Glossary of rheumatic disorders Achilles tendinitis Pain and sometimes swelling of Achilles tendons ('heel cords'); may be traumatic, or secondary to underlying inflammatory arthritis (such as Reiter's disease) AcromegaJic arthritis Articular cartilage hypertrophy; enlarged wrists: compres­ sion of median nerves in carpal tunnels; synovial joints may be painful and enlarged; backache: enlarged vertebrae, calcified intervertebral discs Acromioclavicular arthritis Pain and swelling due to osteoarthritis/mild subluxation of acromioclavicular joints Agammaglobinaemia arthritis See: hypogammaglobinaemia Amyloid joint disease Amyloid infiltration of joints, tendons and carpal tunnels; in association with multiple myeloma, or secondary to severe rheumatoid disease Ankylosing hyperostosis (Forestier's disease) Backache: large osteophytes bridging vertebrae and form­ ing anterior band simulating ankylosing spondylitis, but sacroiliac joints normal; some patients are diabetic or pre­ diabetic. Ankylosing spondyHtis Backache: mainly young adult males; marked hereditary factors - histocompatibility antigen HLA-B27 present in over 90% of patients; limited back movements in all planes, limited chest expansion; typical radiological changes in 139 Problems in arthritis and rheumatism spine and sacroiliac joints; hips and shoulders often affec­ ted, rarely small joints; anterior uveitis (common), specific aortic lesion (rare) Aortic arch syndrome See Pulseless disease Atrophic polychondritis See: Relapsing polychondritis Behttet's syndrome Episodic iritis and painful orogenital ulceration; occasional thrombophlebitis, neurological and other manifestations; arthritis in over 50 % of cases, chronic or episodic Bicipital tendinitis Non-specific inflammation of tendon of long head of biceps, either at anterior aspect of shoulder or at its insertion in cubital fossa Brachial neuralgia See Neuralgia Brucella arthritis Arthralgia or backache (due to spondylitis) in brucellosis; occasionally, chronic destructive changes due to joint or spine infection Bursitis Swelling or effusions into bursae; traumatic or secondary to rheumatoid arthritis or gout Caplan's syndrome (rheumatoid pneumoconiosis) Characteristic radiological appearance of lungs in patients with pneumoconiosis who develop rheumatoid disease; multiple nodules on fibrotic background Capsulitis of shoulder (periarthritis, frozen shoulder) Inflammation and fibrosis of shoulder-joint capsule and surrounding tissues; shoulder initially painful and stiff, later pain subsides but stiffness persists for months; usually idiopathic, but predisposing causes include trauma, myo­ cardial infarction, cervical spondylosis Carpal tunnel syndrome Pain and paraesthesiae in median nerve distribution of hand due to compression of nerve in carpal tunnel; usually no obvious cause, occasionally oedema, tenosynovitis, etc. compresses nerve; occasionally, wasting of thenar emin­ ence; median nerve conduction latency increased Cervical disc lesion/spondylosis Lateral disc herniation/osteoarthritis of cervical spine; 140 Appendix-Glossary neck pain and stiffness; segmental pain and paraesthesia in arm and hand; occasionally, segmental wasting of hand muscles, cord pressure causing cervical myelopathy), faint­ ing attacks due to vertebrobasilar insufficiency. Charcot's joints (neuropathic arthritis) In certain lower motor neurone diseases, especially tabes, diabetes, syringomyelia and polyneuritis; joints enlarged, usually painless, sometimes unstable Chondrocalcinosis Crystal deposition in joints of soft tissues (urate, apatite or pyrophosphate crystals); recurrent attacks of pain (pseudo­ gout), effusions or chronic arthritis Chondromalacia patellae Premature degeneration of patellar cartilage; recurrent pain/slight swelling of knees Colitic arthritis See Enteropathic arthritis Crohn's disease See: Enteropathic arthritis Crystal deposition disease See: Chondrocalcinosis Dermatomyositis Systemic connective tissue disorder characterized by myositis and skin lesions especially in the elderly; some­ times secondary to (latent) malignant neoplasm; proximal muscles weak, may be painful; serum muscle enzymes raised; rashes: heliotrope eruption on face, circumorbital oedema, violaceous rash on knuckles; arthralgia often occurs Disc lesions See under Cervical, Thoracic and Lumbar disc lesions Enteropathic arthritis Peripheral arthritis and sacroiliitis associated with ulcer­ ative colitis, Crohn's disease or Whipple's disease (q.v.); episodic seronegative arthritis affecting mainly lower limb joints, flaring with activity of intestinal disease; backache due to sacroiliitis (does not parallel intestinal disease) Epicondylitis See: Tennis elbow, and Golfer's elbow Erythema nodosum, arthritis with Painful bluish