is needed for what defines ‘high-risk’ patients. The revision TJA (rTJA) population is an appropriate group to study due to having a higher incidence of PJI. The purpose of the current study was to rigorously determine which preoperative conditions described by Inabathula et al. (referred to as Inabathula criteria (IBC)) confer a higher rate of PJI in patients undergoing aseptic rTJA. Method. 2,256 patients that underwent aseptic rTJA at a single high-volume institution between 2016–2022 were retrospectively reviewed. Patient demographics and comorbidities were recorded to determine if they had 1 or more ‘IBC’, a long list of preoperative conditions including autoimmune diseases, active smoking, body mass index (BMI)>35, diabetes mellitus, and chronic kidney disease (CKD). Reoperation for PJI at 90-days and 1-year was recorded. Chi-squared or Fischer's exact tests were calculated to determine the association between preoperative presence/absence of IBC and PJI. Multivariable logistic regressions were conducted to determine if specific comorbidities within the IBC individually conferred an increased PJI risk. Results. 1223 patients (54.2%) had at least one IBC condition. IBC-positive patients were more likely to be female, have an increased ASA score, and higher BMI. IBC-positive patients had a significant increase in PJI risk at both 90-days (relative risk (RR)=2.32, p<0.0001) and 1-year (RR=2.14, p=0.002) versus IBC-negative patients. Within IBC-positive patients, every additional IBC condition conferred a 1.8× odds increase for 90-day PJI (p<0.0001), and 1.76× odds increase in 1-year PJI (p<0.0001). Multivariable logistic regression identified active smoking, BMI>35, CKD, and diabetes mellitus as being independently associated with PJI development (p<0.05). Conclusions. Over half of rTJA patients meet IBC and could be eligible to receive EOAP in the United States. However, the specific presence of active smoking, BMI>35, CKD, and diabetes mellitus appear to be responsible for the increased risk of PJI. Prospective studies investigating EOAP use for patients with these specific conditions are urgently needed to prevent unnecessary antibiotic use

Introduction. Human bone marrow-derived mesenchymal stem cells (hBMSCs) can adopt either an immune suppressive or stimulative phenotype in response to cytokines and pathogen-associated molecular patterns (PAMPs). It is known that the glycoprotein CD24 allows for the discrimination between PAMPs and DAMPs in dendritic cells. We were able to show previously that CD24 is expressed by hBMSCs and found that its overexpression leads to the downregulation of NF-kB-regulated genes, as well as induction of the anti-inflammatory TGF beta. In the present study the influence of various PAMPs and cytokines on the expression of CD24 in hBMSCs was analysed. Furthermore, it was tested whether in vivo-CD24-positive (CD24+) and in vivo-CD24-negative (CD24-) hBMSCs differ in regard to classical hBMSC or immune-associated surface antigens. Methods. hBMSCs were enriched by density gradient centrifugation, cultured in vitro until passage 3 and subsequently stimulated with PAMPs or cytokines (IFN gamma, TGF beta) before analysing the expression of CD24 via qRT-PCR. Cells expressing CD24 in vivo (CD24+ hBMSCs) were enriched from bone marrow aspirates after density gradient centrifugation by the use of magnetic-associated cell sorting (MACS). Successful enrichment was evaluated by flow cytometric analysis. The enriched cells were subsequently cultured in comparison to the CD24-depleted cell population (CD24- hBMSCs) under identical conditions. The expression of various cell surface markers was compared between these two populations using flow cytometry. Results. All tested PAMPs, as well as IFN gamma led to the downregulation of CD24 in comparison to non-stimulated control cells. In contrast, stimulation with TGF beta resulted in an increased CD24 expression. CD24-positive hBMSCs were successfully enriched via MACS and cultured in vitro. While there was no difference between the expression of classical hBMSC surface antigens between the two cell populations, the CD24+ population had a significantly higher expression of PD-L1 than the CD24- population. Discussion. hBMSCs are capable of ameliorating autoimmune processes by inducing T-cell anergy. Polymorphisms in CD24 are associated with the development of autoimmune diseases. In this context it is worth of note that CD24+ hBMSCs show an elevated expression of PD-L1. PD-L1 is a molecule that can induce anergy in T cells by binding to PD-1 thereby dampening the immune response to self antigens. Therefore, hBMSCs with strong CD24-expression might be beneficial in treating autoimmune diseases such as rheumatoid arthritis. PAMPs and IFN-gamma lead to the downregulation of CD24, which may strip hBMSCs of their ability to induce T cell anergy and to dampen immune responses to self antigens

