Synovial fluid over the centuries

This review deals with the most meaningful historical topics on the study of synovial fluid, by starting from the Greco- Roman Medicine, up to Paracelsus (1493-1541), who introduced the term "synovia" to name the intra-articular humour. Afterwards, some till now unreported historical sources are recorded, e.g., a short text by the Italian XVIII century physician Giambattista Contoli ("Breve Instruzione sopre il Glutine, o Colla…, 1699"). Then, in keeping with some recent researches, a brief history of arthrocentesis is outlined, by considering the first procedures, which should have been performed in Mexico, during the precolonial period. Moreover, the first chemical analysis of synovial fluid, as carried out by the French chemist Jean-Louis Margueron (1792), and the first modern study on the synovial membrane by Marie-Francois-Xavier Bichat (1800) are explained. Finally, some XIX century investigations concerning the synovial pharmacodynamics, in particular an Italian one based on the elimination of certain chemical substances through the synovial membrane, are discussed

A short history of anti-rheumatic therapy. II. Aspirin

The discovery of aspirin, an antipyretic, anti-inflammatory and analgesic drug, undoubtedly represents a milestone in the history of medical therapy. Since ancient times the derivatives of willow (Salix alba) were used to treat a variety of fevers and pain syndromes, although the first report dates back to 1763 when the English Reverend Edward Stone described the effect of an extract of the bark willow in treating malaria. In the XIX century many apothecaries and chemists, including the Italian Raffaele Piria and Cesare Bertagnini, developed the biological processes of extraction and chemical synthesis of salicylates, and then analyzed their therapeutic properties and pharmacokinetic and pharmacodynamic characteristics. In 1899 the Bayer Company, where Felix Hoffmann, Heinrich Dreser and Arthur Eichengrun worked, recorded acetyl-salicylic acid under the name "Aspirin". In the XX century, besides the definition of the correct applications of aspirin in the anti-rheumatic therapy being defined, Lawrence L. Crawen identified the property of this drug as an anti-platelet agent, thus opening the way for more widespread uses in cardiovascular diseases

[Filippo Civinini (1805-1844) and the discovery of plantar neuroma].

Pathological abnormality (neuroma) related to the painful foot condition commonly called "Morton's metatarsalgia" was first observed in 1835 by Filippo Civinini (1805-1844) of Pistoia, in course of a cadaverous dissection, and clearly described in the anatomic letter entitled "Su un nervoso gangliare rigonfiamento alla pianta del piede" ("On the neural gangliar swelling of the foot sole"). In this study a brief review on the history of Morton's metatarsalgia is carried out, and the importance of Civinini in the discovery of the neuroma of the III intermetatarsal web is underlined

A short history of anti-rheumatic therapy - VI. Rheumatoid arthritis drugs

The treatment of rheumatoid arthritis traditionally includes symptomatic drugs, showing a prompt action on pain and infl ammation, but without any infl uence on disease progression, and other drugs that could modify the disease course and occasionally induce clinical remission (DMARDs or disease modifying anti-rheumatic drugs). This review describes the historical steps that led to the use of the main DMARDs in rheumatoid arthritis, such as gold salts, sulphasalazine, chloroquine and hydroxychloroquine, D-penicillamine, and other immunoactive drugs, including methotrexate, azathioprine, cyclosporin and lefl unomide. The historical evolution of use of these drugs is then discussed, including the strategy of progressive ("therapeutic pyramid") or of more aggressive treatment, through the simultaneous use of two or more DMARDs ("combination therapy")

Plasma-exchange in the treatment of systemic rheumatic diseases: past and present experience

La terapia con plasma-exchange (PEx) e stata utilizzata sin dagli anni Settanta per la cura di molteplici malattie, nella cui patogenesi fattori umorali si riteneva potessero giocare un ruolo di rilievo. Questa modalita di trattamento comporta la rimozione di autoanticorpi, immunocomplessi circolanti, molecole di adesione, citochine, chemochine ed altri mediatori solubili implicati nello sviluppo del danno tissutale (1). Nel 1993 l'American Society of Apheresis (ASFA) ha per la prima volta pubblicato un elenco di applicazioni cliniche delle diverse tecniche di aferesi terapeutica, fra le quali di gran lunga la piu utilizzata era, allora come oggi, il PEx (2). Questo elenco comprendeva malattie autoimmuni, malattie ematologiche ed oncologiche, disordini metabolici, malattie neurologiche e malattie renali. Fra le malattie autoimmuni figuravano molte forme morbose di pertinenza reumatologica..

