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The Role of the Synovia in the Nociception in Rhizarthritis
Susanne Rein, MD, PhD1; Janet Okogbaa2; Elisabet Hagert, MD, PhD3; Suzanne Manthey, MD4; Amy Ladd, MD2
1Department for Hand and Plastic Surgery, Burn Center, Hospital Bergmannstrost, Halle (Saale), Germany; 2Stanford University, Stanford, CA; 3Karolinska Institutet, Stockholm, Sweden; 4University Hospital "Carl Gustav Carus", Dresden, Germany

Background: The aim of this study was to investigate the immunohistochemical markers in synovia of trapeziometacarpal joint ligaments in surgical specimens, to examine the nociceptive role of the synovia in osteoarthritis.

Methods: The dorsoradial (DRL) and oblique anterior ligaments (AOL) were harvested during resection-suspension arthroplasty in ten females and one male patient, six right and five left thumbs, affected with advanced osteoarthritis. The ligaments were divided in proximal and distal parts and stained with the following immunhistochemical antibodies: Calcitonin Gene Related Peptide (CGRP), Acetylcholin (Ach), Substance P, Neuroproteine Y (NBP Y), Noradrenaline, N-Methyl-D-Aspartate (NMDA)-receptor as well as Met/Leu-Enkephaline. Hematoxylin-eosin staining were used to classify the synovia according to Krenn et al. into No, Low-grade, and High-grade synovitis. The degree of osteoarthritis of the basal thumb joint was analyzed preoperatively with modified Eaton-Littler radiographic grading. Two parts of the AOL had to be excluded from further analysis given insufficient tissue for staining.

Results: Radiological examination revealed grade II in four, grade III in three, and grade IV in four patients. The synovitis score showed the following results for the single ligament parts: no synovitis: nine AOL and eleven DRL, low-grade synovitis: seven AOL and ten DRL, as well as high-grade synovitis: four AOL and five DRL, respectively. The amount of blood vessels increased with higher synovitis score, however they did not correlate to higher grade of radiographic arthritis. Furthermore, no relation was found between the radiographic grade of arthritis and the synovitis score. The synovial lining cell layer had a pronounced immunoreactivity for CGRP, Ach, substance P, NBP Y, noradrenaline, NMDA-receptor, and Met/Leu-enkephalin with higher synovitis score. In contrast, the synovial stroma had no increased immunoreactivity with higher synovitis score.

Conclusion: The synovia in ligaments is higher involved in nociception with increased synovitis score via sympathetic inflammatory (noradrenaline, NBP Y) as well as parasympathetic anti-inflammatory (substance P, CGRP), and opiod anti-inflammatory (enkephalin) neural pathways. Therefore, the synovia plays an important role in nociception in osteoarthritis of the thumb.

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