Introduction. Although osteonecrosis of the femoral head has been observed in young adult patients with autoimmune diseases such as SLE and MCTD that are treated by corticosteroids, the pathogenesis of the osteonecrosis remains unclear. We established a rat model with osteonecrosis of the femoral head by injecting lipopolysaccharide (LPS) and corticosteroid, and assessed consequences of the histopathological alteration of the femoral head, the systemic immune response, and the lipid synthesis. Methods. Male Wistar rats were given 2 mg/kg LPS intravenously on days 0 and 1 and intramuscularly 20 mg/kg methylprednisolone on days 2, 3, and 4. The animals were sacrificed 1, 2, 3, or 4 weeks after the last injection of the methylprednisolone. Histopathological and biochemical analyses were performed every week. The bone samples were then processed for routine hematoxylin and eosin staining to assess the general architecture and injury of the tissue. The triglyceride and the total cholesterol concentrations in the PRP were measured. The levels of various cytokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-γ, TNF-α) in blood samples were measured. Results. The body weight of the rats over time decreased for 2 weeks but had recovered by week 4. The plasma triglyceride concentrations had decreased significantly by weeks 2 and 3. The total plasma cholesterol concentrations had increased significantly by week 1 but then decreased significantly by week 4. The plasma concentrations of IL-1?α, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-γ and TNF-α had increased significantly by week 1. These cytokines can all be induced by toll-like receptor 4 (TLR4) signaling. We defined osteonecrosis as the diffuse presence of empty lacunae or pyknotic nuclei of osteocytes in the bone trabeculae, accompanied by surrounding bone marrow cell necrosis. Osteonecrosis of the femoral head was observed only in the epiphysis of the femoral head in sacrificed specimen every week. Histological analysis revealed osteocytic death surrounded by necrotic bone marrow with or without repaired tissue. Conclusion. We established a new rat model of corticosteroid-induced femoral head osteonecrosis. The necrosis that is generated in this model is similar to that seen in patients treated with corticosteroid. In particular, the necrotic lesion was exclusively observed in the proximal epiphysis. LPS is known to activate the immune system via the TLR4 signaling pathway. It has been recognized that the unique immunogenic effects of LPS promote autoimmune disease . LPS and methylprednisolone induced osteonecrosis of the femoral head in rats and this was associated with a disruption of the innate immune system and lipid synthesis. These findings suggest that the TLR4 signaling pathway plays an important role in the pathogenesis for osteonecrosis of the femoral head

Osteonecrosis (ON) is a debilitating condition that can progress to severe arthritis of the hip. While its exact pathogenesis remains poorly understood, ON is known to be associated with risk factors such as corticosteroid use, alcoholism, and autoimmune disease. Initial radiographic evaluation can reveal sclerotic and cystic changes in the femoral head, which are usually the first clues in diagnosis. Despite these indicators, plain radiographs generally are not sufficient for diagnosis, therefore requiring subsequent magnetic resonance imaging (MRI) studies. Moreover, performing an appropriate assessment of these imaging modalities can help guide the course of treatment. Treatment options are aimed at slowing or stopping the onset of femoral head collapse and include non-operative management, joint preservation procedures, and total joint arthroplasty. Patients at risk of developing ON may benefit from early diagnosis because the characteristic small or medium-sized pre-collapse lesions that are associated with this stage can often be treated with a non-operative or joint preservation approach. However, patients typically present with advanced disease progression and sometimes an unsalvageable joint, thereby necessitating more invasive operative intervention. Surgical modalities include the use of osteotomy, core decompression, vascular grafts, bone graft substitutes, resurfacing, and finally, total hip arthroplasty. Additionally, reports from the past several decades describe improved outcomes and survivorship of these surgical treatment options. Therefore, our purpose is to highlight recent evidence regarding the management of ON with emphasis on the various forms of operative intervention as well as their outcomes

