163 / 245
DOS Kongressen 2016 ·
163
Prospective clinical trial for septic arthritis:
inflammation is associated with cartilage
degradation, up-regulation of cartilage
metabolites, but is inhibited by chondrocytes
Hagen Schmal, Anke Bernstein, Elia Roul Langenmair, Eva Johanna Kubosch
Department of Orthopaedics and Traumatology, Odense University Hospital;
Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University
Medical Center Freiburg, Germany; Department of Orthopedics and Trauma
Surgery, Albert-Ludwigs University Medical Center Freiburg, Germany;
Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University
Medical Center Freiburg, Germany
Background:
Intraarticular infections can rapidly lead to osteoarthritic degra-
dation, but the association of inflammation and cartilage destruction is not yet
fully understood.
Purpose / Aim of Study:
Aim of this clinical trial was to correlate inflammation
severity with parameters of cartilage metabolism.
Materials and Methods:
Patients with acute septic arthritis were enrolled in a
clinical trial and the effusions (n=76) analyzed. Cytokines and cell function were
also investigated using a human in-vitro model of joint infection.
Findings / Results:
Higher synovial IL-1â levels were associated with a higher
degree of disease severity. Additionally, IL-1â concentrations correlated with
infectious serum markers, but not with age or co-morbidity. Both higher serum
leucocytes and synovial IL-1â were associated with increased intraarticular col-
lagen type II cleavage products (C2C) indicating cartilage degradation. Joints
with pre-infectious lesions had higher C2C levels and were more susceptible to
inflammation. Infections led to increased concentrations of typical cartilage me-
tabolites as bFGF, BMP-2, and BMP-7. A subgroup analysis revealed increased
synovial IL-1â levels in patients with an arthroplasty, which could be confirmed
utilizing the in-vitro model. In contrast to IL-4 and IL-10, FasL levels increased
steadily in-vitro, reaching higher levels without chondrocytes (CHDR). Likewise,
the viability of synovial fibroblasts (SFB) during infection was higher in the pres-
ence of CHDR and associated with increased TGFâ levels.
Conclusions:
C2C reliably mark cartilage destruction during septic arthritis,
which is associated with up-regulation of typical cartilage turnover cytokines.
Chondrocytes exhibit an anti- inflammatory effect, which is associated with an
increased resistance of SFB to infections and FAS-mediated cytotoxicity.
No conflicts of interest reported
114.