DOCSLIB.ORG

'Dialysis Related Arthropathy': a Survey of 95 Patients Receiving Chronic Haemodialysis with Special Reference to 132 Microglobulin Related Amyloidosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
'Dialysis Related Arthropathy': a Survey of 95 Patients Receiving Chronic Haemodialysis with Special Reference to 132 Microglobulin Related Amyloidosis Ann Rheum Dis: first published as 10.1136/ard.48.5.409 on 1 May 1989. Downloaded from Annals of the Rheumatic Diseases, 1989; 48, 409-420 'Dialysis related arthropathy': a survey of 95 patients receiving chronic haemodialysis with special reference to 132 microglobulin related amyloidosis N P HURST,' R VAN DEN BERG,' A DISNEY,2 M ALCOCK,3 L ALBERTYN,3 M GREEN,' AND V PASCOE4 From the 'Rheumatology Unit, the 2Renal Unit, the 3Department of Radiology, and the 4Department of Pathology, The Queen Elizabeth Hospital, Woodville, South Australia SUMMARY Ninety five patients receiving chronic haemodialysis (CHD) were surveyed to determine the prevalence of rheumatic disease and, where possible, its aetiology. At least three distinct rheumatic syndromes were identified-a group of patients with a syndrome consisting of large and medium joint synovial swelling, restricted hips and shoulders, tenosynovitis, carpal tunnel syndrome, and bone cysts due to deposition of 132 microglobulin related amyloid (AMP2m); a second group with erosive azotaemic osteoarthropathy; and a third group with age related degenerative disease of small, large, and axial joints. The data presented suggest that in patients receiving CHD (a) the prevalence of AM2i2m deposition and the associated syndrome increases with duration of dialysis, but in patients who have been dialysed for more than 10 years the risk of developing AM2n2m is related to age; (b) AM2i2m deposition in subchondral cysts, but not synovium, causes joint destruction; also, AMp2m may be more prone to deposition in synovium of joints already damaged by other processes; (c) in the absence of synovial iron deposition synovial AM2n2m is not associated with an inflammatory infiltrate; (d) hyperparathyroidism and perhaps other factors such as synovial iron deposition are probably more important than AMgi2m as causes http://ard.bmj.com/ of peripheral joint degeneration and destructive spondyloarthropathy in patients receiving CHD. A number of skeletal and articular abnormalities usually small and perivascular.26 27 A similar trop- have been described in patients undergoing chronic ism for synovial tissue has been described previously haemodialysis (CHD). These include renal for AL-type amyloid,28 but AA-type amyloid osteodystrophy, avascular necrosis of bone, crystal usually spares synovium and bone. A minor degree induced arthritis, periarticular calcification,'-3 and of synovial amyloidosis occurs with increasing age.29 on October 3, 2021 by guest. Protected copyright. recurrent haemarthrosis of shoulders.2 3 A syn- Some bone deposits of AM02m have been re- drome, comprising carpal tunnel syndrome sponsible for fractures,30 31 and it has been sug- (CTS),8 chronic large joint arthropathy,3 9 and gested that AM02m is responsible for the erosive bone cysts,'0 has also been recognised as a major arthropathyll 13 21 23 and spondyloarthropathy25 complication of CHD. Recent studies have demons- which may occur in patients undergoing CHD. It is trated the deposition of amyloid in the carpal not certain, however, whether amyloid alone or tunnel, bone cysts, synovium, and tendons of such other factors such as synovial iron deposition patients.8 1(}4 The major component of the amyloid contribute to the large and medium joint arthro- has been identified as 12 microglobulin,'52 but pathy associated with this syndrome.3 32 amyloid P component is also present.2' A suggested The present study was undertaken to assess the designation is 'AM02m'. 