Wars in the history of rheumatology

Some important discoveries in the history of rheumatology happened during war periods. It is well known that arthritis associated with conjunctivitis and urethritis, following dysenteric episodes, has been described during the First World War from the German Hans Reiter and, nearly contemporarily, from the French Noel Fiessinger and Edgar Leroy. Less known is instead the fact that the first cases of sympathetic algoneurodystrophy have been reported by the American Silas Weir Mitchell in soldiers wounded by fire-arms, during the Civil War of Secession. Other war episodes have been crucial for the development of some drugs now abundantly applied to the care of rheumatic diseases. The discovery of therapeutic effects of immunosuppressive agents, in fact, happened as an indirect consequence of the use of poison gas, already during the First World War (mustard gas), but above all after an episode in the port of Bari in 1943, where an American cargo boat was sunk. It had been loaded with a quantity of cylinders containing a nitrogenous mustard, whose diffusion in the environment provoked more than 80 deaths owing to bone marrow aplasia.Moreover, the history of the cortisone shows a strict link to the Second World War, when Germany imported large quantities of bovine adrenal glands from Argentina, with the purpose of producing some gland extracts for the Luftwasse aviators, in order to increase their performance ability

A short history of anti-rheumatic therapy. I. An introduction on traditional and drug treatments

The origins of anti-rheumatic therapy are very old and mainly related to the use of traditional, sometimes extravagant, treatments, as a part of folk medicine. Spa therapy has long been used for the treatment of rheumatic diseases, as well as, in later times, physical treatments, including electrotherapy. Drug treatment has developed beginning from substances of vegetable origin, such as willow and colchicum extracts. Then it has been spread out through the chemical synthesis of compounds with specific action and therefore more effective, owing to the great development of pharmaceutical industry

The application of a Bayesian approach to assess the seismic vulnerability of historical centers

The seismic vulnerability of historical centers at a territorial scale cannot be assessed performing detailed analysis which are usually adopted at the single building scale. In fact, a traditional complete survey would be extremely time-consuming and not sustainable for this purpose. The approach described in this paper is based on the idea that it is possible to infer quantities which cannot be directly detected from buildings outside inspection starting from parameters that can be measured. In order to achieve this purpose, a Bayesian approach is applied, updating initial hypotheses when new data become available. In this context, the procedure herein proposed aims at applying a probabilistic approach instead of a deterministic one to define facades inter-storey height starting from buildings height knowledge. In order to validate the method, for out of plane local mechanisms of collapse (walls overturning), horizontal loads multiplier \uf0610 values are calculated and compared to results obtained by using data collected on-site

The main stages in the history of systemic lupus erythematosus

Systemic lupus erythematosus can be considered the most characteristic and important among the connective tissue diseases. In this short review the main stages of its history are sketched, from the introduction of the term "lupus", traditionally attributed to Roger Frugardi, in 1230 (but in fact already documented in the 10th century) to the actual knowledge of its clinical and laboratory aspects. Initially considered exclusively of dermatological interest, the first to describe a systemic form with visceral involvement were Moriz Kohn Kaposi and William Osler. Significant contribution was also given by serological diagnosis, and in particular, by the identification of specific markers of disease, such as anti-native DNA and anti-Sm antibodies, allowing early diagnosis and the establishment of an adequate therapy

Model-based sensitivity analysis for outcome reporting bias in the meta analysis of benefit and harm outcomes

Outcome reporting bias occurs when outcomes in research studies are selectively reported, the selection being influenced by the study results. For benefit outcomes, we have shown how risk assessments using the Outcome Reporting Bias in Trials risk classification scale can be used to calculate bias-adjusted treatment effect estimates. This paper presents a new and simpler version of the benefits method, and shows how it can be extended to cover the partial reporting and non-reporting of harm outcomes. Our motivating example is a Cochrane systematic review of 12 studies of Topiramate add-on therapy for drug-resistant partial epilepsy. Bias adjustments for partially reported or unreported outcomes suggest that the review has overestimated the benefits and underestimated the harms of the test treatment