Cases reported "Arthritis"

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11/116. The "SAPHO" syndrome: a case report of a patient with unusual bone scan findings.

    PURPOSE: The authors describe the clinical and bone scintigraphic findings of the SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The case report illustrates the significance of bone scintigraphy in the diagnosis. It shows that Tc-99m MDP scanning can detect signs of arthritis not seen with other imaging methods, because the arthritis is inflammatory in nature and does not always cause bone erosion. Thus it is not visualized on plain radiographs. knowledge of this disorder may help in the differential diagnosis of arthritis. MATERIALS AND methods: Tc-99m MDP bone scintigraphy was used to diagnose arthritic changes. Whole-body and multiple delayed spot images were obtained in a 39-year-old diabetic, hypertensive woman who had tenderness in the plantar aspect of her heels. Swelling of the small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders was noted. She also had hydradenitis suppurativa and a history of a previous episode in which the arthritis improved after surgical treatment for the hydradenitis. RESULTS: All active joint lesions were visualized on the bone scan, including the arthritis, which was not detected with other imaging methods. They were all well demonstrated in the bone scintiscan. The scan findings, along with the presence of hydradenitis, led to the correct diagnosis of SAPHO syndrome. CONCLUSION: Tc-99m MDP bone scanning may be helpful in diagnosing arthritis as associated with the SAPHO syndrome.
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keywords = bone
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12/116. Monarthritis of the ankle as manifestation of a calcaneal metastasis of bronchogenic carcinoma.

    We report a case of bronchiogenic carcinoma metastasizing to the calcaneus and clinically manifesting itself as a therapy-refractory monarthritis in the right ankle. There is a wide spectrum of possible diagnoses of acute ankle monarthritis including different forms of inflammatory rheumatic diseases, sarcoidosis, osteoarthritis, or septic arthritis. Primary or metastatic malignancies of the hand or foot bones are considered to be rare. Persistent monarthritis as a sole symptom of a calcaneal metastasis has never been reported. This case demonstrates possible difficulties in the early differential diagnosis of acute monarthritis, and will be discussed with respect to the few reports on foot acrometastases.
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ranking = 0.090909090909091
keywords = bone
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13/116. Arthropathy, skin and bone lesions in pancreatic disease.

    A patient with a history of alcoholism and pancreatic calcification, developed subcutaneous fat necrosis and an arthropathy, associated with a pancreatic pseudocyst and accompanied by an elevation of serum lipase and amylase. The illness was complicated by bacteremia and destructive bone lesions. A clinical distinction between osteomyelitis and medullary fat necrosis proved difficult. infection of bone was demonstrated at one site but did not exclude medullary fat necrosis elsewhere.
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ranking = 0.54545454545455
keywords = bone
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14/116. Pancreatic pseudocystportal vein fistula manifests as residivating oligoarthritis, subcutaneous, bursal and osseal necrosis: a case report and review of literature.

    Pseudocyst is a common complication of pancreatitis. Pseudocyst may rupture into the surrounding organs. rupture into the portomesenteric vein is extremely rare with only seven cases being described in the English literature. pancreatic portal vein fistula is very difficult to verify. The aim of this study was to view the diagnostic methods of pancreatic portal vein fistula and to describe the results of high-dose corticosteroid treatment to our knowledge for the first time. We report here a case of pancreatic portomesenteric vein fistula that was manifest as subcutaneous fat necrosis, bursal necrosis, intramedullary aseptic bone necrosis and recidivating oligoarthritis. The literature of this unusual complication is reviewed. The results of high-dose corticosteroid treatment are also described. In patients with recidivating oligoarthritis, subcutaneous, bursal or osseal necrosis a pancreatic process should be included in the differential diagnosis even in cases of no abdominal signs or symptoms or previous abdominal history. Operative exploration of the pancreas should be performed in the early phase of the disease. To diminish the ongoing extrapancreatic manifestations after the closure of the fistula massive corticosteroid treatment may be attempted although the role of this therapy remains controversial.
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ranking = 0.090909090909091
keywords = bone
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15/116. Multicentric reticulohistiocytosis: a rare cause of erosive arthropathy of the distal interphalangeal finger joints.

    BACKGROUND: Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, presenting with typical skin abnormalities and erosive polyarthritis, which is often associated with malignancy. CASE REPORT: A case of MRH arthropathy, in which the typical nodular skin manifestation of the disease was absent, is described in a patient with a past history of breast cancer and no evidence of recurrent or new malignancy. RESULTS: Careful clinical and roentgenological evaluation disclosed important clues to differentiate this condition from other more common distal interphalangeal arthritides--namely, osteoarthritis and its "erosive" variant, rheumatoid arthritis, psoriatic arthritis, tophaceous gout, dialysis related hand arthropathy, and from the rarer fibroblastic rheumatism, all of which can be mimicked by MRH. Histopathology showed the characteristic histiocytic and multinucleated giant cell infiltrate with ground glass cytoplasm, and immunohistochemical analysis showed markers evocative of a monocyte/macrophage origin of MRH.
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ranking = 3.3247184803569
keywords = macrophage
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16/116. Inhibition of the TNF-pathway: use of infliximab and etanercept as remission-inducing agents in cases of therapy-resistant chronic inflammatory disorders.

    OBJECTIVE: To examine the potential of the two tumour necrosis factor (TNF) inhibitors infliximab and etanercept as remission-inducing agents in chronic therapy-resistant inflammatory disorders of immune or non-immune pathogenesis. methods: 14 patients with adult Still's disease/macrophage activation syndrome (4), Wegener's disease (3), Behcet's disease (3), keratoscleritis (1), lymphomatous tracheo-bronchitis (1) Cogan's syndrome (1), and rapidly destructive crystal arthropathy (1) were treated with infliximab (n = 10) and etanercept (n = 4). All patients showed organ-threatening progression of their diseases with resistance to conventional immunosuppressive medication. Therapeutic benefit was assessed clinically and by documenting organ-specific functional and morphological alterations. Side effects were compared with the data of our clinic's rheumatoid arthritis (RA) patients treated by TNF inhibitors. RESULTS: A rapid and dramatic beneficial effect was documented in 9 patients and a moderate one in 5. Best responses (clinical and laboratory parameters) were seen in patients with macrophage activation syndrome/adult Still's disease and Behcet's disease, while the results were less impressive in those with Wegener's disease, Cogan's syndrome, idiopathic cerato-scleritis and lymphomatous tracheobronchitis. In all cases immunosuppressive agents and systemic glucocorticoids could be reduced or discontinued. CONCLUSIONS: TNF inhibition may be highly effective in patients with severe, therapy-resistant chronic inflammatory disorders.
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ranking = 6.6494369607137
keywords = macrophage
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17/116. Late-onset spondyloarthropathy mimicking reflex sympathetic dystrophy syndrome.

    Atypical presentations are common when spondyloarthropathy develops in older patients. We report two cases initially mistaken for reflex sympathetic dystrophy syndrome (RSDS). Both the patients were men, aged 62 and 75 years, respectively, with marked painful edema of a foot. One patient reported a moderate-energy trauma as the triggering event. Severe diffuse demineralization was noted on radiographs and diffuse hyperactivity on bone scans starting at the early vascular phase. These findings suggestive of RSDS led to treatment with calcitonin, griseofulvin, and pamidronate, all of which were ineffective. Laboratory tests showed severe inflammation, promoting investigations for other conditions. Spondyloarthropathy was diagnosed based on oligoarthritis with sacroiliitis, presence of HLA B27, and a favorable response to non-steroidal antiinflammatory therapy. In older patients, edema of the foot with severe demineralization and the laboratory evidence of inflammation should suggest a spondyloarthropathy.
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ranking = 0.090909090909091
keywords = bone
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18/116. Etanercept ameliorates sarcoidosis arthritis and skin disease.

    sarcoidosis is a systemic disorder of unknown etiology characterized by its pathological hallmark, the noncaseating granuloma. In granulomatous diseases, the proinflammatory peptide mediators, including tumor necrosis factor-alpha (TNF-alpha), are increased in the blood and fluids surrounding the activated macrophages. We describe a patient with chronic sarcoidosis arthropathy and lupus pernio resistant to corticosteroids and disease modifying antirheumatic agents, who responded to the addition of etanercept. We discuss the possible mechanisms of action of anti-TNF agents in granulomatous diseases and suggest that chronic, resistant sarcoidosis requires combination immunosuppressive therapy.
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ranking = 3.3247184803569
keywords = macrophage
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19/116. The arthritis of familial mediterranean fever.

    familial mediterranean fever (FMF) is a disease of unknown etiology and pathogenesis. In addition to fever, arthritis is among its most frequent manifestations. The arthritis of FMF is typically an acute, episodic, self-limited process with no sequelae. The radiographic features of FMF arthritis are usually limited to transient, often severe osteoporosis. synovial fluid analysis many mimic septic arthritis with very high white blood cell counts; cultures are uniformly negative. The course of FMF is almost always benign, with no residual articular incapacity. Some patients, limited to certain ethnic groups, develop renal amyloidosis. colchicine therapy modifies the natural history of the disease by decreasing the attack frequency and preventing amyloid deposition. At present, a lipocortin deficiency appears to be the likely candidate for a pathogenic mechanism. An unusual case with dramatic periarticular features (periostitis) and a protracted course with an excellent response to synovectomies is reported here. There is no explanation for the exuberant periarticular bone formation noted in this case, but a variety of recently discovered growth factors may be implicated.
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ranking = 0.090909090909091
keywords = bone
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20/116. Total elbow replacement for distal humerus fractures and traumatic deformity: results and complications of semiconstrained implants and design rationale for the Discovery elbow System.

    Recent advances in elbow replacement design have further extended its usefulness as an expedient reconstructive method for restoring elbow function following trauma. This is particularly true in elderly patients, for whom treatment is complicated by the frequent presence of osteoporosis, severe comminution with small condylar fracture fragments, and diminished bone-healing capacity. This article addresses the role of elbow replacement for fracture, traumatic deformity, post-traumatic arthritis, and instability. Indications, techniques, and results are presented. Complications of semiconstrained implants are presented, and the design rationale for, and examples of, the latest-generation Discovery elbow System (Biomet orthopedics, Warsaw, indiana) are discussed.
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ranking = 0.090909090909091
keywords = bone
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