19 AM2i2m has also been prevalence of rheumatic disease and, where poss- identified in synovial fluid24 and vertebral discs.25 ible, its relation with tissue deposition of AM2n2m or AMt12m deposits have been infrequently described in other factors in a defined population of patients other major organs'2 23 and, where present, are receiving CHD. Patients and methods Accepted for publication 27 July 1988. Correspondence to Dr N P Hurst, Rheumatology Unit. The Queen Elizabeth Hospital, Woodville, South Australia 5011. The patient population consisted of all 118 patients 409 Ann Rheum Dis: first published as 10.1136/ard.48.5.409 on 1 May 1989. Downloaded from 410 Hurst, van den Berg, Disney, Alcock, Albertyn, Green, Pascoe receiving CHD under the care of the Queen within 18 months of the study and most within 12 Elizabeth Hospital renal unit during a defined nine months. The remaining patients had either declined month period (May 1986-January 1987). Of these, to undergo bone biopsy or the available biopsy had 23 patients were excluded from the study: seven had been performed more than 18 months previously. received renal transplants, two died before being Other histological specimens were available from 12 reviewed, and a further 14 patients who were patients and synovial fluid from a further seven dialysed at remote regional centres (>250 miles) patients. These were examined for the presence of were not seen for logistic reasons. Ninety five amyloid by Congo red staining. Where Congophilia patients (40 female, 55 male) were available for was identified the presence Of P2 microglobulin was review. sought using rabbit antihuman 12 microglobulin All patients were reviewed for symptoms of antibody and the peroxidase-antiperoxidase tech- musculoskeletal disease or symptoms related to nique (Dakopatt). Tissues containing either AA or systemic amyloidosis using a structured question- AL-type amyloid were used as negative controls for naire and then underwent a complete physical immunoperoxidase studies. Deposition of iron in examination performed by one of two rheumatolog- tissues was sought using Perls' stain. Synovial fluid ists (NH, R van den B). The presence of joint was centrifuged and the sediment examined for the 'restriction' was defined as loss of 30% or more of presence of crystals by polarising microscopy, or the normal range of movement and 'synovitis' as the deposits of AM2n2m using the immunoperoxidase presence of palpable synovial thickening or clinically technique followed by Congo red.24 detectable effusion, or both. CTS was or had been diagnosed on the basis of a typical clinical history, Results physical findings, and nerve conduction studies. In all cases details of dialysis, cause of renal failure, PATIENTS and parathyroid status were obtained by review of Patients were divided into three cohorts according case records. to duration of haemodialysis: group A=0 to 4-9 All patients had radiographs taken of hands, years (n=49), group B=5 to 9-9 years (n=32), and wrists, shoulders, hips, knees, feet, and spine. These group C 310 years (n=14). The mean (SD) ages were reviewed by two radiologists (LA, MA) were: group A 55-8 (11-9), group B 46-8 (13-3), experienced in reporting renal bone disease. A group C 52-1 (13-2) years. of renal was causes of AA-type radiological diagnosis osteodystrophy The renal failure included http://ard.bmj.com/ made if any of the following were present: sub- amyloid in one patient and multiple myeloma in periosteal resorption, tuft resorption, distal clavicu- another. They had received dialysis for two years lar erosions, rugger jersey spine or other typical and one year respectively and neither had arthro- bony sclerosis, or coarse bony trabeculation. A pathy, bone cysts, or CTS. diagnosis of significant active hyperparathyroidism Patients had been treated mostly with cuprophane was based on finding either (a) typical radiological membrane dialysers. Reverse osmosis has been used changes and parathyroid hormone >1000 pmoIIl or for the last 10 years ensuring dialysate aluminium (b) a bone biopsy specimen showing active bone concentrations <10 iimol/l. on October 3, 2021 by guest. Protected copyright. resorption. Nodal erosive osteoarthrosis of hands was defined as loss of joint space, osteophyte CLINICAL AND RADIOLOGICAL FINDINGS formation, and erosive bone damage, usually affect- ing interphalangeal or first carpometacarpal