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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. -
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 -
'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. -
Synovial Fluidfluid 11
LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 253 Aptara Inc CHAPTER SynovialSynovial FluidFluid 11 Key Terms ANTINUCLEAR ANTIBODY ARTHROCENTESIS BULGE TEST CRYSTAL-INDUCED ARTHRITIS GROUND PEPPER HYALURONATE MUCIN OCHRONOTIC SHARDS RHEUMATOID ARTHRITIS (RA) RHEUMATOID FACTOR (RF) RICE BODIES ROPE’S TEST SEPTIC ARTHRITIS Learning Objectives SYNOVIAL SYSTEMIC LUPUS ERYTHEMATOSUS 1. Define synovial. VISCOSITY 2. Describe the formation and function of synovial fluid. 3. Explain the collection and handling of synovial fluid. 4. Describe the appearance of normal and abnormal synovial fluids. 5. Correlate the appearance of synovial fluid with possible cause. 6. Interpret laboratory tests on synovial fluid. 7. Suggest further testing for synovial fluid, based on preliminary results. 8. List the four classes or categories of joint disease. 9. Correlate synovial fluid analyses with their representative disease classification. 253 LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 254 Aptara Inc 254 Graff’s Textbook of Routine Urinalysis and Body Fluids oint fluid is called synovial fluid because of its resem- blance to egg white. It is a viscous, mucinous substance Jthat lubricates most joints. Analysis of synovial fluid is important in the diagnosis of joint disease. Aspiration of joint fluid is indicated for any patient with a joint effusion or inflamed joints. Aspiration of asymptomatic joints is beneficial for patients with gout and pseudogout as these fluids may still contain crystals.1 Evaluation of physical, chemical, and microscopic characteristics of synovial fluid comprise routine analysis. This chapter includes an overview of the composition and function of synovial fluid, and laboratory procedures and their interpretations. -
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. -
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. -
ICD~10~PCS Complete Code Set Procedural Coding System Sample
ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00 -
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. -
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]. -
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. -
Radiation Synovectomy with 166Ho-Ferric Hydroxide: a First Experience
Radiation Synovectomy with 166Ho-Ferric Hydroxide: A First Experience Sedat Ofluoglu, MD1; Eva Schwameis, MD2; Harald Zehetgruber, MD2; Ernst Havlik, PhD3; Axel Wanivenhaus, MD2; Ingrid Schweeger, MD1; Konrad Weiss, MD4; Helmut Sinzinger, MD1; and Christian Pirich, MD1 1Department of Nuclear Medicine, University of Vienna, Vienna, Austria; 2Department of Orthopedics, University of Vienna, Vienna, Austria; 3Department of Biomedical Engineering and Physics and Ludwig Boltzmann Institute of Nuclear Medicine, Vienna, Austria; and 4Department of Nuclear Medicine, General Hospital of Wiener Neustadt, Wiener Neustadt, Austria lage, leading to the progressive loss of joint function and Radiation synovectomy (RS) is indicated when conventional significant disability. Treatment of chronic synovitis using pharmacologic treatment of chronic synovitis has not relieved radiation synovectomy (RS) aims to stop the inflammatory its symptoms. The use of radionuclides that are bound to ferric process causing pain, disability, and nonreversible structural hydroxide (FH) particles has been shown to be effective and damage to the joint (1–3). RS has been in clinical use for 166 safe for this procedure. Ho-FH macroaggregates offer prom- 50y(4) primarily as an alternative to surgical treatment (5). ising properties for RS but there is a lack of clinical data. We Safety is one of the most important aspects when radionu- investigated the efficacy and safety of 166Ho-FH in a prospective clinical trial in patients suffering from chronic synovitis. Meth- clides are applied therapeutically. The use of ferric hydrox- ods: Twenty-four intraarticular injections were performed in 22 ide (FH) particles as a carrier may offer some advantages patients receiving a mean activity of 1.11 GBq (range, 0.77–1.24 over other carriers with respect to the frequency and degree GBq) 166Ho-FH. -
DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment.