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KMID : 0350519950480030813
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Journal of Catholic Medical College
1995 Volume.48 No. 3 p.813 ~ p.824
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Synovial Changes Induced by Steroid and The Effect of Hyaluronic Acid n Mature Rabbit Knee
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Abstract
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Local injection of corticosteroid is commonly used in orthopedic practice on the assumption that it will diminsh pain and inflammation and accelerate healing process. But, it is weell known that repeted intra-articular steroid administration
produce
"steroid-induced arthropathy'. In addition to possible detrimental effects on the cartilage, intra-articular steroid injection may produce deleterious effects on the meniscus and intra-articular ligaments. But there is no report to support the
repeatedly injected steroid effect on the synoyium.
Recently, newly developed synthetic hyaluronic acid has been introduced for therapeutic alternative in the management of asthritis. But there has not been ay repory to support the effect of hyaluronic acid on the synovium as well.
The purpose of this study is to determine the repeatodly injected steroid effect on the synovium of the ravvit left knce and observe the therapeutic effect of hyaluronic acid on the synovium of the mature rabbit knee.
GroupⅠ(6 rabbits) received intra-articular normal saline injection once a week for 12 weeks as a control group, and groupⅡ(20 rabbits) received intra-articular methylprednisolone injection once a week for six weeks, which was followed by
intra-articular hyaluronic acid (1mg/kg) injection once a week for six weeks.
The synovial membranes of all experimental groups were observed grossly, histologically and by transmission-electron-microscope examination at the 10th and 14th week.
@ES The results were as follows :
@EN 1. Grossly, groupⅡandⅢshowed gray color, rubbery consistency, increased vascular congestion and decreased glistening characteristics compared to groupⅠ. But gross changes in groupⅢ compared to groupⅡwere less prominent.
2. Microscopically, destruction of the synovial lining layer with irregular arrangement of cells, vascular congestion, extravasation of red blood cells and fibrosis were observed in groupⅡat the 10th week, and fibrosis is more severe at the
14th
week.
But histologic changes in groupⅢcompeared to groupⅡwas less prominent, and synovial membrane, consists of three or five layers of synovial lining cells, was well preserved compared to groupⅡat the 14th week. In safranin-O stiain, the evidence
of
the
relationship between hyaluronic acid and proteoglycan synthesis in the synovial membrane was not identified. But severe fibrosis shown with light green collor was observed in groupⅡand this finding was less prominet in groupⅢ.
3. In trasmission-electron-microscope examination, the synovial lining cell layer was replaced by fibroblasst and collage fibers in groupⅡ. In groupⅢ, in addition to fibroblast and collagen fibers, synovial cells were also observed. These
synovial
cells had swollen mitochondria and endoplasmic reticulum, dispersed nucleus and increased secondary lysosome at the 10th week observation, but at the 14th week, these cells had normal appearance of mitochondria, pinocytic vesicles, and
endoplasmic
reticulum compared to the 10th week.
Above mentioned results showed the possibility of the clinical application of the hyaluronic acid on the degenerated and destructed synovium by repeated injection of steroid.
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