joints. Joint symptoms Erosive azotaemic osteoarthropathy was defined as Pain and stiffness affecting peripheral and axial the presence of marginal joint erosions, usually joints were very common and the frequency rose affecting metacarpophalangeal or interphalangeal with increasing duration of dialysis (Table 1). joints, and occasionally larger joints, in the absence of joint space narrowing. Large and medium size joints The following biochemical studies were per- The frequency of joint restriction, synovitis, and formed on serum or plasma from all patients: serum effusions in large and medium size joints rose with 12 microglobulin before and after dialysis, C reac- duration of dialysis and affected over 60% of the tive protein, ferritin, serum electrophoresis, patients in group C (Tables 1 and 2). rheumatoid factor, and antinuclear factor. Parathy- Synovitis was most common in the knee (Table 2); roid hormone was measured by immunoassay for in five of these patients there was no radiological the C terminal fragment. change, in five osteoarthritis, in one a large sub- Iliac crest bone biopsy results were reviewed from chondral tibial cyst later shown to contain AM02m 68/95 patients. All biopsies had been carried out (see below), and in one loss of articular cartilage. In Ann Rheum Dis: first published as 10.1136/ard.48.5.409 on 1 May 1989. Downloaded from Dialysis related arthropathy 411 one patient with an acute painless effusion haemar- found for bleeding. Several patients had radiological throsis was found but no organisms or crystals. evidence of major rotator cuff attrition, often Restriction of knee movements
Load more

Recommended publications
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Bursae Around the Knee Joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India
    MUSCULOSKELETAL RADIOLOGY Bursae around the knee joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India Correspondence: Dr. Priyank S. Chatra, Department of Radiology, Yenepoya Medical College, Deralakatte, Mangalore – 575 018, Karnataka, India. E-mail: [email protected] Abstract A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. Key words: Iliotibial bursa; infrapatellar bursa; pes anserine bursa Introduction and the gastrocnemius-semimembranosus bursa. On MRI imaging, bursitis appears as an oblong fluid collection in A bursa is a fluid-filled structure that is present between its expected anatomical location. the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent Prepatellar Bursitis moving structures. Typically, bursae are located around large joints such as the shoulder, knee, hip, and elbow.[1] The prepatellar bursa is located between the patella and the Inflammation of this fluid-filled structure is called bursitis. overlying subcutaneous tissue. Chronic trauma in the form Trauma, infection, overuse, and hemorrhage are some of prolonged or repeated kneeling leads to inflammation of the common
    [Show full text]
  • Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
    Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions.
    [Show full text]
  • Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis And
    yst ar S em ul : C c u s r u r e M n t & R Orthopedic & Muscular System: c e Aydin, et al., Orthopedic Muscul Syst 2014, 3:2 i s d e e a p ISSN: 2161-0533r o c DOI: 10.4172/2161-0533-3-1000159 h h t r O Current Research Review Article Open Access Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment Nuri Aydin*, Okan Tok and Bariş Görgün Istanbul University Cerrahpaşa, School of Medicine, Istanbul, Turkey *Corresponding author: Nuri Aydin, Istanbul University Cerrahpaşa, School of Medicine, Orthopaedics and Traumatology, Istanbul, Turkey, Tel: +905325986232; E- mail: [email protected] Rec Date: Jan 25, 2014, Acc Date: Mar 22, 2014, Pub Date: Mar 28, 2014 Copyright: © 2014 Aydin N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease. Keywords: Arthropathy; Glenohumeral joint; Articular fluid Rotator cuff tear not only plays a role at the beginning of the disease, but also a developed rotator cuff tear is a result of the inflammatory Introduction process.