Introduction and aim: We have previously shown suppressed levels of CD8+ T lymphocytes in patients with metal-on-metal (MOM) hip resurfacing compared to patients with metal on polyethylene hip replacements. Functional assessment of T lymphocytes may help to determine the importance of this CD8+ reduction following hip resurfacing. Method: We isolated peripheral blood mononuclear cells (PBMC) from patients with unilateral MOM hip resurfacing (n=7) and healthy controls without hip replacement (n=8). Patients with hip resurfacing had excellent Harris Hip scores (mean 90) and well fixed components on radiographs. Whole blood and serum levels of Cobalt (Co) and Chromium (Cr) ions were measured with Inductively-Coupled Mass Spectrometry. T cell function was assessed by. cell proliferation assays (3H-thymidine incorporation) and. cytokines secretion (ELISA) following exposure to antigen challenge using Tetanus Toxoid and polyclonal mitogen phytohaemoagglutinin (PHA). Results: Co and Cr ion levels were significantly elevated in the MOM hip resurfacing group compared to the control group (p< 0.001). Proliferation rates of T cells were comparable between the two groups over one week, but interferon-gamma (IFN-γ) production in the MOM hip resurfacing group was significantly decreased (p < 0.05), when compared to the control group. Conclusion: IFN-γ is normally produced by CD8+ (T cytotoxic cells) and CD4+ (T helper 1 cells) in response to viral infection and high levels of IFN-γ is associated with autoimmune disease. Raised levels of metal ions from hip resurfacing reduces the production of IFN-γ following stimulation with PHA. This finding has been patented for potential therapeutic use through MRC technology

Introduction. The purpose of this study was to introduce our perioperative prophylaxis method for infection and clarify surgical site infection rate in our patients performed total hip arthroplasty (THA). Method. Two hundred and eighty four THA (including revision 18 cases) performed by single surgeon between Oct. 2007 and Jan. 2013 were evaluated. The mean age of patients was 65.7 years old. The male to female ratio was 46 to 238. BMI was 23.6. Ninety patients (32%) were compromised host suffering from diabetes mellitus, rheumatoid arthritis, autoimmune disease, history of malignant tumor, hemodialysis or skin disease at surgical site respectively. At preoperative period, we checked decayed tooth, alveolar pyorrhea, hemorrhoids, and leg skin condition. In addition, we examined culture of nasal cavity. At the day of surgery, patient took a shower just before entering surgical room. All of THA was performed in clean room NASA class 100. Surgeons and assistant nurse put on nonwoven fabric gown, space suit and double rubber gloves. We wiped surgical site leg by gauze impregnated by 0.5% chlorhexidine alchohol to eliminate skin bacteria twice just before surgeons scrubbing hands. Surgical site was covered by povidone iodine containing drape. Surgeons or nurse changed gloves when glove was broken at each time. We cleaned surgical field by pulse washer whenever necessary. We did not use drain except for 5 revision THAs. Regarding to prophylactic antibiotics usage, we administered cefcapene pivoxil orally the day before surgery. Drip infusion antibiotics (PIPC: until Oct. 2008, CEZ: after Oct. 2008) was administered at the period of 30 min. before surgery and 4 hours after surgery in case of prolonged surgical time (4 hours >). Skin closure was performed by staple and covered by gauze until May 2010. After that, we used surgical tape and transparent water proof sheet. After finishing surgery, antibiotic was administered 8 hours interval at surgery day and 12 hours interval for additional two days. In case multi-drug resistant bacteria (MRSA, MRSE) was positive in nasal culture, we applied mupirocin ointment to nasal cavity for 3 days before surgery and administered vancomycin (from Aug. 2011) or linezolid (from 2012) for prophylactic antibiotics in perioperative period. Results. Multi-drug resistant bacteria was detected from nasal cavity in 23 patients (8%). The mean operation time was 194 min (due to education for young surgeon). Intraoperative bleeding was 598g. Length of skin incision was 13.6 cm. Intraoperative wash volume was 4500 ml. The infection rate were 0 % in early period and 0.7 % (two case) in late period respectively. One infected case was 75 years old female. Deep infection was occurred 3 years after surgery. She was administered steroid and immunosuppressive drug due to metal allergy after total knee arthroplasty. The other case was 64 years old female. Superficial infection happened 3 months after THA. The patient was suffered from collagen disease and diabetes. Conclusion. Our prophylaxis method for surgical site infection of THA achieved 0 % in early infection and 0.7% late chronic infection respectively

Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting 350,000 people in the UK. Within synovial joints, synoviocytes form a destructive pannus that degrades articular cartilage and bone. Synovial fluid glutamate levels increase 54 fold in RA patients and are also elevated in animal models of inflammatory and osteoarthritis. To determine whether elevated glutamate levels contribute to RA pathology we investigated which synovial joint tissues express glutamate receptors and whether glutamate stimulation influences synovio-cyte phenotype. Various glutamate receptor mRNAs (NMDAR1, KA1, AMPAGluR2, AMPA GluR3, mGluR4) were expressed in tissues of the rat knee. All receptors were expressed in the patella. The fibrocartilagenous menis-cus and articular cartilage chondrocytes expressed mGluR4 and both AMPA receptor subunits. Human synoviocytes expressed NMDAR1 and KA1 mRNA. To determine whether glutamate receptors were functional in human synoviocytes, cells were preloaded with a fluorescent indicator of intracellular calcium (iCa 2+) and stimulated with glutamate or specific agonists (NMDA or kainate, 500mM). Glutamate stimulated release of iCa2+ in 25% of synoviocytes whereas NMDA and Kainate each stimulated 15% of cells. NMDA responses increased to 57% in the absence of Mg2+ consistent with the inhibitory effect of Mg2+ on this receptor. To determine whether activation of glutamate receptors can influence human synoviocyte phenotype, we cultured synoviocytes in various glutamate concentrations (50mM to 2mM) and measured effects of glutamate receptor antagonists on release of a proinflammatory cytokine (IL-6) and degradative enzymes (MMP2 and 9). In some RA patients, glutamate stimulation increased synoviocyte pro MMP-2 release. TIMP1 and TIMP2 release were not affected by glutamate stimulation or co-treatment with receptor antagonists. IL-6 expression varied greatly in human synoviocytes derived from different RA patients (0–120pg/ml media). However, the AMPA/KA receptor antagonist NBQX significantly reduced IL-6 release at all glutamate concentrations. This inhibition was greater than that by CFM2 (AMPAR antagonist), indicating that activation of kainate receptors in human synoviocytes may induce IL-6 release. We conclude that glutamate receptors are functional in human synoviocytes and regulate release of MMP-2 and IL-6 Thus glutamatergic signalling may contribute to RA pathology and represent a new therapeutic target

Background: Bone sarcomas are rare primary tumors. Radiation therapy (RT) can be useful in securing local control in cases where negative surgical margins cannot be obtained or where tumors are not resected. Recent technical advances in RT offer the opportunity to deliver radiation to these tumors with greater precision and accuracy, thus allowing higher doses to the tumor target with less dose to critical normal tissues, which can improve local tumor control and/or reduce treatment-related morbidity. Results of a recently published prospective trial of patients with spine sarcoma treated with high dose photon/proton radiation +/− surgery +/− chemotherapy will be presented to illustrate these concepts. Methods: Eligible patients had nonmetastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or postoperative photon/proton XRT with or without radical resection; patients with osteosarcoma and Ewing’s sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (Gy RBE) to subclinical disease, 70.2 Gy RBE to microscopic disease in the tumor bed, and 77.4 Gy RBE to gross disease at 1.8 Gy RBE qd. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 Gy RBE to surface/center. Intraoperative boost doses of 7.5 to 10 Gy could be given by dural plaque. Results: A total of 50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). With 48 month median follow-up, 5-year actuarial local control, recurrence- free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence (p < 0.001). Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared after 77.12 to 77.4 Gy RBE. Conclusions: Local control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 Gy RBE are at risk for late toxicity. Similar approaches may be considered for other challenging bone and soft tissue sarcomas

