Treatment for HTLV-I associated arthropathy: a case study and synovial tissue culture analysis.
OBJECTIVE
There are few reports regarding the treatment of HTLV-I associated arthropathy (HAAP). This is a case study describing the treatment of a patient diagnosed with HAAP. We also analyzed the effects of various agents on cultured synovial tissue explants from the patient.


METHODS
Arthroscopic synovectomy of the left knee was performed. We investigated the effects of pirarubicin (THP), bestatin, betamethasone, and hyaluronic acid (HA) in synovial tissue culture to evaluate the efficacy of these medications.


RESULTS
Swelling and pain of the left knee was transiently diminished after synovectomy. However, bilateral swelling of the knees and C reactive protein (CRP) concentrations were increased. In the explant culture experiments, CD8+ cells decreased with the addition of bestatin, betamethasone, and HA. The structure of synovial cells was preserved by the addition of HA. However, the addition of THP induced fibrosis of synovial tissues, increased cells without nuclei, and diminished fascin-expressing cells.


CONCLUSIONS
THP inhibited, but HA preserved the structure of hypertrophic synovial cells. Scopic synovectomy effectively improved joint effusion and pain; however, the effect was transient, and additional treatment with predonisolone was required. Therefore, it is important to develop a more effective treatment for HAAP.
Takahashi
Toshiaki
T
Department of Orthopaedics, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan. takahast@m.ehime-u.ac.jp
Takemoto
Shigeki
S
Kiyasu
Katsuhito
K
Yamamoto
Hiroshi
H
Tani
Toshikazu
T
Miyoshi
Isamu
I
Taguchi
Hirokuni
H
Moriki
Toshiaki
T
Miyazaki
Emiko
E
Enzan
Hideaki
H
D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D001182:Arthroscopy; D001623:Betamethasone / Q000494:pharmacology; D002097:C-Reactive Protein / Q000378:metabolism; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism; D002478:Cells, Cultured; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000494:pharmacology; D005260:Female; D015490:HTLV-I Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007930:Leucine / Q000031:analogs & derivatives / Q000494:pharmacology; D008279:Magnetic Resonance Imaging; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D011239:Prednisolone / Q000627:therapeutic use*; D011859:Radiography; D013583:Synovial Membrane / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D007166:Immunosuppressive Agents; D004317:Doxorubicin; D006820:Hyaluronic Acid; D002097:C-Reactive Protein; D001623:Betamethasone; D011239:Prednisolone; C027260:pirarubicin; D007930:Leucine; C012211:ubenimex