    [Show full text]
  • CPT® Procedural Coding 110 L with Areportoftheprocedure
    20610-20611 2017 Illustrated Coding and Billing Expert for Orthopedics Lower 20610-20611 ICD-9-CM Diagnostic Codes M16.7 Other unilateral secondary 711.05 Pyogenic arthritis involving pelvic osteoarthritis of hip 20610 Arthrocentesis, aspiration and/or region and thigh M17.0 Bilateral primary osteoarthritis of injection, major joint or bursa (eg, 711.06 Pyogenic arthritis involving lower leg knee shoulder, hip, knee, subacromial 713.5 Arthropathy associated with ⇄ M17.11 Unilateral primary osteoarthritis, right bursa); without ultrasound guidance neurological disorders knee 20611 Arthrocentesis, aspiration and/or 714.0 Rheumatoid arthritis ⇄ M17.12 Unilateral primary osteoarthritis, left knee injection, major joint or bursa (eg, 715.15 Osteoarthrosis, localized, primary, pelvic region and thigh M17.2 Bilateral post-traumatic osteoarthritis shoulder, hip, knee, subacromial 715.16 Osteoarthrosis, localized, primary, of knee bursa); with ultrasound guidance, with lower leg M17.5 Other unilateral secondary permanent recording and reporting 715.25 Osteoarthrosis, localized, secondary, osteoarthritis of knee (Do not report 20610, 20611 in pelvic region and thigh ⇄ M1A.051 Idiopathic chronic gout, right hip conjunction with 27370, 76942) 715.26 Osteoarthrosis, localized, secondary, ⇄ M1A.062 Idiopathic chronic gout, left knee (If fluoroscopic, CT, or MRI guidance is lower leg ⇄ M25.052 Hemarthrosis, left hip ⇄ M25.061 Hemarthrosis, right knee performed, see 77002, 77012, 77021) 715.35 Osteoarthrosis, localized, not specified whether primary
    [Show full text]
  • Current Trends in Tendinopathy Management
    Best Practice & Research Clinical Rheumatology 33 (2019) 122e140 Contents lists available at ScienceDirect Best Practice & Research Clinical Rheumatology journal homepage: www.elsevierhealth.com/berh 8 Current trends in tendinopathy management * Tanusha B. Cardoso a, , Tania Pizzari b, Rita Kinsella b, Danielle Hope c, Jill L. Cook b a The Alphington Sports Medicine Clinic, 339 Heidelberg Road, Northcote, Victoria, 3070, Australia b La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Victoria, 3083, Australia c MP Sports Physicians, Frankston Clinic, Suite 1, 20 Clarendon Street, Frankston, Victoria, 3199, Australia abstract Keywords: Tendinopathy Tendinopathy (pain and dysfunction in a tendon) is a prevalent Management clinical musculoskeletal presentation across the age spectrum, Rehabilitation mostly in active and sporting people. Excess load above the ten- Achilles tendinopathy don's usual capacity is the primary cause of clinical presentation. Rotator cuff tendinopathy The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and func- tion is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circum- stances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.
    [Show full text]
  • Pigmented Villonodular Synovitis in Pediatric Population: Review of Literature and a Case Report Mohsen Karami*, Mehryar Soleimani and Reza Shiari
    Karami et al. Pediatric Rheumatology (2018) 16:6 DOI 10.1186/s12969-018-0222-4 CASEREPORT Open Access Pigmented villonodular synovitis in pediatric population: review of literature and a case report Mohsen Karami*, Mehryar Soleimani and Reza Shiari Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. Case Presentation: The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. Conclusion: PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment. Keywords: Juvenile idiopathic arthritis, Patellar dislocation, Pigmented villonodular synovitis Background aberrations that cause hemorrhagic tendencies, as well as Pigmented villonodular synovitis (PVNS) is a rare prolif- genetic factors, have been proposed as potential causes erative process that affects the synovial joint, tendon [2, 3]. Trauma and rheumatoid arthritis association have sheaths, and bursa membranes [1]. The estimated inci- also been considered [14, 15, 33].
    [Show full text]
  • Calcified Tendinitis: a Review
    Ann Rheum Dis: first published as 10.1136/ard.42.Suppl_1.49 on 1 January 1983. Downloaded from Ann Rheum Dis (1983), 42, Supplement p 49 Calcified tendinitis: a review G. FAURE,' G. DACULSI2 From the 'Clinique Rhumatologique et Laboratoire d'immunologie, Faculte A de Medecin, Universite de Nancy I, 54500 Vandoeuvre les Nancy, France and 2U225 INSERM, Faculte de Chirurgie Dentaire, Place Alexis Ricordeau, 44042 Nantes, France Introduction Calcified tendinitis in clinical practice Calcified tendinitis is a common CLINICAL FEATURES disorder. Many names have been used According to Welfling calcific to describe it: some of them, such as periarthritis is responsible for 7% of 'calcific periarthritis', emphasise the painful shoulder syndromes,' which extra-articular site of the deposit; have various presentations. others, such as 'periarticular apatite (1) Chronic symptoms-more or deposition', mention the nature of the less severe pain; tenderness leading to compound found in the calcification; various degrees of incapacitation. and more recent ones, such as These symptoms induce the demand 'calcifying tendinitis',-'3 emphasise the. for radiographs, which reveal the Fig. 1 Calcific periarthritis ofthe active process that might explain the presence of deposits. shoulder. Calcification is obvious; it deposition. Differentiated from (2) Acute inflammatory crisis with has already migrated from copyright. arthritis at the end of the nineteenth severe pain, tenderness, and local supraspinatus region to bursa area. century, this syndrome has only oedematous inflammation sometimes recently been related to the presence leading to restricted active an*d passive of apatite in tendon sheaths.4'5 It can motion. Fever and malaise may be affect almost any tendon at its observed.