Introduction: Osteonecrosis of the hip is a devastating disease that often results in the collapse of the femoral head and secondary osteoarthritis of the hip. Although total hip arthroplasty is considered the main therapeutic option in cases of advanced osteonecrosis (Ficat stage III or IV), historically high failure rates have been reported for this treatment. Variables such as, whether or not the prosthesis was cemented, year of implantation, age, various medical comorbidities, and risk factors such as alcohol abuse, corticosteroids usage, autoimmune disease, or sickle cell anemia may lead to better or worse outcomes. The purpose of this study was to determine which factors were associated with risk for failure concerning total hip arthroplasty (THA) for osteonecrosis of the femoral head from a complete meta-analysis of the literature. Methods: A systematic review utilizing the Medline bibliographic database found 35 studies meeting our inclusion criteria that were related to osteonecrosis encompassing 557 hips in 443 patients. These reports were published between the years 1989 to 2007. The mean follow-up was 6.7 years (range, 3 – 10). The study population comprised of 60% men who had a mean age of 47 years (range, 17 to 90). The most frequent associated risk factors for osteonecrosis were corticosteroid usage (26.2%) and alcohol abuse (30.1%). The final outcome parameters were number and percentage of patients who underwent revision surgery, who had impending radiographic failure, such as osteolytic lesions in close proximity to the implant, or who were clinical failures. Clinical failure was defined as a value less than 70% of the maximum score of the relevant hip scoring system used. All reviewed studies were divided into cemented, cementless, or hybrid fixation, as well as year of implantation (before and after 1990). In addition, patients were stratified according to comorbidities, age, gender, and various diagnostic and other risk factors (e.g. systemic lupus erythematosus, sickle cell disease, use of corticosteroids, alcohol abuse). Results: Overall, there were 131 poor outcomes out of 557 hips (23.5%). Seventy-six revision surgeries were performed, with another 55 hips showing either radiographic signs of loosening or clinical failures. Cemented THA had a failure rate of 17.9%, while the cementless THA had a failure rate of 24.5%. Overall outcomes were different for various risk factors; intake of corticosteroids led to a failure rate of 42.3%, alcohol abuse; 38.1%, posttraumatic disorders; 39%, and sickle cell anemia; 45.5%. Patients without known adverse risk factors had only 17% failures. Discussion: Our findings further emphasize the poor results of total hip arthroplasty in patients with various risk factors such as alcohol abuse, use of corticosteroids, lupus, and sickle cell anemia. It also appears that patients without these adverse risk factors have a better survival rate. The importance of this study is that it may help the surgeon understand the risk of total hip arthroplasty in various stratified groups in patients with osteonecrosis

Aims

Mendelian randomization (MR) is considered to overcome the bias of observational studies, but there is no current meta-analysis of MR studies on rheumatoid arthritis (RA). The purpose of this study was to summarize the relationship between potential pathogenic factors and RA risk based on existing MR studies.

Aims

To investigate the correlations among cytokines and regulatory T cells (T-regs) in ankylosing spondylitis (AS) patients, and their changes after anti-tumour necrosis factor-α (TNF-α) treatment.

Aims

Rheumatoid arthritis (RA) is a common chronic immune disease. Berberine, as its main active ingredient, was also contained in a variety of medicinal plants such as Berberaceae, Buttercup, and Rutaceae, which are widely used in digestive system diseases in traditional Chinese medicine with anti-inflammatory and antibacterial effects. The aims of this article were to explore the therapeutic effect and mechanism of berberine on rheumatoid arthritis.

Aims

To explore the synovial expression of mucin 1 (MUC1) and its role in rheumatoid arthritis (RA), as well as the possible downstream mechanisms.

The February 2023 Foot & Ankle Roundup³⁶⁰ looks at: Joint inflammatory response in ankle and pilon fractures; Tibiotalocalcaneal fusion with a custom cage; Topical application of tranexamic acid can reduce blood loss in calcaneal fractures; Risk factors for failure of total ankle arthroplasty; Pain catastrophizing: the same as pain forecasting?.

Aims

Contemporary outcomes of primary total hip arthroplasties (THAs) with highly cross-linked polyethylene (HXLPE) liners in patients with inflammatory arthritis have not been well studied. This study examined the implant survivorship, complications, radiological results, and clinical outcomes of THA in patients with inflammatory arthritis.

Aims

This aim of this study was to analyze the detection rate of rare pathogens in bone and joint infections (BJIs) using metagenomic next-generation sequencing (mNGS), and the impact of mNGS on clinical diagnosis and treatment.