Multiple myeloma
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
A repeat skeletal survey is not routinely indicated as lytic bone deposits often show little evidence of healing radiographically (manifest by shrinkage or sclerosis), even in those patients achieving a complete remission (145–147). The addition of bisphosphonate compounds as antiosteoclast agents leads to bone strengthening, which may further accentuate these features. New or enlarging deposits signify disease progression. As discussed above, new vertebral body compression fractures on conventional radiography do not necessarily indicate disease progression. Persistence of radiological abnormalities should not be considered as evidence of active disease since they may represent residual osteolysis in the absence of plasma cell proliferation. In selected cases, particularly those with a substantial soft tissue component, it is reasonable to use CT to monitor treatment response. Response is indicated by disappearance of extraosseous or extramedullary masses and the reappearance of a continuous cortical outline with fatty marrow content (67,148). CT should also be considered if there are persistent unexplained symptoms, concern about a risk of fracture, or lack of response to therapy. Recent recommendations from the British Society of Haematology allow for use of plain film radiography targeted to new symptomatic sites in the treated patient (43).
Animal Models for Investigations of Biomaterial Debris
Yuehuei H. An, Richard J. Friedman in Animal Models in Orthopaedic Research, 2020
Currently the histopathological effects of orthopaedic wear debris particles have been investigated and described in detail. Many of the inflammatory mediators that are expressed and/or regulated during particle induced inflammation have been identified. However, there are still many poorly understood facets of particle induced inflammation and its contribution to prosthetic implant loosening. The clinical picture in patients having a prosthetic implant with known wear debris problems varies. Some patients have well functioning prostheses and are symptom free for decades despite extensive PE wear and particle generation. Other patients develop extensive osteolysis and implant failure within few years. Little is known about this difference in biological response to prosthetic component implantation and the individual response of patients to wear debris particles. Also the possible involvement of the immune system in the reaction to particulate wear has been implicated. Several studies with particle implantation for 12 months and longer have observed lymphocyte accumulation in the particle generated granuloma tissue.
B Cells and Humoral Immunity
Constantin A. Bona, Francisco A. Bonilla in Textbook of Immunology, 2019
This gammopathy results from proliferation in the bone marrow of IgM-secreting plasmacytoid cells. The clinical presentation is non-specific, most often generalized weakness, fatigue, and weight loss. Diagnosis is made by detecting the M component in immunoelectrophoresis. Common associated symptoms are anemia and hepatosplenomegaly. Bence-Jones proteinuria occurs in about 10% of patients. Osteolytic bone lesions are very rare. The disease is relatively indolent, and even though incidence is rarely before age 60, the mean survival after diagnosis is three to five years, and occasionally ten years or more. Death attributable to this disease is usually due to increased blood viscosity. This can lead to renal failure, hemorrhagic purpura of mucous membranes (paraproteinemia may interfere with coagulation), and occasionally congestive heart failure.
CT-defined body composition as a prognostic factor in multiple myeloma
Published in Hematology, 2023
Alexey Surov, Franz Benkert, Wolfram Pönisch, Hans-Jonas Meyer
Regarding patients with multiple myeloma (MM), body composition assessment might be of special interest, as these patients are of severe risk for anorexia, malnutrition, and muscle wasting [10–12]. Moreover, frailty and potential risk for fractures are of utter importance, as these patients can frequently develop pathological osteolysis [12]. The association between the risk of fractures and LSMM has been established in patients with osteoporosis with results [13,14]. Moreover, the prognostic effect of LSMM assessment was demonstrated in hematological diseases in a recent meta analysis [15]. However, the exact benefit in MM patients is still scarce and further research is needed in this disease. In MM patients this can also be of great importance as the patients undergo regular staging CT investigations to rule out or diagnose new osteolysis.
Osteoclast differentiation in rheumatoid arthritis
Published in Immunological Medicine, 2023
Kazuhiro Yokota
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory synovitis accompanied by bone destruction [1,2]. Recent advances in therapeutic drugs, including targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), biologic DMARDs (bDMARDs), and treat-to-target strategies have increased response and remission rates [2]. However, despite treatment according to the current management recommendations, a significant proportion of RA patients remain symptomatic; this group of patients can be designated as having ‘difficult-to-treat RA (D2TRA)’ [3,4]. In addition, a subgroup of D2TRA patients presents rapid bone destruction in plain radiography, regardless of disease activity. Such cases pose a significant challenge to clinical outcomes, quality of life, productivity, prognosis, and medical economics. This rapid progression of bone destruction is believed to be driven primarily by osteolysis involving activated osteoclast formation and bone resorption in bone-adjacent synovial tissue [5]. Therefore, novel therapeutic strategies that target pathological osteoclasts are required to prevent the progression of bone destruction.
Cross-Linked Versus Conventional Polyethylene for Long-Term Clinical Outcomes After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2021
Jiangyuan Shi, Weicong Zhu, Shaohua Liang, Hongling Li, Siming Li
Previous systematic reviews [9–11] have demonstrated a significant reduction in radiological wear of HXLPE as compared to CPE bearing surfaces, but owing to the inclusion of short-to mid-term trials, these studies were not adequately powered to detect differences in clinical outcomes. Recently, several long-term (>10 years) clinical trials [12–16] have compared HXLPE and CPE. Nevertheless, the clinical advantages of HXLPE remain controversial. For instance, Devane et al. [15] used a 10-year double-blinded randomized controlled trial (RCT) to demonstrate the superiority of HXLPE liner for the prevention of revision and osteolysis. In contrast, Broomfield et al. [16] showed that an HXLPE group had no advantage in terms of reducing the incidence of revision as compared to a CPE group in a 12-year comparative study. Moreover, Tsukamoto et al. [14] reported that the osteolysis incidence was not significantly different between the two groups in a 15-year retrospective cohort study.
Related Knowledge Centers
- Autoimmunity
- Avascular Necrosis
- Bone
- Bone Resorption
- Bone Tumor
- Prosthesis
- Ossification
- Osteoclast
- Hip Replacement
- Ball-and-Socket Joint