    [Show full text]
  • Trauma and Reiter's Syndrome: Development of 'Reactive Arthropathy' in Two Patients Following Musculoskeletal Injury
    Ann Rheum Dis: first published as 10.1136/ard.43.6.829 on 1 December 1984. Downloaded from Annals of the Rheumatic Diseases, 1984, 43, 829-832 Trauma and Reiter's syndrome: development of 'reactive arthropathy' in two patients following musculoskeletal injury JEFFREY J. WISNIESKI From the Medical Service, Rheumatology Section, Cleveland Veterans Administration Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. SUMMARY Two patients are reported who developed arthropathies with some features of Reiter's syndrome shortly after physical injury. Both were HLA-B27 positive. No other precipitating factors were identified, and the possibility that trauma may have precipitated a reactive arth- ropathy is discussed. Key words: endogenous antigen (immunogen), genetic predisposition, collagen. copyright. Concepts of Reiter's syndrome (RS) have changed swelling, pain, and heat; internal mechanical dramatically in the past decade. Notable develop- derangement was suspected. Five months after the ments include: (1) recognition that clinical activity trauma arthroscopy revealed hyperaemic and thick- may be acute/self-limited, acute/recurrent, or ened synovium but no structural abnormality. Syno- chronic'-5; (2) recognition that disease mani- vial biopsy showed chronic synovitis with marked festations vary from 'incomplete' RS to multisystem lymphocyte and plasma cell infiltration. involvement'-3; (3) development of concepts of Seven months after the injury the knee continued genetic predisposition and linkage4 5; and (4) charac- to be warm and painful, with thickened synovium and http://ard.bmj.com/ terisation of RS as reactive arthritis developing in a large effusion. No other joints were involved. Con- genetically predisposed individuals.45 In most junctivitis of the left eye was noted.
    [Show full text]
  • Page 1 of 4 COPYRIGHT © by the JOURNAL of BONE and JOINT SURGERY, INCORPORATED LAMPLOT ET AL
    COPYRIGHT © BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED LAMPLOT ET AL. RISK OF SUBSEQUENT JOINT ARTHROPLASTY IN CONTRALATERAL OR DIFFERENT JOINT AFTER INDEX SHOULDER, HIP, OR KNEE ARTHROPLASTY http://dx.doi.org/10.2106/JBJS.17.00948 Page 1 Appendix TABLE E-1 Included Alternative Primary Diagnoses ICD-9-CM Code Diagnosis* 716.91 Arthropathy NOS, shoulder 716.95 Arthropathy NOS, pelvis 716.96 Arthropathy NOS, lower leg 719.45 Joint pain, pelvis 719.91 Joint disease NOS, shoulder *NOS = not otherwise specified. Page 1 of 4 COPYRIGHT © BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED LAMPLOT ET AL. RISK OF SUBSEQUENT JOINT ARTHROPLASTY IN CONTRALATERAL OR DIFFERENT JOINT AFTER INDEX SHOULDER, HIP, OR KNEE ARTHROPLASTY http://dx.doi.org/10.2106/JBJS.17.00948 Page 2 TABLE E-2 Excluded Diagnoses* ICD-9- ICD-9- ICD-9- ICD-9- CM Code Diagnosis CM Code Diagnosis CM Code Diagnosis CM Code Diagnosis 274 Gouty arthropathy NOS 696 Psoriatic 711.03 Pyogen 711.38 Dysenter arthropathy arthritis- arthritis NEC forearm 274.01 Acute gouty arthropathy 696.1 Other psoriasis 711.04 Pyogen 711.4 Bact arthritis- arthritis-hand unspec 274.02 Chr gouty arthropathy 696.2 Parapsoriasis 711.05 Pyogen 711.46 Bact arthritis- w/o tophi arthritis-pelvis l/leg 274.03 Chr gouty arthropathy w 696.3 Pityriasis rosea 711.06 Pyogen 711.5 Viral arthritis- tophi arthritis-l/leg unspec 274.1 Gouty nephropathy NOS 696.4 Pityriasis rubra 711.07 Pyogen 711.55 Viral arthritis- pilaris arthritis-ankle pelvis 274.11 Uric acid nephrolithiasis 696.5 Pityriasis NEC & 711.08
    [Show full text]