papulonodular rash on legs; arthralgia, usually lower limbs, for a few weeks or months; most cases 141 Problems in arthritis and rheumatism are associated with pulmonary sarcoid (bilateral hilar adenopathy), occasionally focal streptococcal infections, enteropathic arthritis or Beh.;:et's disease. Felty's syndrome Rheumatoid arthritis with hypersplenism: splenomegaly, leukopenia, thrombocytopenia; recurrent infections, due to poor neutrophil chemotaxis Fibrositis Lay term for pain due to muscle spasm, often in the spine; it usually represents referred pain from spinal conditions such as spondylosis Frozen shoulder See: Capsulitis Giant cell arteritis See: Temporal arteritis Golfer's elbow Epicondylitis (a form of enthesopathy) at medial side of elbow, involving common flexor origin from medial epi­ condyle of humerus Gout A form of acute synovitis due to deposition of urate crystals, in patients (mainly males) who have metabolic error leading to high serum urate levels; strong familial tendency; class­ ical attacks of severe pain in metatarsophalangeal joint of big toe spreading up the foot; occasionally, polyarticular attacks; when chronic: urate deposits lead to tophi form­ ation, chronic arthritis and renal failure; secondary gout: due to excess urate production (as in polycythaemia vera) or decreased urate excretion (as in chronic renal failure); raised serum uric acid, synovial fluid contains needle­ shaped urate cyrstals. Haemarthrosis Bleeding into a synovial joint causing severe pain and swell­ ing (as in haemophilia) and not infrequently in osteoarthritic joints in elderly patients Haemophilic arthritis Acute haemarthroses due to haemorrhages into joints in haemophilia and other haemorrhagic disorders; secondary osteoarthritis often supervenes Henoch-Schonlein purpura Acute arthritis, usually of knees or ankles, with petechial 142 Appendix-Glossary rash particularly on buttocks, usually in children; abdom­ inal pain and melaena may occur; haematuria, nephritis in some cases Hydrarthrosis. intermittent Periodic effusions into large joints, especially knees; aetiology uncertain - no connection with rheumatoid disease Hypermobility syndrome Local or generalized pain syndromes due to strain on liga­ mentsinhypermobilejoints; effusions may occur, eventually osteoarthritis; sometimes hereditary (as in Marfan's syndrome) or metabolic (such as homocystinuria); backache due to 'loose back syndrome' often associated with general­ ized hypermobility Hyperparathyroidism Abnormal calcium metabolism may lead to spinal osteo­ porosis, metastatic calcification or pyrophosphate arthro­ pathy (q.v.); synovitis associated with softening of para­ articular bone Hypertrophic osteoarthropathy Arthropathy, finger clubbing and periostitis usually assoc­ iated with malignant tumour (especially bronchogenic carCinoma) Hypogammaglobinaemia, arthritis with Seronegative arthritis resembling rheumatoid in patients with low or absent gammaglobulin and immunoglobulin G; congenital and acquired varieties; mainly large joints involved, often asymmetrical; recurrent respiratory tract infections Hypothyroidism Muscular rheumatism or arthralgia may occur; symptoms respond to thyroid replacement; carpal tunnel syndrome is common Infective arthritis See: Septic arthritis Intermittent hydrarthrosis See: Hydrarthrosis, intermittent Jaccoud syndrome (chronic secondary polyarthritis) Tendon lesions of hands due to fibrosis, hand deformities (ulnar deviation) following recurrent attacks of rheumatic fever 143 Problems in arthritis and rheumatism Juvenile chronic arthritis Arthritis in children (see Still's disease) Leukaemic arthritis Arthritis in acute leukaemia in children; secondary gout may occur; arthritis in chronic leukaemia of adults Lumbar disc lesions/spondylosis Traumatic or degenerative lesions of vertebrae and inter­ vertebral discs; low back pain with or without sciatica in lateral disc prolapse, paraesthesiae in root distribution (commonly L5-S1); occasionally, segmental muscle weak­ ness and wasting; limited straight leg raising (lower lumbar lesions), positive femoral nerve stretch (upper lumbar lesions); cauda equina lesions: weakness, bladder and bowel sphincter disturbance, perianal analgesia Lupus erythematosis See: Systemic lupus erythematosus (SLE) Mixed connective tissue disease Combination of various systemic connective tissue diseases, such as rheumatoid arthritis, systemic sclerosis and SLE, overlapping in the same patient. ANA-positive but DNA­ binding negative and antiRNA antibodies positive; prog­ nosis said to be good but many cases later 'polarize' to become a more definite systemic connective tissue disorder with its appropriate prognosis Morton's metatarsalgia Pain between toes, said to be due to neurofibroma of