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The evolution of the rheumatologic practice involved a handing-over in question of the place and methods of application of the synoviorthesis. The last innovations, in particular the appearance of the bio-therapies, allowed a better control of inflammatory rheumatism thus making it possible to better select arthritis likely to profit precociously from a synoviorthesis before the installation of major articular destruction.Through a general review of the literature, we recall in this work the various means of synoviorthesis, their current indications and their results.An extensive electronic search of the relevant literature was carried out using MEDLINE. Key words used for the final search were: synoviorthesis, osmic acid, radiosynoviorthesis, arthritis, treatment.This systematic review allowed us to conclude that fields of application of the synoviorthesis is in addition widens because of the interesting results to see spectacular this technique in some other affections such as the haemophilia. In addition we have compared the efficiency and the tolerance of the different methods of synoviorthesis.The synoviorthesis constitutes a tempting therapeutic alternative of share its effectiveness and its good tolerance so much so that it constitutes an undeniable factor of articular protection. Its fields of application widened. Thus on the good knowledge of the indications and the precautions necessary to its realization its success.

To evaluate clinical, radiological and histological characteristics as well as outcome of pigmented villonodular synovitis (PVNS) in 14 patients.This retrospective study examined data from 14 cases of pathologically-confirmed PVNS over a 10-year period (1990-1999).All 14 cases (9 women and 5 men) of PVNS involved the knee. Mean age at diagnosis was 32.7 years. The principal functional signs were mechanical pain and disability. All patients had radiographs (normal for 8 patients); 3 had arthrography, which found diffuse cyst formations, 2 had MRI, which showed images characteristic of PVNS, and 4 had arthroscopy. All patients underwent complete surgical excision, and 4 also had osmic acid synoviorthesis. Recurrence occurred in 4 patients, within 10 months on average.MRI and arthroscopy improve the early management of pigmented villonodular synovitis.

An immunogold labeling technique was carried out on plants infected with CMV, fixed with glutaraldehyde and osmium tetroxide and embedded in araldite CY 212. The effect of the type of support-film used, the resin and manipulations of the grids during immunogold steps, were studied and are discussed. The antigenic activity of virus was restored by treating the sections with sodium metaperiodate. The very high non-specific reactions observed with the support-film or with the resin were eliminated by adding powdered skimmed milk or non-purified albumin into the buffers. Purified bovine serum albumin (grade V) or chicken albumin (grade III to V) were inefficient in reducing this non-specific background.

Osmium tetroxide and potassium permanganate destroy F-actin filaments in vitro, and split actin molecules into smaller peptides. It is shown by viscometry, spectrophotometry, electrophoresis and electron microscopy that the destruction of F-actin by these agents is inhibited by phalloidin. Other proteins are unprotected.

Virotoxins are a group of monocyclic peptides recently identified in the deadly mushroom Amanita virosa by Faulstich and coll. We found that two of these peptides, which have a methyl sulfonyl group, namely viroidin and viroisin are very effective to protect F-actin against oxidative degradation by osmium tetroxide in vitro. Their desoxo analogs, which have a methyl sulfoxyde group instead of methyl sulfonyl are less active, therefore there exists a relationship between the chemistry of the sulfur group and the activity of the peptides.

Abnormal radiological opacities are sometimes observed after intra-articular injection of osmic acid. These opacities are radio-opaque because osmium is a heavy metal (atomic number = 76). They are usually found near the suprapatellar pouch which is the usual injection site. A parasynovial injection (or back flow from the joint cavity) of some of the osmic solution, followed by concentration and fixation of the osmic deposits at this level, seems to be the cause of these radiological opacities. This could be the reason for the poor clinical results encountered in some cases of osmic acid therapy followed by such deposits.

Tissue post-fixation with imidazole buffered osmium tetroxide allows localization of lipids rich in unsaturated fatty acids (Angermüller and Fahimi, 1982). In odontoblasts, a positive reaction is observed in mitochondria, in membranous structures and in vesicles containing an osmiophilic and amorphous material. In odontoblastic processes, tubulo-vesicular structures and electron-dense coated vesicles seemed to be engaged in endocytosis and transfer processes towards lysosomial structures of the cell body. In the enamel organ, lipidic structures are observed in the stellate reticulum and the stratum intermedium. The plasma membrane of secretory ameloblasts as well as the content of some lysosomial structures are well contrasted. However the distal membranes of the Tomes processes showed weakly stained portions alternating with electron dense segments. Extracellular lipidic globules, sometimes associated with plasma membranes were also seen. These observations demonstrated the alternating weak and strong staining reactions in unsaturated fatty acids of plasma membrane areas of the cell processes, which contrasts with the continuous staining of the plasma membrane of the cell bodies. These observations could be related to functional differences.

Osmic acid synoviorthesis is an adjuvant form of local treatment for rheumatoid arthritis, the value of which has been demonstrated by a large number of studies over some 30 years. However, it is widely considered that the stability of the results of this type of synoviorthesis is less satisfactory than that obtained with isotope synoviorthesis and that osmic acid may damage the articular cartilage. The authors analyzed the results of a retrospective study of 90 rheumatoid knees treated by this method with a follow-up of more than 5 years (mean period 9 years). With such a follow-up, a satisfactory clinical result was seen in 44.5 p. cent of cases and radiological evaluation of the knees treated showed no worsening in initial signs in an identical percentage of cases. Best results were obtained in joints where there was little radiological damage and in cases of inflammatory or only moderately progressive arthritis, good results may also be hoped for in more severe or advanced cases. The good overall quality of the results obtained with a mean follow-up of 9 years would be in favour of the value of osmic acid synoviorthesis in the local treatment of rheumatoid arthritis.

We have studied by viscometry and spectrophotometry the effects of glutaraldehyde, acetaldehyde, acrolein and formaldehyde on F-actin in vitro. Pretreatment with acrolein and, to a lesser extent, with glutaraldehyde, results in increased destruction of F-actin during the subsequent degradation with osmic acid. Formaldehyde alone disintegrates actin filaments. Acetaldehyde gives the best results and does not seem to damage F-actin. Phalloidin protects F-actin against destruction by osmic acid and this protection is also observed in the F-actin which has been pretreated with the four aldehydes mentioned.