  • “Mutilans-Type” Jaccoud Arthropathy
    Images in Rheumatology “Mutilans-type” Jaccoud Arthropathy MITTERMAYER B. SANTIAGO, MD, PhD; VIVIANE MACHICADO, MD; DANIEL SÁ RIBEIRO, MD, Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico. Address correspondence to Dr. M.B. Santiago, Serviços Especializados em Reumatologia da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia, Brazil. E-mail: [email protected]. J Rheumatol 2015;42:725–6; doi:10.3899/jrheum.141188 Jaccoud arthropathy (JA) is a clinical complication most fibrosis in the soft tissues of the joints. This condition frequently seen in patients with systemic lupus erythe- limited her articular functional capacity and decreased her matosus (SLE). It occurs at a prevalence of about 5%. JA is quality of life. defined as the presence of reversible joint deformities, Laboratory investigations showed an antinuclear particularly in the hands, in the absence of articular erosions antibody of 1/5120 homogeneous pattern with positivity of on plain radiographs1. A few small bone erosions may be both anti-dsDNA and anti-SSA/Ro antibodies. Anticyclic identified by magnetic resonance imaging (MRI)2. The citrullinated peptide antibodies and rheumatoid factor by etiopathogenic mechanisms of the development of JA are ELISA were negative. Plain radiograph of the hands had no unknown, but higher levels of serum interleukin 6 are evidence of bone erosion; MRI revealed tenosynovitis, but observed in patients with concurrent SLE and JA than in also failed to show any erosion (Figure 2). patients without these conditions3. We herein present a case involving a 48-year-old woman REFERENCES with a 17-year history of SLE mainly characterized by malar 1.
    [Show full text]
  • Acromegalic Arthropathy
    Ann. rheum. Dis. (1971), 30, 243 Ann Rheum Dis: first published as 10.1136/ard.30.3.243 on 1 May 1971. Downloaded from Acromegalic arthropathy R. BLUESTONE*, E. G. L. BYWATERS, M. HARTOG, P. J. L. HOLT, AND S. HYDE From the Department of Medicine, Royal Postgraduate Medical School, London Introduction comparable age-range. X rays were obtained of the peripheral joints and of the total spines in most patients. Spinal and peripheral joint abnormalities in patients with acromegaly, which have been recognized since Results (Table, overleaf) the original description was published by Marie (1886), may be severely disabling. However, the PERIPHERAL JOINTS nature of the arthropathy is not clear, and only Sixteen patients (9 men and 7 women) gave a history very limited morphological information is available of intermittent and long-lasting pain with episodes (Erdheim, 1931; Waine, Bennett, and Bauer, 1945; lasting weeks or months, usually of the shoulders, Keligren, Ball, and Tutton, 1952). Furthermore, knees, hands, or hips, but generalized in five and present day pituitary gland ablation, together with associated with widespread morning stiffness in more accurate assessment of treatment, should allow two. the reversibility of the arthropathy to be gauged. Peripheral joint abnormalities were detected in We have systematically characterized the loco- 26 patients of both sexes and all age groups. Joint motor system disorders in a group of patients swelling, other than simple bone-end enlargement, copyright. with acromegaly. Detailed studies of joint mor- was found in nine patients. This was usually a phology have been undertaken in three patients; painful knee swelling, sometimes due to effusion and we have correlated the arthropathy with the but more usually thickened synovial or periarticular duration and severity of the acromegaly.
    [Show full text]