1/81. Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. methods: review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean c-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
2/81. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome).A 63-year-old man presented with acute symmetrical polysynovitis associated with pitting edema of both the hands and feet. He was seronegative for rheumatoid factor and no radiologically evident erosion was noted in the joints of his hands and feet. Evaluation excluded congestive heart failure, nephrotic syndrome, and hypothyroidism as the cause of edema. Treatment with nonsteroidal anti-inflammatory drugs and low-dose steroids induced complete remission. The clinical manifestations of this patients were consistent with those of a distinctive, although rare, form of arthritis called remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. This syndrome has a good prognosis in elderly patients.- - - - - - - - - - ranking = 6keywords = synovitis (Clic here for more details about this article) |
3/81. Remission of inflammatory arthropathy in association with anti-CD20 therapy for non-Hodgkin's lymphoma.We describe a case involving a 53-yr-old male with a marginal zone B-cell lymphoma, associated with an IgM paraprotein and a rheumatoid factor-negative inflammatory polyarthropathy, treated with monoclonal anti-CD20 antibody. During the subsequent 12 weeks, evidence of synovitis reduced to a negligible level, despite no significant change in lymphoma bulk or paraprotein level. The relationship between the lymphoma and the arthropathy, and the likely mechanism of remission of the arthropathy, are discussed in the context of the potential value of anti-CD20 therapy in rheumatoid arthritis.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
4/81. Infections of the hand.In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua new guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
5/81. Erosive polyarthritis in Crohn's disease. Report of a case.Erosive polyarthritis in Crohn's disease is rare and raises diagnostic and pathophysiological problems. A case with destructive lesions of the shoulders and hips is reported in a 43-year-old woman with a 26-year history of Crohn's disease. ankylosis of the spine and hips, motion range limitation of the shoulders and wrists, and boutonniere deformity of the third finger of the right hand were present. Tests were negative for rheumatoid factor and the hla-b27 antigen. Plain radiographs showed a triple rail pattern at the spine; synostosis of the hips; and destructive lesions of the shoulders, wrists, tarsal bones, and third proximal interphalangeal joint of the right hand. Glucocorticoid therapy was effective in suppressing the bowel symptom flares but only partially improved the joint symptoms, whose treatment relied mainly on nonsteroidal antiinflammatory agents and rehabilitation therapy. Erosive arthritis in Crohn's disease is frequently monoarticular, with the hip being the most common target. It can complicate a spondylarthropathy or reveal granulomatous synovitis. Polyarticular forms pose difficult diagnostic and therapeutic challenges and add to the disability caused by the bowel disease. The potential role of genetic factors remains to be studied.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
6/81. Lipophagic granulomatous panniculitis with lipoatrophy mimicking arthritis with pitting edema.We describe a preadolescent girl with intense ankle synovitis and pitting edema that obscured the subcutaneous origin of the inflammation. Typical nodular disease emerged after corticosteroid tapering when regional atrophy developed.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
7/81. Seropositive polyarthritis and skin manifestations in T-prolymphocytic leukemia/Sezary cell leukemia variant.Sezary cell leukemia (SCL) is a rare T cell neoplasia that has been suggested to be a variant of T-prolymphocytic leukemia (T-PLL). Both disorders have an aggressive clinical course, lymphocytosis with characteristic morphology, lymphadenopathy, hepatomegaly, characteristic cytogenetic abnormalities and mature T cell phenotypes. Skin lesions, however, are mainly found in T-PLL. We describe a patient with T-PLL/SCL, who atypically presented with severe seropositive polyarthritis and skin lesions, responding to treatment with human CD52 antibody, CAMPATH-1H and pentostatin. Meningeal leukemia and an assumed myocardial infiltration subsequently developed. Polyarthritis is common in T large granular lymphocyte leukemia and adult T cell lymphoma-leukemia, but both entities could be ruled out in the present case. In rheumatoid arthritis, an expansion of CD4 and/or CD8 T lymphocytes is well documented and this phenomenon is believed to be of pathogenetic importance. We speculate that the T cell clone in the present case had special homing properties or cytokine effects resulting in synovitis.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
8/81. Acute non-purulent inflammatory arthropathy associated with staphylococcus aureus abscess.Case 1. A 20-year-old woman presented 4 weeks post-partum with widespread symmetrical inflammatory polyarthropathy with marked synovitis. Investigations revealed grossly raised CRP with negative immunology screen. A few days before presentation she saw her general practitioner with left-sided mastitis, which then developed into a Staphylococcus breast abscess. Surgical drainage of this led to almost immediate resolution of the joint complaints and return of CRP to normal. Case 2. A 27-year-old man developed widespread symmetrical inflammatory arthropathy. A few days prior to this he had developed folliculitis with a furuncle on his neck. Swab grew staphylococcus aureus. His arthritis settled immediately following spontaneous drainage of his abscess and a full course of antibiotic. The pathogenic mechanism is unclear but could be toxin-mediated.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
9/81. Evaluating patients with arthritis of recent onset: studies in pathogenesis and prognosis.Inflammatory synovitis of recent onset poses a diagnostic and prognostic challenge to primary care physicians and rheumatologists. A lack of understanding of the underlying etiologic and pathogenic processes limits the ability to distinguish forms of arthritis that follow a benign, self-limiting course from forms that proceed to an aggressive, erosive disease requiring intensive immunosuppressive therapy. It is estimated that between 30% and 40% of patients presenting with early synovitis have disease that remains unclassified. Using data from a cohort of patients with early synovitis and reviewing current literature, we discuss investigational approaches toward a new classification of patients with early synovitis. Although a lack of understanding of this heterogeneous clinical syndrome has led clinicians to take a largely empirical approach to treatment thus far, the evolving awareness of disease predisposition at a genetic level and the expanding ability to specifically manipulate biological pathways may ultimately change the approach to this clinical problem. JAMA. 2000;284:2368-2373.- - - - - - - - - - ranking = 4keywords = synovitis (Clic here for more details about this article) |
10/81. Amyloid arthropathy revealed by RS3PE syndrome.Amyloid arthropathy is a form of primary AL amyloidosis with a monoclonal component in the blood and/or urine, and RS3PE syndrome is acute edematous polysynovitis in subjects older than 60 years. A 74-year-old man was diagnosed with both disorders. He was admitted for benign acute polyarthritis of the hands and feet and reported carpal tunnel symptoms predominating on the right. A synovial biopsy at the right wrist disclosed deposits that stained with congo red even after potassium permanganate treatment (positive Wright's test). Articular AL amyloidosis was diagnosed. The symptoms resolved under glucocorticoid therapy alone, casting some doubt on their relationship with the amyloidosis. Roentgenograms showed geodes, a feature not present in RS3PE. Whether RS3PE may be among the possible presentations of articular amyloidosis is discussed.- - - - - - - - - - ranking = 1keywords = synovitis (Clic here for more details about this article) |
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